Bridgesswanson5019

Malingering is the intentional fabrication of symptoms for material gain. Malingering among frequent utilizers and patients with psychiatric symptoms is suspected to be common in emergency settings but difficult to detect and manage. We present a case report of a 50-year-old man feigning psychosis and suicidality in order to obtain shelter. Strategies to identify malingered psychiatric symptoms are presented. Understanding how malingering is adaptational can help clinicians begin to manage these patients and symptoms in a compassionate manner that preserves healthcare resources, improves patient care, and reduces the risk of burnout for clinicians.Müllerian duct aplasia-renal agenesis-cervicothoracic somite dysplasia (MURCS) association is a rare syndrome. This unique condition consists of Müllerian duct aplasia, cervicothoracic somite dysplasia, and renal aplasia, and skeletal abnormalities manifesting in childhood. We report the case of a 14-year-old girl who presented to the orthopedic clinic with spinal deformity and Sprengel's shoulder complicated by a background of MURCS association. The treatment modalities of scoliosis include posterior spinal fusion and the vertical expandable prosthetic titanium rib. On the other hand, Sprengel's deformity is surgically managed by Woodward's procedure. The management plan for our patient involved correcting scoliosis by the posterior spinal fusion procedure and performing Woodward's procedure to correct Sprengel's deformity simultaneously. Simultaneous scoliosis correction with posterior spinal instrumented fusion and Sprengel's deformity correction with modified Woodward's procedure is a promising surgical technique that can lead to favorable outcomes.Benign primary tumors are uncommon, with the majority of these tumors being leiomyomas; schwannomas of the esophagus are rare. Here, we present a case of a 78-year-old woman referred for complaints of intermittent dysphagia with a chest computed tomography scan showing a homogenous mass, compressing the esophagus. Upper gastrointestinal endoscopy revealed a submucosal mass, which was eventually diagnosed as a schwannoma after an endoscopic ultrasound with fine-needle aspiration and subsequent pathologic and immunohistochemical examination. Schwannomas could be managed conservatively.Osteoid osteoma (OO) of the elbow is a very rare entity as it typically occurrs in the lower extremity of extra-articular long bones. Hereby, we report a case for a 28-year-old female patient has been diagnosed with a unique presentation of sub-periosteal osteoid osteoma in the intra-articular portion of distal humerus. She underwent arthroscopic excision for the lesion which is considered a reliable minimally invasive management modality. In addition to this, findings of a 1-year follow-up after excision is reported.Objective The use of high-flow nasal cannula (HFNC) as non-invasive respiratory support in children with bronchiolitis has increased over the last several years. Several studies have investigated enteral feeding safety while on HFNC. This study compares the safety of oral feeding prior to and following implementation of an HFNC feeding guideline. Patients and methods A retrospective study was designed, in children ≤2 years of age with bronchiolitis, requiring HFNC, from 2017 to 2019. We defined feeding complications on HFNC and defined safety as the absence of such complications. We gathered the following data oral feeding timing from the HFNC initiation, duration of enteral feeding on HFNC, and HFNC flow rate at which the feeding was initiated. We compare the data prior to and post-implementation of an HFNC feeding guideline. Results Descriptive statistics were calculated separately by pre and post guideline implementation. Patients in both pre and post guideline implementation groups had no feeding complications on HFNC. Subjects in the post (n=50) vs. pre-guideline implementation (n=36) had a higher median amount of liters flow when initiating enteral feeding (8.0 vs. 6.0 respectively, p less then 0.024), spent fewer days in the pediatric intensive care unit (PICU) (two days vs. 0 days). Post guideline implementation, enteral feeding was initiated sooner (days nil per os [NPO] 1.0 vs 2.0). No other significant differences between the two cohorts with respect to other variables were observed. Conclusions Our data supports that oral feeding in patients with bronchiolitis on HFNC is safe. Utilization of current guidelines allowed safe earlier feeding of children on HFNC, reducing the time spent NPO.A global effort is underway to distribute coronavirus disease 2019 (COVID-19) vaccines to limit the crisis. Although adverse events related to vaccination are rare, there have been cases of new-onset neurologic symptoms following vaccination. We present two cases of new-onset neurologic symptoms post-vaccination that, upon further workup, revealed two different neuro-oncologic processes requiring neurosurgical intervention and further treatment. We hypothesize that despite these processes being unrelated to vaccination, the COVID-19 vaccines may induce an inflammatory cascade with the ability to uncover underlying sinister pathology. Our report therefore emphasizes the need for careful evaluation in the setting of new-onset neurologic symptoms after COVID-19 vaccination.A variety of protocols have evaluated the use of several forms of gonadotropins in controlled ovarian stimulation (COS). We aim to review the evolving trends on the use of gonadotropins human chorionic gonadotropin (hCG), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) over time and their combinations in COS for patients who undergo assisted reproductive techniques (ART) protocols. A meticulous search of three electronic databases was performed for articles published in the field up to September 2020. The administration of hCG seems a promising alternative to conventional modalities for COS related to the enhancement of LH activity. The use of gonadotropins was associated with significantly elevated pregnancy rates that ranged from 20.8% to 46.2%. However, the currently available outcomes with regards to oocytes retrieved, number of embryos are still conflicting. A potential beneficial effect was observed by the majority of the studies in terms of the number of embryos and implantation rates, which is, however, highly affected by the type of protocol used (gonadotropin-releasing hormone [GnRH] agonist or antagonist). Further studies are warranted to elucidate the exact pathways of action of gonadotropins in controlled ovarian stimulation to attain the optimal effect.The role of hysterectomy in the development of pelvic floor dysfunction (PFD) remains widely disputed. The controversy is fueled by two key factors. The first is conflicting association studies that make it difficult to establish whether a link truly exists. Although many retrospective studies report a correlation between hysterectomy and increased risk of stress urinary incontinence (SUI) or pelvic organ prolapse (POP), prospective studies often fail to replicate these results, leading some to conclude that no association exists. However, most prospective studies do not follow up for a sufficient length of time to account for the long latency of PFD and cannot unilaterally prove the absence of an association. The second source of controversy is the absence of a plausible mechanism to explain how hysterectomy could predispose patients to PFD. CX-5461 mw In this paper, we investigate autonomic innervation and smooth muscle in the three layers of pelvic floor support and propose a mechanism through which autonomic damage from hysterectomy could predispose patients to PFD. We then identify key research areas needed to evaluate this theory. This report aims to inspire a discussion on how to further the collective understanding of the relationship between hysterectomy and PFD. Clarifying the nature of this connection could have enormous consequences in redefining the risks and benefits of hysterectomy.Fusobacterium nucleatum may be implicated in cases of emphysematous cholecystitis (EC) and carries a high mortality risk, especially in individuals with heart disease, renal insufficiency, and underlying malignancy. Fusobacterium infections are rarely detected in the setting of cholecystitis possibly due to the difficulty with properly culturing the bacteria. We describe a case of a patient with EC in whom blood cultures were positive for growth of F. nucleatum in one of two samples. The patient was treated with empiric antibiotic therapy consisting of metronidazole and cefepime. In patients with EC and negative cultures, it is possible that they may have an undetected infection with fusobacteria, which carries a high mortality risk. As such, clinicians should maintain a high degree of suspicion of obligate anaerobic infection in patients who have negative blood culture for growth in the setting of EC and consider continuation of adequate antimicrobial coverage.Penile strangulation is not commonly encountered in orthopedic practice. Quick decision and immediate removal of the metallic ring with readily available instruments is the key to a successful outcome. Jumbo cutter is a commonly available instrument. It can be used with ease without causing any thermal or soft tissue damage, giving satisfactory results.Some solid cancers (such as lung, breast, and esophageal cancer, and melanoma) can lead to pericardial effusion by metastatic spread, potentially provoking hemodynamic instability. Detection by echocardiography is therefore essential. Pericardiocentesis can help restore cardiac function and provide fluid for establishing an etiology through cytological, microbiological, and cellularity analysis. A 60-year-old woman with metabolic syndrome and obesity hypoventilation syndrome presented to the emergency department with dyspnea at rest. A chest X-ray showed cardiomegaly and massive left pleural effusion. Ultrasound findings were pericardial effusion with signs of cardiac tamponade. We performed pericardiocentesis, extracting 1000 mL of exudate, and thoracentesis, which confirmed the diagnosis of lymphocytic exudative effusion. A CAT (computerized tomography) scan of the chest, abdomen, and pelvis revealed a left kidney mass. A biopsy of the mass confirmed the diagnosis of clear cell renal cell carcinoma and a pleural biopsy revealed metastatic involvement. This report describes a rare presentation of cardiac tamponade due to clear cell renal cell carcinoma and discusses the pathogenesis, mechanisms, and prognosis of this condition.A congenital cheek fistula is a rare malformation in the buccal area. Here, we report the case of a congenital cheek fistula in a 50-year-old woman who visited our clinic with complaints of swelling and pain in her left cheek. Physical examination revealed a small hole in the left corner of the mouth present since birth. She had no other congenital malformations in the maxillofacial region such as an accessory ear and cleft lip. Manual compression of the cheek mass induced serous discharge from the hole. Magnetic resonance imaging (MRI) showed a cystic lesion in the left cheek and a fistula within the orbicularis oris muscle that opened into the small hole. After immediate incision and drainage of the cyst, both the cyst and fistula were surgically resected. The cystic lesion was completely delineated from the boundary of the parotid gland. The orbicularis oris muscle was partially incised to remove the fistula and the surrounding scar tissue. Histopathological examination of the resected specimen revealed a cavity consisting of epithelium inside the fistula.