In this study, we report a case of a late-stage clival chordoma in a 29-year-old African American male and the unfortunate linear progression course since his initial diagnosis. Upon his initial encounter in 2020, radiation therapy did not offer any promising curative outcome. He was initially treated with a combination treatment of partial resection, radiation, and proposed oral imatinib, none of which modified the natural history and progression of his illness. Instead, these methods were performed as palliative measures to reduce the current size of the tumors and decrease growth rates to minimize his pain. Social issues acted as a contributory risk factor in his prognosis and due to the patient's socioeconomic barriers, he was not able to continue seeking available radiotherapy, leading to disease exacerbation. Poor adherence was noted with his follow-up. The risks of being affected by this disease are likely multifactorial and more reports of such cases need to be added to bridge this gap in the current literature. In addition, there is a gap in the current study of reports of such tumors found in diverse racial groups and in patients who are in their first few decades of life. Novel treatment strategies were reviewed, and it is expected they could generate assertive treatment guidelines.

Spider angiomas (SAs) are a well-known physical exam feature found in patients with chronic liver disease. While SAs are thought to correspond with a higher risk of mortality in chronic liver disease (CLD) patients, only few studies have been done to assess the number and location of SAs as prognostic indicators. We present a case of a 64-year-old patient with decompensated CLD who was found to have three SAs on physical exam. The patient presented to the inpatient service at a community hospital in Miami, Florida. He had experienced previous esophageal varices banding, had a Model for End-Stage Liver Disease (MELD) score of 31, and needed large-volume paracentesis due to significant ascites. It was determined that he had a very poor prognosis and was in need of a liver transplant. We suggest that more research is necessary to determine if there is a prognostic importance to the number and location of SAs in patients with CLD, as earlier interventions could potentially lead to improvements in outcomes through this physical exam finding.

Intending to demonstrate the utility of the global longitudinal strain (GLS) in patients with hypertrophic cardiomyopathy (HCM) and preserved ejection fraction, we describe a case of a 54-year-old female who presented to our emergency department with an acute onset of palpitations and chest pain. The patient was noted to have a new onset of atrial fibrillation. An echocardiogram showed an unimpaired ejection fraction suggesting normal left ventricular systolic function with findings of concentric left ventricular and apical hypertrophy. However, the speckled ultrasound revealed a GLS of -6.2%, suggesting marked impairment of ventricular wall movement. A CHA₂DS₂-VASc score was calculated and yielded a score of 2, indicating a moderate risk for thromboembolism. After a full evaluation of the case, the patient was started on anticoagulation due to her GLS result that suggested stasis within the left ventricle that may lead to a thrombus. Additional advice was to follow up closely for possible automatic implantable cardioverter defibrillator placement. We conclude that GLS is a cheap and easy tool to utilize as an additional prognostic marker for cardiovascular complications, particularly among those who have progression of HCM or start with symptoms such as atrial fibrillation and may have impaired left ventricular systolic function despite a preserved ejection fraction. Thus, we encourage the medical community to utilize and further study this novel technology.

In this study, a case of severe rhabdomyolysis in a 28-year-old incarcerated patient is presented. The patient initially presented with emesis, abdominal pain, and myalgias to the clinic at the corrections facility and was treated with antiemetics and analgesics. The onset of symptoms occurred approximately 24 h after ingestion of an illicit substance produced by inmates. Despite intervention, the patient was eventually transferred to the hospital on the third day after symptom onset for further evaluation and treatment. The manuscript presents the events that preceded the diagnosis of rhabdomyolysis, as well as symptoms of hyperactive delirium that developed during the patient's hospital course, leading to the high suspicion of illicit substance intoxication as a contributing inciting factor of rhabdomyolysis. This study aimed to bring awareness to the medical community about substance use in the correction system and its consequences.

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