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Ultimately, the patient was discovered to have right-sided femoral-popliteal occlusion, and she required urgent femoral-tibial bypass. Despite an initial improvement in symptoms postoperatively, she continued to have lower extremity pain and recurrent arterial thrombi, even with antiplatelet and anticoagulation therapy. Eventually, the patient required a right-sided below the knee amputation. This case highlights the high index of suspicion that clinicians must have in young patients with lower extremity pain, both with and without atherosclerotic risk factors, as early intervention facilitates better outcomes. Introduction.A complicated alcohol withdrawal syndrome (AWS) includes epileptic seizures and/or delirium tremens (DT). However, there is still a dearth of literature for catatonia as a consequence of AWS especially in terms of clinical reports. Secondly, the few noted reported cases in the literature were mainly of non-American populations. Hence, we present the case of a middle-aged woman with no past psychiatric history admitted for psychosis and altered sensorium with delayed catatonic features in the context of a history of alcohol use disorder. Ms. selleck compound M., a 44-year-old African American female with no past psychiatric history but a past medical history of gastric bypass surgery, presented to the psychiatric emergency department via emergency medical service due to roaming the street because of acute onset of altered mental status and psychotic features. She had a Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA) score of 33 following last alcohol use a few hours prior to presentation. While on the inpatient unit, the patient had an isolated episode of catatonic stupor despite being administered lorazepam 2mg every four hours as needed. Supportive medical staff should also be aware of catatonia as a rare manifestation of alcohol withdrawal. A persistent, thorough medical workup and evidence-based "investigative" history gathering can help elucidate the source of the presenting symptom in this patient population.Iron deficiency is a well-known cause of anemia. However, it is an under-recognized cause of venous thromboembolism (VTE). Iron deficiency predisposes to VTE mainly by inducing thrombocytosis, which can lead to a hypercoagulable state. Identifying iron deficiency as a possible cause of thromboembolic phenomena has clinical significance since this is a potentially avoidable risk factor. This case report serves as a reminder that iron deficiency is an important risk factor for VTE that should be considered in the evaluation of patients. This is particularly true in patients like ours who have recurrent venous thromboembolic disease.Background The medical community's understanding of the novel coronavirus disease (COVID-19) was limited initially, and many laboratory investigations were performed to observe effects of the virus on the body, its complications, and outcomes. We observed that some laboratory investigations provided redundant information regarding outcomes, and, therefore, were not necessary. Therefore, the extent of laboratory investigations may need to be pared down to not only avoid issues related to repeated blood sampling but also to minimize the financial burdens in poor socioeconomic countries. Objective This study aimed to observe trends of clinical and laboratory values in COVID-19 patients and their relationship to outcomes, including disease severity, length of hospital stay, and mortality. Methods We conducted an observational cohort study of COVID-19 patients treated as inpatients at the Shifa International Hospital (SIH) in Islamabad in April 2020. Patients were included if they were nonsurgical, adult inpatient the height of symptoms and oxygen saturations less then 80% on admission was associated with prolonged hospital stays. Two complete blood count (CBC) parameters (platelet counts and mean corpuscular volume, MCV) were strongly associated with mortality and severity in our patients. Four non-CBC parameters (alanine transaminase, ALT; D-dimer; C-reactive protein, CRP; and lactate dehydrogenase, LDH) had strong statistical impact on disease severity, length of hospital stay, and mortality in our patients. Conclusion In a resource-limited country, laboratory testing must be chosen wisely and used appropriately. Patient age, gender, comorbid conditions, drugs, residence, and ferritin levels did not affect COVID-19 outcomes. Hemoglobin, platelet count, MCV, CRP, D-dimer, ALT, LDH, hypoxia, and hypotension were all correlated to disease outcomes. Therefore, these factors are useful laboratory examinations for COVID-19 patients, especially in poor countries.Klippel-Feil syndrome (KFS) is characterized by failed segmentation of the cervical spine leading to inappropriately fused vertebral bodies. A 64-year-old male with a previous L5-S1 decompression presented with significant neck pain with radiation into the entire right upper extremity and hand. Imaging demonstrated fusion of the vertebral bodies at C2-3, C4-6, and C7-T1 with associated disc bulges at C3-4 and C6-7. Common presentation of KFS includes significant spondylosis and cervical myeloradiculopathy in addition to the classic triad of short neck, low posterior hairline, and restricted neck motion. We present exemplary images of this rare condition to aid clinicians in future diagnoses.Attention-deficit hyperactivity disorder (ADHD) is a neuropsychological disorder that causes inattentiveness, hyperactivity, and impulsiveness in patients. Ventral striatal hypo-responsiveness, orbitofrontal cortex, and dopaminergic status in the brain are related to the pathogenesis of ADHD. Reinforcement tasks by monetary incentive delay (MID) was shown to produce more responsiveness in patients. In this study, we reviewed how reinforcement interventions and compensatory mechanisms affect the behavior of ADHD patients. This systematic review was undertaken as per the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, and PubMed database was used for literature search. The quality appraisal was completed using the Newcastle-Ottawa scale, and nine case-control studies were included in this systematic review. A total of 976 participants were included, with 493 cases and 330 controls. The studies included discuss reinforcement, attention networks, and compensatory mechanisms. Our review concludes that reinforcement improves responsiveness to gain and loss of rewards in ADHD patients.
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