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Spontaneous coronary artery dissection (SCAD) is a rare cause of chest pain and cardiomyopathy. This phenomenon usually occurs during the peripartum period. SCAD associated with exercise and heavy weight lifting is even rarer and has been reported in less than 10 cases in the literature. We describe a case of SCAD associated with heavy weight lifting and exercise in a 29-year-old male who presented with exertional chest pain. The patient subsequently underwent a cardiac catheterization that showed a left ventricular ejection fraction of 40% and a dissection in the left anterior descending (LAD) coronary artery after the first diagonal/septal branch with extension to the distal LAD that wrapped around the apex. He was effectively managed with the combination of medical therapy followed by a few days later with stenting. In summary, diagnosis and treatment of this rare phenomenon is a challenge, but early diagnosis and appropriate management can lead to a successful outcome.

The aim of this study is to determine the determine effects of magnesium supplementation on anthropometric indices Consist of body weight (BW), waist circumference (WC), body mass index (BMI) and body fat percentage (BF%). In this systematic review and dose–response meta-analysis, we searched PubMed, Cochrane Library, Scopus, Web of Science and Google Scholar from databases inception up February 2020 for relevant randomized controlled trials. Quality of evidence was evaluated using the Cochrane Collaboration Tool. All of outcome in this meta-analysis were pooled using Random Effect Model. Analysis of dose–response for magnesium dosage was carried out using a fractional polynomial model. The systematic review and metal analysis include Twenty-eight RCTs, comprising 2013 participants. There were no significant changes in anthropometric indices after magnesium supplementation in the overall analysis. However, subgroup analysis revealed that magnesium supplementation decreases WC in subjects with BMI> 30 (obese) [12 trials, n = 997 participants; weighted mean difference (WMD) = −2.09 cm, 95% CI: −4.12 to −0.07, p =0.040; I2 = 0%]. Dose–response analysis revealed a non-significant nonlinear effect of supplementation dosage on anthropometric indices. The results suggest that magnesium supplementation is associated with lower WC only in obese subjects. However, more high-quality studies are needed to clarify the nature of this association.

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Abstract. Background: It is now becoming increasingly recognized that the effects of vitamin D supplementation may vary by several factors including vitamin D deficiency status, ethnicity, and/or the presence of genetic variants, which affect individual responses to supplementation. This study investigates the interaction between metabolic traits and circulating 25-hydroxyvitamin-D (25OHD) concentration with 4 polymorphisms of vitamin D receptor (VDR) including BsmI, ApaI, TaqI, FokI, and vitamin D supplementation. Methods: A systematic review and meta-analysis of papers until August 2021 on PubMed, The Cochrane Library, Scopus, Web of Science, Google Scholar, ProQuest, Science Direct, and Embase about the association between functionally relevant VDR variants and vitamin D supplementation on circulating 25OHD and metabolic traits. Results: A total of 2994 cases from 16 randomized controlled trial (RCT) studies were included in meta-analyses. There were no significant changes in the serum concentrations of 25OHD and metabolic traits after vitamin D supplementation in different variants of BsmI, ApaI, TaqI, and FokI polymorphism in the VDR gene in the overall analysis (p>0.05). However, the results showed there is significant interaction between these above VDR polymorphisms and vitamin D supplement on serum 25OHD level after subgroup analyses based on the study duration, gender, age, BMI, health status, Hardy–Weinberg Equilibrium, PCR, and race (p<0.05). Conclusions: The present meta-analysis demonstrates that the effect of vitamin D supplementation on serum 25OHD and metabolic traits is independent of genetic variants of the VDR gene (BsmI, ApaI, TaqI, and FokI). However, future trials should consider inter-individual differences and, in particular, should aim to clarify whether certain subgroups of individuals may benefit from vitamin D supplementation in the context of metabolic health.

BACKGROUND: Symptoms of asthma have been shown to correlate poorly with spirometric variables of obstruction. We hypothesized that lung volume measurements might correlate with symptoms and frequency of rescue inhaler use in asthma. METHODS: Patients with persistent asthma on treatment for 612 months were enrolled from university-based clinics. The association between lung volumes, spirometry, asthma symptoms, and rescue inhaler use were explored by using linear modeling. RESULTS: Among the 120 subjects, 76% were women. The mean age 6 SD was 52 6 15 y. With regard to ethnicity, 64% of the subjects were caucasian, 23% were Hispanic, and 13% were African-American. Twenty-one percent of the subjects reported chest pain. There was no significant correlation between asthma symptoms or rescue inhaler use to spirometry indices of obstruction. The residual volume percent of predicted showed a significant association with the wheeze score (r 5 0.32, P 5 .001) and frequency of rescue inhaler use (r 5 0.35, P £ .001). Linear contrast analysis showed that the mean wheeze score (P 5 .003) and frequency of rescue inhaler (P 5 .007) use increased linearly from the lowest to the highest quartiles of residual volume. Furthermore, multiple regression analysis showed an association only to the residual volume percent predicted value to the pressurized metered-dose inhaler score and the wheeze score. CONCLUSIONS: Frequent albuterol use and wheezing may be a sign of unrelieved air trapping. Chest pain is a unique symptom in persistent asthma, and the pathogenesis requires further studies. Lung volume measurement added to routine spirometry can help identify patients with asthma and with air trapping.

Background: Lung nodules are frequently identified during chest imaging. Coccidioidomycosis may represent up to 30% of nodules in endemic areas. Fungal nodules can be difficult to distinguish from lung nodules due to lung cancer. There is limited data evaluating Coccidioides serology, CT biopsies, bronchoscopies or galactomannan antigen assay in diagnosing nodules due to Coccidioidomycosis. Methods:We established a Lung Nodule Clinic in Fresno, CA, an endemic Coccidioidomycosis region. We reviewed nodule cases seen between October 2009 and December 2012. In addition, we prospectively evaluated a separate cohort of twenty-three patients referred with a nodule using urine, serum and BAL fluid for Coccidioides galactomannan antigen. Results:We retrospectively evaluated 1079 patients. 192 patients had a diagnosis of bronchogenic carcinoma, 110 had a diagnosis of Coccidioidomycosis, and 109 had another specific diagnosis. The sensitivity of Coccidioides serology was 77% by immunodiffusion (ID) and 54% by complement fixation (CF). The specificity for ID was 93% and for CF was 98%. Sensitivity for granulomas on biopsy by CT was 78% but much lower by bronchoscopy at 12%. Sensitivity of cultures from CT biopsy and by BAL ranged from 30-33%. Of the 23 patients prospectively evaluated for Coccidioides antigen by EIA of BAL, sensitivity was only 12.5%. Conclusions:In lung nodule patients, Coccidioides serology has insufficient sensitivity to exclude Coccidioidomycosis but has high specificity. Coccidioides galactomannan antigen testing and culture have poor sensitivity in this population. We need better noninvasive diagnostic tools to differentiate lung nodules due to Coccidioidomycosis from those due to lung cancer.

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