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Taylor Sawyer, Megan Gray, Melinda Hendrickson, Elizabeth Jacobson, Rachel Umoren
Emergency umbilical venous catheter placement is a critical procedure during newborn resuscitation. Providing training in this high-acuity and low-frequency procedure is important to optimize the skills of newborn resuscitation teams. Available simulators use simulated umbilical cords which are lower in fidelity than real human umbilical cords and may not provide optimal training. This technical report describes the creation and use of a real human umbilical cord simulator model for emergency umbilical venous catheter placement training...
November 5, 2018: Curēus
Huma Zahid, Saira Hassan, Salma Gul, Komal Rizwan, Saif Ullah Khan, Maaz A Maghazi
Young patients presenting with thrombotic events like pulmonary embolism and cardiological phenomenon such as presence of an intracardiac mass, without any underlying risk factors, should be promptly investigated for thrombophilias including antiphospholipid syndrome (APLS). This case is reported to highlight rare occurrence of co-existing bilateral extensive pulmonary embolism and an intra-cardiac mass at presentation of antiphospholipid syndrome as well as progression to near catastrophic APLS.
October 10, 2018: Curēus
Mohammad Adeel, Muhammad Shaheryar Ahmed Rajput, Asif Ali Arain, Maqbool Baloch, Mumtaz Khan
Introduction Ameloblastoma is a locally destructive tumor with a propensity for recurrence if not entirely excised. Management of ameloblastoma poses a challenge for all involved in the field of head and neck surgery because successful treatment requires not only adequate resection but also a functional and aesthetically acceptable reconstruction of the residual defect. Methods Patients who had histologically proven ameloblastoma between 1991 and 2009 were identified from the database of Aga Khan University Hospital...
October 10, 2018: Curēus
Haley M McKissack, Jun Kit He, Tyler P Montgomery, John T Wilson, Aaradhana J Jha, Leonardo V Moraes, Ashish Shah
Metatarsal stress fractures are common injuries of the foot and can be a source of chronic pain without appropriate management. Conservative management is first line, but surgery may be indicated in athletes, cases of nonunion, and fractures of the fifth metatarsal. We report a case of a 34-year-old female who presented to clinic for intractable pain of the left foot secondary to a stress fracture of the left second metatarsal, which had been previously treated with injectable acrylic bone cement. Calcium sulfate hydroxyapatite cement has a multitude of applications in orthopedic surgery, but to our knowledge no studies have documented its use in the treatment of metatarsal stress fractures...
October 9, 2018: Curēus
Darin Gopaul, Dilip Panjwani, Robert F Stephens, Michael Lock
Purpose To evaluate acute and late genitourinary (GU) and gastrointestinal (GI) toxicity and the biochemical control of pure hypofractionated radiotherapy (without acceleration) for the treatment of prostate cancer. Methods and materials This phase II prospective trial evaluated low-risk and intermediate-risk prostate cancer patients who received hypofractionated radiotherapy. Fifty-three patients with low-risk prostate cancer received 50 Gy in 15 fractions, 156 patients with intermediate-risk prostate cancer received 60 Gy in 20 fractions over eight weeks...
October 9, 2018: Curēus
Glenn Goodwin, Dyana Picache, Brian J Louie, Nicholas Gaeto, Tarik Zeid, Paxton P Aung, Armando Clift, Sonu Sahni
Background Despite advances in resuscitation science and public health, out-of-hospital cardiac arrest (OOHCA) cases have an average survival rate of only 12% nationwide, compared to 24.8% of cases occurring in hospital. Many factors, including resuscitation interventions, contribute to positive patient outcomes and have, therefore, been studied in attempts to optimize emergency medical services (EMS) protocols to achieve higher rates of return of spontaneous circulation (ROSC) in the field. However, no consensus has been met regarding the appropriate amount of time for EMS to spend on scene...
October 9, 2018: Curēus
Katherine Bliven, Karisa Snow, Adrian Carlson, Sarah Yeager, Nicole Kenyon, Lonnie Smith, Crystal M Truax, Eryberto Martinez, Jeffrey Campsen
The purpose of this study was to retrospectively evaluate if a change in practice from January 2013 to August 2015 affected the rate of surgical-site infections following kidney transplantation at the single academic medical center. More patients were found to have a surgical-site infection when surgical antibiotics were only given intra-operatively despite a lower incidence of risk factors identified in the literature when compared to the cohort who received antibiotics intra-op and post-op for 24 hours.
October 9, 2018: Curēus
Sakthivel Chinnakkulam Kandhasamy, Anubhav Sangwan, Ashok K Sahoo, Gopalakrishnan Gunasekaran, Neelam Sahani, Thangadurai Ramasamy Raju, Subhashini Puducherry Ravichandran
Cecal leiomyomas are rare benign tumors of smooth muscle arising from the colonic muscularis mucosa or muscularis propria. They are usually asymptomatic in nature and, if symptomatic, may present as pain in the abdomen, intestinal obstruction, or bleeding. In some cases, leiomyoma can cause free perforation leading to peritonitis. Contrast-enhanced computed tomography (CECT) and colonoscopy were the diagnostic modalities used for evaluation. It is extremely unusual for a benign lesion of the cecum to present as a ruptured subcutaneous abscess...
October 9, 2018: Curēus
Shahram Paydar, Nader Moein-Vaziri, Maryam Dehghankhalili, Hossein Abdolrahimzaeh, Shahram Bolandparvaz, Hamid Reza Abbasi
Purpose The aim of the current study was to report the surgical outcome and complications of jejunostomy with enteroenterostomy for enteral nutrition (EN) in critically ill trauma patients with prolonged nasogastric (NG) nutrition. Methods This cross-sectional study was carried out in a level I trauma center in Shiraz, southern Iran during a one-year period from 2016 to 2017. We included a total number of 30 patients with severe trauma admitted to the intensive care unit (ICU) with more than three months NG nutrition and bowel atrophy...
October 9, 2018: Curēus
Auerilius E Hamilton, Angad Singh, Kirk K Austin, JooShik Shin, Jonathan S Hong
This report is of a rare case involving a 27-year-old female who presented to the hospital with the pathological couplet of colocolic intussusception and cecal bascule causing bowel obstruction. Up to the time of presentation to the hospital, this patient had not undergone a full investigation for a known iron deficiency, anemia. Subsequently, during the emergency admission and after having an operative surgical procedure, the patient was found to have both a congenitally malpositioned cecum and a benign colonic polyp-forming condition...
October 9, 2018: Curēus
Jiunn Loong L Ling, Koon Ling Koh, Evelyn Tai, Zakariah Sakinah, Yusof Nor Sharina, Adil Hussein
In human, sporotrichosis infection commonly manifests as skin lesions through direct inoculation. It is rarely associated with ocular manifestation via a zoonotic transmission. We describe a young lady who presented with acute left eye granulomatous conjunctivitis who had a history of exposure to her sick cat diagnosed with sporotrichosis infection. Sporothrix schenckii was isolated from the culture of the excised conjunctival tissue. The patient recovered fully after six months of oral anti-fungal treatment...
October 8, 2018: Curēus
Konstantinos Koutsouflianiotis, George K Paraskevas, Eleni Zagelidou, Katerina Dimakopoulou, George Noussios
Nikolai Ivanovich Pirogov is considered one of the most important anatomists and surgeons in the history of medicine. The Russian physician conducted more than 11,000 dissections and meticulously studied human anatomy, discovering important anatomical regions such as Pirogov's triangle. Pirogov developed surgical methods and techniques used by physicians for many decades such as Pirogov's amputation. Pirogov is also known for his contribution to war medicine, given his experience practicing medicine in the Crimean War as a surgeon, where he introduced innovative methods for the treatment of injured soldiers...
October 8, 2018: Curēus
Clement D Marshall, Maureen E Fay, Brian Phillips, Robert Faurote, Jamie Kustudia, Ryan C Ransom, Christine Henley, Lisa DiConstanzo, Jeffrey K Jopling, Adam X Sang, David A Spain, Julie A Tisnado, Thomas G Weiser
Introduction Patient care in the trauma-surgical intensive care unit (SICU) requires trust and effective communication between nurses and physicians. Our SICU suffered from poor communication and trust between nurses and physicians, negatively impacting the working environment and, potentially, patient care. Methods A SICU Task Force studied communication practices and identified areas for improvement, leading to several interventions. The daily physician rounding was altered to improve communication and to enhance the role of the registered nurses (RN) in rounds...
October 8, 2018: Curēus
Sardar H Ijaz, Shakeel M Jamal, Rehan Qayyum
Background The hormones of the hypophysis-thyroid axis (HTA), thyroid stimulating hormone (TSH), and thyroid hormones, L-thyroxine (T4) and 3, 3', 5-L-triiodothyronine (T3), modulate the metabolism, differentiation, and proliferation of almost every cell in the body. Several studies have examined the effect of HTA hormones on platelet count and mean platelet volume (MPV), but have reported inconsistent results. Our aim was to examine the association between HTA hormones and platelet count and MPV in a large cohort of the adult population of the United States...
October 8, 2018: Curēus
Jennifer Dotson, Heather Katz, Hassaan Jafri, Muhammad Omer Jamil, Kara S Willenburg
Disseminated Nocardia infections are a rare occurrence that typically occur in immunocompromised hosts. Chronic lymphocytic leukemia (CLL) is a hematologic malignancy which makes patients susceptible to infections through various mechanisms. The treatments for CLL also target immunologic pathways which can contribute to infections. Ibrutinib is a commonly utilized tyrosine kinase inhibitor for CLL which targets the Bruton tyrosine kinase pathway. Although it is generally well tolerated, patients sometimes experience infections while on this medication, however, opportunistic infections are unusual...
October 8, 2018: Curēus
Edward Florez, Todd Nichols, Ellen E Parker, Seth T Lirette, Candace M Howard, Ali Fatemi
Purpose The definition of radiotherapy target volume is a critical step in treatment planning for all tumor sites. Conventional magnetic resonance imaging (MRI) pulse sequences are used for the definition of the gross target volume (GTV) and the contouring of glioblastoma multiforme (GBM) and meningioma. We propose the use of multiparametric MRI combined with radiomic features to improve the texture-based differentiation of tumor from edema for GTV definition and to differentiate vasogenic from tumor cell infiltration edema...
October 8, 2018: Curēus
Sadiq Naveed, Amber E Faquih, Amna Mohyud Din Chaudhary
Pregabalin is used for the treatment of neuropathic pain, partial seizures, generalized anxiety disorder, social anxiety disorder, and insomnia. The discontinuation symptoms of pregabalin are mild to moderate which resolve in about one week after the discontinuation of pregabalin. This case report describes the withdrawal symptoms in a 62-year-old patient despite a slow titration over a period of several weeks. It highlights the importance of cautious monitoring of withdrawal symptoms during the period of taper...
October 8, 2018: Curēus
Yasir J Khattak, Ayman A Sibaie, Muhammad Anwar, Raza Sayani
Subarachnoid hemorrhage due to a ruptured cerebral aneurysm is a disastrous event accounting for approximately 5%-15% of all stroke cases and has a high mortality rate. One of the major goals in the management of these patients is to prevent rebleeding by securing the aneurysm either surgically or by endovascular means. Endovascular treatment is considered the first line of treatment for intracranial aneurysms; however, wide-neck aneurysms (WNAs) are specifically difficult to treat by endovascular means due to the difficulty in achieving a stable coil mass inside the aneurysm sac...
October 5, 2018: Curēus
Katherine Buddemeyer, Haley M McKissack, Chason Farnell, Joseph X Robin, Morad Qarmali, Chandan R Basetty, Perry Washburn, Leonardo V Moraes, Ashish Shah
Leiomyomas are benign tumors of smooth muscle origin. They are most commonly found in the uterus, but cutaneous leiomyomas may be occasionally present in the extremities and cause pain secondary to mass effect. Few studies have reported leiomyoma of the foot, and leiomyoma of the heel is particularly rare. We present a case of a 41-year-old female who presented to our clinic for a tender nodule on the posterior aspect of her right heel. The tumor was surgically excised and biopsied revealing cutaneous leiomyoma...
October 5, 2018: Curēus
Raghavendra L Girijala, Ruth L Bush
Lower extremity amputation is one of the most unfortunate, yet preventable, consequences of uncontrolled lower limb ischemia occurring secondary to diabetes mellitus or peripheral arterial disease. In the United States, racial and socioeconomic disparities are associated with significant differences seen in the incidence and type or level of lower extremity amputation among patients. Due to shifting demographics and the uncertain state of healthcare coverage, lower extremity amputation rates are only projected to increase in the future...
October 5, 2018: Curēus
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