Hyperglycaemia during inpatient admission is indicative of higher morbidity and mortality risks in critically ill patients. The severe acute respiratory distress coronavirus 2 (SARS-CoV-2) has been reported to induce ketoacidosis and diabetic ketoacidosis (DKA) even in nondiabetic patients. The pathophysiology of the SARS-CoV-2 infection that can contribute to hyperglycaemia, and the exacerbated inflammatory cytokine storm can overlap with the metabolic chronic inflammatory state attributable to the metabolic syndrome, which underlies diabetes mellitus. In this report, we explore the possible pathophysiology and metabolic mechanisms that lead to metabolic acidosis in nondiabetic patients.

Background: Artificial intelligence (AI) is a revolutionary tool yet to be fully integrated into several health care sectors, including medical imaging. AI can transform how medical imaging is conducted and interpreted, especially in cardio-oncology. Objective: This study aims to systematically review the available literature on the use of AI in cardio-oncology imaging to predict cardiotoxicity and describe the possible improvement of different imaging modalities that can be achieved if AI is successfully deployed to routine practice. Methods: We conducted a database search in PubMed, Ovid MEDLINE, Cochrane Library, CINAHL, and Google Scholar from inception to 2023 using the AI research assistant tool (Elicit) to search for original studies reporting AI outcomes in adult patients diagnosed with any cancer and undergoing cardiotoxicity assessment. Outcomes included incidence of cardiotoxicity, left ventricular ejection fraction, risk factors associated with cardiotoxicity, heart failure, myocardial dysfunction, signs of cancer therapy–related cardiovascular toxicity, echocardiography, and cardiac magnetic resonance imaging. Descriptive information about each study was recorded, including imaging technique, AI model, outcomes, and limitations. Results: The systematic search resulted in 7 studies conducted between 2018 and 2023, which are included in this review. Most of these studies were conducted in the United States (71%), included patients with breast cancer (86%), and used magnetic resonance imaging as the imaging modality (57%). The quality assessment of the studies had an average of 86% compliance in all of the tool’s sections. In conclusion, this systematic review demonstrates the potential of AI to enhance cardio-oncology imaging for predicting cardiotoxicity in patients with cancer. Conclusions: Our findings suggest that AI can enhance the accuracy and efficiency of cardiotoxicity assessments. However, further research through larger, multicenter trials is needed to validate these applications and refine AI technologies for routine use, paving the way for improved patient outcomes in cancer survivors at risk of cardiotoxicity.

Background: Outbreaks of methanol poisoning have been described in the medical literature in different regions around the world. Even though in Saudi Arabia a few outbreaks of methanol poisoning have occurred, they remain undocumented. Herein, we describe several cases of methanol poisoning in Saudi Arabia with the goal of increasing awareness about the dangers of methanol poisoning among healthcare staff. Case presentation: Nine middle-aged Saudi patients (five men aged 24, 26, 27, 36, and 49 years and four females aged 19, 20, 24, and 25 years) were admitted to our emergency department after alcohol consumption. All patients presented with severe metabolic acidosis and some visual impairment. Treatment was initiated based on the clinical suspicion of methanol intoxication because of laboratory test limitations and time constraints. Patients showed improvement and favorable hospital outcomes after aggressive empirical treatment. Conclusions: Many social and cultural factors influence the lack of reporting of methanol poisoning cases in Saudi Arabia. We believe it is important to document these outbreaks to increase the knowledge among healthcare providers and promote public health awareness. A high index of suspicion and the development of local public health networks to monitor, survey, follow-up, and facilitate data exchange can help healthcare providers recognize and aggressively treat affected individuals. Early empiric and aggressive management can greatly decrease morbidity and mortality despite challenges and limited resources.

Introduction: Simultaneous occurrence of acute ischemic stroke and myocardial infarction is reported to have variable precipitating causes. This occurrence has been rarely reported in the literature and described only in very few case reports. During the surge of coronavirus disease (COVID-19) in our region, we noted an increase in the simultaneous occurrence of cardio-cerebral infarction. This led us to explore the possible mechanisms and pathophysiology that could contribute to this increase. The retrospective nature of the study limited us from drawing any conclusion about causation. Rather, we aimed to formulate a hypothesis for future, more rigorous studies. Patient concerns: We present an overview of 5 cases of simultaneous cardio-cerebral infarction that we encountered in our emergency department within 1 month. Diagnosis: In all cases, diagnosis was confirmed using an electrocardiogram, assessment of laboratory cardiac markers, and imaging. Interventions: In all cases, dual antiplatelet therapy was started and thrombolysis was held, as the condition was considered high risk in most of the patients. Cardiac catheterization lab was not activated either because the patient was unstable or the risk of COVID-19 in staff outweighed the benefit added in patient treatment. Outcomes: Two out of 5 patients died because of early complications that lasted for few days. The remaining 3 were discharged from the hospital in moderate functionality for extensive therapy and rehabilitation. Conclusion: Early recognition and immediate treatment is important in different scenarios leading to thrombosis as the outcome. Additionally, addressing the unknown risks that could contribute to our traditional understanding of these causative mechanisms is important. The hypothesis of exacerbated damage caused by inflammatory and immunological endothelial systemic damage should further be explored to be able to delineate new possibilities in managing these conditions.

Background: The allocation of resident physicians to clinical rotations presents a complex challenge that requires balancing multiple objectives with the goals of providing optimal patient care, maintaining adequate departmental staffing, and maximizing residents’ training experience. While adhering to governing guidelines and training regulations, these physicians must comply with curricular milestones and educational goals for progression that must be achieved within specific time constraints. This manuscript reports on how to create annual master rotation schedules to meet the training requirements for 60 residents, while addressing the requirements detailed above. Methods: Trainees in the field of Emergency Medicine have to meet variable essential annual curricula requirements. Methods of preparing rotations in different Emergency Departments are presented which usually need early planning to ensure the best coordination and number allocation among the different internal and external collaborative departments. This off-institution and off-service external rotation is an educational necessity regulated by the Saudi Commission of Health Sciences to maximize residents’ exposure and meet the expected educational milestones unique to Emergency Medicine training. Results: We report how to create annual master rotation schedules to meet the training requirements for 60 Emergency Medicine residents, while maintaining steady adequate departmental staffing and accommodating the different external rotation capacities, a task that is usually handled by the chief residents and program director. Although some parts of this process can be performed by using scheduling software or with particular decision support management systems, many steps are still filtered and checked manually. External circumstances mandate changes in schedules that require last-minute changes which may overrule training restrictions and make them unfeasible. Conclusion: To create such an agile schedule, we maintain a standardized template with preset blocks and rotations. Residents can choose the most suitable track that meets their preference for year-long rotation blocks. Thus, we minimize the individual variability in the preset allocations, guarantee an even distribution, give equal chances to each resident to accommodate and approximate their individual preferences, and decrease the overall workload and time consumed annually.