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Clinics and Practice

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https://www.readbyqxmd.com/read/28959388/a-rare-presentation-of-cryptococcal-meningoencephalitis-in-an-immunocompetent-individual
#1
Ashwin Malhotra, Qin Rao, Sean Kelly, Danielle Schwartz, Robert Chow
Cryptococcal meningoencephalitis is a leading of morbidity and mortality in immunocompromised individuals worldwide. However, there are few documented cases in immunocompetent patients. We present a rare case of disseminated Cryptococcus with progression to meningoencephalitis in an immunocompetent patient, with a possible atypical presentation. Magnetic resonance imaging of the brain and electroencephalogram to rule out brain metastasis were negative. Lumbar puncture resulted positive for Cryptococcus neoformans antigen at titers of 1:2048 and a detailed history later revealed occupational exposure to bird dander by cleaning floors and cages...
September 15, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28928914/reducing-radiation-exposure-in-an-electrophysiology-lab-with-introduction-of-newer-fluoroscopic-technology
#2
Munish Sharma, Koroush Khalighi
The use of fluoroscopic devices exposes patients and operators to harmful effects of ionizing radiation in an electrophysiology (EP) lab. We sought to know if the newer fluoroscopic technology (Allura Clarity) installed in a hybrid EP helps to reduce prescribed radiation dose. We performed radiation dose analysis of 90 patients who underwent various procedures in the EP lab at a community teaching hospital after the introduction of newer fluoroscopic technology in June of 2016. Watchman device insertion, radiofrequency ablation procedures, permanent pacemaker (PPM)/implantable cardioverter defibrillator (ICD) placement and battery changes were included in the study to compare radiation exposure during different procedures performed commonly in an EP lab...
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28855978/a-case-of-shunting-postoperative-patent-foramen-ovale-under-mechanical-ventilation-controlled-by-different-ventilator-settings
#3
Claudio Pragliola, Sara Di Michele, Domenico Galzerano
A 56-year old male with ischemic heart disease and an unremarkable preoperative echocardiogram underwent surgical coronary revascularization. An intraoperative post pump trans-esophageal echocardiogram (TOE) performed while the patient was being ventilated at a positive end expiratory pressure (PEEP) of 8 cm H2O demonstrated a right to left interatrial shunt across a patent foramen ovale (PFO). Whereas oxygen saturation was normal, a reduction of the PEEP to 3 cm H2O led to the complete resolution of the shunt with no change in arterial blood gases...
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28839528/hemochromatosis-as-junctional-tachycardia-a-rare-presentation
#4
Ali Ghani, Irfan Ahsan, Charles Gottleib
We present here a 45-year-old male with no past medical problem who presented with palpitations. He was found to have supraventricular tachycardia intractable to medical therapy. Later his rhythm converted to junctional tachycardia. Further workup revealed hemochromatosis to be primary etiology causing the arrhythmia. The low index of suspicion for additional workup is key to diagnosis and successful outcome.
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28839527/a-new-imaging-tool-for-realtime-measurement-of-flow-velocity-in-intracranial-aneurysms
#5
Athanasios K Petridis, Marius Kaschner, Jan F Cornelius, Marcel A Kamp, Angelo Tortora, Hans-Jakob Steiger, Bernd Turowski
With modern imaging modalities of the brain a significant number of unruptured aneurysms are detected. However, not every aneurysm is prone to rupture. Because treatment morbidity is about 10% it is crucial to identify unstable aneurysms for which treatment should be discussed. Recently, new imaging tools allow analysis of flow dynamics and wall stability have become available. It seems that they might provide additional data for better risk profiling. In this study we present a new imaging tool for analysis of flow dynamics, which calculates fluid velocity in an aneurysm (Phillips Electronics, N...
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28839526/primary-breast-lymphoma-a-case-report-and-review-of-the-literature
#6
Kamal E H Mohamed, Rusha A E Ali
Primary breast lymphoma (PBL) represents 0.04-0.5% of all malignant breast tumors, <1% of all patients with non-Hodgkin's lymphomas and 1.7-2.2% of all patients with extra nodal lymphomas. Despite the high prevalence of breast cancer, primary breast lymphoma is very rare. We report a rare case of PBL, successfully treated with surgery, chemotherapy and radiotherapy. This is the first case of PBL to be reported from Sudan to our knowledge.
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28811871/do-all-patients-with-atrial-fibrillation-need-long-term-anticoagulation
#7
Munish Sharma, Rohit Masih, Daniel A N Mascarenhas
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide with an estimated number of 2.7-6.1 million cases in the United States (US) alone. The incidence of AF is expected to increase 2.5 fold over the next 50 years in the US. The management of AF is complex and includes mainly three aspects; restoration of sinus rhythm, control of ventricular rate and prevention of systemic thromboembolism. AF as a cause of systemic embolization has been well known for many years, and majority of patients are on oral anticoagulants (OACs) to prevent this...
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28808520/gallstone-ileus-dilemma-in-the-management
#8
Girish D Bakhshi, Rajesh G Chincholkar, Jasmine R Agarwal, Madhukar R Gupta, Prachiti S Gokhe, Amogh R Nadkarni
Gallstone ileus is a mechanical intestinal obstruction caused due to impaction of a large gallstone within the bowel. The ideal treatment of gallstone ileus remains controversial, with the main dilemma being between a one-stage and a two-stage surgical procedure. A 69-year old male patient presented with gallstone ileus. A one-stage procedure with enterolithotomy and primary closure of duodenal fistula was done. His immediate postoperative recovery was uneventful, but after 3 weeks of surgery, he developed respiratory complications and expired of multi-organ failure...
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28808519/rectus-sheath-hematoma-associated-with-apixaban
#9
Kulothungan Gunasekaran, Amanda R McFee Winans, Swetha Murthi, Mudassar Raees Ahmad, Scott Kaatz
Apixaban is an oral anticoagulant that directly inhibits Factor Xa and is indicated for the prophylaxis and treatment of deep venous thrombosis and stroke prevention in non-valvular atrial fibrillation. Rectus sheath hematoma is a rare, life-threatening complication of anticoagulant treatment. We describe a case of an elderly patient on apixaban for the treatment of deep venous thrombosis who developed severe abdominal pain during hospitalization. Computed tomography of the abdomen revealed left rectus sheath hematoma...
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28791083/epidemiology-of-first-epileptic-seizures-in-the-northern-aegean-island-of-lesvos-greece
#10
Anastasia Verentzioti, George Stranjalis, Theodosis Kalamatianos, Anna Siatouni, Damianos E Sakas, Stylianos Gatzonis
We aimed at establishing the epidemiologic profile of first epileptic seizures (FES) in the Greek island of Lesvos. During a 1-year period (01/06/2010 to 31/05/2011), cases of FES admitted to the Lesvos General Hospital/addressed by general practitioners/private neurologists were prospectively identified. A total of 45 cases (30 males and 15 females; mean age ± SD of 59.4 ± 28.4 and 58.9 ± 26.8 years, respectively), were collected. The FES incidence rate was 52.1 (95% CI 37-67) per 10(5) persons. Provoked and unprovoked FES had an incidence of, 16...
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28652909/a-case-of-hypoglycemiainduced-qt-prolongation-leading-to-torsade-de-pointes-and-a-review-of-pathophysiological-mechanisms
#11
Faris Hannoodi, Hashim Alwash, Kushal Shah, Israa Ali, Sarwan Kumar, Khalid Zakaria
Torsades de pointes is a life-threatening cardiac arrhythmia. Occurrence of this arrhythmia as a result of hypoglycemia has not been reported in the literature. We describe an interesting case of an insulin-dependent diabetic patient presenting with torsades de pointes resulting from hypoglycemia. A 62-year-old male was admitted to the hospital following an episode of severe insulin-induced hypoglycemia and a cardiac arrest. He was found to unresponsive at home after taking insulin. His serum glucose was found to be 18...
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28626546/o-blood-group-as-a-risk-factor-for-helicobacter-pylori-igg-seropositivity-among-pregnant-sudanese-women
#12
Gasim I Gasim, Abdelmageed Elmugabil, Hamdan Z Hamdan, Duria A Rayis, Ishag Adam
The objective was to investigate the prevalence and the association between blood groups and Helicobacter pylori IgG seropositivity among pregnant Sudanese women. A cross-sectional survey was carried-out at Saad Abul Ela Maternity Hospital, Khartoum, Sudan during the period of July 2014 through December 2015. Questionnaires covering socio-demographic and obstetrics information were administered. Specific H. pylori IgG antibody was analysed using ELISA. One hundred eighty six pregnant women were enrolled. The mean (SD) of the age, parity was 28...
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28626545/case-of-acute-st-segment-elevation-myocardial-infarction-in-infective-endocarditis-management-with-intra-coronary-stenting
#13
Ghulam Murtaza, Zia Ur Rahman, Puja Sitwala, Vatsal Ladia, Bhavesh Barad, Kais Albalbissi, Timir K Paul, Vijay Ramu
Embolic events from infective endocarditis can cause acute coronary syndrome. Mortality rate is high and optimal management might be different from those chosen in setting of classic atherosclerotic coronary artery disease. We present a case of 56-year-old male who had received 5 weeks of antibiotics for aortic valve endocarditis and developed acute ST segment elevation myocardial infarction in hospital settings. Interestingly, patient had recent left heart catheterization that was normal. This was recognized as embolic event from sterile vegetation...
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28567237/level-of-headaches-after-surgical-aneurysm-clipping-decreases-significantly-faster-compared-to-endovascular-coiled-patients
#14
Athanasios K Petridis, Jan F Cornelius, Marcel A Kamp, Sina Falahati, Igor Fischer, Hans Jakob Steiger
In incidental aneurysms, endovascular treatment can lead to post-procedural headaches. We studied the difference of surgical clipping vs. endovascular coiling in concern to post-procedural headaches in patients with ruptured aneurysms. Sixty-seven patients with aneurysmal subarachnoidal haemorrhage were treated in our department from September 1(st) 2015 - September 1(st) 2016. 43 Patients were included in the study and the rest was excluded because of late recovery or high-grade subarachnoid bleedings. Twenty-two were surgical treated and twenty-one were interventionally treated...
April 6, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28567236/emphysematous-cystitis-mortality-risk-factors-and-pathogens-of-a-rare-disease
#15
Andreas Schicho, Christian Stroszczynski, Philipp Wiggermann
Although high mortality rates have been reported for emphysematous pyelonephritis (EP), information on emphysematous cystitis (EC), which is less common, is sparse. Here, we report one new case of severe EC and 136 cases of EC that occurred between 2007 and 2016, and review information about the characteristics, diagnosis, treatment and mortality of these patients, and the pathogens found in these patients. The mean age of the 136 patients was 67.9±14.2 years. Concurrent emphysematous infections of other organs were found in 21 patients (15...
April 6, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28567235/investigating-idiopathic-inflammatory-myopathy-initial-cross-speciality-experience-with-use-of-the-extended-myositis-antibody-panel
#16
Antoinette O'Connor, Jennifer Mulhall, Sinead M J Harney, John G Ryan, Grainne Murphy, Michael T Henry, Peter Annis, Vincent Tormey, Aisling M Ryan
The discovery of unique autoantibodies has informed and altered our approach to the diagnosis and management of the inflammatory myopathies. This study reports the initial clinical experience of use of the Extended Myositis Antibody (EMA) panel in the largest university teaching hospital in Ireland. We conducted a retrospective review of all patients who had serum samples tested for myositis specific antibodies and myositis associated antibodies from April 2014 to March 2015. A positive EMA panel was of significant clinical utility in facilitating decisions on appropriate investigations, and need for onward referral to other physicians...
April 6, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28484587/reducing-error-in-anticoagulant-dosing-via-multidisciplinary-team-rounding-at-point-of-care
#17
Munish Sharma, Mahesh Krishnamurthy, Richard Snyder, James Mauro
The incorporation of a clinical pharmacist in daily rounding can help identify and correct errors related to anticoagulation dosing. Inappropriate anticoagulant dosing increases the risk of developing significant bleeding diathesis. Conversely, inappropriate dosing may also fail to produce a therapeutic response. We retrospectively reviewed electronic medical records of 41 patients to confirm and analyze the errors related to various anticoagulants. A clinical pharmacist in an integrated rounding between the period of February 2016 and April 2016 collected this data...
April 6, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28484586/bilateral-chylothorax-complicating-a-case-of-chronic-lymphocytic-leukemia-a-case-report
#18
Munish Sharma, Divakar Sharma
Chylothorax occurs when lymphatic fluid leaks from the thoracic duct and accumulates in the pleural space. Bilateral chylothorax caused by chronic lymphocytic leukemia (CLL) has been rarely reported in the literature. Sludging of lymph might be the underlying cause. We present a case of bilateral chylothorax in a patient with CLL.We also briefly discuss etiology, possible pathogenesis in our case along with diagnostic options and treatment modalities.
April 6, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28484585/disappearance-of-electrocardiographic-abnormalities-associated-with-the-arrhythmic-pattern-of-a-barlow-disease-after-surgical-mitral-valve-repair
#19
Matteo Augello, Luca Lanzarini
We describe the case of a 46-year old female with a Barlow's disease (MVP) characterized by systolic curling of posterior left ventricular (LV) wall + significant mitral annular disjunction + complex ventricular arrhythmias + syncope + inverted T waves in inferolateral leads in whom a successful surgical mitral valve rapair determined the disappearance not only of the echocardiographic but also the electrocar-diographic abnormalities (in particular the inferolateral T waves inversion on basal electrocardiogram and the complex basal arrhythmic pattern)...
April 6, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28484584/etiology-and-laboratory-abnormalities-in-bacterial-meningitis-in-neonates-and-young-infants
#20
David Kotzbauer, Curtis Travers, Craig Shapiro, Margaux Charbonnet, Anthony Cooley, Deborah Andresen, Gary Frank
We conducted a retrospective review of electronic medical records of all cases of bacterial meningitis in neonates and young infants at our institution from 2004 to 2014. Fifty-six cases were identified. The most common causative organism was group B streptococcus, followed by Escherichia coli and then Listeria monocytogenes. Forty-four of the 56 patients in the study had abnormalities of the blood white blood cell (WBC) count. The most common WBC count abnormalities were leukopenia and elevation of the immature to total (I:T) neutrophil ratio...
April 6, 2017: Clinics and Practice
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