Follow up echocardiography was scheduled upon discharge to monitor the resolution of cardiac vegetations. Copyright © 2020, Hassan et al.In the pre-antibiotic era, neurosyphilis (NS) was common, occurring in 34% of patients with syphilis. Currently, there has been a rising trend in syphilis with HIV-infected patients being more prone to develop NS. Ocular involvement is very rare in NS and accounts for only 1%-5% of the cases in the United States. We report the case of a 53-year-old male with a past medical history of gastroesophageal reflux disease and hyperlipidemia who presented to his ophthalmologist for blurred vision in both eyes. He had been noticing a black spot in the visual field of his left eye for two weeks. He had also noticed a rash on his forearms. His past and social history was significant for treated Lyme disease, having pet cats. He identified as a heterosexual male, married, and with five children. Autophinib manufacturer However, on further history taking, he reported a homosexual exposure about five years prior. He denied any history of genital ulcer or penile discharge. On examination at the ophthalmology clinic, he was found to have a visual ah history taking, even for patients who appear to be at a low risk for sexually transmitted infections. Copyright © 2020, Paulraj et al.Introduction Several studies have found celiac disease may be associated with a variety of cardiac manifestations. Atrial fibrillation (AF) is one of the most common arrhythmias that can cause significant morbidity. However, the risk of atrial fibrillation in patients with celiac disease according to epidemiological studies remains unclear. The aim of this meta-analysis study is to assess the risk of atrial fibrillation in patients diagnosed with celiac disease compared to controls. Methods A systematic literature review was conducted in MEDLINE, EMBASE, Cochrane databases from inception through December 2017 to identify studies that evaluated the risk of atrial fibrillation in patients with celiac disease. We included randomized controlled trial, cross sectional and cohort studies that reported the odds ratio, relative risk, hazard ratio, and standardized incidence ratio comparing the risk of developing atrial fibrillation among patients with celiac disease, versus patients without celiac disease as control.llation and celiac disease. Some of the limitations of this study are that all were observational studies, some were medical registry-based and there was high heterogeneity between studies. Copyright © 2020, Hidalgo et al.Cardiac tamponade is a condition characterized by the accumulation of pericardial fluid, compromising the hemodynamics of the circulation. It has several known causes, including traumatic injury to the pericardium, idiopathic, neoplastic or purulent pericarditis, and, rarely, iatrogenic etiology. Inferior vena cava (IVC) filter removal can lead to multiple complications including but not limited to IVC perforation, air embolism, pneumothorax or filter migration. Here, we present a case of a middle-aged woman presenting with cardiac tamponade after IVC filter removal. She was successfully managed with pericardiocentesis followed by pericardial window placement. As this case and literature review illustrates, cardiac tamponade is a rare but potentially devastating complication of IVC filter manipulation. Copyright © 2020, Roomi et al.Background Multiple sclerosis (MS) is an autoimmune and demyelinating inflammatory disease that affects the central nervous system (CNS). The etiology of the disease remains unknown. Multiple theories highlight genetic, environmental, and infectious factors that may a role. MS is considered as the main cause of disability in young people. Cladribine, known chemically as (2-Chloro-2'-deoxyadenosine), is a purine analog chemotherapy used for hairy cell leukemia and other B-cell lymphomas. The goal of this study was to evaluate the safety and efficacy of cladribine in patients with rapidly evolving or early secondary progressive MS. Methods This observational, single-center, retrospective chart review at the MS Clinic in the Ottawa General Hospital, Ottawa, Canada. A total of 24 patients (median Expanded Disability Status Scale (EDSS) of 4.5) received cladribine (0.07 mg/kg/day) for four consecutive days every six months for ≥ 2 cycles with further cycles depending on lymphocyte recovery or disease activity to aadribine reduced the relapse rate from 1.25 to 0.42, which was statistically significant (p-value = 0.002). MRI activity in patients with rapidly evolving or early secondary progressive multiple sclerosis had a reasonable safety profile. Copyright © 2020, Alshamrani et al.Rescue cervical cerclage can effectively prolong a nonviable gestation to viability, if done correctly in chosen patients after appropriate counseling. Here, we present a case study of an antenatal woman with advanced cervical changes at 24 weeks who benefited from the rescue cervical cerclage procedure to have a successful pregnancy outcome. Copyright © 2020, Pandey et al.Adequate visualization of the proximal and distal vessels and clip reconstruction of the bifurcation with complete aneurysm neck exclusion are often difficult in the setting of bulbous small- and moderate-sized middle cerebral artery (MCA) aneurysms. We describe our experience with bipolar aneurysm dome remodeling in the setting of bulbous MCA aneurysms. The charts of the senior author's (Aaron Cohen-Gadol) patients who underwent clip ligation of their MCA aneurysm (220 patients), and more specifically those whose aneurysm clipping was facilitated through bipolar coagulation remodeling (8 patients), were reviewed. Patient demographics, aneurysm characteristics, and postoperative angiographic results were analyzed. Eight patients with eight MCA aneurysms were treated through this technique over a six-year period. Their mean age was 53 years, and six of the eight patients were women. Two involved the anterior temporal artery, and the rest were at the M1 bifurcation or trifurcation. Three of the eight were ruptured; the mean aneurysm maximum diameter was 7 mm. Postoperative angiography demonstrated complete aneurysm obliteration in seven of eight patients; one patient had an asymptomatic mild stenosis of her anterior temporal artery's origin, and another had a small neck remnant in the setting of a highly atherosclerotic neck. On the basis of this experience, dome coagulation remodeling of small- and moderate-sized bulbous aneurysms in the setting of poor proximal and distal vessel visualization was found to be safe for facilitating aneurysm clipping and offers more desirable clip deployment. Copyright © 2020, Kulwin et al.