Juarezmcgrath1209

Immune thrombocytopenia (ITP) is a rare, acquired bleeding disorder caused by various underlying etiologies. ITP can be triggered by medication, infections, cancers, and autoimmune diseases. One of the rare triggers is vaccination. As in many cases, the symptoms are mild and the cause is idiopathic, and it may not be diagnosed without extensive investigations. It can also be difficult to differentiate between medication-induced thrombocytopenia and ITP, particularly in older patients with multiple comorbidities and receiving multiple medications. Here, we describe an older patient with acute onset ITP following influenza vaccination. selleck An 88-year-old man presented with complaints of systemic itchiness and bleeding from his mouth. Four days prior to the symptoms appearing, he had received an influenza vaccine and did not experience any severe pain or anaphylactic symptoms. On presentation, he had multiple bleeding blisters and systemic petechiae. Blood tests revealed a platelet count of 1000/µL. A month prior, his platelet count was 1.5×105/µL. The blood culture results were negative and a bone marrow biopsy revealed multiple megakaryocytes, without blastocytes or evidence of hemophagocytosis. The patient was diagnosed with influenza vaccine-induced severe ITP and was treated with intravenous high-dose prednisolone. Although vaccine-related ITP is rare, in patients with systemic symptoms, primary care physicians should perform systematic physical examinations to detect any hemorrhage, as ITP is a possibility.Background The incidence of hip fractures is increasing in the current population. It is estimated by the year 2050 around 6.3 million hip fractures may occur per year. Management of hip fractures and replacement surgeries might be associated with substantial blood loss which leads to perioperative anemia. Tranexamic acid is an antifibrinolytic agent that has evidence of reducing blood loss during arthroplasty surgeries. This study aims to evaluate the efficacy and safety of tranexamic acid in patients undergoing hip surgeries. Materials and methods This is a cross-sectional study of the patients during the period of May 2020 to April 2021. Forty-eight patients who underwent hip surgery during this period were taken up for the study. Patients were divided into the following groups group T (n=24) and group P (n=24). Group T received tranexamic acid 10 mg/kg intravenously, as a bolus slowly, 30 minutes prior to skin incision and 1 mg/kg/h intravenous infusion till the closure of skin incision. Group P received tive in reducing intraoperative blood loss and blood transfusion requirement rates. It is also safe and efficacious in patients undergoing hip surgeries.Introduction To compare the healthcare utilization in patients who presented with no pseudomeningocele (PSM) following vestibular schwannoma (VS) surgery (nd-PSM), PSM following VS surgery and required surgical repair (s-PSM) and those who presented with PSM and did not require surgical repair (ns-PSM). Methods MarketScan database was queried using the International Classification of Diseases, ninth and tenth revisions, and current procedural terminology four, from 2000 to 2018. We included patients ≥18 years of age with a PSM diagnosis with at least two years of continuous enrollment. The hospital admissions, outpatient services, medication refills, and associated payments were analyzed. Results Of 1,460 patients, 96.6% (n=1,411) had no PSM following surgery for VS, 2.4% (n=35) were in s-PSM and only 0.95% (n=14) were in ns-PSM cohorts. Patients in the s-PSM cohort incurred higher hospital readmission rate, outpatient payments compared to those in the nd-PSM and ns-PSM cohorts at six months, one-year, and two-years following the following VS resection. At one-year following VS resection, the median combined payments for the s-PSM cohort were $74,683 compared to $42,664 for the ns-PSM and $9,476 for the nd-PSM cohort, p less then 0.0001. Similarly, at two-years, median combined payments for s-PSM cohort were $83,351 compared to $63,942 for ns-PSM and $18,839 for the nd-PSM cohort, p less then 0.0001. Conclusion Patients in the s-PSM cohort incurred eight times and 4.4 times the combined payments at one- and two-years, respectively, compared to the nd-PSM cohort. Also, patients in the ns-PSM cohort incurred 4.5 times and 3.4 times the payments compared to the nd-PSM cohort.Rhegmatogenous retinal detachment (RRD) is a medical eye emergency that can lead to loss of vision, especially if not promptly treated. High myopia, retinal holes or tears, previous surgery, and trauma have been identified as risk factors for developing RRD. Although some obstetricians may believe labor or vaginal delivery increases the risk for RRD, there has been no significant evidence in the literature to support a correlation. This is a case report of a retinal detachment a month after childbirth as experienced by me, an ophthalmologist.The brachial plexus injury is a rare complication after vaccination like that of the Influenza virus. Though a well-known and reported complication, there is still a dearth of literature mentioning its pathophysiology, the trend of involvement, symptoms, and treatment. This has also been reported after the coronavirus disease 2019 (COVID-19) vaccination. To the best of our knowledge, to date, only four cases have been reported so far. Every case needs to be reported to better understand the complication and formulate a line of management for better outcomes. We report a case of brachial plexus involvement after Covishield vaccination with complete recovery after treatment.Spinal discitis (SD) is a rare condition, particularly in the pediatric population. The course of SD may be acute or chronic, and the non-specificity of symptoms leads to great delays in diagnosis. The most commonly isolated causative organism is Staphylococcus aureus whereas gram-negative infections are hardly ever reported in the literature. Comorbidities that increase the risk of bacteremia such as diabetes, chronic kidney disease, HIV, and cancer are major risk factors for SD. Hereby, we present an atypical case of SD in a previously healthy 15-year-old male with an unusual organism, Klebsiella aerogenes, diagnosed by plasma microbial cell-free DNA with negative blood cultures. The clinical course was complicated by antibiotic resistance and subsequent development of a ventral epidural abscess requiring readmission followed by surgical drainage of the abscess with a prolonged course of antibiotics.Secondary hyperkalemic paralysis is a life-threatening manifestation of hyperkalemia seen with a potassium level of 7 or above 7 milliequivalents per liter (Meq/L) in an acute or chronic state. Standard hyperkalemic treatment should be initiated upon diagnosis with emergency dialysis in refractory cases. Here we present the case of a patient with end-stage renal disease (ESRD) compliant with dialysis three times a week. The patient presented with generalized ascending flaccid paralysis and was found to have serum potassium of 9.6 Meq/L. Spontaneous resolution of the paralysis was observed shortly after the completion of one hemodialysis session. The goal of this case report is to raise awareness of a life-threatening complication of electrolyte imbalances in ESRD even in patients that are compliant with dialysis.Background Primary bone and soft tissue sarcoma treatment includes surgical resection, with or without peri-operative chemoradiotherapy. The aim of surgery is to achieve complete excision, to prevent localised recurrence and achieve cure. For various reasons, excision with adequate margins is not always possible. Our aim is to assess the occurrence of unexpected positive margins following primary excision within a tertiary centre and the impact on patient outcomes. Methods A retrospective analysis of 567 patients discussed at the Royal National Orthopaedic Hospital Multi-disciplinary team (MDT) meeting with positive margins between 1999-2020 was performed. Exclusion criteria included excisions performed externally and lesions treated with curettage. Information gathering from electronic records highlighted 23 cases with unexpected positive margins following primary excision. Results All patients pre-operatively expected to achieve complete primary resection. The median age was 60 years (8-92), 10M13F. Tumour patient expectations.Abdominal actinomycosis is a rare disease caused by a Gram-positive bacillus (Actinomyces). Liver manifestation is rare and, in patients with a history of cancer, differential diagnosis with secondary malignant disease can be difficult. Microbiological result is necessary for a correct diagnosis, though not always possible in preoperative workout. The authors present a case of hepatic actinomycosis that mimicked oncological disease and led to a more aggressive surgical approach.In the following report, we document a case of gastroesophageal reflux disease (GERD) emerging from a peculiar etiology. A 20-year-old male presented to the out-patient department (OPD) of ear, nose & throat (ENT) of Dow University Hospital in Karachi, Pakistan, by referral from remote hospitals with a complaint of stomach upset. Upon a detailed historical assessment of the patient, the picture of a convoluted path to diagnosis emerged. Considering the patient's short stature and a bony mass on the mandible, a full body bone scan was ordered, uncovering a brown tumor. An elevated serum parathyroid hormone (PTH) level was detected in the presence of elevated serum calcium and low vitamin D levels. Upon subsequent computed tomography (CT) and magnetic resonance imaging (MRI), a cystic tumor of the pancreas was discovered in addition to a parathyroid adenoma which was promptly operated upon through a right-sided parathyroidectomy. The procedure successfully controlled the serum calcium levels of this patient which are suspected to have produced his gastroesophageal reflux-related symptoms. This case highlights the importance of accessible medical infrastructure and one of the unique causes of GERD.Niemann-Pick disease (NPD) is a rare lysosomal storage disease (LSD) with multisystemic involvement. The disease is heterogeneous and classified into three subtypes type A and B result from deficient acid sphingomyelinase activity and leads to the accumulation of sphingomyelin and type C is a genetically different disease resulting from defective intracellular trafficking of cholesterol with accumulation of glycosphingolipids. Type A is generally a neurodegenerative disease and is fatal in infancy. Type B is a less severe form characterized by pulmonary involvement, hepatosplenomegaly, hyperlipidemia and most patients live into adulthood. In type C, clinical presentation is dominated with neurological involvement. Pulmonary involvement occurs in all three types of Niemann-Pick but most frequently in type B. Clinical manifestations range from a lack of symptoms to respiratory failure, and respiratory symptoms are usually mild with recurrent cough, dyspnoea on exertion and recurrent respiratory infections. Interstitial lung disease (ILD) is the most prominent feature with slow progression, characterized by worsening pulmonary function tests. In recent years, enzyme replacement therapy has shown promising results in clinical trials, such as improvement in organomegaly and pulmonary involvement with the potential to improve patients' lives. We present three cases of NPD with pulmonary involvement, each exhibiting a different pattern of ILD and evaluate therapeutic options.