1,3-dimethylamylamine (DMAA) is a common additive in sport supplements that was banned by the FDA in 2013. Specifically, this additive received much publication for its role in causing adverse cardiovascular events, particularly sudden cardiac death. However, it has been our experience that products containing this additive may also lead to acute liver injury and liver failure. We present a series of seven cases encountered by a military treatment facility in Southern California which involved the use of OxyELITE Pro, a sport supplement containing DMAA, that all resulted in acute liver injury with two cases requiring transplant for acute liver failure. To our knowledge, this is the first case series reported involving OxyELITE Pro or other DMAA-containing supplements with a specific focus on acute liver injury. This review is limited by the paucity of clinical studies and trials based on OxyElite Pro and its effect on the liver. The presented cases are notably observation, and no standardized diagnostic or treatment protocol was utilized. This series is important to the general population as a whole due to the prevalence of sport supplement use, and is particularly important for practitioners who work with the military or athletic populations due to the high use in these demographics. These cases are followed by a brief discussion regarding DMAA.

Pleural space infections have been a well-recognized clinical syndrome for over 4000 years and continue to cause significant morbidity and mortality worldwide. However, our collective understanding of the causative pathophysiology has greatly expanded over the last few decades, as have our treatment options. The aim of this paper is to review recent updates in our understanding of this troublesome disease and to provide updates on established and emerging treatment modalities for patients suffering from pleural space infections. With that, we present a review and discussion synthesizing the recent pertinent literature surrounding the history, epidemiology, pathophysiology, diagnosis, and management of these challenging infections.

A 45-year-old man presented with 4 days of fevers up to 398C and a diffuse pustular rash on the upper body. Clinical history was notable for recent nocturia and urinary hesitancy for which he was empirically prescribed sulfamethoxazole/trimethoprim. The patient discontinued this antibiotic after 3 days due to diarrhea and

Dilated cardiomyopathy, heart failure and atrial septal defects are well-recognised entities in isolation, but are rarely seen together. Now that 90% of children with congenital heart disease survive into adulthood, such combinations of disease are increasingly seen in adult cardiology. While most young patients with dilated cardiomyopathy respond well to medical therapy, some do not, and require more invasive management. We describe a 32 year-old man with dilated cardiomyopathy and a sinus venosus-type atrial septal defect associated with a remarkable pulmonary to systemic flow ratio of 5:1. We propose that the atrial septal defect blunted his heart failure symptoms by serving as a 'pop-off' valve and limiting pulmonary congestion. The patient ultimately failed medical management and received a left ventricular assist device. The case is presented along with a discussion of this unique pathophysiology and a brief review of the literature in this rapidly evolving field.