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Clinical Registered nurse Specialist Increases in order to Situation Operations Position Through COVID-19 Crisis.
A 73-year-old man with a history of hypertension was referred to our department because of progressive frailty while being treated for acute heart failure. Physical examination revealed loss of tendon reflexes in the lower extremities and muscle weakness in all extremities. After close examination, he was diagnosed with Guillain-Barre syndrome (GBS), which was preceded by a Mycoplasma pneumoniae infection. He was given high-dose intravenous immunoglobulin (IVIg) therapy, and his muscle weakness improved. This case suggests that symptoms of neurological disorders in the elderly may be viewed as frailty. Being elderly is a poor prognostic factor for GBS; therefore, early diagnosis and consultation with a neurologist are necessary. Physical examination is essential to differentiate frailty from neurological disorders, and deep tendon reflexes are instrumental in making a diagnosis of GBS.Postpartum ovarian vein thrombosis (POVT) is an uncommon cause of postpartum fever. Because POVT is sometimes complicated by pulmonary embolism, preventing diagnostic delay is critical. Nonetheless, the diagnostic delay of POVT is common due to its rarity. Antibiotics along with anticoagulants are recommended as the standard therapy for POVT, but this recommendation is based on older, low-quality literature. Here, we present a case of POVT, presenting with a persistent postpartum fever, which was treated by anticoagulants without antibiotics. Our case highlights the importance of awareness of POVT as a differential diagnosis and the need for studies to investigate the role of antibiotics in POVT.Mesotheliomas are a rare malignancy of the serosal membrane. Mainly it affects the pleural surfaces followed by the second most common location, "peritoneum." The disease follows an aggressive pattern of spread, and by the time the diagnosis is established, the condition significantly spreads to distant locations. Diagnosis of malignant peritoneal mesothelioma is typically made by tissue biopsy. The standard treatment is radical resection; however, patients have benefited from several other modalities. The current case report describes a unique case of malignant mesothelioma, biphasic peritoneal mesothelioma (BPM), which comprises less than 25% of all peritoneal mesotheliomas. The diagnosis and treatment do not differ from other subtypes; however, the prognosis is poor, and if untreated, the survival is typically less than six months.Hospital-acquired infections are nosocomially acquired infections that are not present or incubating at the time of admission to a hospital. During the COVID-19 pandemic, many hospitals became sources of the infection, creating a great challenge for health care providers and uninfected patients who visited these hospitals seeking medical or surgical advice. We are presenting a middle-aged man who complained of abdominal pain associated with poor oral intake during the COVID-19 pandemic in January 2021. After being diagnosed with a perforated duodenal ulcer, he underwent laparoscopic repair. He was postoperatively referred to interventional radiology for central line insertion. However, as one of the pre-procedure perquisites during the COVID-19 pandemic, he underwent a nasopharyngeal swab real-time PCR test, which was positive for COVID-19 infection to be considered hospital-acquired. This article shows how the pandemic may complicate the post-surgical condition, increasing patient morbidity and mortality.Pyoderma gangrenosum (PG) is a rare inflammatory skin disease of unknown origin. As with other vaccines, COVID-19 vaccines have been associated with many cutaneous reactions. Although COVID-19 vaccination is crucial, it is important for dermatologists and other physicians to be aware of the possible cutaneous reactions that can occur following COVID-19 vaccination. In this report, we describe a 73-year-old woman with a personal history of PG who experienced a recurrence after receiving her second dose of the tozinameran vaccine. Although extremely rare, flares of other inflammatory dermatoses, including lichen planus, have been reported following COVID-19 vaccination. Here we discuss the overlap in pathogenesis of PG and COVID-19, proposing possible mechanisms behind this rare phenomenon.For individuals with mild-to-moderate coronavirus disease 2019 (COVID-19, caused by severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]), monoclonal antibodies (MOABs) are known to prevent progression of the disease and hospitalization. Pregnant women, who are at an increased risk of severe COVID-19 infection, have been significantly underrepresented in studies for MOAB treatments, especially sotrovimab. Specifically, there has only been one case reported of a pregnant woman using sotrovimab successfully. We report a second such patient - an unvaccinated 21-year-old, COVID-19-positive, 16-week pregnant woman who was followed closely over the next 60 days post-MOAB infusion. We noted prevention in the progression of the disease and hospitalization without any fetal/pregnancy-related complications.We present a case of a 46-year-old female presenting with syncope. Echocardiography initially showed a right atrial mass. Further evaluation revealed a mass arising from the fundus of the uterus, with a tumor thrombus in the left gonadal vein, extending into the left renal vein and through the inferior vena cava (IVC) into the right heart across the tricuspid valve. She was managed with surgical resection, and postoperative pathology was consistent with intravenous leiomyomatosis (IVL). IVL is a rare uterine smooth muscle cell neoplasm which extends into the venous system. Gynecological tumors are often overlooked in differential diagnosis for atrial masses. A benign tumor like fibroid, in rare circumstances, can extend into the right side of the heart causing dynamic obstruction to outflow tract, thus increasing mortality. The objective of this article is to present such a case and highlight the broad differentials of atrial masses, including IVL.A wide variety of social determinants of health have been associated with various risks and impacts on quality of life. Specifically, poverty, lack of insurance coverage, large household sizes, and social vulnerability are all factors implicated in incidence and mortality rates of infectious disease. However, no studies have examined the relationship of these factors to the COVID-19 pandemic on a state-wide level in Florida. Thereby, the objective of this study is to examine the relationship between average household size, poverty, uninsured populations, social vulnerability index (SVI), and rates of COVID-19 cases and deaths in Florida counties. The objective was accomplished by analyzing the cumulative case and death reports from state and local health departments in Florida. The data was compiled into a single dataset by the CDC COVID-19 Task Force. Using US Census Bureau data, all Florida counties were classified into tertiles of the separate categories of poverty rate, average household size, uninsured rhe high poverty counties were markedly higher in Florida than the national average. In contrast, moderate and low poverty rates were below average. Similarly, counties with a high SVI had case and mortality rates greatly above state and national averages. Counties with a high proportion of uninsured displayed the highest case rates. However, mortality rates were the highest in counties with a low proportion of uninsured individuals. No clear correlation was observed between COVID-19 rates and household size. It was concluded that compiled CDC and US census data suggests a significant correlation between poverty, social vulnerability, lack of insurance coverage, and increased incidence and mortality from COVID-19. Future research should statistically analyze the correlations and examine the individual factors of SVI as potential COVID-19 predictors.Ocular trauma is a major cause of visual impairment. Corneal injuries can range from minor and insignificant to major and vision-threatening. This report describes the case of a healthy 21-year-old soldier who presented to the emergency department with a major ocular trauma to his left eye caused by a bayonet. The bayonet had penetrated the cornea and reached the anterior chamber. see more Under general anesthesia, we washed the anterior chamber, filled it with viscoelastic, and sutured the trauma. Visual acuity was 10/10 in his left eye after the surgery. We report this case because there is a limited number of patients with penetrating corneal bayonet injuries reported in the literature and to emphasize the importance of immediate and correct treatment for a good visual outcome.Atypical hemolytic uremic syndrome (HUS) is a part of a large category of diseases known as thrombotic microangiopathies that present with hemolytic anemia, thrombocytopenia, and target organ damage mostly characterized by acute kidney injury. It is a rare and challenging diagnosis due to the complex pathophysiology underlying the disease and its overlap with other conditions. We report the case of atypical hemolytic uremic syndrome in a 61-year-old female with a history of metastatic peritoneal serous carcinoma of the ovary presenting with anemia and acute renal failure.Chronic aspiration bronchiolitis or diffuse aspiration bronchiolitis is a rare disease characterized by chronic inflammation of the bronchioles due to recurrent aspiration of foreign material. To date, there are limited data on chronic aspiration bronchiolitis because it is often present subclinically or remains undiscovered until autopsy. Additionally, time to diagnosis is often prolonged and includes invasive workup prior to definitive diagnosis. Here, we present a case of lung disease attributed to chronic aspiration after a thorough workup resulted in histopathology consistent with a primary diagnosis of aspiration bronchiolitis. Radiographic and pathologic specimens also demonstrated features of usual interstitial pneumonia adding to the complexity of pathology that can be seen with aspiration diseases.Celiac artery compression syndrome is a rare and poorly understood condition. Compression of the celiac artery by the median arcuate ligament causes intractable nausea, vomiting, and postprandial pain. We present a case of a 55-year-old male with a 50-pound unintentional weight loss and intractable vomiting, whose symptoms persisted despite robotic median arcuate ligament release. He later returned to the emergency department where he was found to have a low gallbladder ejection fraction on imaging indicative of biliary dyskinesia, for which he underwent a cholecystectomy. Eventually, his symptoms improved, and he was able to return to his baseline body weight.Hemoglobin D (Hb D), a variant of hemoglobin appears in a few Asian individuals belonging to India, Pakistan, Iran, Iraq, and other parts of the world. In India, it is mainly reported in the North-Western states. Hb D disease causes subclinical jaundice, or it may be asymptomatic with pallor in its heterozygous form. Being a country with hunger and poverty, pallor is always attributed to iron deficiency anemia, but one should not miss out on various other causes. Here, we report a rare case of Hb D with iron deficiency anemia in a 13-year-old child of South Indian origin (Tamil Nadu) and emphasize the detailed evaluation of cases with severe pallor. He presented with gradually progressing generalized weakness with easy fatigability for the past four weeks. On examination, he was pale, there was no icterus and systemic examination was normal. Investigation revealed a microcytic hypochromic type of anemia. Hb electrophoresis showed the Hb D-Punjab variant. Iron indices were suggestive of iron deficiency anemia.
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