Malignant hidradenocarcinoma is a very rare and highly aggressive primary skin neoplasm that arises in the eccrine sweat glands. Diagnosis is typically made with histopathological evaluation after excisional biopsy. Reports of this tumor are scarce in the literature, thus making its characterization and management particularly challenging. A 71-year-old male presented in the clinic with swelling of the left lateral axilla on routine dermatological examination. Clinically, the lesion was suspected to be a capillary hemangioma. Upon surgical excision, the specimen was diagnosed as malignant hidradenocarcinoma based on histological characterization with immunohistochemical staining. Subsequent wide excision with sentinel lymph node biopsy was performed, which came back negative for residual tumor and metastasis. Due to the low incidence of this cancer and the markedly poor prognosis, accurate diagnosis of these tumors is highly important. Wide excisional biopsy and sentinel lymph node biopsy appear to be the most common initial treatment plans based on the available literature. With high rates of recurrence and metastasis, there remains the need to characterize effective adjuvant therapy for the post-operative management of hidradenocarcinoma. Copyright © 2020, Johnson et al.Blood viscosity is increased by elevated concentrations of acute phase reactants and hypergammaglobulinemia in inflammation. These increase blood viscosity by increasing plasma viscosity and fostering erythrocyte aggregation. Blood viscosity is also increased by decreased erythrocyte deformability, as occurs in malaria. Increased blood viscosity contributes to the association of acute infections with myocardial infarction (MI), venous thrombosis, and venous thromboembolism. It also increases vascular resistance, which decreases tissue perfusion and activates stretch receptors in the left ventricle, thereby initiating the systemic vascular resistance response. This compensates for the increased vascular resistance by vasodilation, lowering hematocrit, and decreasing intravascular volume. This physiological response causes the anemias associated with malaria, chronic inflammation, and other chronic diseases. Since tissue perfusion is inversely proportional to blood viscosity, anemia may be beneficial as it increases tissue perfusion when erythrocyte aggregating factors or erythrocytes with decreased deformability are present in the blood. Copyright © 2020, Sloop et al.Traumatic lumbosacral dissociation is a unique, but well-documented, phenomenon that generally stems from high-energy impact injuries to the lower lumbar spine. Patients typically present with complicated and multisystem injuries with wide-ranging neurological deficits below the level of trauma. This presents stark challenges regarding the diagnosis, management, and surgical correction technique utilized. In this study, we present the case of a 21-year-old, morbidly obese, male patient that presented after a traumatic motor vehicle accident with L5-S1 lumbosacroiliac dissociation, cauda equina syndrome, and left lower extremity monoplegia.  https://www.selleckchem.com/  The degree of disruption warranted a 360° approach, we opted for an anterior lumbar interbody fusion followed by a posterior, lumbar interbody, short segment fusion. We review the case and relevant literature of similar lumbosacral dissociation studies with their management options and outcomes. Due to the rare nature of these devastating injuries, there remains wide variability in their management, with a combination of open anterior and posterior approaches resulting in variable long-term outcomes. The management of these rare injuries will require appropriate consideration of the patient's unique etiology, coexisting injuries, and radiological imaging in deciding surgical stabilization techniques. Copyright © 2020, Scott et al.Introduction Individuals who use electronic cigarettes (e-cigarettes) may have a poor perception of physical and mental health. We, therefore, studied the association of e-cigarettes with subjectively reported health domains. Methods We utilized cross-sectional data from the 2016 and 2017 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative U.S. telephone-based survey. All variables were self-reported. E-cigarette use was characterized as never, former, or current. Health domains included overall health, physical health, and mental health, which was assessed as the frequency of emotional support, life satisfaction, and feeling stressed. Weighted multivariable-adjusted logistic regression models were used to examine the association between e-cigarette use and these health domains. Results Our study population consisted of 755,355 (79%) never e-cigarette users, 111,940 (16%) former users, and 28,917 (5%) current users. There was a significant association between e-cigarette use and the less favorable perceived state of overall health, physical health, or mental health. For example, the OR (95% CI) for the association of current e-cigarette use with health domains was as follows good perception of overall health 0.78 (0.74,0.83), physical health 0.69 (0.66,0.73), adequate emotional support 0.89 (0.79,0.99), feeling satisfied 0.83 (0.71,0.96), or being free of stress 0.64 (0.53,0.76). Similar results were obtained in younger individuals (aged 18-34 years). Conclusions E-cigarette use is associated with a less favorable perception of physical and mental health as compared to never use, particularly among younger adults. These results have important implications for clinicians for patient counseling and regulatory agencies to regulate e-cigarette sales. Copyright © 2020, Al Rifai et al.Introduction Acute-on-chronic liver failure (ACLF) is a serious complication of liver cirrhosis which presents with hepatic and/or extrahepatic organ failure and often needs admission to an Intensive Care Unit (ICU). This condition typically needs organ support and carries a high mortality rate. ICU care may not benefit these patients. There are many scores to assess prognosis in these patients, such as the Model for End-stage Liver Disease (MELD) score, the MELD score refined to take into account serum sodium level (MELD-Na), the chronic liver failure organ failure (CLIF-OF) score, the CLIF Consortium acute-on-chronic liver failure (CLIF-C ACLF) score and the Child-Turcotte-Pugh classification. This study was conducted to compare CLIF-C ACLF and MELD scores for selecting patients at risk of high mortality, as ICU care to these patients in the absence of liver transplantation may be of no value. Methods The data of 75 patients admitted to the ICU of Shifa International Hospital in Islamabad were prospectively analyzed.