The potential etiologies of fulminant myocarditis include autoimmune diseases, infections, drug hypersensitivity, and drug/toxin reactions. We present an atypical case of fulminant myocarditis in a patient with a history of diabetic ketoacidosis with recent novel coronavirus (COVID-19) infection, who presented with acute upper gastrointestinal bleeding. The patient improved with a three-day course of methylprednisolone 1 gram daily.

Licorice has been around for centuries and has been commercialized in the food, tobacco, and healthcare industry. Historically, its therapeutic benefits have been reaped in countless ways, including as a thirst sensation suppressor in battlefields, flavoring agent in medicinal preparations, antacid for gastric discomfort and peptic ulcers, and even as an estrogenic agent in postmenopausal women. Licorice and its derivatives are recognized safe by the US Food and Drug Administration (FDA). Though FDA recognized the licorice to be a food additive in certain concentrations, it has issued warnings against its use in at-risk group and in larger amount. However, it is a lesser known fact that glycyrrhizic acid, the active component in licorice, can cause a metabolic syndrome presenting as pseudohyperaldosteronism. Chronic consumption leads to the development of hypertension, metabolic alkalosis, and hypokalemia. We present a patient who developed a sinus pause on telemetry and subsequent syncope after presenting for evaluation of hypertension and hypokalemia. The patient had been ingesting a significant quantity of deglycyrrhizinated licorice for many years to alleviate postprandial epigastric pain. Although seemingly benign electrolyte disturbance, it is crucial to recognize that chronic consumption of licorice without strict regulation can lead to supraventricular and ventricular ectopics and tachyarrhythmias with the potential to develop lifethreatening arrhythmias including ventricular tachycardia, ventricular fibrillation, and Torsades de Pointes.

Lion's foot (Alchemilla vulgaris L.) which is widely known as lady's mantle, bear's foot or lion's foot is traditionally used due to their tannin contents for the treatment of inflammations, diarrhea, wound healing and inhibit cardiovascular diseases and cystic fibrosis. The present work aims to high light the reverse effect of dried lion's foot (Alchemilla vulgaris) leaves and its water and ethanol extracts at various ratios against the toxicity of CCl 4 on serum lipids profile that may occur on albino rats. Also, preparation of guava and mango pulp that fortified with lion's foot powder and its water and ethanol extracts as an available product rich in bioactive component to help hyperlipidemic patients. Fifty-six male albino rats were used in this experiment. These rats were divided into eight main groups (seven rats of each) and were fed on diets for 45 days as follows: Group 1: Negative control group was fed on basal diet. Forty nine rats were fed on basal diet and treated with CCl 4 subcutaneous injection to induce toxicity, then divided into 7 groups form group 2 to group 8. Group 2: Positive control group will be fed on basal diet till final experiment. Groups 3:8 as the same of the second group with (50 and 100 ppm ethanol extract, 50 and 100 ppm water extract, 1% and 2% dry leaves powder respectively) daily orally. Moreover, guava and mango pulps were classified to 7 groups as follows: control sample, and the samples (2 to 7) were fortified with lion's foot as follows ethanol extract 50ppm and 100ppm , water extract 50ppm and 100ppm, 1% and 2% dried leaves for sensory evaluation. All these samples were organoleptically evaluated for general appearance, color, flavor, taste, consistency and overall acceptability. Results: The results revealed that treatment with lion's foot leaves and its ethanol and water extracts caused significant decreased levels of serum lipid profile of total cholesterol, triglycerides, total lipids, LDL-C and VLDL-C induced by CCl 4 and enhancement HDL-C in all groups. The best result of lipid profile was in groups treatment with the high level 2% dried lion foot followed 1 % dried lion's foot and 100ppm ethanol extract. These results due to the antioxidants content in Lion's foot as polyphenols, flavonoids, tannins and saponins (359.65, 183.10, 150.64 and 296.32, respectively). The best sample of fortified guava pulp was 1% dried leaves. While, the best result of mango pulp was in the samples fortified with 50ppm ethanol extract, water extracts (50 and 100 ppm) and 1% dried leaves. Conclusion:This study showed that the fortification of Alchemilla vulgaris L. can be proposed to protect the toxicity induced by CCl 4 in rats, also to help inhibit the improvement cardiovascular diseases and cystic fibrosis.

Objective: While effective connectivity (EC, causal interaction) between brain areas has been investigated in chronic users of cocaine as they view cocaine pictures cues, no study has examined EC while they take part in a resting-state scan. This resting-state fMRI study aims to investigate the causal interaction among brain areas in the mesocorticolimbic system (MCLS), which is involved in reward and motivation, in cocaine users (vs. controls).Method: Twenty cocaine users and 17 healthy controls finished a structural and a resting-state scan. Mean voxel-based time series data were obtained from brain regions of interest (ROIs) from the MCLS, and were input into a Bayesian search algorithm called IMaGES. Results:The causal interaction pattern was different between the two groups. The feed-forward pattern found in cocaine smokers, between 7 ROIs of the MCLS during resting-state [ventral tegmental area (VTA)→hippocampus (HIPP)→ventral striatum (VenStri)→orbital frontal cortex (OFC), medial frontal cortex (MFC), anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (DLPFC)], was absent in controls. That is, the subcortical VenStri area had a causal influence on four cortical brain areas only in cocaine users. Conclusions:During the resting-state scan, the VTA of cocaine smokers abstinent for at least 72 hours, but not controls, begins causal connections to limbic, midbrain, and frontal regions in the MCLS in a feed-forward manner. Following replication, further studies may assess if changes over time in EC during resting-state predict cocaine treatment efficacy and outcome.

Behçet's disease (BD) is a systemic vasculitis characterized by various symptoms, including orogenital ulcers, uveitis, arthritis, skin lesions, and the involvement of the gastrointestinal tract and central nervous system. BD has been associated with malignancies such as leukemia, myelodysplastic syndrome, lymphoma, multiple myeloma, Hodgkin's disease, and lymphosarcoma. The rarity of association with B-cell lymphoma may also be added to the list, given our findings in this case report. Patients with vasculitides benefit from immunosuppressive therapy that can minimize disease and may prevent disease manifestations and exacerbations. However, there may be an increased risk of cancer development, which calls for consideration while starting and maintaining this population of patients on immunosuppressive therapy.