Eventration of the diaphragm is an abnormal elevation of the dome of diaphragm. It is a condition in which all or part of the diaphragm is largely composed of fibrous tissue with only a few or no interspersed muscle fibers. It can be complete or partial. Complete eventration of the right diaphragm, as seen in this adult patient, is relatively rare.

We describe an adult patient with a primary left atrial leiomyosarcoma in whom live/real time three-dimensional transthoracic echocardiography showed echolucent areas within the mass consistent with necrosis or hemorrhage surrounded by dense band-like echo densities indicative of fibrosis or collagen giving a "doughnut" like appearance. These findings were consistent with histopathology, which showed areas of necrosis and dilated vascular channels within the fibrotic tumor. Our case further illustrates the usefulness of three-dimensional transthoracic echocardiography in characterizing the morphologic features of an intracardiac mass.

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Background Regional variation in Helicobacter pylori resistance patterns is a significant contributing factor for the ineffectiveness of traditional treatments. To improve treatment outcomes, we sought to create an individualized, susceptibility‐driven therapeutic approach among our patient population, which is one of the poorest in the nation. It is medically underserved, minority‐predominant and has high incidence of H pylori infection. Methods We compiled various factors involved in the antibiotic resistance of H pylori from literature. We then created a predictive model to customize therapies based on analyzed data from 2,014 H pylori patients with respect to several of these factors. The predictions of the model were further tested with analysis of patient stool samples. Results A clear pattern of H pylori prevalence and antibiotic resistance was observed in our patients. We observed that majority of H pylori patients were women (62%) and over the age of 40 years (80%). 30% and 36% of the H pylori patients were African American and Hispanic, respectively. A median household income of less than $54,000, past H pylori infection, previous use of certain antibiotics for any infection decreased the chance of eradication. Results of the stool testing were consistent with model predictions (90% accuracy). Conclusion This model demonstrates the predictive accuracy of H pylori infection and antibiotic resistance based on patient attributes and previous treatment history. It will be useful to formulate customized treatments with predicted outcomes to minimize failures. Our community attributes may contribute toward broad applicability of model for other similar communities.

To compare the fluoride release from Conventional Glass Ionomer Cement (GIC), Resin Modified GIC (RMGIC), and Cention N Alkasite Material. Material and Methods: Forty-five disc-shaped specimens of three different restorative materials (Conventional GIC, RMGIC, and Alkasite material) were made and divided into 3 groups (n=15). Fluoride release was evaluated at the end of Day 1, 7, 14, and Day 28 using fluoride ion-selective electrode. Intergroup and Intra-group analysis was done using One-way ANOVA with a Post-hoc test. A p-value of <0.05 was considered statistically significant. Results: Cention showed more fluoride release (in parts per million) than GIC and RMGIC at increased time duration. However, at the end of day 1, there was lesser fluoride release with Cention, as compared with the other groups. Conclusion: The new Alkasite restorative material showed promising results in terms of fluoride release and is better than GIC and RMGIC at increased time duration.

We investigated the effects of i.v. adenosine on coronary blood flow in 10 normal subjects undergoing investigation for chest pain. Coronary flow transiently doubled after > 3.5 mg adenosine without increase in perfusion pressure, systolic load or inotropic state at a constant, paced heart rate. The data provide direct evidence that adenosine dilates coronary arteries in man. The transience of the effect suggests a possible role for adenosine in repeated estimations of coronary flow reserve.

M ycobacterium tuberculosis infects approximately 1.7 billion people in the world and causes disease in 10 million annually. Musculoskeletal tuberculosis accounts for 2% to 5% of cases, generally presenting as Pott's spine or large joint arthritis 1 ; the involvement of muscle by tubercle bacilli, referred to as tuberculous myositis, is rare. Muscle involvement can occur either due to hematogenous spread (primary) or as a result of extension from a contiguous site (secondary); the former being less common. 2 We report a case of primary tuberculous myositis and review all cases published in the last 25 years. CASE REPORTA 49-year-old man was admitted with swelling and dullaching pain over the right gluteal region, fever, and loss of appetite for 6 months. Three years prior to the current presentation, he had been diagnosed with dermatomyositis and treated with corticosteroids and azathioprine; these drugs were tapered and stopped after 2 years. With a possibility of relapse, corticosteroids were restarted 1 month before his admission.On examination, a localized tender swelling was present over the right gluteal area and posterior thigh, extending to the knee. Magnetic resonance imaging of this region revealed active myositis of the gluteal muscle and muscles in the posterior compartment of the right thigh (Figs. 1A, B). Positron emission tomographycomputed tomography showed uptake in these muscles, and an image-guided biopsy was performed. This revealed granulomatous inflammation on histopathology (Fig. 2), and a cartridge-based nucleic acid amplification test GeneXpert MTB/RIF (Cepheid, Sunnyvale, CA) detected M. tuberculosis. Computed tomography of the thorax did not show any pulmonary tuberculosis; however, tuberculin skin test was positive. Antitubercular therapy was started with isoniazid, rifampicin, ethambutol, and pyrazinamide for 2 months, followed by isoniazid, rifampicin, and ethambutol for 8 months. The fever resolved within 2 weeks, and over the next few months, the swelling subsided, and the patient gained weight. At 1 year, he was found to be asymptomatic and disease-free. METHODS FOR SYSTEMATIC REVIEWWe carried out a search in PubMed (MEDLINE), Scopus, EMBASE, and Web of Science, using the words "tubercular myositis," "tubercular pyomyositis," "tuberculous myositis," or "tuberculous pyomyositis." This review was restricted to articles in English language that were published between January 1995 and December 2019. Abstracts and full texts of relevant articles were examined by 2 authors (H.S., V.D.), and those articles that described cases of primary tuberculous myositis confirmed by microbiological tests (or on histopathology) were included for review. The outcome of cases was noted, factors associated with death analyzed, and odds ratios (ORs) (95% confidence intervals [CIs]) calculated. Analysis was done by GraphPad Prism (version 8 for Windows, La Jolla, CA).

Diabetic ketoacidosis is one of the most serious complications of diabetes mellitus. Role of bicarbonate therapy in severe diabetic ketoacidosis is controversial. There are only few case reports of management of refractory diabetic ketoacidosis with renal replacement therapy. Here, we present a case of young male with severe diabetic ketoacidosis, which was refractory to fluid resuscitation, insulin and was managed successfully managed with peritoneal dialysis.