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Zardoost P, Tyabuddin S, Cantu A, Abu‐Jubara M, Mittlesteadt J, Wehrum H. Primary focal segmental glomerulosclerosis in a patient with ankylosing spondylitis: A rare presentation requiring a broad differential in nephrotic syndrome. Clin Case Rep 2024; 12:e8901. [PMID: 38751961 PMCID: PMC11093901 DOI: 10.1002/ccr3.8901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Ankylosing spondylitis (AS) presents with renal failure and proteinuria in a minority of cases, usually due to secondary amyloidosis or IgA nephropathy. While focal segmental glomerulosclerosis (FSGS) is less common, it should still be in the differential regardless of the patient's clinical profile.
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2
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Gard J, Howell A, Boubeta C, Corcoran H, Bell F, McMahon K. Sore throat, fever, and pancytopenia during winter. Clin Case Rep 2024; 12:e8800. [PMID: 38659496 PMCID: PMC11039805 DOI: 10.1002/ccr3.8800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Care must be taken to mitigate the effect of cognitive bias in times of frequent common presentations. The etiology of bicytopenias and pancytopenias must always be carefully investigated. Blast cells in low count B ALL may not be seen on a peripheral smear and diagnosis often requires confirmational bone marrow aspirate with flow cytometry and molecular typing.
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Affiliation(s)
- Jye Gard
- Department of PaediatricsWerribee Mercy HospitalWerribeeVictoriaAustralia
- The Department of Paediatrics, Melbourne Medical SchoolNotre Dame UniversityWerribeeVictoriaAustralia
- The Royal Children's Hospital MelbourneParkvilleVictoriaAustralia
- The Department of Paediatrics, Melbourne Medical SchoolUniversity of MelbourneMelbourneVictoriaAustralia
| | - Amy Howell
- Department of PaediatricsWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Claudia Boubeta
- Department of PaediatricsWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Hannah Corcoran
- Department of PaediatricsWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Fiona Bell
- Department of PaediatricsWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Kathryn McMahon
- Department of PaediatricsWerribee Mercy HospitalWerribeeVictoriaAustralia
- The Department of Paediatrics, Melbourne Medical SchoolNotre Dame UniversityWerribeeVictoriaAustralia
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3
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Alhatemi AQM, Hashim HT, Al‐Tarbosh MAS, Abdulhussain R, Hashim AT. Single-dose ibuprofen induced Stevens-Johnson Syndrome. Clin Case Rep 2024; 12:e8574. [PMID: 38623360 PMCID: PMC11017452 DOI: 10.1002/ccr3.8574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 04/17/2024] Open
Abstract
Key Clinical Message Ibuprofen single dose may rarely induce Stevens-Johnson Syndrome, emphasizing the vital need for heightened vigilance in healthcare and public awareness for safer medication practices. Abstract Stevens-Johnson Syndrome (SJS) is a severe and potentially life-threatening skin disorder associated with certain medications, including ibuprofen. We present a case of a 45-year-old woman who developed SJS following a single dose of ibuprofen. Despite its rarity, this case underscores the importance of heightened vigilance in healthcare and public awareness regarding the potential risks of commonly used medications. Prompt recognition of SJS symptoms and immediate medical intervention are crucial for patient outcomes. Healthcare providers should exercise caution when prescribing ibuprofen, particularly in patients with a history of adverse drug reactions. This case emphasizes the need for ongoing monitoring, patient education, and informed decision-making to promote medication safety and optimal patient care.
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4
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Chen HA, Chang BL, Chang CJ. Older man with acute dyspnoea. Emerg Med J 2024; 41:227-265. [PMID: 38514201 DOI: 10.1136/emermed-2023-213629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 03/23/2024]
Affiliation(s)
- Hsuan-An Chen
- Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Bao-Luen Chang
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chih-Jung Chang
- Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan City, Taiwan
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5
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Febra C, Santos AR, Cabrita I, Bento J, Pacheco J, Mendes M, Isidro M, Batista R, Macedo AMAFM. Comparison of diuretics and fluid expansion in the initial treatment of patients with normotensive acute pulmonary embolism: a systematic review and meta-analysis. Emerg Med J 2024; 41:187-192. [PMID: 38253364 DOI: 10.1136/emermed-2023-213525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Right ventricular (RV) dysfunction is the main cause of death in patients with normotensive acute pulmonary embolism (PE). The optimal management for this subset of patients remains uncertain. This systematic review and meta-analysis focused on the comparison of diuretics and fluid expansion in patients with acute PE presenting with RV dysfunction and haemodynamic stability. METHODS A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines considering only RTCs. The authors searched the traditional and grey literature through 1 November 2022. Meta-analysis used open source packages in R. Inverse variance fixed-effects models with OR as the effect measure were used for primary analyses. The main outcomes defined in this review protocol included pulmonary arterial systolic pressure (PASP), creatinine value changes and N-terminal pro-B-type natriuretic peptide during the first 24 hours. RESULTS Four studies with a total of 452 patients met the inclusion criteria. The baseline characteristics of patients were similar across all studies. Overall, patients receiving diuretics had a significant 24 hours reduction in pro-B-type natriuretic peptide (standard mean difference of -41.97; 95% CI -65.79 to -18.15), and PASP (standard mean difference of -5.96; 95% CI -8.06 to -3.86). This group had significantly higher creatinine levels (standard mean difference of 7.74; 95% CI 5.04 to 10.45). The quality of the studies was heterogeneous; two had a low risk of bias, and the other two had a high risk of bias. CONCLUSIONS Very few studies have compared the efficacy and safety of diuretics and fluid expansion in normotensive patients with acute PE with RV failure. Overall, furosemide appears to reduce RV dysfunction in this subset of patients compared with fluid expansion. Further research is required to confirm these findings.
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Affiliation(s)
- Cláudia Febra
- University of Porto, Porto, Portugal
- Department of Intensive Care, Hospital da Luz, Lisboa, Lisboa, Portugal
| | - Ana Rita Santos
- Faculdade de Medicina da Universidade do Algarve, Universidade do Algarve, Faro, Portugal
| | - Isabel Cabrita
- Faculdade de Medicina da Universidade do Algarve, Universidade do Algarve, Faro, Portugal
| | - Joana Bento
- Faculdade de Medicina da Universidade do Algarve, Universidade do Algarve, Faro, Portugal
| | - João Pacheco
- Faculdade de Medicina da Universidade do Algarve, Universidade do Algarve, Faro, Portugal
| | - Mariana Mendes
- Faculdade de Medicina da Universidade do Algarve, Universidade do Algarve, Faro, Portugal
| | - Michael Isidro
- Faculdade de Medicina da Universidade do Algarve, Universidade do Algarve, Faro, Portugal
| | - Rafael Batista
- Faculdade de Medicina da Universidade do Algarve, Universidade do Algarve, Faro, Portugal
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6
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Yang SC, Lee CW. Man with swollen arm. Emerg Med J 2024; 41:82-102. [PMID: 38253359 DOI: 10.1136/emermed-2023-213072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 01/24/2024]
Affiliation(s)
- Shih-Chia Yang
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Wei Lee
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan
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7
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Yates G, Melon E. Trip-killers: a concerning practice associated with psychedelic drug use. Emerg Med J 2024; 41:112-113. [PMID: 38123961 DOI: 10.1136/emermed-2023-213377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
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8
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Alavi-Moghaddam M, Tajabadi Z, Najafpour S. Best Evidence Topic report: does blood group type O decrease the risk of severe COVID-19 infection? Emerg Med J 2024; 41:123-127. [PMID: 38071537 DOI: 10.1136/emermed-2023-213216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
A short-cut systematic review was conducted using a described protocol. The three-part question addressed was: In patients with COVID-19 infection, does blood group type O versus non-O blood groups lead to a lower risk of severe COVID-19 infection? MEDLINE, Embase, and Cochrane databases were searched for relevant evidence. Altogether, 238 papers were found using the search strategy developed. Seventeen provided the best evidence to answer the three-part question. The data on first author name, publication year, country of origin, study type, study sample size, participant's gender, reported effect sizes, main findings and limitations were extracted from the relevant studies and listed in a table. Finally, 4 out of 17 studies revealed that having blood group type O may be associated with a lower risk of severe COVID-19 among patients with COVID-19 infection and the 13 remaining studies reported no significant relationship between having O blood group and risk of COVID-19 severity among the infected individuals. Of three systematic reviews and meta-analyses identified, none detected a protective effect of blood group type O. The clinical bottom line is that the best available evidence does not support the notion that blood group type O is protective against serious outcomes in COVID-19.
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Affiliation(s)
- Mostafa Alavi-Moghaddam
- Emergency Medicine Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohreh Tajabadi
- Digestive Disease Research Institute, Tehran Universiy of Medical Sciences, Tehran, Iran
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9
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Wu HY, Chong WS, Chang CJ. Man with odynophagia. Emerg Med J 2023; 41:59-66. [PMID: 38135448 DOI: 10.1136/emermed-2023-213091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Hsin-Yi Wu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wah Sheng Chong
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chih-Jung Chang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan City, Taiwan
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10
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O'Brien A. When is a diagnosis not a diagnosis? Emerg Med J 2023; 41:2-3. [PMID: 37907326 DOI: 10.1136/emermed-2023-213590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/24/2023] [Indexed: 11/02/2023]
Affiliation(s)
- Aileen O'Brien
- Population Health Research Institute, St George's University of London, London, SW17 0RE, UK
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11
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Kulkarni S, Knight T, Cooksley T, Marshall E, Patel N, Selvaratnam R, Atkin C. Provision of acute oncology services in the UK: data from the Society for Acute Medicine Benchmarking Audit 2022 (SAMBA22). Clin Med (Lond) 2023; 23:571-581. [PMID: 38065597 PMCID: PMC11046619 DOI: 10.7861/clinmed.2023-0251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Acute oncology services (AOS) manage acute cancer-related presentations alongside acute medical teams. This study assessed AOS provision against national peer review measures and the burden of acute cancer-related admissions. The 2022 Society for Acute Medicine Benchmarking Audit surveyed UK hospitals, collecting hospital-level and patient-level data for all medical admissions over a 24-h period. Logistic regression models were constructed to identify differences in patient outcomes for cancer-related admissions. Most hospitals (n=120 or 91.6%) reported having an AOS. There was heterogeneity in AOS provision, with many failing to meet peer-review measures. Of the 7,116 patients, 542 (7.6%) were cancer-related admissions. Cancer-related admissions had greater clinical acuity (p<0.05), length of stay (p<0.001) and 14-day mortality (adjusted odds ratio (OR)=3.54, 95% confidence interval (CI): 2.41-5.22, p<0.001) compared with other medical admissions. Increasing availability of AOS with integration of ambulatory pathways are vital next steps to improving care for acute cancer-related admissions.
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Affiliation(s)
- Sanat Kulkarni
- Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Thomas Knight
- Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Tim Cooksley
- The Christie NHS Foundation Trust, Manchester, UK
| | - Ernie Marshall
- Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, UK
| | - Neil Patel
- Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
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12
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Jadav RS, Dadana S, Avula A. Cystic bronchiectasis in sarcoidosis. Clin Case Rep 2023; 11:e8045. [PMID: 37830063 PMCID: PMC10565096 DOI: 10.1002/ccr3.8045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/21/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
Pulmonary sarcoidosis can manifest in different radiologic patterns. Typical manifestations in high-resolution computed tomography are bilateral perihilar lymphadenopathy, micronodules, and fibrotic changes. Atypical manifestations are mass-like or alveolar opacities, honeycomb-like cysts, miliary opacities, tracheobronchial involvement, and pleural disease. Cystic bronchiectasis in pulmonary sarcoidosis is rare, with only a few reported cases in the literature. We present another case of cystic bronchiectasis with a honeycomb-like pattern in pulmonary sarcoidosis and with cardiac involvement. This case was presented as an abstract poster at the American Thoracic Society conference in 2022.
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Affiliation(s)
| | - Sriharsha Dadana
- Internal MedicineCheyenne Regional Medical CenterCheyenneWyomingUSA
| | - Akshay Avula
- PulmonologyUniversity of Pittsburgh Medical CenterPhiladeplhiaPennsylvaniaUSA
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13
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Arvig MD, Lassen AT, Gæde PH, Gärtner SW, Falster C, Skov IR, Petersen HØ, Posth S, Laursen CB. Impact of serial cardiopulmonary point-of-care ultrasound exams in patients with acute dyspnoea: a randomised, controlled trial. Emerg Med J 2023; 40:700-707. [PMID: 37595984 PMCID: PMC10579498 DOI: 10.1136/emermed-2022-212694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/23/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Serial point-of-care ultrasound (PoCUS) can potentially improve acute patient care through treatment adjusted to the dynamic ultrasound findings. The objective was to investigate if treatment guided by monitoring patients with acute dyspnoea with serial cardiopulmonary PoCUS and usual care could reduce the severity of dyspnoea compared with usual care alone. METHODS This was a randomised, controlled, blinded-outcome trial conducted in three EDs in Denmark between 9 October 2019 and 26 May 2021. Patients aged ≥18 years admitted with a primary complaint of dyspnoea were allocated 1:1 with block randomisation to usual care, which included a single cardiopulmonary PoCUS within 1 hour of arrival (control group) or usual care (including a PoCUS within 1 hour of arrival) plus two additional PoCUS performed at 2 hours interval from the initial PoCUS (serial ultrasound group). The primary outcome was a reduction of dyspnoea measured on a verbal dyspnoea scale (VDS) from 0 to 10 recorded at inclusion and after 2, 4 and 5 hours. RESULTS There were 206 patients recruited, 102 in the serial ultrasound group and 104 in the control group, all of whom had complete follow-up. The mean difference in VDS between patients in the serial ultrasound and the control group was -1.09 (95% CI -1.51 to -0.66) and -1.66 (95% CI -2.09 to -1.23) after 4 and 5 hours, respectively. The effect was more pronounced in patients with a presumptive diagnosis of acute heart failure (AHF). A larger proportion of patients received diuretics in the serial ultrasound group. CONCLUSION Therapy guided by serial cardiopulmonary PoCUS may, together with usual care, facilitate greater improvement in the severity of dyspnoea, especially in patients with AHF compared with usual care with a single PoCUS in the ED. Serial PoCUS should therefore be considered for routine use to aid the physician in stabilising the patient faster. TRIAL REGISTRATION NUMBER NCT04091334.
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Affiliation(s)
- Michael Dan Arvig
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Annmarie Touborg Lassen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Peter Haulund Gæde
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Stefan Wernblad Gärtner
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark
- Department of Anaesthesiology, Herlev Hospital, Herlev, Denmark
| | - Casper Falster
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Inge Raadal Skov
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Ømark Petersen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Emergency Medicine, Regional Hospital Horsens, Horsens, Denmark
| | - Stefan Posth
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Asako S, Suyama Y, Sugita M. Woman with sudden oral discomfort. Emerg Med J 2023; 40:699-736. [PMID: 37758292 DOI: 10.1136/emermed-2022-212641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 10/03/2023]
Affiliation(s)
- Suguru Asako
- Department of Emergency Medicine, JR Tokyo General Hospital, Tokyo, Japan
| | - Yasuhiro Suyama
- Division of Rheumatology, JR Tokyo General Hospital, Tokyo, Japan
| | - Manabu Sugita
- Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
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15
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Lyall MJ, Dear J, Simpson J, Lone N. Duration of consultant experience and patient outcome following acute medical unit admission: an observational cohort study. Clin Med (Lond) 2023; 23:458-466. [PMID: 37775159 PMCID: PMC10541280 DOI: 10.7861/clinmed.2022-0546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND The effect of the duration of consultant experience on clinical outcomes in the acute medical unit (AMU) model remains unknown. METHODS Unscheduled AMU admissions (n=66,929) admitted by 56 consultant physicians between 2017 and 2020 to two large teaching hospital AMUs in Lothian, Scotland were examined. The associations of consultant experience on AMU with patient discharge, mortality, readmission and postdischarge death were calculated adjusting for clinical acuity, pathology and comorbidity. RESULTS Increasing consultant experience was associated with a continuous increase in likelihood of early AMU discharge (odds ratio (OR) 1.08; 95% confidence interval (CI) 1.07-1.10; p<0.001 per 5 years' experience), which persisted after adjustment for confounders (OR 1.06; 95% CI: 1.01-1.11; p=0.01). There was no association with early readmission, death after discharge or 30-day inpatient mortality. The marginal effect estimate translates into 31 (95% CI: 25-36), 41 (95% CI: 30-53) and 52 (95% CI: 35-71) additional safe discharges per 1,000 admissions for clinicians of 15, 20 and 25 years' experience, respectively compared with those recently completing training. CONCLUSIONS Increasing consultant physician experience associates with early safe discharge after AMU admission. These data suggest that the support and retention of experienced clinicians is vital if escalating pressures on unscheduled medical care are to be addressed.
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Affiliation(s)
- Marcus J Lyall
- Usher Institute for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - James Dear
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Johanne Simpson
- Department of Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- Usher Institute for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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16
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Cottey L, Shanahan TAG, Gronlund T, Whiting C, Sokunbi M, Carley SD, Smith JE. Refreshing the emergency medicine research priorities. Emerg Med J 2023; 40:666-670. [PMID: 37491155 PMCID: PMC10447359 DOI: 10.1136/emermed-2022-213019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/03/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND The priorities for UK emergency medicine research were defined in 2017 by a priority setting partnership coordinated by the Royal College of Emergency Medicine in collaboration with the James Lind Alliance (JLA). Much has changed in the last 5 years, not least a global infectious disease pandemic and a significant worsening of the crisis in the urgent and emergency care system. Our aim was to review and refresh the emergency medicine research priorities. METHODS A steering group including patients, carers and healthcare professionals was established to agree to the methodology of the refresh. An independent adviser from the JLA chaired the steering group. The scope was adult patients in the ED. New questions were invited via an open call using multiple communications methods ensuring that patients, carers and healthcare professionals had the opportunity to contribute. Questions underwent minisystematic (BestBETs) review to determine if the question had been answered, and the original 2017 priorities were reviewed. Any questions that remained unanswered were included in an interim prioritisation survey, which was distributed to patients, carers and healthcare professionals. Rankings from this survey were reviewed by the steering group and a shortlist of questions put forward to the final workshop, which was held to discuss and rank the research questions in order of priority. RESULTS 77 new questions were submitted, of which 58 underwent mini-systematic review. After this process, 49 questions (of which 32 were new, 11 were related to original priorities and 6 unanswered original priorities were carried forward) were reviewed by the steering group and included in an interim prioritisation survey. The interim prioritisation survey attracted 276 individual responses. 26 questions were shortlisted for discussion at the final prioritisation workshop, where the top 10 research priorities were agreed. CONCLUSION We have redefined the priorities for emergency medicine research in the UK using robust and established methodology, which will inform the agenda for the coming years.
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Affiliation(s)
- Laura Cottey
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | | | - Toto Gronlund
- James Lind Alliance, National Institute for Health and Care Research, School of Healthcare Enterprise and Innovation, University of Southampton, Southampton, UK
| | - Caroline Whiting
- James Lind Alliance, National Institute for Health and Care Research, School of Healthcare Enterprise and Innovation, University of Southampton, Southampton, UK
| | - Moses Sokunbi
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Simon David Carley
- Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
- Postgraduate Medicine, Manchester Metropolitan University, Manchester, UK
| | - Jason E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
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17
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Ushimoto T, Yao S, Nunokawa C, Murasaka K, Inaba H. Association between the COVID-19 pandemic in 2020 and out-of-hospital cardiac arrest outcomes and bystander resuscitation efforts for working-age individuals in Japan: a nationwide observational and epidemiological analysis. Emerg Med J 2023; 40:556-563. [PMID: 37280044 PMCID: PMC10423471 DOI: 10.1136/emermed-2022-213001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/20/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Improving out-of-hospital cardiac arrest (OHCA) prognosis within the working-age population is important, but no studies have investigated the effects of COVID-19 pandemic specifically on the working-age population with OHCAs. We aimed to determine the association between the 2020 COVID-19 pandemic and OHCA outcomes and bystander resuscitation efforts among the working-age population. METHODS Prospectively collected nationwide, population-based records concerning 166 538 working-age individuals (men, 20-68 years; women, 20-62 years) with OHCA between 2017 and 2020 were assessed. We compared characteristics and outcome differences of the arrests between three prepandemic years (2017-2019) and the pandemic year 2020. The primary outcome was neurologically favourable 1-month survival (cerebral performance category 1 or 2). Secondary outcomes were bystander cardiopulmonary resuscitation (BCPR), dispatcher-assisted instruction for cardiopulmonary resuscitation (DAI-CPR), bystander-provided defibrillation (public access defibrillation (PAD)) and 1-month survival. We examined variations in bystander resuscitation efforts and outcomes among pandemic phase and regional classifications. RESULTS Among 149 300 OHCA cases, 1-month survival (2020, 11.2%; 2017-2019, 11.1% (crude OR (cOR) 1.00, 95% CI 0.97 to 1.05)) and 1-month neurologically favourable survival (7.3%-7.3% (cOR 1.00, 95% CI 0.96 to 1.05)) were unchanged; however, the neurologically favourable 1-month survival rate decreased in 12 of the most COVID-19-affected prefectures (7.2%-7.8% (cOR 0.90, 95% CI 0.85 to 0.96)), whereas it increased in 35 other prefectures (7.5%-6.6% (cOR 1.15, 95% CI 1.07 to 1.23)). Favourable outcomes decreased for OHCAs of presumed cardiac aetiology (10.3%-10.9% (cOR 0.94, 95% CI 0.90 to 0.99)) but increased for OHCAs of non-cardiac aetiology (2.5%-2.0% (cOR 1.27, 95% CI 1.12 to 1.44)). BCPR provision increased from 50.7% of arrests prepandemic to 52.3% (crude OR 1.07, 95% CI 1.04 to 1.09). Compared with 2017-2019, home-based OHCAs in 2020 increased (64.8% vs 62.3% (crude OR 1.12, 95% CI 1.09 to 1.14)), along with DAI-CPR attempts (59.5% vs 56.6% (cOR 1.13, 95% CI 1.10 to 1.15)) and multiple calls to determine a destination hospital (16.4% vs 14.5% (cOR 1.16, 95% CI 1.12 to 1.20)). PAD use decreased from 4.0% to 3.7% but only during the state of emergency period (7 April-24 May 2020) and in prefectures significantly affected by COVID-19. CONCLUSIONS Reviewing automated external defibrillator (AED) locations and increasing BCPR through DAI-CPR may help prevent pandemic-associated decreases in survival rates for patients with cardiac OHCAs.
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Affiliation(s)
- Tomoyuki Ushimoto
- Emergency Medicine, Kanazawa Medical University, Uchinada-machi, Japan
| | - Shintaro Yao
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Chika Nunokawa
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Kenshi Murasaka
- Emergency Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Hideo Inaba
- Emergency Medicine, Kanazawa Medical University, Uchinada-machi, Japan
- Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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18
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Sandoval L, Cafundó NR, Ferreira R, Segovia S, Rosa X. Rumpel-Leede phenomenon as a rare complication after transulnar percutaneous coronary angiography and intervention. Clin Case Rep 2023; 11:e7485. [PMID: 37305874 PMCID: PMC10248200 DOI: 10.1002/ccr3.7485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 04/23/2023] [Accepted: 05/23/2023] [Indexed: 06/13/2023] Open
Abstract
The Rumpel-Leede sign, characterized by a non-blanching petechial rash distal to venous occlusion, has historically been associated with thrombocytopenia and capillary fragility. This phenomenon has been observed in various situations involving pressure application, such as tourniquet tests and continuous non-invasive pressure monitoring. Here, we present a case of Rumpel-Leede sign occurring after transulnar percutaneous coronary angiography in a 55-year-old female patient with a history of myocardial infarction. The patient had an uneventful recovery, highlighting the benign nature of the rash and the lack of intervention required. This underscores the importance of recognizing this sign and its association with specific procedures.
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Affiliation(s)
- Letícia Sandoval
- University of Brasilia, School of Medicine, University Hospital of BrasíliaBrasiliaBrazil
| | | | - Raphael Ferreira
- University of Brasilia, School of Medicine, University Hospital of BrasíliaBrasiliaBrazil
| | - Samela Segovia
- University of Brasilia, School of Medicine, University Hospital of BrasíliaBrasiliaBrazil
| | - Ximena Rosa
- University of Brasilia, School of Medicine, University Hospital of BrasíliaBrasiliaBrazil
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19
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Marcel A, Jovan J, Myrick K. Abdominal aortic aneurysm presenting to the orthopedic clinic as posterior hip and low back pain. Clin Case Rep 2023; 11:e7443. [PMID: 37346884 PMCID: PMC10279937 DOI: 10.1002/ccr3.7443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/13/2023] [Accepted: 05/14/2023] [Indexed: 06/23/2023] Open
Abstract
Abdominal aortic aneurysms (AAAs) are typically asymptomatic. When symptomatic, AAA may present as a chief concern of musculoskeletal hip and low back pain. Assessment in the orthopedic clinic should focus on a holistic examination of the patient.
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Affiliation(s)
- Aaron Marcel
- Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenConnecticutUSA
| | - John Jovan
- Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenConnecticutUSA
| | - Karen Myrick
- Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenConnecticutUSA
- University of Saint JosephWest HartfordConnecticutUSA
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20
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Joudeh AI, Elsiddig Awadelkarim HA, Gul MI, Elayana MS, Soliman DS, Amer A, Alsamawi M. Visceral leishmaniasis complicated by hemophagocytic lymphohistiocytosis: A case report from a nonendemic area. Clin Case Rep 2023; 11:e7309. [PMID: 37151937 PMCID: PMC10160431 DOI: 10.1002/ccr3.7309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/01/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023] Open
Abstract
Key Clinical Message Visceral leishmaniasis and hemophagocytic lymphohistiocytosis share many features in common and may coincide in the same patient. Timely diagnosis and management of visceral leishmaniasis could save patients from unnecessary toxic treatment. Abstract Visceral leishmaniasis and hemophagocytic lymphohistiocytosis share many clinical features in common and may coexist in the same patient. Visceral leishmaniasis should be promptly ruled out in patients coming from endemic areas before starting immunosuppressive therapy for hemophagocytic lymphohistiocytosis. The mainstay treatment, in this case, is anti-leishmania medications preferably liposomal amphotericin-B.
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Affiliation(s)
- Anwar I. Joudeh
- Department of Internal Medicine, Al‐Khor HospitalHamad Medical CorporationDohaQatar
| | | | - Mohammadshah Isam Gul
- Department of Internal Medicine, Hamad General HospitalHamad Medical CorporationDohaQatar
| | - Mahmoud Salm Elayana
- Department of Internal Medicine, Hamad General HospitalHamad Medical CorporationDohaQatar
| | - Dina Sameh Soliman
- Department of Laboratory Medicine and PathologyHamad Medical CorporationDohaQatar
| | - Aliaa Amer
- Department of Laboratory Medicine and PathologyHamad Medical CorporationDohaQatar
| | - Musaed Alsamawi
- Department of Internal Medicine, Infectious Diseases Division, Al‐Khor HospitalHamad Medical CorporationDohaQatar
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21
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Donaldson L, Tayeb S, Margolin E. Sudden vision loss in a 68-year-old man: the life-saving value of funduscopy. Emerg Med J 2023; 40:332-334. [PMID: 37085189 DOI: 10.1136/emermed-2022-212472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 04/23/2023]
Affiliation(s)
- Laura Donaldson
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
| | - Safwan Tayeb
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Ontario, Canada
| | - Edward Margolin
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Neurology, University of Toronto, Toronto, Ontario, Canada
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22
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Wan N, Weerakkody S. Herpes simplex virus encephalitis: An atypical presentation of delirium. Clin Case Rep 2023; 11:e7123. [PMID: 36992671 PMCID: PMC10040492 DOI: 10.1002/ccr3.7123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 03/28/2023] Open
Abstract
Herpes simplex encephalitis (HSE) is the most common cause of infectious encephalitis. Our case is of a 75‐year‐old woman who presented with dysuria and altered mental status. Our case addresses the difficulties in diagnosis and highlights the importance of early recognition of HSE and its associated neurological sequelae.
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Affiliation(s)
- Nicholas Wan
- Department of General Medicine, Flinders Medical CentreBedford ParkSouth AustraliaAustralia
- Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Sanath Weerakkody
- Department of General Medicine, Flinders Medical CentreBedford ParkSouth AustraliaAustralia
- College of Medicine and Public Health, Flinders UniversityBedford ParkSouth AustraliaAustralia
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23
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Wu CJ, Sun JT, Chang CJ. Woman with cough and chest pain. Emerg Med J 2023; 40:227-234. [PMID: 36822832 DOI: 10.1136/emermed-2022-212463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 02/25/2023]
Affiliation(s)
- Chun-Jen Wu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Chih-Jung Chang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
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24
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Todd J, Murden M, Brooks E. A report of two cases of sepsis in patients with spinal cord injuries. J R Coll Physicians Edinb 2023; 53:40-43. [PMID: 36705095 DOI: 10.1177/14782715221148055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Sepsis is a common presentation to the emergency department (ED) with the main aim of treatment being prompt antibiotics, source identification and control, all preferably within the initial golden hour. In the majority of patients, a good history and examination is adequate to elicit the most likely source of infection and thus target therapy appropriately. However it is well known that this can be difficult in some patient groups. In this report we present two patients with sepsis with spinal cord injury (SCI) where both the history and examination were unhelpful in identifying the source of infection and demonstrate why the unique physiology and risk factors in SCI patients must be considered early in their work up. Both patients were admitted with vague, nonspecific constitutional symptoms. Both had no evidence of abdominal or flank pain or any objective tenderness. One of the patients had a long-term suprapubic catheter and one intermittently self catheterised meaning that urine dip stick results were unreliable. In both instances, the patients were found to have obstructed renal stones with associated infection and both had good outcomes after surgical intervention.
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Affiliation(s)
| | - Matthew Murden
- Ashford and Saint Peter's Hospitals NHS Trust, Surrey, UK
| | - Emma Brooks
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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25
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Bryant AD, Pitman SK, Lessing JN. Trust but verify: A case report of unintended medication omission. Clin Case Rep 2023; 11:e6800. [PMID: 36619493 PMCID: PMC9810832 DOI: 10.1002/ccr3.6800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/25/2022] [Indexed: 01/05/2023] Open
Abstract
An accurate medication history prevents medication errors during transitions of care, whereas an inaccurate medication history may lead to unnecessary tests or prolonged hospitalization. We describe the case of a patient with chronic hypothyroidism who presented to the hospital with severe hypothyroidism and reported strict adherence to her home levothyroxine.
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26
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Bishop AA, Krohn E, Vakayil VR, Pribyl K, Reding MT, Tignanelli C, Harmon JV. A laparoscopic approach to address massive splenomegaly, symptomatic cholelithiasis, and a planned postoperative pregnancy: A case report. Clin Case Rep 2023; 11:e6831. [PMID: 36703775 PMCID: PMC9869644 DOI: 10.1002/ccr3.6831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/04/2022] [Accepted: 12/13/2022] [Indexed: 01/25/2023] Open
Abstract
We report long-term follow-up of a patient who underwent a tailored laparoscopic procedure for symptomatic cholelithiasis, massive splenomegaly, and a planned pregnancy. There were no complications, and the patient remained symptom-free at the 5-year follow-up. We supplemented our case report with national surgical data demonstrating the safety of laparoscopic splenectomy.
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Affiliation(s)
| | - Eric Krohn
- Department of SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | | | - Kyle Pribyl
- Department of SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Mark T. Reding
- Department of MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
| | | | - James V. Harmon
- Department of SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
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27
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Franz K, Deutschbein J, Riedlinger D, Pigorsch M, Schenk L, Lindner T, Möckel M, Norman K, Müller-Werdan U. Malnutrition is associated with six-month mortality in older patients admitted to the emergency department with hip fracture. Front Med (Lausanne) 2023; 10:1173528. [PMID: 37153099 PMCID: PMC10158933 DOI: 10.3389/fmed.2023.1173528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/30/2023] [Indexed: 05/09/2023] Open
Abstract
Background Hip fractures in older people are a common health problem often associated with malnutrition that might affect outcomes. Screening for malnutrition is not a routine examination in emergency departments (ED). This analysis of the EMAAge study, a prospective, multicenter cohort study, aimed to evaluate the nutritional status of older patients (≥ 50 years) with hip fracture, factors associated with malnutrition risk, and the association between malnutrition and the six-months mortality. Methods Risk of malnutrition was evaluated using the Short Nutritional Assessment Questionnaire. Clinical data as well as data on depression and physical activity were determined. Mortality was captured for the first six months after the event. To assess factors associated with malnutrition risk we used a binary logistic regression. A Cox proportional hazards model was used to assess the association of malnutrition risk with six-month survival adjusted for other relevant risk factors. Results The sample consisted of N = 318 hip fracture patients aged 50 to 98 (68% women). The prevalence of malnutrition risk was 25.3% (n = 76) at the time of injury. There were no differences in triage categories or routine parameters measured in the ED that could point to malnutrition. 89% of the patients (n = 267) survived for six months. The mean survival time was longer in those without malnutrition risk (171.9 (167.1-176.9) days vs. 153.1 (140.0-166.2) days). The Kaplan Meier curves and the unadjusted Cox regression (Hazard Ratio (HR) 3.08 (1.61-5.91)) showed differences between patients with and patients without malnutrition risk. In the adjusted Cox regression model, risk of death was associated with malnutrition risk (HR 2.61, 1.34-5.06), older age (70-76 years: HR 2.5 (0.52-11.99); 77-82 years: HR 4.25 (1.15-15.62); 83-99 years: HR 3.82 (1.05-13.88)) and a high burden of comorbidities (Charlson Comorbidity Index ≥3: HR 5.4 (1.53-19.12)). Conclusion Risk of malnutrition was associated with higher mortality after hip fracture. ED parameters did not differentiate between patients with nutritional deficiencies and those without. Therefore, it is particularly important to pay attention to malnutrition in EDs to detect patients at risk of adverse outcomes and to initiate early interventions.
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Affiliation(s)
- Kristina Franz
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Geriatrics and Medical Gerontology, Geriatrics Research Group, Berlin, Germany
- *Correspondence: Kristina Franz,
| | - Johannes Deutschbein
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Dorothee Riedlinger
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Berlin, Germany
| | - Mareen Pigorsch
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Liane Schenk
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Tobias Lindner
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Berlin, Germany
| | - Martin Möckel
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Berlin, Germany
| | - Kristina Norman
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Geriatrics and Medical Gerontology, Geriatrics Research Group, Berlin, Germany
| | - Ursula Müller-Werdan
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Geriatrics and Medical Gerontology, Geriatrics Research Group, Berlin, Germany
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28
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Fogarty AW, Card T, Shaw D, West J, Simmonds M, Crooks CJ. Error in respiratory rate measurement by direct observation impacts on clinical early warning score algorithms. J Accid Emerg Med 2022; 40:458-459. [PMID: 36456170 DOI: 10.1136/emermed-2022-212689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Andrew W Fogarty
- NIHR Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tim Card
- NIHR Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Dominick Shaw
- NIHR Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Joe West
- NIHR Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mark Simmonds
- Nottingham Universities Hospitals NHS Trust, Nottingham, UK
| | - Colin J Crooks
- NIHR Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
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29
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Martin LPJ. What matters in acute care? Values and decision making in the acute medical unit. Future Healthc J 2022; 9:243-247. [PMID: 36561820 PMCID: PMC9761441 DOI: 10.7861/fhj.2022-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An acute medical unit (AMU) requires a broad range of decisions to be made under time pressure, where consensus is not always easily attainable. In such circumstances, having a clear and workable framework of values is of heightened importance in order to judge what course of action is best. Within the NHS, a multi-value framework and a single-value framework have both been proposed in the last 10 years. However, it remains unclear what values currently guide the work of an AMU. Data from a 16-month ward-based ethnography in an AMU in the north of England, supported by 27 semi-structured interviews, were analysed thematically in order to characterise a framework of values in decision making. Within an AMU, people figure out what is best according to three values simultaneously: welfare, choice and effectiveness. These values operate as an irreducible triad, with implications for holism and realism in healthcare.
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Affiliation(s)
- Luke PJ Martin
- Northumbria Healthcare NHS Foundation Trust, Cramlington, UK and visiting fellow, Policy, Ethics and Life Sciences Research Centre (PEALS), Newcastle Upon Tyne, UK,Address for correspondence: Dr Luke PJ Martin, Acute Medicine Department, Northumbria Specialist Emergency Care Hospital, Northumbria Way, Cramlington NE23 6NZ, UK.
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30
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Riegel M, Klemm V, Bushuven S, Strametz R. Self-Stigmatization of Healthcare Workers in Intensive Care, Acute, and Emergency Medicine. Int J Environ Res Public Health 2022; 19:14038. [PMID: 36360916 PMCID: PMC9655018 DOI: 10.3390/ijerph192114038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 06/16/2023]
Abstract
This quantitative study examines whether employees in the fields of intensive care or acute and emergency medicine experience psychological distress because of their daily work. In addition, it was examined if self-stigmatization tendencies can significantly influence the willingness to seek help, and therefore psychological problems are not being treated adequately. These problems lead to various difficulties in professional and private contexts and ultimately endanger patient safety. From May to June 2021, an online questionnaire survey was conducted. This questionnaire combined two validated measuring instruments (PHQ-D and SSDS). To ensure high participation, the departments of anesthesia and/or intensive care medicine in 68 German hospitals were contacted, of which 5 responded positively. A total of 244 people participated in the questionnaire survey. On average, depressive symptoms were of mild severity. At the same time, self-stigmatization regarding depressive symptoms was high. These results highlight the practical need to prepare staff who work in the field of intensive care or acute and emergency medicine at the early onset for potentially traumatic and emotionally demanding events during their university education or studies. Adequate, evaluated, and continuously available support services from the psychosocial field should become an integral part of every staff care structure.
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Affiliation(s)
- Maike Riegel
- Institut für Mensch, Arbeit und Psychologie (IMAP), Rennenbergstraße 3, 53639 Königswinter, Germany
| | - Victoria Klemm
- Wiesbaden Institute for Healthcare Economics and Patient Safety (WiHelP), Wiesbaden Business School, RheinMain UAS, Bleichstr. 44, 65183 Wiesbaden, Germany
| | - Stefan Bushuven
- Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, 78224 Singen, Germany
- Institute of Medical Education, University Hospital, LMU Munich, 80336 Munich, Germany
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg im Breisgau, Germany
| | - Reinhard Strametz
- Wiesbaden Institute for Healthcare Economics and Patient Safety (WiHelP), Wiesbaden Business School, RheinMain UAS, Bleichstr. 44, 65183 Wiesbaden, Germany
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31
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Knight T, Kulkarni S, Atkins C, Kamwa V, Sapey E, Punj E, Lasserson D. Journal update monthly top five. Emerg Med J 2022; 39:486-487. [PMID: 35613737 DOI: 10.1136/emermed-2022-212547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Thomas Knight
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Acute Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Sanat Kulkarni
- Department of Acute Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Catherine Atkins
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Vicky Kamwa
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Ekta Punj
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Daniel Lasserson
- Department of Acute Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- Health Sciences Division, University of Warwick, Coventry, UK
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32
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Maeker É, Roche J, Maeker-Poquet B. [Announcement of the diagnosis of Alzheimer's disease or a related disorder in a geriatric short-stay unit]. Soins Gerontol 2022; 27:33-37. [PMID: 35738763 DOI: 10.1016/j.sger.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The disclosure of the diagnosis of Alzheimer's disease or a related disorder, or rather the time of the diagnostic disclosure, is a crucial step in the care of people with these neurocognitive diseases. While the disclosure procedures are well defined for practitioners who work in memory consultations, there is a grey area for hospital professionals who work in acute medical units.
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Affiliation(s)
- Éric Maeker
- Unité de court séjour gériatrique, centre hospitalier de Calais, 1601 boulevard des Justes, 62100 Calais, France.
| | - Jean Roche
- Pôle gériatrie, hôpital Fontan 2, 59037 Lille, France
| | - Bérengère Maeker-Poquet
- Unité de court séjour gériatrique, centre hospitalier de Calais, 1601 boulevard des Justes, 62100 Calais, France
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Abstract
Medical emergencies causing unplanned hospital admission place considerable demands on acute healthcare services. Some patients can be assessed and treated through ambulatory pathways without inpatient admission, via same day emergency care (SDEC), potentially benefiting patients and reducing demands on inpatient services. There is currently considerable variation within acute medicine in aspects of SDEC delivery ranging from overall service design to patient selection methods. Scoring systems identifying patients likely to be successfully managed through SDEC services have been suggested, but evidence of utility in diverse populations is lacking. Specific scoring systems exist for some common medical problems, including cardiac chest pain and pulmonary embolism, but further research is needed to demonstrate how these are most effectively incorporated into SDEC services. This review defines SDEC and describes the variation in services nationally. It reviews the evidence for their clinical impact, tools to screen patients for SDEC and current gaps in our knowledge regarding service deployment.
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Affiliation(s)
| | - Bridget Riley
- South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Ibrahim H, Mohamad MK, Adi AAK, Kamour AM, Harhara T. The Impact of an Acute Medical Unit in Internal Medicine on Resident Education. J Med Educ Curric Dev 2022; 9:23821205221091037. [PMID: 35399787 PMCID: PMC8984854 DOI: 10.1177/23821205221091037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical trainees are expected to provide care for increasingly sick and treatment intensive patients. To improve patient care, hospitals worldwide have developed acute medical units (AMUs), dedicated medical wards that provide care for patients during the first 24 to 72 hours of an emergency medical hospital admission. A distinguishing feature of these units is that they are supervised by senior clinicians and offer multidisciplinary patient-centered care. Little is known about the impact of AMUs on trainee supervision and education. METHODS In this educational case study, we describe the evolution, process and structure of our AMU service. We also provide resident and teaching faculty perceptions of the impact of this intervention on education and supervision. RESULTS Questionnaire results showed that residents and teaching attendings believed that supervision and education were improved on the AMU, as compared to the traditional medical ward model. Residents also felt that their knowledge and clinical skills in managing acute patients improved. Procedure skills were less impacted by the intervention. A small number of residents believed that the AMU model worsened supervision and education. CONCLUSION Integrating medical trainees into an AMU allowed for early evaluation and input from senior clinicians and increased opportunities to work in and learn from multidisciplinary teams, contributing to improved resident supervision and education. Future studies are needed to assess the long-term impact of the AMU on educational outcomes.
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Affiliation(s)
- Halah Ibrahim
- Khalifa University College of Medicine and Health Sciences, Abu
Dhabi, United Arab Emirates
| | - Mohamad Kasem Mohamad
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi,
United Arab Emirates
| | - Abd Al Kareem Adi
- Education Institute, Sheikh Khalifa Medical City, Abu Dhabi, United
Arab Emirates
| | - Ashraf M. Kamour
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi,
United Arab Emirates
| | - Thana Harhara
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi,
United Arab Emirates
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35
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Pedersen PB, Henriksen DP, Brabrand M, Lassen AT. Organ failure, aetiology and 7-day all-cause mortality among acute adult patients on arrival to an emergency department: a hospital-based cohort study. Eur J Emerg Med 2021; 28:448-455. [PMID: 34115711 PMCID: PMC8549456 DOI: 10.1097/mej.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 05/06/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND Organ failure is both a frequent and dangerous condition among adult patients on arrival to an emergency department (ED). The risk of an unfavourable outcome could depend on the underlying aetiology. Knowledge of the relation between aetiology and prognosis could improve the risk stratification at arrival. OBJECTIVES To describe the relation between organ failure, aetiology and prognosis through 7-day all-cause mortality. METHODS An observational three-year cohort study at the ED at Odense University Hospital, Denmark, including all acute adult patients.First-measured vital signs and laboratory values were included to evaluate the presence of the following organ failures: respiratory, coagulation, hepatic, circulatory, cerebral or renal.The primary outcome was 7-day all-cause mortality. Aetiological disease categories were based on primary discharge diagnoses. We described the association between 7-day mortality, aetiology category, site of organ failures and number of patients at risk. RESULTS Of 40 423 patients with a first-time visit at the ED, 5883(14.6%) had an organ failure on arrival. The median age was 69 (IQR 54-80), and 50% were men. The most frequent aetiology was infection (1495, 25.4%). Seven-day all-cause mortality ranged between aetiologies from 0.0% (95% confidence interval [CI], 0.0-14.2) allergy) to 45.6% (95% CI, 41.3-50.0) (cardiac). Combining aetiology and site of organ failure, 7-day all-cause mortality was the highest in the cardiac category, from 14.8% (95% CI, 4.2-3.7) with hepatic failure to 79.2% (95% CI, 73.6-84.1) with cerebral failure. The combination of infection and respiratory failure characterised most patients (n = 949). CONCLUSION Infection was the most prevalent aetiology, and 7-day all-cause mortality was highly associated with the site of organ failure and aetiology.
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Affiliation(s)
- Peter Bank Pedersen
- Department of Emergency Medicine, Odense University Hospital, Odense
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus
| | - Daniel Pilsgaard Henriksen
- Department of Public Health, University of Southern Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense
| | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense
- Department of Regional Health Research, University of Southern Denmark
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg
| | - Annmarie Touborg Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense
- Institute of Clinical Research, University of Southern Denmark
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Pietrantonio F, Vinci A, Rosiello F, Alessi E, Pascucci M, Rainone M, Delli Castelli M, Ciamei A, Montagnese F, D'Amico R, Valerio A, Manfellotto D. Green Line Hospital-Territory Study: A Single-Blind Randomized Clinical Trial for Evaluation of Technological Challenges of Continuous Wireless Monitoring in Internal Medicine, Preliminary Results. Int J Environ Res Public Health 2021; 18:10328. [PMID: 34639631 DOI: 10.3390/ijerph181910328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/28/2021] [Accepted: 09/24/2021] [Indexed: 12/25/2022]
Abstract
Background: Wireless vital parameter continuous monitoring (WVPCM) after discharge is compared to regular monitoring to provide data on the clinical-economic impact of complex patients (CPs) discharged from Internal Medicine Units of Ospedale dei Castelli, Lazio. Primary outcome: Major complications (MC) reduction. Secondary outcomes: Patients who reached discharge criteria within the 7th day from admission; difference in MC incidence at the conclusion of the standard telemonitoring/clinical monitoring phase, 5 and 30 days after discharge; and conditions predisposing to MC occurrence. Methods: Open label randomized controlled trial with wearable wireless system that creates alerts on portable devices. Continuous glycemic monitoring is performed for patients with diabetes mellitus. Results: There were 110 patients enrolled (mean age: 76.2 years). Comorbidity: Cumulative Illness Rating Scale CIRS-CI (comorbidities index): 3.93, CIRS SI (severity index): 1.93. About 19% scored a BRASS (Blaylock Risk Assessment Screening Score) ≥20 indicating need for discharge planning requiring step-down care. Globally, 48% of patients in the control group had major complications (27 out of 56 patients), in contrast to 22% in the intervention group (12 out of 54 patients). Conclusions: Since WVPCM detects early complications during the post-discharge CPs monitoring, it increases safety and reduces inappropriate access to the Emergency Room, preventing avoidable re-hospitalizations.
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37
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Seife Hassen S, Salih Ali M, Khan A, Mohammed AM, Altermanini M, Al Mohanadi DHSH, Zahid M. Recurrent thyrotoxic periodic paralysis with normokalemia in a 36-year-old man: A case report. Clin Case Rep 2021; 9:e04849. [PMID: 34584714 PMCID: PMC8457415 DOI: 10.1002/ccr3.4849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/11/2021] [Accepted: 08/29/2021] [Indexed: 12/29/2022] Open
Abstract
Among patients with thyrotoxicosis and proximal muscle weakness, some patients with TPP may present with apparent normokalemia in whom a careful administration of potassium may lead to rapid reversal of muscle weakness.
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Affiliation(s)
- Sara Seife Hassen
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
| | - Mohamed Salih Ali
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
| | - Adeel Khan
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
| | - Areej Marwan Mohammed
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
| | - Mohamed Altermanini
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
| | | | - Mohamed Zahid
- Department of Internal MedicineHamad General HospitalHamad Medical CorporationDohaQatar
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38
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Daniilidis A, Charitidou S, Petousis S, Margioula‐Siarkou C, Liberis A, Dinas K. Isolated torsion of the fallopian tube associated with hydrosalpinx in a 17-year-old sexually inactive girl: A case report. Clin Case Rep 2021; 9:e04794. [PMID: 34552738 PMCID: PMC8443439 DOI: 10.1002/ccr3.4794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 08/02/2021] [Accepted: 08/22/2021] [Indexed: 11/11/2022] Open
Abstract
Isolated tubal torsion is an unusual cause of acute abdominal pain in young sexually inactive patients. However, it should be still taken into account regarding the differential diagnosis of such conditions.
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Affiliation(s)
- Angelos Daniilidis
- 2nd Department of Obstetrics and GynaecologyAristotle University of ThessalonikiThessalonikiGreece
| | - Sonia Charitidou
- 2nd Department of Obstetrics and GynaecologyAristotle University of ThessalonikiThessalonikiGreece
| | - Stamatios Petousis
- 2nd Department of Obstetrics and GynaecologyAristotle University of ThessalonikiThessalonikiGreece
| | | | - Anastasios Liberis
- 2nd Department of Obstetrics and GynaecologyAristotle University of ThessalonikiThessalonikiGreece
| | - Konstantinos Dinas
- 2nd Department of Obstetrics and GynaecologyAristotle University of ThessalonikiThessalonikiGreece
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39
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Kenney A, Adhikari A. Immune thrombocytopenia in a 68-year-old woman after COVID-19 vaccination. Clin Case Rep 2021; 9:e04689. [PMID: 34466248 PMCID: PMC8385179 DOI: 10.1002/ccr3.4689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/03/2021] [Accepted: 07/23/2021] [Indexed: 12/02/2022] Open
Abstract
This case discusses a patient who presented with immune thrombocytopenia purpura (ITP) one week after COVID-19 vaccination, introducing ITP as a consideration for a potential, but rare, adverse reaction to COVID-19 vaccination.
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Affiliation(s)
- Ashley Kenney
- Ascension Columbia St. Mary’s Milwaukee HospitalMilwaukeeWIUSA
| | - Anju Adhikari
- Ascension Columbia St. Mary’s Milwaukee HospitalMilwaukeeWIUSA
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40
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Rouai M, Chaabani M, Laabidi A, Litaiem N, Rebai L. Miliaria crystallina in an intensive care patient. Clin Case Rep 2021; 9:e04665. [PMID: 34430023 PMCID: PMC8365851 DOI: 10.1002/ccr3.4665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 07/14/2021] [Indexed: 11/24/2022] Open
Abstract
Miliaria crystallina is frequently seen in intensive care patients. This skin condition should be known by both anesthesiologists and dermatologists to avoid unnecessary investigations.
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Affiliation(s)
- Meriem Rouai
- Department of Dermatology Charles Nicolle Hospital Tunis Tunisia
| | - Meryam Chaabani
- Department of Dermatology Charles Nicolle Hospital Tunis Tunisia
| | - Ayette Laabidi
- Department of Anesthesiology Traumatology and Severe Burns Center of Ben Arous Tunis Tunisia
| | | | - Lotfi Rebai
- Department of Anesthesiology Traumatology and Severe Burns Center of Ben Arous Tunis Tunisia
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41
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Bae JY, Jeon JE, Hussein KI, Lee MS. Coombs-negative hemolytic anemia in a male with COVID-19. Clin Case Rep 2021; 9:e04503. [PMID: 34257990 PMCID: PMC8259792 DOI: 10.1002/ccr3.4503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2021] [Accepted: 06/06/2021] [Indexed: 01/18/2023] Open
Abstract
This case illustrates the need to consider SARS-CoV-2 infection as a catalyst for Coombs-negative hemolytic anemia as well as the potential for IVIG to serve as an effective treatment for the condition.
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Affiliation(s)
- Ju Young Bae
- Department of MedicineGreenwich HospitalYale‐New Haven Health SystemGreenwichCTUSA
| | - June Evelyn Jeon
- Department of MedicineGreenwich HospitalYale‐New Haven Health SystemGreenwichCTUSA
| | - Khalil Ian Hussein
- Department of MedicineGreenwich HospitalYale‐New Haven Health SystemGreenwichCTUSA
| | - Merlin Sung Lee
- Division of Hematology and Medical OncologyGreenwich HospitalYale‐New Haven Health SystemGreenwichCTUSA
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42
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Frountzas M, Theodoropoulos C, Karathanasis P, Nikolaou C, Zografos CG, Larentzakis A, Zografos GC, Michalopoulos NV. Severe anaphylactic reaction after blue dye injection for sentinel lymph node biopsy in breast surgery: Report of two cases and literature review. Clin Case Rep 2021; 9:CCR33904. [PMID: 34322237 PMCID: PMC8301567 DOI: 10.1002/ccr3.3904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/06/2021] [Accepted: 01/24/2021] [Indexed: 12/30/2022] Open
Abstract
Anaphylactic reactions, and especially the severe ones (types III and IV), should be kept in mind as considerable adverse effects while using blue dyes for SLNB.
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Affiliation(s)
- Maximos Frountzas
- 1st Department of Propaedeutic SurgeryMedical SchoolUniversity of Athens“Hippocratio” General HospitalAthensGreece
| | - Charalampos Theodoropoulos
- 1st Department of Propaedeutic SurgeryMedical SchoolUniversity of Athens“Hippocratio” General HospitalAthensGreece
| | - Panagiotis Karathanasis
- 1st Department of Propaedeutic SurgeryMedical SchoolUniversity of Athens“Hippocratio” General HospitalAthensGreece
| | - Christina Nikolaou
- Laboratory of Experimental Surgery and Surgical Research “N. S. Christeas”Medical SchoolUniversity of AthensAthensGreece
| | | | - Andreas Larentzakis
- 1st Department of Propaedeutic SurgeryMedical SchoolUniversity of Athens“Hippocratio” General HospitalAthensGreece
| | - George C. Zografos
- 1st Department of Propaedeutic SurgeryMedical SchoolUniversity of Athens“Hippocratio” General HospitalAthensGreece
| | - Nikolaos V. Michalopoulos
- 1st Department of Propaedeutic SurgeryMedical SchoolUniversity of Athens“Hippocratio” General HospitalAthensGreece
- 4th Department of SurgeryMedical SchoolUniversity of Athens“Attikon” University HospitalChaidariGreece
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43
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Sharma N, Agustin M, Polonsky A, Bruck L. Ectopic pregnancy of the fundal myometrium in a patient with tuberous sclerosis. Clin Case Rep 2021; 9:e04303. [PMID: 34322240 PMCID: PMC8301587 DOI: 10.1002/ccr3.4303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/08/2021] [Accepted: 04/20/2021] [Indexed: 11/15/2022] Open
Abstract
A myometrial ectopic pregnancy is a rare and potentially fatal diagnosis. This diagnosis should be considered when presented with large increases in serum beta-hCG with no evidence of an intrauterine pregnancy, particularly with altered myometrium.
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44
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Sargent W, Ali S, Kukran S, Harvie M, Soin S. The prognostic value of chest X-ray in patients with COVID-19 on admission and when starting CPAP. Clin Med (Lond) 2021; 21:e14-e19. [PMID: 33479078 DOI: 10.7861/clinmed.2020-0576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective was to explore if chest X-ray severity, assessed using a validated scoring system, predicts patient outcome on admission and when starting continuous positive pressure ventilation (CPAP) for COVID-19. DESIGN The study was a retrospective case-controlled study. PARTICIPANTS There were 163 patients with COVID-19 deemed candidates for CPAP on admission, including 58 who subsequently required CPAP. OUTCOME MEASURES On admission, we measured the proportion of patients meeting a composite 'negative' outcome of requiring CPAP, intubation or dying versus successful ward-based care. For those escalated to CPAP, 'negative' outcomes were intubation or death versus successful de-escalation of respiratory support. RESULTS Our results were stratified into tertiles, those with 'moderate' or 'severe' X-rays on admission had significantly higher odds of negative outcome versus 'mild' (odds ratio (OR) 2.32; 95% confidence interval (CI) 1.121-4.803; p=0.023; and OR 3.600; 95% CI 1.681-7.708; p=0.001, respectively). This could not be demonstrated in those commencing CPAP (OR 0.976; 95% CI 0.754-1.264; p=0.856). CONCLUSIONS We outline a scoring system to stratify X-rays by severity and directly link this to prognosis. However, we were unable to demonstrate this association in the patients commencing CPAP.
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45
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Une K, Hidaka Y, Maeda J, Kinoshita H, Kodama H, Sato K. Acute aortic dissection combined with cardiac tamponade in an elderly patient saved by pericardial drainage: A case report. Clin Case Rep 2021; 9:274-277. [PMID: 33489172 PMCID: PMC7813048 DOI: 10.1002/ccr3.3513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/14/2020] [Accepted: 10/23/2020] [Indexed: 11/19/2022] Open
Abstract
Acute aortic dissection combined with cardiac tamponade is fatal. The radical treatment is an aortic replacement; however, the risk is high. We suggest conservative treatment with pericardial drainage as a treatment option in elderly patients with comorbidities.
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Affiliation(s)
- Kazunobu Une
- Department of Emergency and General medicineJA Onomichi General HospitalOnomichi CityJapan
| | - Yui Hidaka
- Department of Emergency and General medicineJA Onomichi General HospitalOnomichi CityJapan
| | - Junji Maeda
- Department of CardiologyJA Onomichi General HospitalOnomichi CityJapan
| | - Hiroki Kinoshita
- Department of CardiologyJA Onomichi General HospitalOnomichi CityJapan
| | - Hiroshi Kodama
- Department of Cardiovascular SurgeryJA Onomichi General HospitalOnomichi CityJapan
| | - Katsutoshi Sato
- Department of Cardiovascular SurgeryJA Onomichi General HospitalOnomichi CityJapan
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46
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Jafaripour I, Ansari Ramandi MM, Gholami A, Pourkia R, Amin K. Successful intracoronary thrombolysis in a patient with anterior myocardial infarction and large thrombus burden associated with coronary artery ectasia. Clin Case Rep 2021; 9:93-97. [PMID: 33489139 PMCID: PMC7812998 DOI: 10.1002/ccr3.3449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 11/25/2022] Open
Abstract
Although ectatic coronary arteries with high thrombus burden, leading to acute coronary events, can be difficult to manage, intracoronary thrombolytics and glycoprotein IIb/IIIa inhibitors can act as potential successful treatment options.
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Affiliation(s)
- Iraj Jafaripour
- Department of CardiologySchool of MedicineBabol University of Medical SciencesBabolIran
| | | | - Amir Gholami
- Department of Nuclear MedicineShahid Beheshti HospitalBabol University of Medical SciencesBabolIran
| | - Roghayeh Pourkia
- Department of CardiologySchool of MedicineBabol University of Medical SciencesBabolIran
| | - Kamyar Amin
- Department of CardiologySchool of MedicineBabol University of Medical SciencesBabolIran
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47
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Nitschke C, Ghadban T, Izbicki J, Grotelüschen R. Hypocalcemia as an important differential diagnosis in patients suffering from stridor following thyroidectomy. Clin Case Rep 2021; 9:470-472. [PMID: 33505693 PMCID: PMC7813116 DOI: 10.1002/ccr3.3559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/27/2020] [Accepted: 11/01/2020] [Indexed: 12/01/2022] Open
Abstract
It is essential to consider hypocalcemia as a cause of stridor, especially following postoperative thyroidectomy, as hypocalcemia secondary to hypoparathyroidism is an important differential diagnosis. Advances in intraoperative technology to optimize the vascularization of the parathyroid glands can help to predict and prevent patients from a postoperative hypoparathyroidism.
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Affiliation(s)
- Christine Nitschke
- Department of General, Visceral and Thoracic SurgeryUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Tarek Ghadban
- Department of General, Visceral and Thoracic SurgeryUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Jakob Izbicki
- Department of General, Visceral and Thoracic SurgeryUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Rainer Grotelüschen
- Department of General, Visceral and Thoracic SurgeryUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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48
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Rivera G, Lajud S, Gonzalez L, Garratón M, Labat E. Management of life-threatening post-traumatic otorrhagia. Clin Case Rep 2021; 9:5-7. [PMID: 33489125 PMCID: PMC7813099 DOI: 10.1002/ccr3.3340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022] Open
Abstract
Otorrhagia can be life-threatening, and acute control of the hemorrhage using easily accessible and practical techniques in the otolaryngology field such as Merocel packing and Kerlix gauze pressure dressing is essential to manage this complication.
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Affiliation(s)
- Gabriel Rivera
- Otolaryngology‐Head and Neck SurgeryUniversity of Puerto Rico School of MedicineSan JuanPuerto Rico
| | - Shayanne Lajud
- Otolaryngology‐Head and Neck SurgeryUniversity of Puerto Rico School of MedicineSan JuanPuerto Rico
| | - Leonardo Gonzalez
- Otolaryngology‐Head and Neck Surgery DepartmentMedical University of South CarolinaColumbiaSCUSA
| | - Miguel Garratón
- Otolaryngology‐Head and Neck SurgeryUniversity of Puerto Rico School of MedicineSan JuanPuerto Rico
| | - Eduardo Labat
- Department of Diagnostic Radiology – NeuroradiologyUniversity of Puerto Rico School of MedicineSan JuanPuerto Rico
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Abstract
During COVID-19 there has been increased pressure on mental health services internationally. In this report, we compare admissions to one acute medical unit (AMU) for patients with mental health problems during the COVID-19 pandemic (April, May and June 2020) to the same period of time in 2019. We found an increase in this cohort of patients in 2020, both as an absolute number and as a proportion of the medical take. We outline some strategies which we have adopted locally to improve care for this patient group.
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50
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Zaalouk TM, Bitar ZI, Maadarani OS, El‐shably ALAM. White lung with milky effusion. Clin Case Rep 2020; 8:2557-2560. [PMID: 33363779 PMCID: PMC7752631 DOI: 10.1002/ccr3.3207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/30/2020] [Accepted: 07/08/2020] [Indexed: 02/06/2023] Open
Abstract
Thoracic duct injury is a rare complication of dorsal spine operations. Ultrasound chest plays an important tool for rapid diagnosis of acute dyspnea, drainage of massive effusion, and daily follow-up. Conservative treatment of postoperative chylous with measures to decrease chylous formation can lead to a resolution of chylothorax.
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