Leptospirosis, Q fever, scrub typhus, and murine typhus are endemic zoonotic diseases in southern Taiwan that often present as acute undifferentiated febrile illness. We retrospectively compared epidemiological, clinical, laboratory, and outcome characteristics of leptospirosis (n = 41) and rickettsial infections, including Q fever, scrub typhus, and murine typhus (QSM; n = 103), in Kaohsiung City from 2013 to 2024. Leptospirosis occurred mainly during rainy and typhoon seasons and was associated with myalgia, gastrointestinal symptoms, jaundice, conjunctival suffusion, hepatic and renal dysfunction, leukocytosis, elevated C-reactive protein, and higher rates of acute kidney injury and shock. QSM occurred year-round, with eschar characteristic of scrub typhus, while prolonged activated partial thromboplastin time and relative bradycardia were more common in QSM. QSM generally showed a milder clinical course, particularly Q fever. Distinct clinical and seasonal patterns may facilitate early differentiation and risk stratification in endemic areas.

ObjectivesCats undergoing perineal urethrostomy (PU) often have acute kidney injury (AKI). Minimizing additional kidney injury during anesthesia is critical to prevent exacerbation of AKI. The impact of surgical positioning for PU on anesthetic variables is unknown. This study evaluated pre-, intra- and postoperative variables in cats undergoing PU in sternal (SR) or dorsal (DR) recumbency. We hypothesized there would not be a significant difference in anesthetic complications and postoperative serum creatinine (SCr) concentrations in cats positioned in SR as compared with those positioned in DR.MethodsMedical records of 97 client-owned cats undergoing PU in SR (n=55) or DR (n=42) were retrospectively reviewed. Cats undergoing procedures in addition to PU were excluded. Data collection included signalment, number of preoperative obstructive episodes, pre- and postoperative SCr, surgical and anesthetic duration, drugs in the anesthetic regimen, and presence and duration of intraoperative hypotension, hypertension, bradycardia, tachycardia, hypoventilation, and hypothermia. Data were compared using Mann-Whitney U or Fisher's exact tests.ResultsA significant difference was detected in the number of preoperative obstructive episodes in cats undergoing PU in SR compared to DR (SR median episodes=2 [range=0-5]; DR median episodes=2 [range=1-6]; P=0.0074). No other differences were identified in preoperative or intraoperative variables. Postoperative SCr and change from preoperative SCr did not differ between groups.Conclusion and relevanceAnalysis of these data demonstrate no measurable differences in anesthetic parameters or postoperative outcomes in cats undergoing PU in SR or DR. The statistical difference between groups relative to preoperative obstructive episodes does not appear to be clinically relevant. Thus, we accept our hypothesis and conclude SR or DR positioning should not be a consideration in establishing an optimized anesthetic experience for cats with urethral obstruction associated AKI. Surgeon preference should continue to be the driving force on positioning for a PU in cats.

Hypothermia is a relatively common occurrence typically seen in the emergency department (ED) during the winter months. The condition is defined by a decrease in core body temperature and classified by severity, based on temperature ranges from mild to severe. While initial symptoms have correlated with core body temperature, patient outcomes have not demonstrated a correlation. Shock occurs secondary to bradycardia and increased cardiac excitability, leading to arrhythmia, and hypotension can occur during rewarming if the peripheral vasculature is warmed prior to the core body. In this case, a woman was found unconscious in the early morning after spending the night outside without appropriate clothing. She was brought to the ED, and upon arrival, her rectal temperature was confirmed to be 28.3°C, placing her in the moderately hypothermic category. This case is an example of not only the initial symptoms of moderate hypothermia but also possible complications during rewarming, making it very important in the field of Emergency Medicine.

Background/Objectives: The purpose of this study was to investigate the association between cardiovascular adverse drug events (ADEs) and the use of COVID-19 medicines. Methods: The analyses were conducted by leveraging pharmacovigilance data from the Food and Drug Authority (FDA) Adverse Event Reporting System (FAERS) and TriNetX electronic health records (EHRs). Transcriptomic data from human embryonic stem cell-derived cardiomyocytes (hESC-CMs) exposed to remdesivir were analyzed to provide supportive biological context for the observed cardiovascular safety signals. Results: Comparative analysis of three approved COVID-19 therapies revealed that COVID-19 patients treated with remdesivir had a higher risk of cardiovascular events than those treated with Paxlovid or REGEN-COV. FAERS analysis further indicated that bradycardia, hypotension, and cardiac arrest were the most frequently reported cardiovascular events associated with remdesivir, which was validated by propensity score-matched EHR data. These findings suggest an association between remdesivir exposure and increased cardiovascular ADEs relative to other COVID-19 therapies. Sex-stratified analysis using FAERS and EHR did not show strong sex-dependent patterns for remdesivir-associated cardiovascular ADEs. Age-stratified analyses of EHR data showed age-associated variation across the three cardiovascular ADEs. Bradycardia displayed a non-uniform pattern with higher prevalence in the youngest and oldest age groups, hypotension showed an overall age-associated increase, and cardiac arrest showed only a weak age-associated effect. Pathway enrichment analysis on transcriptomic data revealed that the "cGMP-PKG signaling pathway", "dilated cardiomyopathy", and "calcium signaling pathway" were enriched among genes up-regulated by remdesivir exposure. Conclusions: In summary, our integrated analysis of pharmacovigilance, EHR, and transcriptomic data provides convergent evidence for associations between remdesivir and cardiovascular ADEs and offers biological context into these associations.

Brain-heart interactions have garnered considerable interest in the landscape of traumatic brain injury (TBI). This scoping review focused on bradycardia caused by high intracranial pressure (ICP), brainstem injury, autonomic imbalance, hypothalamic-pituitary-adrenal axis disruption, or massive bleeding. The latter condition is attributed to a physiological phenomenon called relative bradycardia (RB). True bradycardia results from underlying physiological or pathological cardiac disorders, whereas RB has different definitions and implications in medical and surgical settings. The former reflects pulse-temperature dissociation, while the latter reflects pulse-pressure dissociation. However, it can reflect an abnormal neurological response called the Cushing reflex. Therefore, bradycardia may indicate imminent shock after TBI associated with torso injuries or high ICP following severe isolated TBI. RB is underrecognized and underappreciated in emergency settings. This review investigated whether RB affects patient survival and neurological function. Physicians should approach patients presenting with RB with a high index of suspicion and timely management.

SUMMARYSalmonella enterica serovars Typhi and Paratyphi A cause enteric (typhoid/paratyphoid) fever, a systemic disease that remains a major source of morbidity and mortality worldwide. The most distinctive clinical manifestations, such as sustained fever with relative bradycardia, leukopenia, neuropsychiatric symptoms/encephalopathy, and ileal perforation, have long lacked a unifying mechanistic explanation. Over the past two decades, studies of typhoid toxin have reframed how we understand this disease. Typhoid toxin is a human-adapted, chimeric A2B5 exotoxin assembled exclusively inside infected cells. It couples an ADP-ribosyltransferase (PltA) and a DNase I-like nuclease (CdtB) on a pentameric delivery ring (PltB or the alternate, PltC), that recognizes N-acetylneuraminic acid (Neu5Ac)-terminated human sialoglycans. The toxin is produced by bacteria residing within the Salmonella-containing vacuole (SCV), secreted across the bacterial envelope into the SCV lumen by a phage-derived pathway now classified as type 10 secretion system, sorted for export by the host CI-M6PR/COPII trafficking machinery, and then re-enters distant target cells via retrograde transport to the endoplasmic reticulum (ER). Recent work has linked typhoid toxin to leukopenia, blood-brain barrier disruption causing encephalopathy, gut-vascular and immune dysfunction leading to intestinal perforation, and hepatobiliary injury. The discovery of an alternate B-subunit (PltC) established a paradigm of modular B-subunit exchange that diversifies receptor usage, tissue tropism, and biology. Collectively, these insights redefine typhoid fever as a toxin-driven immunovascular disease and identify actionable targets for neutralizing antibodies and barrier-protective therapies.

We report a rare case of diffuse large B-cell lymphoma (DLBCL) presenting with both nasal and cardiac tumors. The patient was a 77-year-old man who initially visited a local clinic with a two-month history of right-sided nasal discharge and nasal obstruction. A tumor lesion was identified in the nasal cavity, and he was subsequently referred to our hospital. Blood tests revealed leukocytosis, and computed tomography demonstrated a right nasal tumor, multiple lymphadenopathies, and an irregular mass in the right atrium. A biopsy of the nasal lesion confirmed the diagnosis of DLBCL. Transthoracic echocardiography revealed a relatively immobile cardiac mass, approximately 50 mm in diameter, located in the right atrium, which was suspected to represent cardiac infiltration of lymphoma. Chemotherapy with polatuzumab vedotin in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone was initiated. During the clinical course, the patient exhibited tachycardic atrial fibrillation and sinus pauses lasting up to approximately six seconds, suggesting tachycardia-bradycardia syndrome. With ongoing chemotherapy, the cardiac tumor showed a marked reduction in size over time. To date, the patient has been successfully managed without pacemaker implantation. This case suggests that careful management, including close monitoring, is crucial for arrhythmias associated with cardiac involvement of malignant lymphoma.