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BACKGROUND: Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation lower triglyceride levels. The impact on epicardial adipose tissue volume (EATV), which is associated with cardiovascular events, is unclear. OBJECTIVE: To determine if triglyceride reduction with EPA+DHA supplementation decreases EATV and whether EATV affects coronary plaque. METHODS: 139 subjects with coronary artery disease on statins were randomized to 3.36 g EPA+DHA daily or none (control) for 30 months. EATV, coronary plaque volumes and coronary artery calcium score were measured with coronary computed tomographic angiography. RESULTS: Change in triglyceride level correlated with change in EATV (r=0.236; p=0.006). Despite a 6.7% triglyceride reduction (p=0.021) with EPA+DHA supplementation compared to no change in control (between group p=0.034); both groups had similar reductions in EATV possibly due to statin treatment. EATV above the median (>115.6 cm3) was the only determinant of baseline coronary fatty plaque volume (ß=2.4, p=0.010). After multivariate adjustment, waist circumference, a surrogate of abdominal visceral adiposity, was the only determinant of baseline EATV (OR:1.093; 95% CI:1.003-1.192, p=0.042). Moreover, increase in waist circumference was the only predictor of an increase in EATV at 30 months (ß=0.320, p=0.018). CONCLUSIONS: EATV is associated with higher coronary fatty plaque volume and is regulated by waist circumference but not EPA+DHA supplementation at 30-month follow-up in CAD patients on statin treatment. The direct correlation between waist circumference and EATV suggests that maintaining a healthy weight may limit EATV and coronary fatty plaque volume, potentially leading to a decrease in cardiovascular events. Two sentence summary Subjects with clinical CAD on statin treatment randomized to EPA+DHA had similar reductions in epicardial adipose tissue volume (EATV) compared to control, despite a significant reduction in triglyceride level in the EPA+DHA group. Higher EATV was linked to greater fatty, rupture-prone plaques, boosting the risk of MI, and change in waist circumference was the only predictor of an increase in EATV at 30-month follow-up.
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Anaplasmosis, caused by the tick-borne bacterium Anaplasma phagocytophilum, is an emerging infectious disease with a broad spectrum of clinical manifestations. Here, we present a case report of a 66-year-old Caucasian woman residing in Connecticut who exhibited severe anaplasmosis with multi-organ involvement. The patient, with a medical history of rheumatoid arthritis and hypothyroidism, presented with confusion, lethargy, fever, myalgia, generalized weakness, and poor appetite in May 2023. Laboratory investigations revealed pancytopenia, hyponatremia, elevated liver enzymes with mild hyperbilirubinemia, and lactic acidosis. A buffy coat smear analysis demonstrated basophilic intracytoplasmic inclusion bodies in the neutrophils, supporting the diagnosis of severe anaplasmosis. Prompt administration of doxycycline, the recommended treatment for anaplasmosis, was initiated. However, the patient subsequently developed acute respiratory distress syndrome (ARDS) necessitating heated humidified high-flow nasal cannula (HFNC) therapy. Anaplasma polymerase chain reaction (PCR) confirmed the presence of the bacterium in the patient's blood. Following doxycycline treatment, the patient demonstrated improvement in peripheral blood findings, resolution of ARDS, and complete neurologic recovery. This case underscores the potential severity and diverse clinical manifestations of anaplasmosis, highlighting the importance of early recognition, prompt diagnosis, and timely initiation of appropriate treatment to prevent severe complications and improve patient outcomes.
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Coronavirus disease 2019 (COVID-19) continues to be fatal despite advances in the understanding of characteristics of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), global prevention strategies, new anti-viral treatments, and worldwide vaccination programs. The exact underlying mechanism through which SARS-CoV-2 leads to acute respiratory distress syndrome (ARDS) resulting in intensive care unit admission, mechanical ventilation, and eventually death remains elusive. Cytokine storm is one of the most favorable mechanisms that scientists show remarkable interest to target in randomized clinical trials with promising outcomes. Macrophage activation syndrome (MAS), the most serious form of cytokine storm, requires early recognition and treatment regardless of etiology. Here, we report a 59-year-old gentleman with a COVID-19 infection complicated by MAS. Our aim is to increase awareness of this condition among health care providers as it necessitates prompt diagnosis and treatment due to an extremely poor prognosis.
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Acute abdominal pain is one of the most common reasons for emergency admissions. Even though initial differentials are wide, a physician is able to narrow them down with detailed history, careful physical examination, and appropriate laboratory tests along with imaging studies. Unfortunately, some of the cases do not have an established diagnosis despite multiple blood work and imaging studies in the emergency department. In such conditions, physicians' recognition of rare diseases generally avoids extra costs for additional investigations, unnecessary consultations, and most importantly wasting valuable time in life-threatening conditions in emergency settings. Here, we report a 30-year-old woman with acute severe abdominal pain and hemodynamic instability who was found to have ascites that was actually hemoperitoneum secondary to spontaneous primary non-parasitic splenic cyst rupture. The primary splenic cyst is an extremely rare entity and is often found on imaging incidentally. A few case reports regarding primary splenic cyst and its complications were published in the literature. Since it is an exceptionally uncommon condition, there is no consensus on treatment. We aimed to increase the understanding of spontaneous primary splenic cyst rupture and its management among healthcare providers with this case report.
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BACKGROUND: Omega-3 (n-3) fatty acids have shown benefit in cognitively impaired subjects, but the effect on cognitively healthy older subjects is unclear. OBJECTIVES: Our aim was to determine if long-term, high-dose ω-3 ethyl esters, EPA (20:5n-3) and DHA (22:6n-3), prevent deterioration of cognitive function in cognitively healthy older adults. METHODS: A total of 285 subjects with stable coronary artery disease (CAD) on statin treatment were randomly assigned to 3.36 g EPA and DHA or none (control) for 30 mo. Cognitive function was assessed in all 285 subjects at baseline and in 268 and 250 subjects who returned at 12- and 30-mo follow-up, respectively, with neuropsychological testing as a prespecified secondary outcome. A completer's analysis, along with a sensitivity analysis carrying forward the last observation, was performed. RESULTS: Over the 30-mo period, subjects randomly assigned to EPA and DHA had significantly better scores than control for verbal fluency, language, and memory (mean: 1.08; 95% CI: 0.25, 1.91; P = 0.011) and 2 tests of visual-motor coordination (mean: -2.95; 95% CI: -5.33, -0.57; P = 0.015 and mean: -9.44; 95% CI: -18.60, -0.30; P = 0.043, respectively). The better scores for EPA and DHA were due to an improvement at 12 mo compared with baseline in verbal fluency, language, and memory (P = 0.047) and 2 tests of visual-motor coordination (P = 0.033 and P < 0.001, respectively), whereas control had no change. Post hoc analyses indicated no difference by age, sex, or diabetes status. CONCLUSIONS: Cognitively healthy older adults with stable CAD randomly assigned to high-dose EPA and DHA had improved cognitive function over a 30-mo period compared with control. These findings may be especially important for CAD patients because CAD is a risk factor for cognitive decline.This trial was registered at clinicaltrials.gov as NCT01624727.