Background Omega-3 (n–3) fatty acids have shown benefit in cognitively impaired subjects, but the effect on cognitively healthy older subjects is unclear. Objectives Our aim was to determine if long-term, high-dose ω-3 ethyl esters, EPA (20:5n–3) and DHA (22:6n–3), prevent deterioration of cognitive function in cognitively healthy older adults. Methods A total of 285 subjects with stable coronary artery disease (CAD) on statin treatment were randomly assigned to 3.36 g EPA and DHA or none (control) for 30 mo. Cognitive function was assessed in all 285 subjects at baseline and in 268 and 250 subjects who returned at 12- and 30-mo follow-up, respectively, with neuropsychological testing as a prespecified secondary outcome. A completer's analysis, along with a sensitivity analysis carrying forward the last observation, was performed. Results Over the 30-mo period, subjects randomly assigned to EPA and DHA had significantly better scores than control for verbal fluency, language, and memory (mean: 1.08; 95% CI: 0.25, 1.91; P = 0.011) and 2 tests of visual-motor coordination (mean: −2.95; 95% CI: −5.33, −0.57; P = 0.015 and mean: −9.44; 95% CI: −18.60, −0.30; P = 0.043, respectively). The better scores for EPA and DHA were due to an improvement at 12 mo compared with baseline in verbal fluency, language, and memory (P = 0.047) and 2 tests of visual-motor coordination (P = 0.033 and P < 0.001, respectively), whereas control had no change. Post hoc analyses indicated no difference by age, sex, or diabetes status. Conclusions Cognitively healthy older adults with stable CAD randomly assigned to high-dose EPA and DHA had improved cognitive function over a 30-mo period compared with control. These findings may be especially important for CAD patients because CAD is a risk factor for cognitive decline. This trial was registered at clinicaltrials.gov as NCT01624727.

Coronavirus disease 2019 (COVID-19) continues to be fatal despite advances in the understanding of characteristics of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), global prevention strategies, new anti-viral treatments, and worldwide vaccination programs. The exact underlying mechanism through which SARS-CoV-2 leads to acute respiratory distress syndrome (ARDS) resulting in intensive care unit admission, mechanical ventilation, and eventually death remains elusive. Cytokine storm is one of the most favorable mechanisms that scientists show remarkable interest to target in randomized clinical trials with promising outcomes. Macrophage activation syndrome (MAS), the most serious form of cytokine storm, requires early recognition and treatment regardless of etiology. Here, we report a 59-year-old gentleman with a COVID-19 infection complicated by MAS. Our aim is to increase awareness of this condition among health care providers as it necessitates prompt diagnosis and treatment due to an extremely poor prognosis.

Acute abdominal pain is one of the most common reasons for emergency admissions. Even though initial differentials are wide, a physician is able to narrow them down with detailed history, careful physical examination, and appropriate laboratory tests along with imaging studies. Unfortunately, some of the cases do not have an established diagnosis despite multiple blood work and imaging studies in the emergency department. In such conditions, physicians' recognition of rare diseases generally avoids extra costs for additional investigations, unnecessary consultations, and most importantly wasting valuable time in life-threatening conditions in emergency settings. Here, we report a 30-year-old woman with acute severe abdominal pain and hemodynamic instability who was found to have ascites that was actually hemoperitoneum secondary to spontaneous primary non-parasitic splenic cyst rupture. The primary splenic cyst is an extremely rare entity and is often found on imaging incidentally. A few case reports regarding primary splenic cyst and its complications were published in the literature. Since it is an exceptionally uncommon condition, there is no consensus on treatment. We aimed to increase the understanding of spontaneous primary splenic cyst rupture and its management among healthcare providers with this case report.

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