This case presentation discusses a rare cardiac malignancy initially thought to be a benign tumor. A 36-year-old presented with syncope, dyspnea, Computed Tomography Pulmonary angiography study obtained was negative for pulmonary emboli but revealed a left atrial mass. A transesophageal echocardiogram (TEE) confirmed a mass with multiple lobes and a broad base attached to the septum, encroaching into the right atrium, aortic root wall, base of the anterior mitral leaflet flowing to the mitral orifice in diastole also obstructing the right pulmonary vein. Despite a quick diagnosis and plan to begin treatment, the patient rapidly declined owing to the extent and aggressive nature of this cardiac malignancy. This case reports the insidious nature of these tumors as well as how challenging and life threatening they are at the time of their clinical manifestation.

Multiple sclerosis (MS) has classically been described as a disease of the young Caucasian female. While the prevalence may seem to be higher in Caucasians (CAs), recent studies suggest that the real incidence of MS may actually be higher in African Americans (AAs). Here, we discuss a nonclassical case of MS in an older African American male, prognostic factors, disease patterns in African Americans, and how a delay in diagnosis and socioeconomic factors can lead to worse outcomes. In patients that present with possible symptoms of MS, a high suspicion for MS should be entertained even in epidemiologically atypical patients to prevent delay in diagnosis and irreversible disability.

Background: Minority populations are two to three times as likely to die of preventable cardiovascular events. Two main forces behind the challenge in managing hypertension among minority populations are disparities in health and healthcare. Aims: To identify the common health and healthcare disparities (HHD) among hypertensive patients who presented to a community medical center and propose a collaborative alliance for improvement. Methods: Internal medicine residents at the Newark Beth Israel Medical Center utilized a (P: Provider, I: Insurance, F: Food, E: Economic stability, N: Neighborhood, C: Culture and Language, E: Education, S: Social (PI-FENCES) model to identify health and health care disparities in hypertensive patients who presented to the ambulatory and inpatient settings over a 12-week-period. Demographic and baseline clinical characteristics were recorded. The distribution of each of the elements of PI-FENCES was documented and their association with respective demographics was determined. A protocol for usability study was designed based on preliminary data collected. Results: Between May 2019 and July 2019, a total of 86 hypertensive patients (mean ± SD age: 54 ± 12 years, BMI: 31± 8 kg/m 2 ) were identified. Seventy-one (83%) of them were African Americans. Of the patients identified, 51 (59%), presented to the ambulatory setting, 24 (28%) were seen in the in-patient setting and 11 (13%) were admitted to the Intensive care unit. According to the PI-FENCES model, distribution of HHD were as follows: n(%); P: 6 (6.9%), I: 40 (47%), F: 8(9.3%), E: 10 (11.6%), N: 1 (1.2%), C: 10 (14%), E: 26 (30.2%), S: 17 (19.7%). While 61 (71%) patients had at least 1 element of HHD, 9 (1.1%) had more than 2 elements of HHD. Associated cardiovascular conditions noted among admitted patients (n=35) were heart failure exacerbation (n=8) (22%) and cerebrovascular accident (n=4) (11%). Compared to patients with insurance, patients with no insurance were more likely to be admitted to the inpatient service or intensive care unit (Insurance: 31% vs. No insurance: 69%, p<0.0001). Based on the preliminary data, a Reducing ReAdmission Secondary to Hypertension (RRaSH) proposal will be implemented. RRaSH will focus on developing follow-up and referral plans for all uninsured hypertensive patients who present to the in-patient setting. The program will also encourage free health screening of families and friends of this uninsured population. Conclusion: About one out of every two patients who presented with systemic hypertension to a community medical center had no insurance. Compared to patients with insurance, patients with no insurance were more likely to be admitted to the inpatient service or intensive care unit. RRaSH will be a follow-up and referral plan to help reduce readmissions secondary to hypertension.

Left atrial fibrous band is a rare clinical and echocardiographic finding characterized by the presence of a fibrous band attached to the mitral valve. Diagnosis is accomplished with transesophageal echocardiography (TEE), live 3D imaging, or cardiac MRI. Most patients are asymptomatic and incidental findings. However, in rare cases, an atrial fibrous band can produce symptoms such as dyspnea on exertion, fatigue, and lightheadedness secondary to mitral regurgitation (MR) which can lead to heart failure if unattended to. More serious complications such as cardioembolic phenomenon can occur. We herein report a case of a 55-year-old male with hypertension who presented with dyspnea on exertion and chest pain. Transthoracic echocardiography (TTE) showed mitral valve prolapse with moderate to severe mitral regurgitation. TEE showed an atrial fibrous band. Given the patient’s poor exercise tolerance, he was taken to surgery for a mitral annuloplasty.

This is a case of a 38-year-old female with latent TB complicated by disseminated peritoneal TB with associated spontaneous abortion, who was initially thought to have an ovarian neoplasm, prompting extensive workup. Laparoscopy with biopsy later confirmed the patient's condition; she was initiated on the appropriate therapy and had a full recovery.