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Background The rising costs of healthcare delivery globally and the increasing research production rate create immense opportunities for implementing novel and more effective medical interventions that significantly benefit patient outcomes. However, the successful uptake of medical innovations is complex and often extremely contextual based on many sociopolitical and economic factors. These barriers to implementation can delay or derail new practices, procedures, products, and pharmaceuticals. Understanding the barriers to the successful implementation of medical innovations and the best practices and strategies to mitigate them is an extremely important area for translational research in health sciences. This study examines the barriers and potential challenges in implementing medical innovations and the possible preemptive measures that can be addressed early to increase the use of life-saving medical innovations. We consider the importance of appropriate, timely, and user-defined implementation techniquesrengthening the credibility of the survey results. The insights from this study are intended to inform both the continued implementation of TAVR and to contribute to a broader field of investigation that aims to identify and operationalize the principles and best practices of translational research that may contribute to the efficacy of implementing other medical innovations in Ontario hospitals and beyond.Benign paroxysmal positional vertigo (BPPV) is a common medical condition in which the patient feels a spinning sensation when making certain head movements. There is evidence to support those free-floating calcium crystals in the semi-circular canals (the inner ear) may be the cause. BPPV can be a disabling condition. It can be easily diagnosed after taking a careful history and performing bedside examinations. BPPV can be treated successfully through a specific set of physical maneuvers leading to the removal of these crystals from the inner ear. We present three cases of BPPV, living in three different countries, treated successfully using telehealth via Zoom. This approach can be a particularly useful consultation stand during the coronavirus disease 2019 (COVID-19) pandemic.The lethal triad of coagulopathy, hypothermia, and acidosis is a well-known cause of severe deterioration and poor prognosis in trauma patients. The presence of this triad complicates the surgical management of a patient suffering from penetrating injury and hemorrhage. Here, we report the case and management of a 44-year-old man with multiple high-caliber gunshot wound (GSW) injuries who became severely acidotic (pH less then 6.8) with hemorrhagic shock in the setting of massive hemorrhage due to penetrating chest and abdominal trauma. The patient sustained one high-caliber GSW to the left upper quadrant of the abdomen, one high-caliber GSW to the left periumbilical region of the abdomen, one high caliber GSW to the fourth intercostal space of the left chest just medial to the midclavicular line with an expanding hematoma, and one high-caliber GSW to the left shoulder with a floating left shoulder. He arrived at the Emergency Department conscious with a stable pulse but quickly became hemodynamically unstable. He required a thoracotomy and exploratory laparotomy in addition to a massive transfusion protocol. This case demonstrates the reversal of a severely acidotic patient due to massive hemorrhage to a blood pH within normal limits using damage control resuscitation surgery and massive transfusion protocols. The patient has since been discharged home in a stable condition with minimal long-term sequelae.Giant cell arteritis (GCA), previously referred to as temporal arteritis, continues to pose significant diagnostic challenges to clinicians as it could have unusual and atypical presentations. We present the case of a 69-year-old Caucasian male who had presented with painful scrotal swelling and bilateral arm pain and was eventually diagnosed with GCA based on histological findings. His symptoms resolved completely with the initiation of high-dose steroids. It is important to note that some clinical manifestations of GCA could be subtle, atypical, and maybe entirely extracranial. A high index of suspicion is helpful when diagnosing patients who present with non-specific or constitutional symptoms as delay in diagnosis or treatment in these patients could result in severe adverse outcomes.Introduction Patients that present to the emergency department (ED) with undifferentiated hypotension have a high mortality rate. Hypotension can be divided into four categories obstructive, hypovolemic, distributive, and cardiogenic. While it is possible to have overlapping or concomitant shock states, being able to differentiate between cardiogenic shock and the other categories is important as it entails a different treatment regime and extra cautions. In this secondary analysis, we investigate if using focused cardiac ultrasonography (FOCUS) to determine left ventricular dysfunction (LVD) can serve as a reliable test for cardiogenic shock. Methods We prospectively collected FOCUS findings performed in 135 ED patients with undifferentiated hypotension as part of an international study. Patients with clearly identified etiologies for hypotension were excluded, along with other specific presumptive diagnoses. LVD was defined as the identification of a generally hypodynamic left ventricle in the setting of shotherwise undifferentiated hypotensive adult patients in the emergency department.As the coronavirus pandemic continues to evolve, so does the understanding of different presentations of disease. In this case report, we describe a patient whose presentation of COVID-19 was with acute icteric hepatitis without respiratory symptoms. This is the first case in the literature to our knowledge to report jaundice as the initial presentation of disease and adds to just a handful of cases in the literature of acute hepatitis as the sole presentation of COVID-19. Additionally, despite severe hepatitis, the patient had a benign course of COVID-19 and did not require aggressive medical care; this strays from conventional paradigms that associate severity of COVID-19 with a degree of aminotransferase elevation. DNA Repair inhibitor The purpose of this report is to make physicians aware of acute icteric hepatitis as a presentation of COVID-19 infection and to facilitate discussion and further research in the area of COVID-19-induced hepatitis.Background Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that causes Coronavirus disease has caused one of the most damaging pandemics in the recorded human history. Objective To assess pregnancy outcomes with COVID-19 lessons learned from the pandemic. Study design This retrospective observational study was conducted at Teerthanker Mahaveer Medical College and Research Centre, Moradabad, a level 3 COVID hospital in Northern India, with a patient pool of all the antenatal females diagnosed COVID 19 positive via a positive quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) test of maternal pharyngeal and nasal swab samples in the given time period of three months and ten days, i.e., May 25, 2020 to September 3, 2020. In conjunction with maternal outcomes, neonatal outcomes including evidence of perinatal transmission of SARS-CoV-2 was assessed by testing neonatal pharyngeal swab samples. Results Out of 100 COVID-19 positive patients, the average age of women was 26.2 years, 7orted due to respiratory distress. There were two documented intrauterine demise (IUD) cases both due to PIH. Furthermore, all 30 live neonates tested for SARS CoV-2 had negative results. Conclusion The spectrum of Coronavirus infection leans more towards asymptomatic and mild symptomatic clinical presentation. Favourably, the likelihood of spontaneous preterm birth was not escalated in our current study and remained low. The rate of intrauterine fetal demise and neonatal death were less. As none of the neonates tested positive for COVID-19, there is no corroborative proof of vertical perinatal transmission.Acute rheumatic fever (RF) and acute post Streptococcal glomerulonephritis (APSGN) are non-suppurative complications of a Group A Streptococcus (GAS) infection. The concomitant incidence of both complications in a patient is rare because nephritogenic and rheumatogenic strains belong to different serotypes of Group A beta-hemolytic Streptococcus (GABHS). We present a case of a 47-year-old female who had concomitant acute RF and APSGN from a Streptococcus pyogenes infection. It is important to have a high clinical suspicion for the sequela of GABHS infection in the setting of cardiac and renal disease following upper respiratory infection (URI) symptoms even in adults and in geographic locations with the nearly undetectable burden of acute RF because of the importance of secondary prophylaxis with an antibiotic.Mycobacterium abscessus is a rapidly growing mycobacterium (RGM) known to be abundant in soil, dust and water. Unlike other non-tuberculous mycobacteria, RGM is typically resistant to first-line anti-tuberculosis drugs. These organisms are known to cause community and hospital-acquired infections; however, central nervous system (CNS) infections caused by these pathogens have not been abundantly reported. As the use of vascular catheters and prosthetic devices is becoming more common, a rise in CNS infections secondary to M. abscessus has been noted. Here, we present such a case where the removal of a ventricular catheter was necessary to guarantee source control and eradication of the infection.Lyme disease is a vector-borne illness of North America and Europe transmitted by Borrelia burgdorferi, over 30,000 cases are reported in the United States yearly. Patients typically present having early localized disease with fevers, headaches, myalgias, and a single erythema migrans. Usually, oral doxycycline is administered with a good disease prognosis but we report the case of a 58-year-old male who presented with Lyme disease diagnosed by immunoassay; he was treated with doxycycline but was refractory and saw an improvement in his symptoms with IV ceftriaxone.Background The global incidence and prevalence of chronic kidney disease (CKD) is skyrocketing. In Asia, the prevalence of CKD varies from 10%-18%. However, as Asia is largely populated by developing countries with nascent health care systems, there is a dearth of research and data. It is estimated that a large number of cases go unreported. As a result, the exact disease burden remains unclear. The knowledge about risk factors and their proportionate role in CKD is indispensable in regards to patient management and care. Objective The early recognition of the most important risk factors for end-stage renal disease (ESRD) is key to early diagnosis, successful treatment, and general heightened awareness regarding CKD. In developing countries, the provision of medical services, in general, and nephrological services, in particular, is wholly inadequate. The insufficiency of solid and regularly updated data compounds the problem. This research study aims to partake in catering to that need. Methodology A structuery little among the two groups. Conclusion In conclusion, our study has reinforced the existing body of knowledge and brought some fresh evidence regarding the prevalence of risk factors in ESRD to light. Hypertension and DM, together, represent the vast majority of cases with ESRD. However, hypertension far outpaces DM as the leading risk factor. Nephrolithiasis was also present in a considerable minority, with a figure much higher than previously reported. Finally, a relatively younger age group (45-60 years) formed the majority of the ESRD patients which is a concerning development. It points to early progression of CKD to ESRD. Long-term adequate control of these risk factors limits disease progression.
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