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langes of toes 2 to 5 serving to extend the toes and assist in ankle dorsiflexion while the extensor hallucis longus inserts on the dorsal base of the distal phalanx of the great toe and thus extends the interphalangeal (IP) joint of the hallux. Understanding the anatomy of the foot is critical to understanding its various deformities. Deformities of the fifth toe are often congenital and include deformities such as an overlapping fifth toe or a congenital curly toe.Liver lesions have a broad spectrum of pathologies ranging from benign liver lesions such as hemangiomas to malignant lesions such as primary hepatocellular carcinoma and metastasis. Imaging is a crucial step in diagnosing these conditions as liver enzymes can elevate in 8% of people in the U.S. A combination of medical history, serologic, and radiologic investigations can provide the diagnosis in most of these cases. Liver lesions can be categorized into focal and diffuse liver lesions. Focal liver lesions can subclassify into three main clinical categories. Diffuse liver lesions can categorize into vascular, inflammatory diseases, and storage disease. Benign liver lesions can be classified into 3 categories based on their origination Cholangiocellar hepatic cyst, biliary cystadenoma, intraductal papillary neoplasm of the bile ducts, peribiliary cyst, intrahepatic bile adenoma, Hepatocellular focal nodular hyperplasia, hepatic adenoma Mesenchymal hemangioma, lipoma Liver ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI) are the primary imaging modalities to diagnose liver lesions. Post intravenous (IV) contrast imaging has unique features in the liver because the liver has three distinct phases, which are the arterial phase, the portal venous phase, and the venous phase. The US can be a method of choice as a screening modality, and contrast-enhanced multidetector CT (MDCT) as a modality of choice in most hepatic imaging.FDA approved IndicationsAtrial fibrillation (AF) is the most common type of heart arrhythmia affecting 33.5 million people worldwide. The most dreaded complication of this disease is stroke, which is also the leading cause of disability in the United States. AF increases the risk of ischemic stroke by 4 to 5 fold in all ages when left untreated. Moreover, AF is correlated with a higher risk of extracranial thromboembolic aortic events, and also of mesenteric, renal, and peripheral arteries. The number of strokes attributed solely to AF increases with age approaching 23.5%. Oxaliplatin In AF patients, oral anticoagulants (OACs) remain the gold standard treatment. The role of OACs in preventing strokes is well established, yet it is contraindicated in patients with an increased risk of bleeding. Hence, left atrial appendage occlusion (LAAO) has risen as an alternative approach in this subset of patients.The human immune system is a complicated marvel that has evolved to demonstrate wide distribution through all the systems of the body. For example, the skin has the Langerhans cells; the liver has the Kupffer cells, the adenoids of the nasopharynx, etc. One such improvisation of the immune system is the MALT- the mucosa-associated lymphoid tissue. The MALT of the gut is the gut-associated lymphoid tissue(GALT). This article is about a part of the GALT- the Peyer's patches.Copper is a trace element (minerals required in amounts 1 to 100 mg/day by adults) found in high concentrations in the brain, liver, and kidney. However, because of their size, bone, and muscle contain more than half of the copper in the body. Copper is bound to ceruloplasmin in the liver, which transports the copper from the liver to the peripheral tissues. Approximately 50 percent of copper is excreted in the bile while the remaining half is excreted through other gastrointestinal secretions. As such, the gastrointestinal tract is the major regulator of copper homeostasis. While copper is required as an important catalytic cofactor in redox chemistry for many proteins, when present in excess, free copper ions can cause damage to cellular components. A delicate balance between the uptake and efflux of copper ions determines the amount of cellular copper. Excess copper induces not only oxidative stress but also DNA damage and reduced cell proliferation. Ingestion of more than 1 g of copper sulfate results in symptoms of toxicity. Copper toxicosis can be classified as primary when it results from an inherited metabolic defect, and secondary when it is the consequence of high intake or increased absorption or reduced excretion due to underlying pathologic processes. Copperiedus (copper toxicity) can be caused by consuming acidic foods cooked in uncoated copper cookware, or due to exposure to excess copper in drinking water or other environmental sources.Facial trauma is a common reason for patients to visit the emergency department. Midface trauma, in particular, provides a unique challenge for physicians in regards to treatment. Otolaryngologists (ENT) and oral maxillofacial surgeons are commonly consulted for the evaluation of maxillary sinus fractures (MSFs). Knowledge about the diagnosis and treatment of such fractures is very important as it has a large socioeconomic burden on the patient and the healthcare system as a whole. These patients tend to have multiple facial bone fractures, which may require extensive surgery and rehabilitation. Though a maxillary sinus fracture can be used to describe any fracture involving the borders of the maxillary sinus, this paper focuses mostly on anterior and posterior wall maxillary sinus fractures, as other fractures of the midface are out of the scope of this paper. Anatomy In order to understand the diagnosis and treatment of maxillary sinus fractures, it is important to be familiar with the anatomy of the midfacrbital artery, and the posterior lateral nasal artery. Innervation of the maxillary sinus and its blanketed mucosa comes primarily from the maxillary division of the trigeminal nerve (V2).Millipedes are arthropods from the class Diplopoda that consists of more than 12,000 species. Many of the species are brown or black but can also vary in color, including orange and red. They are detrivores meaning that they feed primarily off of decaying plant matter. Size is variable and ranges from 2 mm to greater than 160 mm, and their body shape can be flattened or cylindrical. Their distribution extends to all continents except Antarctica with a preference for burrowing in dark areas of warm, humid climates such as the tropics. They are easily confused with their distant relative to the centipede but can typically be distinguished by the following criteria. Millipedes have two pairs of legs per body segment compared to centipedes, which have one, they are slower moving than centipedes, and they lack forcipules or fangs like centipedes and are unable to inject venom. Millipedes instead employ defensive mechanisms by curling up in a ball and secreting irritating chemicals from micropores along their sides to deter predators.Salmeterol is a highly selective, long-acting beta-2 adrenergic agonist indicated in the treatment of asthma, maintenance of airflow obstruction in chronic obstructive pulmonary disease (COPD), and prevention of exercise-induced bronchospasm (EIB). Salmeterol is used in combination with inhaled corticosteroids in the treatment of asthma. It can be useful in both the maintenance of asthma and the prevention of asthma attacks. It is usually prescribed for severe persistent asthma not properly controlled with the combination of a short-acting beta-adrenergic agonist and a corticosteroid. Salmeterol is not indicated in patients with mild asthma who are well maintained on short-acting beta-agonists. Salmeterol monotherapy is a contraindication for treating asthma patients due to the increased risk of mortality. Salmeterol administration with concomitant inhaled corticosteroid (ICS) has significantly reduced asthma mortality. Salmeterol can, however, be used as a monotherapy in the treatment of COPD, particularly as a maintenance treatment. Salmeterol has shown to increase FEV1 and the FEV1/FVC ratio in both asthma and COPD patients.The esophagus is a portion of the digestive system, connecting the mouth to the stomach, allowing the passage of food for digestion. It is approximately 25 cm long, beginning at the inferior border of the cricoid cartilage in the neck (about at C6), descending in the posterior mediastinum through the esophageal hiatus of the diaphragm and terminating at the stomach (at T11 level). During its course, the esophagus encounters three anatomic constrictions - (1) at the level of the cricopharyngeus muscle, (2) as it travels posteriorly to the aortic arch/left mainstem bronchus and (3) at the level of esophageal hiatus of the diaphragm. These constrictions are considered as the most frequent site for a foreign body or food impaction when encountered. The esophagus has two functional sphincters, the upper and lower esophageal sphincters. The upper esophageal sphincter (UES) lies at the transition of the pharynx to the esophagus. It is composed of striated muscle - primarily the cricopharyngeus with assistance from the inferior pharyngeal constrictors that prevents the reflux of swallowed foods into the pharynx, thus reduces the risk of aspiration. The lower esophageal sphincter (LES), located at the distal end where it meets the stomach, is composed of a bundle of smooth muscle and functions to protect the reflux of gastric contents into the esophagus. The diaphragmatic crura and the phreno-esophageal ligament provide anatomical support to LES and further protection against gastric reflux. Impaired contraction or reduced tone of the LES leads to reflux, where increased pressure or impaired relaxation of the LES results in dysphagia.Menstrual related headaches (MRH) are a common class of headaches that occur in women related to a decline in estrogen during the menstrual cycle. To treat this type of headache, it must be properly diagnosed in relation to the menstrual cycle or align with exogenous hormones, which is usually two days before the onset of menses to the third day of menstrual bleeding. This activity reviews the evaluation and treatment of MRH and highlights the role of the interprofessional team in evaluating and treating patients with this condition. Triptans, NSAIDs, and hormone therapy are just a few of many pharmacological interventions used in the management and treatment of menstrual-related headaches. This article will review the indications, contraindications, activity, adverse effects, and other key elements of all therapies used to treat headaches in the correct clinical setting. It will review the essential points needed by members of an interprofessional team managing the care of patients who suffer from headaches during menses and its related conditions and sequelae.Thoracic outlet syndrome (TOS) is a nonspecific diagnosis representing many conditions that involve the compression of the neurovascular structures that pass through the thoracic outlet. TOS was first reported by Rogers in 1949 and more precisely characterized by Rob and Standeven in 1958. Wilbourne Suggests five different types of TOS; a venous variant, arterial, a traumatic, a true neurogenic, and a disputed neurogenic. The first rib, scalene muscles, and the clavicle comprise the thoracic outlet. Patients present with a wide range of symptoms, from minor complaints to debilitating manifestations. Imaging of the musculature and vasculature can help identify this condition. Electrodiagnostic studies can also be useful if the condition is neurologic in origin. Both nonsurgical and surgical treatment methods are options for patients in managing this condition — patients who are treated appropriately generally fair well, with the vast majority having their symptoms resolve completely.