Mucormycosis is a highly invasive and rapidly progressing form of fungal infection that can be fatal. The infection usually begins after oral or nasal inhalation of fungal spores and can enter the host through a disrupted mucosa or an extraction wound. The organism becomes pathogenic when the host is in an immunocompromised state. There are several clinical presentations of mucormycosis including rhinocerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and miscellaneous forms. The most common clinical presentation of mucormycosis is the rhinocerebral form which has a high predilection for patients with diabetes and metabolic acidosis. An indolent disease course taking weeks to months of this infection is rare making it difficult to diagnose. Therefore, early detection and prompt treatment with surgical and antifungal therapy are very important in achieving good treatment outcomes.

Between 2013 and 2016 there were approximately 6.2 million adults in the United States living with heart failure; nearly half had an ejection fraction that was preserved. Despite the high prevalence of heart failure with preserved ejection fraction (HFpEF), our understanding of this disease is limited and it still carries significant morbidity and mortality worldwide. At present, physicians are burdened by the inconclusive benefits of currently available treatment options. Recently the scientific community has seen an influx of new pathophysiology studies and outcome trials that have reshaped our understanding of HFpEF as a complex, multi-systemic disease. Pharmacological trials involving beta-blockers, angiotensin II receptor antagonists, aldosterone antagonists, and angiotensin-neprilysin inhibitors have demonstrated encouraging results, but have yet to reach the significance of advancements made in the treatment of heart failure with reduced ejection fraction. This review aims to summarize landmark clinical trials that have influenced current treatment guidelines, and reports on emerging evidence supporting/ refuting new treatment modalities including pharmacotherapy, lifestyle modification and device therapy.

INTRODUCTION: Desmoplastic small round cell tumors (DSRCT) are a rare and aggressive variant of soft-tissue sarcomas. Data suggest that occurs as a consequence of a translocation of (11;22) (p13; q12) resulting in a fusion of EWS/WT1 genes. The incidence of DSRCT is more common in young Caucasian males between the ages of 15 and 25 [6,7]. CASE DESCRIPTION/METHODS: A 26-year-old male with no past medical history complaining of shortness of breath, anorexia, unintentional weight loss of 20 pounds and increased abdominal girth associated with pain starting two months prior to presentation. Physical exam was remarkable for cachexia, mild diffuse tenderness to palpation, protuberant abdomen without a distinct mass. Initial workup showed the following abnormality; normocytic anemia with hemoglobin of 12.6, ALP 189, AST 58, ALT 73 and HIV negative. Abdominopelvic CT scan revealed a large mass measuring 20 × 10 × 10 cm in the left upper quadrant, nodular deposits in the anterior abdomen concerning for carcinomatosis and multiple liver metastases, largest measuring 10 × 8 cm (Figure 1). Mesenteric lymph node biopsy showed findings consistent with desmoplastic fibromyxoid stroma and immunohistochemically positive for AE1/AE3, EMA, vimentin, desmin, synaptophysin, and CD99 (Figures 2–3). DISCUSSION: DSRCT's are aggressive soft tissue sarcomas that are extremely rare. They predominantly involve the pelvis, retroperitoneum, and mesentery. Upon diagnosis, it is crucial to exclude desmoid tumors and Ewing sarcomas, since, these malignancies that can be confused with DSRCT. Accumulating data suggest that is more prevalent in young adults, making the diagnosis challenging at the early stages, since, it can be potentially confused with less aggressive conditions such as gastritis, dyspepsia or gastroesophageal reflux disease. Prognosis is frequently poor given a late presentation of disease; five-year survival is estimated at 15 to 30% [2]. The exact mechanism of DSRCT is not well understood, but research suggest it arises from a translocation. Some promising therapies are undergoing phase trials as surgical interventions and hyperthermic intraperitoneal chemotherapy [2]. Systemic chemotherapy with aggressive surgical resection has shown improved outcomes [6]. Nonetheless, systemic therapy tends to be very toxic, requiring frequent admissions to control potential adverse events. Further research is needed to characterize the exact pathogenesis and treatment of this uncommon malignancy.

As per the 2013 guidelines of ACCF/AHA (American College of Cardiology Foundation/American Heart Association), ST Elevation (STE) in lead augmented vector right (aVR), along with ST depression in multiple leads, is associated with critical stenosis of left main coronary artery (LMCA), left anterior descending artery (LAD) or a triple vessel disease (TVD). Early identification of ST-Elevation Myocardial Infarction (STEMI) is important as timely reperfusion with intervention can save myocardium and improve survival. We present a case of a 70 years old female, with cardiovascular risk factors, who presented to the emergency department with chest pain decompensating with ventricular tachycardia. On cardioversion, she was found to have ST elevation in aVR with ST depression in V4-V6, I, II, and aVL. However subsequent echocardiogram and coronary angiogram showed normal coronary arteries and left ventricular function.