Takotsubo cardiomyopathy, also called stress cardiomyopathy, is a form of reversible cardiomyopathy that occurs during periods of emotional or physical stress. There are many variants of takotsubo. They are classified depending on the region of hypokinesis: the most common four variants include the apical/typical variant (left ventricular apical hypokinesis), the midventricular type (midventricular hypokinesis), the basal type (basal hypokinesis), and the focal type (isolated segmental dysfunction of the left ventricle). Rarely takotsubo presents as a global variant where there is global left ventricular hypokinesis. Takotsubo cardiomyopathy has had an increasing incidence since the COVID-19 pandemic. We report a case of a 29-year-old woman with no prior cardiac history who presented with a seizure and was found to have COVID-19. The patient's echocardiogram showed global cardiomyopathy, a rare type of takotsubo cardiomyopathy.

Case Description: A 56-year-old man with a history of hypertension, diabetes, hyperlipidemia, and ischemic stroke 2 years ago presented with left-sided weakness, unsteady gait, and vomiting for 12 hours. The patient was vitally stable, and examination revealed dysarthria, left ataxic hemiparesis, and chronic right facial droop. Magnetic Resonance Imaging (MRI) brain showed an evolving acute infarct in the left superior cerebellum with trace petechial hemorrhage, chronic small right posterior inferior cerebellar infarct, and chronic bilateral cerebellar lacunar infarcts. The patient had an implantable loop recorder placed after his previous stroke, which did not show any arrhythmias on interrogation. MRI Angiography of the head/neck did not show large vessel occlusions. Transesophageal echocardiography (TEE) ruled out a patent foramen ovale but did reveal multiple filamentous structures (<5mm in size) on the atrial side of the posterior mitral valve leaflet (figure 1); these were consistent with fibrin valve strands, or Lambl’s excrescences (LE). Anticoagulation therapy was started, and surgical excision was recommended. Discussion: LE are rare fibrous/filamentous valvular strands caused by wear and tear at the closure lines of left-sided heart valves. LE can be associated with thromboembolic strokes and acute coronary syndromes; however, it can also be found incidentally. TEE is the gold standard in diagnosis. This is a middle-aged man without a clear cause of ischemic strokes, subsequently found to have LE on the mitral valve. There is a paucity of evidence on the management of LE due to its rarity. Prior case reports suggest the use of antiplatelets/anticoagulants in symptomatic patients and surgery in cases of recurrent thromboembolic episodes refractory to conservative treatment. Given multiple strokes, this patient was started on anticoagulation and will be evaluated for surgery. Further high-powered studies are needed to guide management.

BackgroundThe objective of this study was to assess the accessibility and content of the critical care fellowship websites provided on the Electronic Residency Application Services (ERAS) website. MethodsUsing the online information provided by ERAS, we compiled a list of Accreditation Council for Graduate Medical Education (ACGME)-accredited critical care fellowship programs. Each of the links provided by ERAS was evaluated by a standard search on Google as follows: the program name + "critical care fellowship". After assembling the working links, those websites were subsequently evaluated based on the program description, application process, and educational content. ResultsWe reviewed 59 critical care fellowship programs that were obtained from ERAS. Of the 59 programs, one retracted its participation and was not included in the study, and six other programs were excluded due to repeated links on ERAS, nonworking links, and websites without any content. We analyzed the data collected from the remaining 52 programs. Our data shows a general lack of information being provided to prospective critical care candidates. ConclusionsERAS is a major source of information for prospective fellows looking for critical care fellowships in the current match. Unfortunately, the majority of the programs evaluated lack substantial information for prospective candidates. Despite many websites containing adequate information regarding program descriptions, there was a lack of information regarding the application process and educational activities.

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Brain abscesses are collections of infectious fluid within the brain parenchyma, with mortality ranging from 15% to 31%. They can result from direct inoculation or via hematogenous spread. Streptococcus and staphylococcus species and Gram-negative bacilli are common bacteria responsible for brain abscesses. In immunocompromised patients, such as those with organ transplants or HIV, brain abscesses can be caused by fungi, mycobacteria, or parasites. Lactobacillus is a very rare cause of brain abscess and has only been observed in a few case reports. We report a case of a woman with uncontrolled diabetes who presented with altered mental status and was found to have a brain abscess secondary to Lactobacillus fermentum .