Farahhagen4640

Total marrow radiation is an emerging treatment modality used in patients undergoing stem cell transplantation. We present a rare case of a patient undergoing total marrow irradiation with concurrent ablative stem cell transplantation with local failures in two out-of-field areas that were not included in the clinical target volume A 31-year-old female patient initially presented with abdominal pain secondary to chronic myelogenous leukemia. She underwent dasatinib treatment for years, but subsequently developed recurrence and underwent consolidation systemic chemotherapy followed by allogeneic stem cell transplantation with adjuvant total marrow irradiation. Several months later, she noticed increased left jaw swelling and dysphagia with associated right ankle swelling. Biopsy of the right ankle and left mandible were consistent with recurrent myeloid sarcoma. This case report suggests that inclusion of the mandible and lower extremities may be necessary when performing total marrow radiation.Introduction Traumatic brain injury (TBI) results in primary and secondary brain injuries. Secondary brain injury can lead to cerebral edema resulting in increased intracranial pressure (ICP) secondary to the rigid encasement of the skull. Increased ICP leads to decreased cerebral perfusion pressure which leads to cerebral ischemia. Refractory intracranial hypertension (RICH) occurs when ICP remains elevated despite first-tier therapies such as head elevation, straightening of the neck, analgesia, sedation, paralytics, cerebrospinal fluid (CSF) drainage, mannitol and/or hypertonic saline administration. If unresponsive to these measures, second-tier therapies such as hypothermia, barbiturate infusion, and/or surgery are employed. Methods This was a retrospective review of patients admitted at Arrowhead Regional Medical Center from 2008 to 2019 for severe TBI who developed RICH requiring placement into a pentobarbital-induced coma with therapeutic hypothermia. Primary endpoints included mortality, good recovery which was designated at Glasgow outcome scale (GOS) of 4 or 5, and improvement in ICP (goal is 25 mmHg prior to initiation of pentobarbital and hypothermia is suggestive of a poor response to treatment. We recommend patients with severe TBI who develop RICH should first undergo a 12 x 15 cm decompressive hemicraniectomy because they have better survival and are more likely to have ICP less then 25 mmHg as the highest elevation of ICP if the ICP were to become and stay elevated again. Pentobarbital and hypothermia should be initiated if the ICP becomes elevated and sustained above 20 mmHg with a prior decompressive hemicraniectomy and refractory to other medical therapies. However, our data suggests that patients are unlikely to survive if there ICP does not decrease to less than 15mmHg at 8 and 12 hours after pentobarbital/hypothermia and remain less than 20 mmHg within first 48 hours.Fusobacterium species are gram-negative anaerobic non-spore-forming bacteria, which colonize mucous membranes in humans. Over the recent decade, the significance of these organisms has been increasingly recognized. We describe a rare case of acute hepatitis, which was found to be likely due to Fusobacterium nucleatum, grown on blood culture. In our case, the hepatitis caused by this microorganism resolved completely without any long-term sequelae to the liver, through conservative management namely intravenous antibiotics and supportive therapy only. This case highlights that early detection and prompt treatment in a case of acute hepatitis resulted in a good outcome. In addition, this case also illustrates that the differential diagnosis can be varied in cases of acute hepatitis.The World Health Organization is still revising the epidemiology of multi-system inflammatory syndrome in children (MIS-C) and the preliminary case definition, although there is a dearth of robust evidence regarding the clinical presentations, severity, and outcomes. Researchers, epidemiologists, and clinicians are struggling to characterize and describe the disease phenomenon while taking care of the diseased persons at the forefronts. This report tackles the first case of a 13-year-old Saudi female with the MIS-C mimicking Kawasaki disease. Her main manifestations were fever, gastrointestinal symptoms, evidence of organ failure with an increase in inflammatory markers, and a history of coronavirus disease (COVID-19) infection. She had glucose-6-phosphate dehydrogenase (G6PD) deficiency and no significant previous history of any disease. She presented with signs of acute illness high-grade fever (39.6°C) for five days accompanied by sore throat, malaise, reduced oral intake, abdominal pain, diarrhea, skin rash, bilateral non-suppurative conjunctivitis, and erythematous, cracked lips. Eventually, she died despite aggressive management based on the Centers for Disease Control and Prevention and the Saudi Ministry of Health guidelines for COVID-19 management. Based on this case, we suggest that pediatricians need to be aware of such atypical presentations and early referral to tertiary care is imperative for further early diagnosis and management. MIS-C is a rare yet severe and highly critical complication of COVID-19 infection in pediatrics, leading to serious and life-threatening illnesses. Knowledge about the wide spectrum of presenting signs and symptoms and disease severity, including early detection and treatment, is pivotal to prevent a tragic outcome.Simulation-based medical education (SBME) is an educational technique that enables participants to experience an immersive representation of a clinical event for the purpose of practice, learning, and evaluation. This experience is intended to improve trainees' competency and confidence in both procedural tasks, as well as team-based and interpersonal skills when responding to real-world clinical encounters. Moreover, SBME improves procedural exposure and competency in low-frequency, high-stakes clinical procedures without the risk of adverse consequences, error, or patient harm - a priority for physician training at all levels. This technical report describes a novel bi-phasic maternal cardiac arrest simulation that can be used to teach and train post-graduate year one (PGY1) emergency medicine and obstetrics and gynecology trainees in the use of perimortem cesarean sections (PMCS) prior to in-situ exposure. Using a high-fidelity simulation protocol employing training manikins and 3-D printed models of gravid uteri, this bi-phasic simulation, completed over two sessions, six months apart, will equip trainees with the knowledge, skills, and professionalism behaviors necessary for difficult clinical decisions and time-critical procedures.A case of unilateral genu recurvatum (GR) in a 15-year-old boy with a history of Guillain-Barre syndrome (GBS) and subsequent bilateral drop-foot is presented. Muscle imbalance of the lower limb and repetitive pressure from prolonged usage of an orthosis to deal with drop-foot may be the causative factors for early partial physeal arrest of his right proximal tibia. The result was a right GR and a shorter right lower limb. A below the tibial tuberosity anterior opening-wedge oblique proximal tibial osteotomy was performed. The deformity was gradually corrected using an Ilizarof circular frame. The center of rotation and angulation of the procedure was placed at the posterior tibial cortex. The procedure was completed uneventfully within four months. Excellent clinical and radiological improvement of the deformity was obtained.Duodenal diverticulosis (DD) is a rare disease in children, and its etiology is unknown. Here, we report a 13-year-old boy with severe abdominal pain. A diagnosis of DD was made based on clinical and image findings. He responds to analgesic, antibiotic and nutritional treatment. The early identification of child with DD as potential cause of severe abdominal pain with pancreatitis is important - because delayed diagnosis might lead to irreversible consequences - to avoid morbidity and mortality, and unnecessary surgery.

The incidence and significance of hyperparathyroidism in patients after bariatric surgery have been established to some degree; however, the impact it has on the national healthcare system has not.We sought to assess the risk of readmission and related comorbidities in this patient population.

The Healthcare Cost and Utilization Project Nationwide Readmission Database was queried for all patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Multivariate logistic regression analysis was conducted to identify factors associated with readmission for hyperparathyroidism.

A total of 915,792 patients between 2010 and 2015 were queried; 43.2% had undergone SG and 56.8% had RYGB. A total of 589 patients were readmitted for hyperparathyroidism; 80.8% were female and 68% had a Charlson comorbidity index≥ 2. Factors associated with readmission were as follows age 45-64 years (odds ratio [OR] 1.42, p=0.001), Medicare (OR 3.01, p<0.001) or Medicaid (OR 2.61, p<0.001) insurance status, lower median household income, renal failure (OR 17.14, p<0.001), hypertension (OR 2.89, p<0.001), and deficiency anemia(OR 2.62, p<0.01).

Parathyroid axis monitoring may provide benefits to predictably high-risk patients. Appropriate surveillance may decrease the impact of bariatric hyperparathyroidism readmission on the U.S. healthcare system.

Parathyroid axis monitoring may provide benefits to predictably high-risk patients. Appropriate surveillance may decrease the impact of bariatric hyperparathyroidism readmission on the U.S. healthcare system.Background and objective Acute pulmonary embolism (APE) is a serious cardiovascular emergency, mainly secondary to deep vein thrombosis (DVT), which causes death. The goal of the current study was to determine the levels of different serum markers in combination among patients with and without acute pulmonary embolism in order to use them as a diagnostic tool. Methodology A sample of 96 patients was kept with a 90% power of study and a 5% level of significance in the current study. It was carried from January to June 2020 in the Department of Medicine, Bahawal Victoria Hospital, Bahawalpur, after the hospital's Ethical Committee approval. find more Written informed consent was taken. Serum levels of C-reactive protein (CRP), D-dimer, fibrinogen, and Troponin-I between both groups were done once enrolled. SPSS software, version 25 (IBM Corp. Armonk, NY) was used to analyze the collected data. Results Patients with acute pulmonary embolism had a mean age of 50.4 ± 10.4 years. All serum markers were significantly raised in patients suffering from acute pulmonary embolism with a p-value of less then 0.05. Conclusion We concluded that all these serum markers can be used together as a tool in making the correct diagnosis of acute pulmonary embolism in our setup.A school-age boy with a complex medical history underwent a minor elective surgical procedure. Propofol was used for sedation during the procedure. The patient could not be awakened post-operatively. Laboratory findings demonstrated metabolic lactic acidosis, leukocytosis with bandemia, and transaminitis. Neuroimaging demonstrated findings that were consistent with hypoxic-ischemic or toxic-metabolic brain injury involving the bilateral basal ganglia, hippocampi, and cerebellum. The patient's condition progressively worsened over the course of the following few weeks, and brain death was confirmed by scintigraphy seven weeks later. Prompt neuroimaging in unresponsive patients with suspected propofol infusion syndrome (PRIS) is of critical importance in detecting neurologic injuries, excluding alternative diagnoses, and determining prognostication.