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David C Lauffer, Peter A Kuhn, Marc Kueng, Sandrine U Thalmann, Géraldine Risse, Pierre-Alain Tercier, Bernhard Egger, Abdelkarim S Allal
[This corrects the article DOI: 10.7759/cureus.2713.].
August 8, 2018: Curēus
Dana A Schinasi, Irini N Kolaitis, Frances M Nadel, Yuemi An-Grogan, Rebekah Burns, Leah Berman, Annie M Quinn, Kathy N Shaw
Background Full disclosure of patient safety events (PSE) is desired by patients and their families, is required by the Joint Commission and many state laws, and is vital to improving patient outcomes. A key barrier to consistent disclosure of patient safety events is a self-reported lack of proper training. Physicians must be trained to recognize when a PSE has occurred and effectively carry out disclosure, all while caring for a patient who is actively experiencing the consequences of an unintended outcome...
August 3, 2018: Curēus
Peter J Tomaselli, Dimitrios Papanagnou, Jonathan E Karademos, Elizabeth Teixeira, Xiao Chi Zhang
Healthcare costs in the United States have skyrocketed over the past decade, contributing to an estimated $750 billion in wasteful spending annually. Despite the demand to improve residency education on value-based, cost-conscious healthcare, there is no consensus on how to best teach this practice. Traditional lectures have failed to demonstrate enduring change in clinical practice patterns, provider attitudes, and reductions in hospital expenditures. We sought to evaluate whether gamification is an effective pedagogical tool to teach cost-consciousness to emergency medicine (EM) residents by creating a 60-minute interactive session based on the popular gameshow, the Price is Right...
August 3, 2018: Curēus
Muniba Fayyaz, Syeda S Jaffery
Progressive multifocal leukoencephalopathy is a fatal demyelinating disease caused by the John Cunningham virus. It causes white matter inflammation in multiple areas of the brain. Although rare, it has been known to occur in patients with immunodeficiency states and those taking chronic immunosuppressive medications for diseases such as multiple sclerosis and psoriasis. In this article, we will discuss about the drug-induced progressive multifocal encephalopathy and its diagnosis and management in patients taking natalizumab and other disease-modifying therapies among patients with multiple sclerosis...
August 3, 2018: Curēus
Gouthami Nalakonda, Mimsa Islam, Vera E Chukwu, Ahmad Soliman, Rujina Munim, Inas Abukraa
The main purpose of this paper is to bring together all the antibodies and markers related to neurological and psychiatric manifestations in systemic lupus erythematosus and also the pharmacology that could help treat these symptoms. Existing research data regarding specific antibodies involved in the disease process and drugs that were being studied was collected and analyzed. After reviewing the studies published by various authors, symptoms were shown to be mainly caused by antibodies against N-methyl-D-aspartate receptor (NMDAR) antibodies, anti-endothelial, anti-ribosomal P, antiphospholipid antibodies, cytokines like interferons and chemokines...
August 3, 2018: Curēus
Askari Hasan, Akriti G Jain, Huda Naim, Alvina Munaf, George Everett
Hemolytic uremic syndrome (HUS) is the triad of nonimmune (Coombs negative) hemolytic anemia, low platelet count, and renal impairment. HUS has been associated with a variety of gastrointestinal malignancies and chemotherapeutic agents. We present a patient with pancreatic cancer treated with gemcitabine for palliation who developed gemcitabine-induced HUS (GiHUS) which responded to some extent to blood and platelet transfusions. With the increase in the use of gemcitabine therapy for pancreatic and other malignancies, it is essential to accurately and timely diagnose GiHUS to avoid the life-threatening complications...
August 2, 2018: Curēus
Claire Isbell, Stephen M Cohn, Kenji Inaba, Terence O'Keeffe, Marc De Moya, Seleshi Demissie, Mira Ghneim, Matthew L Davis
BACKGROUND: In trauma patients with cirrhosis who require laparotomy, little data exists to establish clinical predictors of the outcome. We sought to determine the prognosticators of mortality in this population. METHODS: We performed a 10-year review at four, busy Level I trauma centers of patients with cirrhosis identified during trauma laparotomy. We compared vital signs, laboratory values, and transfusion requirements for those who survived versus those who died...
August 2, 2018: Curēus
Sameer Shaikh, Tara Stratton, Alim Pardhan, Teresa M Chan
Introduction With thousands of new medical trials released every year, health care policymakers must work diligently to incorporate new evidence into clinical practice. Although there are some broad conceptual frameworks for knowledge translation in the emergency department (ED), there are few user-centered studies that illustrate how local policymakers develop and disseminate new policies. Objectives Our study sought to evaluate the process by which new departmental policies are formed in ED, how new evidence was integrated into this process, and to explore barriers to implementation...
August 2, 2018: Curēus
Raja Kalaiarasi, Avvaru Satya Kiran, Chellappa Vijayakumar, Ramakrishnan Venkataramanan, Manusrut Manusrut, Ravi Prabhu
Introduction Facial nerve has the longest and complex course in its bony canal. The anatomical variations make the nerve prone to injury during mastoid surgeries. Having a thorough anatomical knowledge and its variations is must for the surgeons to avoid injury to this vital structure and for the safe surgery. The objective of the study was to describe the anatomical variations of intratemporal portion of facial nerve. Materials and methods The study was conducted in the department of otorhinolaryngology in the temporal bone dissection laboratory of a tertiary health care centre...
August 2, 2018: Curēus
Moustafa Younis, Laith Derbas, Stephen M Eikermann, Majdi S Hamarshi
We present a rare case of rasburicase-induced methemoglobinemia and hemolytic anemia in the setting of presumed glucose-6-phosphate dehydrogenase (G6PD) deficiency. A 78-year-old male with a known history of chronic lymphocytic leukemia presented to the clinic with fever of unknown origin. Laboratory results were significant for hyperuricemia. He was empirically started on levofloxacin and rasburicase. He then presented to the emergency department with shortness of breath and syncope. Physical examination was remarkable for a fever of 102...
August 1, 2018: Curēus
Rama Nassri, Mayssan Muftah, Ammar Nassri, Ahmad Alkhasawneh, Jadranko Corak
Testicular choriocarcinoma is a non-seminomatous germ cell tumor (NSGCT) and is the rarest of all testicular cancers. Nearly all choriocarcinomas can be classified as either pure choriocarcinoma or as a component of a mixed germ cell tumor. Pure testicular choriocarcinoma is extremely aggressive and metastasizes early and extensively. We present a case of testicular cancer that metastasized to the skin, gastrointestinal tract, and brain, and discuss the case in light of the available literature.
August 1, 2018: Curēus
Sorabh Datta, Shanan Mahal, Virendrasinh Ravat, Bipin Saroha, Ehinor E Isidahome, Priya Patel
Objective To evaluate the difference in hospitalization outcomes, including morbidity and mortality among patients admitted for Pneumocystis pneumonia (PCP) with human immunodeficiency virus (HIV) and non-HIV condition. Methods A case-control study was done using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) data. We identified PCP and HIV as the primary and secondary diagnosis using ICD-9--CM diagnosis codes. We used the multinomial logistic regression model to generate odds ratios (OR)...
August 1, 2018: Curēus
Toru Iga, Ken Kato, Tatsuro Karita
A subtrochanteric fracture of the femur accompanying pre-existing osteoarthritis of the ipsilateral hip is rare. A deformity of the hip joint complicates the insertion of the intramedullary nail and varus malreduction is anticipated when surgery is performed on a fracture table with a perineal post. We report a successful case of intramedullary fixation performed in the lateral decubitus position and discuss the importance of avoiding varus and the superiority of the lateral position in surgery.
July 31, 2018: Curēus
Nikhil Kapila, Gianina Flocco, Bo Shen, Jamak Modaresi Esfeh
Vedolizumab is a humanized monoclonal α4β7 integrin antibody used in patients with Crohn's disease (CD) and ulcerative colitis (UC). Limited data are available on the use of vedolizumab in patients with concurrent cirrhosis and inflammatory bowel disease (IBD). Patients with cirrhosis are unique, as they have a predilection for developing opportunistic infections and malignancies. Additionally, it is not known if vedolizumab alters the natural course of cirrhosis. We report our experience in three patients with concomitant CD and cirrhosis, who were treated with vedolizumab...
July 31, 2018: Curēus
Rabjot Rai, Joe Iwanaga, Gaffar Shokouhi, Rod J Oskouian, R Shane Tubbs
The tentorium cerebelli functions as a partition, dispelling the burden of weight from supratentorial structures upon inferior brain matter. Clinicians and neurosurgeons, when assessing pathological findings, should have knowledge regarding the tentorium cerebelli anatomy. This work of literature is a comprehensive review of the tentorium cerebelli, including its anatomy, embryology, and clinical and surgical implications. The evolutionary pattern demonstrates sequential stages to higher mammalian lineage...
July 31, 2018: Curēus
Saif Hassan, Abdul Q Alarhayema, Stephen M Cohn, John C Wiersch, Mitchell R Price
Head injury is the most common cause of neurologic disability and mortality in children. We had hypothesized that in children with isolated skull fractures (SFs) and a normal neurological examination on presentation, the risk of neurosurgical intervention is very low. We retrospectively reviewed the medical records of all children aged six to sixteen years presenting to our Level 1 trauma center with traumatic brain injuries between January 1, 2006 and December 31, 2014. We also analyzed the National Trauma Data Bank (NTDB) research data set for the years 2012-2014 using the same metrics...
July 31, 2018: Curēus
Karthikeyan Gengaimuthu
Standard infection control bundles have not been consistently effective in combating sepsis due to multidrug-resistant organisms (MDROs). Recent trials showing the beneficial effects of probiotics in controlling late-onset sepsis, the so-called "cross-contamination" or "cross-colonization" phenomenon that draws a parallel with the herd immunity concept in vaccinology. This editorial highlights the putative benefits of adapting the vaccinology-based concept using probiotic bacteria in our combat against MDROs...
July 31, 2018: Curēus
Sharon A Clark
The tradition in medical school includes taking the Hippocratic Oath usually at graduation. The purpose of this review is to examine what that oath has been, what forms it currently has, and the implications for physicians in today's healthcare environment. The changes in health economics affect physicians as they try to follow the oath's allegiance to the individual patient's needs. At times, this goal conflicts with the perspective of the financial world's controls of insurance companies and medical groups and institutions...
July 30, 2018: Curēus
Yuanxuan Xia, Leila A Mashouf, Brock R Baker, Russell Maxwell, Chetan Bettegowda, Kristin J Redmond, Lawrence R Kleinberg, Michael Lim
Introduction Brain metastases are common in patients with advanced systemic cancer and often recur despite treatment with surgical resection and radiotherapy. Whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) have significantly improved local control rates but are limited by complications including neurocognitive deficits and radiation necrosis. These risks can be higher in the re-irradiation setting. Brachytherapy may be an alternative method of additional targeted adjuvant radiotherapy with acceptable rates of toxicity...
July 30, 2018: Curēus
Sourabh Verma, Sean M Bailey, Pradeep V Mally, Elena V Wachtel
Therapeutic hypothermia (TH) is provided to newborns with moderate to severe hypoxic-ischemic encephalopathy (HIE) to improve survival and long-term neurodevelopmental outcomes. Although the benefits certainly outweigh the risks associated with therapeutic hypothermia, it is important to be mindful of potential rare side effects in the background of asphyxia-related injury to various body organs. One of those side effects includes subcutaneous fat necrosis (SCFN) that can occur in term newborns after perinatal hypoxia-ischemia or other stressing factors such as systemic hypothermia...
July 30, 2018: Curēus
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