BackgroundSyncope, the sudden transient loss of consciousness due to multiple etiologies, usually has worse outcomes in African Americans compared with other races because of other comorbidities. This study aims to identify a correlation between the etiologies of syncope and age in a predominantly African-American sample population to facilitate future investigations with potentially improved specificity to address this condition.MethodsWe reviewed the medical records of 155 patients who presented with syncope concerns to the emergency department at our university hospital. After three charts were discarded due to poor data, the patients were divided into four age groups: <40 years old (25 patients), 40–60 years old (62 patients), 61–80 years old (44 patients), and >80 years old (21 patients). The etiology of syncope was reviewed in each case and categorized as either a vasovagal episode, orthostatic hypotension, pulmonary embolism, and related to cardio, neurologic, drug, or unspecified.ResultsFor most of the patients in our study population, regardless of age, the etiology of syncope remained unspecified. Vasovagal related was the second most common etiology. The likelihood of having cardiac etiology under the age group of 40 is very low compared with those over 40 years (p = 0.026). Also, the incidence of pulmonary embolism is very low in all age groups with pulmonary embolism as a cause of syncope seen in only three patients (n = 3; 1.95%).ConclusionsExcept for cardiac etiology being more likely in patients over age 40, we found no other correlation of age to syncope etiology. We also found that the etiology of syncope in African-American patients is similar to that of the general population. We recommend physicians to order a relevant workup, when clinical suspicion for syncope is present along with specific etiologies.

INTRODUCTION­­­Acute pericarditis is the most commonly encountered manifestation of pericardial disease (incidence: 0.2 percent to 0.5 percent in hospitalized patients). However, data regarding manifestations, workup, and the management of acute pericarditis in the African American population is lacking. This study aims to collect and analyze more clinical data related to acute pericarditis in this understudied population.METHODOLOGYWe conducted a retrospective chart review of all patients managed for acute pericarditis at a university hospital serving a predominantly African American population. A total of 78 charts were reviewed during the period of study from January 2011 to July 2016. Out of these, nine charts were excluded due to poor data. We descriptively analyzed data regarding presenting symptoms, underlying etiologies, co-morbidities, investigation results, management strategies, and prognoses.RESULTSWe found an equal number of males and females in our study population. The most common comorbid conditions were hypertension, chronic kidney disease, and diabetes mellitus (in order of incidence). The most common presentation of symptomatic pericarditis consisted of chest pain, dyspnea, tachycardia, and tachypnea. Electrocardiogram (EKG) findings included diffuse ST elevation (15 percent) and sinus tachycardia (41 percent). Leukocytosis was seen in 15 percent of the patients. The most common etiology noted in our patient population was idiopathic and was treated with NSAIDS.CONCLUSIONAs compared to other populations, the incidence of uremic pericarditis and pericarditis secondary to cardiac etiologies is slightly higher in the African American population; however, the clinical presentation, examination and laboratory findings, as well as investigations, are remarkably similar.

Gastric duplication cyst is an uncommon anomaly typically found in the greater curvature of the stomach. It is usually diagnosed in children and quite difficult to diagnose in adult because of variable presentation. We present a 76-year woman who was admitted for abdominal pain of few weeks' duration. Her X-ray showed calcification in the region of left kidney, and she was subsequently managed with a presumptive diagnosis of staghorn calculus. Computerized Tomography (CT) scan of her abdomen disclosed calcification in the gastric wall for which an endoscopic ultrasound and biopsy was done. Findings were consistent with the presence of gastric epithelium and a diagnosis of gastric duplication cyst was made. Surgery was the continuation of care. The presence of symptomatic gastric cyst in an elderly patient is very rare. This is the first case in which gastric duplication cyst mimicked staghorn calculus on abdominal X-ray. Consequently, this diagnosis, though rare, should be considered in the differentials of upper abdominal pain.

No abstract

A high serum bromide level can cause erroneously high serum chloride levels measured through routine assays. Here, we describe a case of pseudohyperchloremia in which routine labs showed a negative anion gap and elevated chloride levels measured with ion-selective assay. The serum chloride level was found to be lower when measured with a chloridometer that employs a colorimetric method of quantification. The initial serum bromide level was elevated at 1100 mg/L that was confirmed by repeating the test that again showed an elevated level of 1600 mg/L and appeared to cause erroneous hyperchloremia when using conventional serum chloride quantification methods. Our case highlights lab errors and factitious hyperchloremia as a cause of the negative anion gap caused by bromism, even without a clear history of bromide exposure. The case also underscores the importance of chloride measurement using both colorimetric methods and ion-selective assay in the case of hyperchloremia.