Kaygentry8295

Airway management in patients suffering from mucopolysaccharidoses (MPS) is one of the most difficult anesthesiologic challenges. MPS is a group of rare, inherited diseases caused by the absence or malfunctioning of lysosomal enzymes needed to break down macromolecules called glycosaminoglycans (GAGs). MPS is associated with clinical symptoms and physical features, which all together contribute to the high incidence of difficulty in providing airway during surgical procedures. We used PubMed as our main database (PubMed Advanced Search Builder) to search for relevant literature. At first, we looked for the prevalence of MPS worldwide. Then, we searched for airway management complications in the MPS population using the keywords "Mucopolysaccharidoses," "Anesthesia complications," and "airway management." Another search was carried out to look for new therapeutic agents and explore their impacts on body organs. We reviewed the finalized articles to explore how anesthesiologists used different airway techniques. We discovered that video laryngoscope and I-gel aided fiber-optic intubation have been available in recent years and have been used uneventfully in several patients. We presented recommendations regarding preoperative and intraoperative preparation to avoid airway-related complications in the future. We realized that many therapy approaches had been suggested, especially after further understanding of the pathophysiology of MPS. However, more investigation needs to be conducted to determine their efficacy and explore if there is any impact on airway management.Biliary cysts refer to cystic dilatation in the biliary ductal system that may be congenital or acquired. Extrahepatic biliary cysts constitute less than 10% of biliary cysts. Extrahepatic mucinous cystadenoma represents an extremely rare clinical condition with less than 100 cases reported in the English medical literature. Enitociclib Herein, we report the case of a middle-aged woman who presented with a clinical picture of cholestatic jaundice. Laboratory findings revealed elevated bilirubin and alkaline phosphatase. After a thorough investigation, she was found to have a cystic lesion in the common bile duct near the cystic duction site. The patient underwent exploratory laparotomy, which revealed a 2.0 × 2.0 cm cystic lesion in the common bile duct that is exerting an obstructive effect on the biliary ducts. Complete en-block excision of the cystic lesion was performed with Roux-en-Y hepaticojejunostomy reconstruction. Histopathological examination revealed mucinous biliary cystadenoma. Although very rare, biliary cystadenoma should be kept in mind as a differential diagnosis of cholestatic jaundice particularly in patients with no history of biliary stones or cholecystectomy.Background Tuberculosis (TB) is one of the most common infectious diseases and is commonly associated with comorbidities. However, data regarding TB and comorbidities are lacking from northeast India. The aim of the study is to see the clinical spectrum of TB and the frequency of comorbidities. Methods This was a prospective observational study of all hospitalized TB patients between January 2016 and June 2017 who were selected by consecutive sampling. Data were analyzed using SPSS v. 17.0 (IBM Corp., Armonk, NY), and a p-value of less then 0.05 was considered significant. Results Of the 173 patients selected, the mean age was 41.05±17.04 years with a malefemale ratio of 4.271. Pulmonary TB (PTB) was found in 43.94%, extra-pulmonary TB (EPTB) in 52.02%, and disseminated TB in 4.04%. Fever (61.27%) was the most common presentation, followed by cough (54.33%) and breathlessness (32.94%). Of the 76 patients with PTB and seven with disseminated TB, making a total of 83 patients, 56 (67.4%) were sputum positive. Out of 90 patients suffering from EPTB, pleural effusion (53.33%) was the commonest type of EPTB, followed by central nervous system (CNS) tuberculosis (26.66%) and abdominal tuberculosis (8.88%). Comorbidities were present in 53.17% of the patients, of which diabetes mellitus (DM) (26.58%) and hypertension (17.34%) were the most common. Comorbid conditions were significantly higher in PTB than EPTB (51 of 83 vs. 41 of 90, p less then 0.05). Mean glycated hemoglobin (HbA1c) was significantly higher in PTB as compared to EPTB (8.74±2.04 vs. 7.58±0.29, p less then 0.05). Conclusion Comorbidities, particularly DM, were present in half of the patients, mostly in PTB than EPTB, with glycemic control being significantly poorer in PTB patients.Background Coronary artery calcium (CAC) scoring based on gated non-contrast cardiac computed tomography (CT) is a validated risk marker of major adverse cardiovascular events (MACE). Reporting of CAC on non-gated CT chest (NGCT) scans and the impact on medical therapy is not well studied. Methods A retrospective cohort of 5,043 NGCT scans was reviewed for the presence of CAC. The radiology report was reviewed to determine whether CAC was mentioned in either the body of the report or the final impression. Electronic medical records (EMR) were abstracted for baseline demographics, cardiovascular (CV) risk factors, lipid-lowering agents, and aspirin (ASA) prior to and after NGCT. Results CAC was present in 63.0% of NGCT scans. Of these scans, CAC was mentioned in the body of the report in 81.6% of studies. Conversely, CAC was mentioned in the final impressions in only 15.1% of these scans. Amongst patients with CAC, initiation of a statin in treatment-naive patients was more common when CAC was mentioned in the final impression versus the body only (12.3% vs. 4.9%, p=0.001) despite the fact that baseline utilization of statins in this cohort was higher (71.1% vs. 64.1%, p=0.005). Initiation of a statin in treatment-naive patients had a trend towards significance when CAC was mentioned in the body of the report versus not reported (4.9% vs. 2.62%, p=0.142). Reporting of CAC in the final impression significantly increased the initiation of ASA in treatment-naive patients (9.52% vs. link2 4.33%, p=0.033). link3 Reporting of CAC in either the final impression or the body of the report did not affect the initiation of non-statin lipid-lowering therapies in patients with CAC. Conclusion The inclusion of CAC in the final impression of NGCT radiology reports positively impacts the appropriate initiation of statin and aspirin therapy in treatment-naive patients. Universal adherence to a standardized reporting system for the presence of CAC on NGCT should be considered to improve the initiation of guideline-directed medical therapy.Introduction Mass casualty incident (MCI) simulation and triage are educational methods used to provide high fidelity training to first response teams. Simulation and triage need to be as effective as possible to train professionals for true emergencies involving mass casualty. Although MCI simulation and triage have been used in the pre-professional setting (i.e. medical school, nursing school, etc.), more data is required regarding quality improvement of these simulations. This study focuses on quality improvement of MCI simulation and triage in the pre-professional training. In order to evaluate simulation quality to optimize future triage simulations, this study had three specific aims (1) assess participant accuracy of triage after training in Sort, Assess, Life-Saving Interventions, Triage/Transport (SALT); (2) evaluate the role of stress and confidence in participants of triage simulation; (3) determine trainees' perception of unmanned aerial vehicles (drones) in the setting of mass casualty simulationerall accuracy of 52.43%. Survey data showed that confidence in mass casualty triage improved post-simulation, improving from median 3/10 to 5/10. Most participants were unaware of the use of unmanned aerial vehicles in MCI but most had positive opinions of their usefulness in MCI after the simulation, with a median score of 8/10. Conclusions Participant accuracy of triage after undergoing a 15-minute training in SALT triage was 52.43%, with a non-statistically significant tendency to under-triage. This accuracy level is consistent with other studies of SALT triage in MCI, but the tendency to undertriage requires further study for validation. Stress levels during the simulation were significantly elevated, while post-simulation confidence increased significantly from pre-simulation. The perception of drone utility in MCI was favorable among participants in this study, indicating drones may be useful for first response teams in future mass casualty simulations.Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation of chronic liver disease associated with organ failures. Anemia of diverse etiology is common in patients with ACLF. Spur cell anemia (SCA) is a form of acquired hemolytic anemia that occurs rarely in such patients due to dysregulated lipids metabolism. Spur cells are large erythrocytes with spike-like projections, which predispose them for sequestration and destruction in splenic canaliculi. There is a paucity of data on SCA in patients with ACLF. Here we report a series of five ACLF patients who had severe (hemoglobin level less then 8 g/dL) and transfusion-refractory SCA with aggressive clinical course and high mortality rate.Objective To explore effectiveness of alternative methods of neurology resident electroencephalogram (EEG) learning during COVID-19 pandemic due to social distancing requirements which caused disruption of traditional in-person teaching. Methods Virtual EEG learning was instituted using Zoom platform. Residents participated in live, interactive virtual sessions for eight weeks. A pre-test and post-test were administered and a survey was performed at the end of the project. Results Based on pre-test and post-test results, there was a significant improvement on average resident test scores. On the survey, 100% agreed (81.8% strongly agreed, 18.2% agreed) that virtual EEG sessions provided a conducive learning environment with easy access while preserving effective communication with the instructor. When compared to traditional EEG reading, 100% agreed (81.8% strongly agreed and 18.2% agreed) that virtual sessions were more accessible, 72.7% agreed (54.5% strongly agreed, 18.2% agreed) that they were more interactive; 81.9% (45.5% strongly agreed, 36.4% agreed) felt more engaged and 90.9% agreed (81.8% strongly agreed, 9.1% agreed) that they were able to attend more sessions. Hundred percent residents (72.7% strongly agreed, 27.3% agreed) felt more confident in their EEG reading and all (81.8% strongly agreed and 18.2% agreed) would sign up for more virtual learning courses. Conclusions Virtual EEG education is an efficient method of resident education with improved ease of access while maintaining interactive discussion leading to increased confidence in learners. It should be considered even after resolution of the need for social distancing and its applications in other fields of learning should be further explored.Background Deep neck space infections (DNSIs) in children may lead to airway compromise and damage to the great vessels in the neck. They occur more commonly in the HIV-infected population. To our knowledge, this is the first case series of DNSI in HIV-infected children Objectives The aim of this study was to describe the demography and document the sites of infection; organisms identified and resistance patterns in HIV-infected children with DNSI. Methods We retrospectively reviewed the clinical records of children ( less then 16 years) diagnosed with deep neck infections at the teaching hospitals for the Department of Otolaryngology, Head and Neck Surgery, University of the Witwatersrand, between January 2010 and December 2018. Results We identified 17 patients with DNSI of which six children had concomitant HIV infection. The average age at presentation was six years (range 0.35-13 years); there were four males and two females. The most common site involved was the submandibular space, which was affected in four patients.