Honeycuttross1432

We present the case of a 54-year-old lady who presented to hospital with palpitations and was diagnosed with atrial fibrillation with rapid ventricular response. She was given intravenous metoprolol 5 mg initially followed by a further 5 mg and was commenced on bisoprolol 2.5 mg once daily. She reverted back to normal sinus rhythm and was referred for echocardiography following an episode of paroxysmal atrial fibrillation. The echocardiogram showed a large mobile atrial myxoma in the left atrium and mild-to-moderate mitral regurgitation with preserved left ventricular function. Her past medical history includes transsphenoidal surgery for acromegaly in 1979, followed by radiotherapy and partial thyroidectomy for goitre. Her chest radiograph was normal and blood results were unremarkable. She was accepted for inpatient transfer to a cardiothoracic centre for surgical removal of atrial myxoma. She underwent surgery with successful excision of the atrial myxoma, and biopsies confirmed the mass to be atrial myxoma. The surgery was complicated by the patient developing atrial fibrillation with fast ventricular response that was chemically cardioverted with an intravenous loading dose of amiodarone 300 mg over 2 hours followed by 900 mg infusion over 24 hours. She had follow-up in the outpatient clinic with cardiology and endocrine specialists for a year and no recurrence of myxoma was noted. Her blood tests including growth hormone and thyroid function tests were normal.Organ space surgical site infection (SSI), in itself, is a problematic condition for the surgeon and also adds pain and misery to the patient. If it happens along with deep pelvic collection, it further increases the risk of sepsis to the patient. Untreated abdominal or pelvic abscesses are associated with high mortality. This outcome is improved due to advances in image-guided percutaneous interventional techniques. The aim is to drain the collection with minimal morbidity to the patient. We report a case of deep surgical site infection following caesarean section in a COVID-19 positive patient managed with minimal intervention.Myxedema coma is a rare life-threatening emergency that usually presents in the elderly during the winter months. The neurological changes caused by uncontrolled hypothyroidism may precipitate seizure activity and its deleterious consequences. A 65-year-old homeless man with a history of non-Hodgkin lymphoma in remission for over 20 years presented to the emergency department (ED) following an episode of syncope. His physical examination was remarkable for hypothermia and bradycardia. Shortly after the admission, he had two tonic-clonic seizures with sphincter relaxation and no recovery between the convulsions. His thyroid-stimulating hormone (TSH) level was 304 uIU/ml. He received appropriate treatment for his condition and was discharged after a full recovery. This case illustrates the catastrophic consequences of long-term uncontrolled hypothyroidism. A high index of clinical suspicion is essential for beginning prompt hormone supplementation in such patients.Doxorubicin (DOX) is an anthracycline antibiotic used to treat many cancers, including breast cancer, leukemia, and Hodgkin's lymphoma. Positive aspects of DOX use are limited by the cardiomyopathy that it may cause. For this reason, it is crucial to uncover effective treatments against DOX-induced cardiomyopathy (DIC). Oxidative stress plays a pivotal role in DIC, and this understanding has helped guide potential treatments for DIC. The purpose of this study was to review and describe current and emerging treatments for DIC and their potential cardioprotective effects against DIC. The goals were to (1) provide a single-source report to aid clinicians in exploring different treatment plans that are personalized for their patients and (2) stimulate researchers to consider evaluating promising and emerging treatment modalities. Evolving understanding of DIC pathophysiology remains fundamental in elucidating the course for future medical therapies. The main conclusion of this study was that the use of existing pharmaceutical agents might represent a possible approach towards mitigating DIC with more extensive clinical data. A limitation of all reviewed studies was that none included an experimental model in which DOX was used to treat animals with preexisting cancer. This limitation fails to identify the impacts that cancer may play in DIC pathophysiology and the potential mitigating effects of DIC treatments. Future research should consider this limitation with appropriately revised protocols.Chronic allergic rhinosinusitis is a debilitating condition in a group of susceptible individuals with multifactorial etiology. I present my case of suffering from chronic allergic rhinosinusitis for 25 years treated with multiple drugs and surgeries with no relief. Adjunctive daily saline nasal douching has provided significant relief for three years to date. Genetic susceptibility with defective ciliary clearance, mucosal metaplasia with increased goblet cells secreting thick and inspissated mucus blocking the normal drainage, and stasis of secretions with inadequate mucosal immunity predisposes to polymicrobial infections, including fungal infections, antimicrobial resistance, and recurrent episodes of rhinosinusitis. Medical and surgical strategies often fail to manage this condition appropriately in a few cases. Adjunctive daily saline nasal douching is a safe and effective alternative to manage the debilitating symptoms of chronic allergic rhinosinusitis.Collision tumors are rare neoplasms composed of two different types of histological tissues in the same organ. The most frequent association with cerebral cavernous malformations (CCMs) are meningiomas, gliomas, and gangliogliomas, while the most frequent sellar collision is between pituitary adenoma (PA) and craniopharyngiomas, and still very few cases have been reported. We present the case of a 43-year-old woman who started two months ago with a fall from her height followed by severe headache and bilateral hemianopsia. An isointense, enhancing sellar tumor, and a right frontal lesion compatible with CCM were observed on MRI. Surgery was performed through anterior interhemispheric and endoscopic transnasal approaches for the cavernoma and the sellar tumor, respectively, removing both lesions and sending them to pathology. The sellar tumor corresponded to a PA showing positive immunohistochemistry for prolactin and follicle-stimulating hormone (FSH). In the post-op period, the patient developed a seizure and diabetes insipidus, for which she received appropriate treatment. Our findings were conclusive with a collision tumor, since both lesions presented two different histological tissues. Different densities were observed in both lesions using imaging studies, which were later confirmed with histopathology and immunohistochemistry.Coronary artery disease is one of the most dreadful and life-threatening diseases out of all cardiac diseases. The diagnosis and management of coronary artery disease comprise stepwise approaches. All these approaches are mostly guideline-driven. While the majority of the time, guidelines help us take the most appropriate care, exceptions do exist. For example, patients may have unusual risk factors and abnormal test results; however, they do not fit into the guideline algorithm to proceed further. This case report of a 68-year-old male patient depicts a true example of such a situation. He presented to the cardiologist's office for pre-operative cardiac evaluation for urological surgery. In view of associated risk factors, an exercise stress test was done, which showed critical abnormalities. As per the pre-operative cardiac assessment guidelines, the patient did not meet the criteria for further testing. However, a clinician's strong judgment and persistent negotiation superseded those barriers. Given critical abnormalities of the exercise stress test, the patient underwent cardiac catheterization. He was found to have triple vessel disease on cardiac catheterization. The scheduled surgery was withheld, and the patient underwent a coronary artery bypass graft. This life-threatening condition could have been easily missed if only the guidelines were to be followed. While guidelines cover a significant portion of the bell curve, this case report represents the importance of not missing the tail ends of the curve. It enhances the importance of thinking out of the box based on clinical training and expertise.Chronic portal vein thrombosis (PVT) is a major vascular complication of liver cirrhosis. Patients may be asymptomatic and chronic PVT might be detected incidentally on imaging. PVT is associated with worsening liver disease, poorer clinical outcomes, and might proceed to life-threatening intestinal ischemia. Management of chronic PVT with anticoagulation has been shown to be successful in promoting recanalization and reducing thrombus extension in patients with cirrhosis. However, optimal anticoagulation for PVT in cirrhosis has not yet been addressed in any large-scale trial, and the decision to anti-coagulate varies on a case by case presentation. We report the case of a 62-year-old male patient with a history of liver cirrhosis, pancytopenia, and grade II esophageal varices presenting with abdominal pain who was incidentally found to have chronic thrombosis of the portal vein on imaging and was managed appropriately with a good outcome.Background With COVID-19 leading to several isolation measures for preventative care, health care utilization, especially within urology, decreased substantially. The impact of COVID-19 on the population's interests in urologic conditions remains to be established. By using the platform of Google Trends, which allows search behaviors and interest in healthcare topics to be quantified over time, we investigated the impact of COVID-19 on online search behaviors relating to common urologic conditions in the US. Methods The platform of Google Trends was utilized to analyze online interest in twelve common urologic conditions in the US from October 1, 2018 to August 1, 2021 (divided into "pre-COVID" and "COVID" periods at March 1, 2020). Search volume index (SVI), a measure of relative search volume on Google, data sets for the US, top queried and populated states, rising queries, and top queries were retrieved and analyzed for all conditions. Pre-COVID and COVID median SVIs were compared using the Mann Whitney U ced interest could translate to delayed diagnosis and treatment of these conditions. Only erectile dysfunction showed increasing interest, potentially due to research or misinformation linking it to COVID-19.The current study presents a case of right upper extremity ischemia secondary to cardioembolism in an elderly female with active and previously undiagnosed atrial fibrillation. The patient had no past medical history of any chronic cardiac disease or significant cardiac events. JAKInhibitorI Computed tomographic angiography (CTA) was not performed due to her allergy to contrast material. A non-contrast computed tomography (CT) revealed mild atherosclerotic calcification of the right brachiocephalic artery; however, dissection or mural thrombus of the inflow vessels could not be ruled out. In evaluating a patient with acute ischemia of the upper limb, it is essential to obtain a complete history, including allergies, and be prepared to use alternative techniques for assessing arteries, if necessary. Routine cardiac function testing should also be prioritized in all elderly individuals, even those with no previous history of cardiovascular disease or symptoms.