Background: “Time is brain” is a trope from the neurologist Camilo Gomez that emphasizes the importance of early treatment to improve the neurological prognosis of ischemic stroke patients. Given the short therapeutic window of evidence-based therapies such as thrombolysis and endovascular treatment, it is important to diagnose ischemic stroke from the numerous possible diagnoses accurately [...]

Background: Delays in antibiotic administration in sepsis – particularly after the development of hypotension – are associated with increased mortality. Current guidelines recommend antibiotic initiation within one hour of sepsis recognition. However, it is not known how timing of hypotension relates to the timing of meeting sepsis diagnostic criteria and the initiation of treatment. We [...]

Case Presentation: A 29-year-old man with a history of morbid obesity, asthma, and chronic tracheostomy presented with 3 weeks of abdominal pain. The pain was intermittent and epigastric, without relationship to eating. He had poor appetite and nausea, though no emesis. He denied use of ibuprofen or alcohol. He denied fevers or chills. The pain [...]

Case Presentation: A 60 year-old woman with a history of chronic hepatitis C without cirrhosis and schizophrenia with paranoid delusions was admitted with severe progressive bilateral burning foot pain. She had a history of intermittent alcohol use and recent homelessness. She lacked a primary care doctor and sought care for her bilateral lower extremity pain [...]

Case Presentation: 71-year-old female with history of DM2, HTN, breast carcinoma in situ status post mastectomy, B-cell lymphoma (R-CHOP in 2016 & RT, currently in remission), autoimmune hepatitis related cirrhosis on Azathioprine presented to the hospital with a 4-day history of progressively worsening productive cough, mild hemoptysis, fever and shortness of breath. In the Emergency [...]

Case Presentation: A 41-year-old male presented with three-day history of fever with chills, headache, and emesis. His prior medical history was significant for splenomegaly with thrombocytopenia of unclear etiology for several years. He had recent travel throughout the United States and the United Kingdom. He also noted remote travel to East Africa, China and Chile [...]

Case Presentation: A 29-year-old Japanese man who attended to an orthopedist in an outside hospital with multiple fractures of rib bones and a compression fracture of vertebral bones was referred to our hospital for further investigation for the tentative diagnosis of rheumatoid arthritis worried about increased serum level of matrix metalloproteinase-3. In advance of the [...]