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How much time perform mood induction treatment (MIP) primes really last? Effects with regard to psychological vulnerability study.
BACKGROUND Eye examination in distressed young children can be challenging in a busy emergency department. A full, detailed evaluation is, however, often needed in ocular emergencies. CASE REPORT A 2-year-old boy presented to our pediatric emergency department with refusal to open his left eye for 1 day. Eye examination was difficult and yielded limited findings, despite analgesia and parental facilitation. Under such circumstances, this might require sedation or forcibly everting the child's eyelids for the eye evaluation. A rapid ocular point-of-care ultrasound was performed, which revealed sonographic findings suggestive of a retinoblastoma in the left eye. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? The use of ocular point-of-care ultrasound facilitated the diagnosis of retinoblastoma in a child who was highly distressed and difficult to examine. Its use under such circumstances facilitated the patient's prompt evaluation and subsequent management. BACKGROUND Chyluria is a rare condition where chyle is excreted into the urine. Clinically, most patients manifest with intermittent passage of milky urine. Patients may also present with dysuria, urinary frequency, urgency, retention, or with the sequelae of chronic malnutrition. CASE REPORT We present a 55-year-old African American man who presented to the emergency department complaining of milky white urine, dysuria, decreased urine output, and suprapubic abdominal pain once a day. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? Patients may present to the emergency department complaining of milk-colored urine, hematuria, urinary retention, or the sequelae of malnutrition. Initial evaluations should include laboratory investigations of common causes of chyluria and the severity of the potential malnutrition. If the patient presents with urinary retention, after relieving the obstruction in the emergency department, assessment for clot/chyle burden and likelihood of recurrence of urinary retention should be performed by urology. Arrangements for proper outpatient follow-up should be made if the disease manifestations are not severe enough to warrant admission. BACKGROUND Acute aortic dissection is the most common life-threatening disorder affecting the aorta, and can mimic other disease processes. We describe an unusual presentation of a critically ill patient with initial hematospermia diagnosed with a type A acute aortic dissection. CASE REPORT A 68 year old man presented to a community ED after masturbation and report of blood in his ejaculate, followed by rapid development of severe low back, chest and hip pain with shock. ECG showed evidence of ST segment elevation, but suspicion remained high for thoracic or abdominal aortic catastrophe. Bedside ultrasound demonstrated no pericardial effusion, a severely hypokinetic myocardium and a question of fluid in the left perinephric space. Attempts were made to resuscitate the patient, and an ED chest/abdomen/pelvis CT showed a type A acute thoracic aortic dissection. Unfortunately, the patient remained profoundly unstable, with multiple arrests. He was transferred to a tertiary care facility, but expired shortly after arrival. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? An emergency physician needs to be aware of the myriad of presentations of acute aortic dissection. Although hematospermia was felt ultimately to be an incidental symptom, sexual activity may bring about a significant transient increase in blood pressure, which could contribute to sheer force causing aortic injury. Awareness of this trigger and a careful sensitive history may aid the clinician in early diagnosis. PURPOSE Propensity score matching (PSM) is often used to estimate the average treatment effect among the treated (ATT) using observational data. We demonstrate how the use of "double propensity score adjustment" can reduce residual confounding and avoid bias due to incomplete matching compared with traditional PSM methods. METHODS The DC Cohort is an observational clinical HIV cohort in Washington, DC. We compared the mean percent change in non-high-density lipoprotein cholesterol (non-HDL-C) concentration after 3-12 months between participants treated and participants not treated with statin therapy between 2011 and 2018. We conducted traditional PSM procedures (optimal, nearest neighbor, and nearest neighbor caliper matching) and double propensity score adjustment. RESULTS Among 202 treated and 1252 untreated participants, the ATT was -14.5% (95% CI -18.4, -10.6) after optimal matching (202 matched pairs; 15/22 covariates balanced), -14.9% (-18.9, -11.0) after nearest neighbor matching (202 matched pairs; 17/22 covariates balanced), and -12.0% (-16.5, -7.5) after nearest neighbor caliper matching (153 matched pairs; 21/22 covariates balanced). www.selleckchem.com/autophagy.html After double propensity score adjustment, the ATT was -13.0% (-16.0, -10.1). CONCLUSIONS In PSM analyses, double propensity score adjustment is a readily accessible alternative approach for estimating ATTs when sufficient covariate balance between treatment groups cannot be achieved without excluding treated participants. RATIONALE AND OBJECTIVES To retrospectively analyze the chest imaging findings in patients with coronavirus disease 2019 (COVID-19) on thin-section CT. MATERIALS AND METHODS Fifty-three patients with confirmed COVID-19 infection underwent thin-section CT examination. Two chest radiologists independently evaluated the imaging in terms of distribution, ground-glass opacity (GGO), consolidation, air bronchogram, stripe, enlarged mediastinal lymph node, and pleural effusion. RESULTS Fourty-seven cases (88.7%) had findings of COVID-19 infection, and the other six (11.3%) were normal. Among the 47 cases, 78.7% involved both lungs, and 93.6% had peripheral infiltrates distributed along the subpleural area. All cases showed GGO, 59.6% of which were round and 40.4% patchy. Other imaging features included "crazy-paving pattern" (89.4%), consolidation (63.8%), and air bronchogram (76.6%). Air bronchograms were observed within GGO (61.7%) and consolidation (70.3%). Neither enlarged mediastinal lymph nodes nor pleural effusion were present.
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