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Chest pain is a frequently encountered chief complaint in the Emergency Department and entails a broad differential. Point-of-care ultrasound (POCUS) can be utilized to guide diagnostic decision making and initial triaging. Takotsubo cardiomyopathy presents similarly to acute coronary syndrome and has characteristic findings on echocardiogram. This case presentation details a scenario of ST segment elevation on electrocardiogram and elevated high sensitivity troponin levels, worrisome for a ST elevation myocardial infarction (STEMI). Apical hypokinesis to akinesis and apical ballooning were appreciated on echocardiogram, raising suspicion for Takotsubo cardiomyopathy, subsequently confirmed by coronary angiogram. A cardiac focused point-of-care ultrasound assessment can provide valuable information to aid in diagnostic accuracy.

Amyloidomas are focal solitary amyloid masses without systemic involvement that have been observed to occur in various body locations. When presenting intracranially, they pose a challenging diagnostic and therapeutic course given their location and rarity. We report a case of a 62-year-old man with a 4-year history of seizure and headaches. Magnetic resonance imaging was initially inconclusive but revealed an ill-defined right temporal lobe lesion. Biopsy later confirmed a cerebral amyloidoma. We also review the current literature on the pathogenesis, imaging findings, prognosis, and treatment of cerebral amyloidomas.

The use of nutraceuticals in aquaculture is getting attention to minimize oxidative stress and increase immunity of aquatic animals. In our experiment, we tested the potency of Phyllanthus niruri, as a stress-reducing and immune-stimulating agent in Nile tilapia, Oreochromis niloticus. We reared fish in a recirculating system for 90 days at low (5 g/L) and high (30 g/L) densities. We fed half of the low and high-density fish with commercial feed (control feed) and the other half, with 5% Phyllanthus niruri incorporated into commercial feed (supplemented feed). We assessed plasma cortisol, blood glucose, packed cell volume, plasma proteins, phagocytic capacity, respiratory burst activity, and lysozyme activity. None of these parameters showed any significant difference among the experimental groups. Based on our findings, we conclude that Phyllanthus niruri does not have any potential role in modulating stress and immune response in fish as a nutraceutical. [ABSTRACT FROM AUTHOR]

This study evaluates hotel guest perspectives on adopting personalised technology-enabled hospitality services by using a quantitative survey methodology. Applying unified theory of acceptance and use of technology (UTAUT) model constructs, the questionnaire gauges 200 guest views on performance benefits, usage effort and conditions influencing adoption of artificial intelligence (AI), the internet of things (IoT) and mobility. Descriptive and correlational analyses highlight innovation by capability and reveal barriers around complexity, privacy and reliability. Findings can inform hotel technology investment decisions and strategic planning to effectively leverage data-driven customisation capabilities across the entire guest journey — from pre-arrival trip planning to post-stay loyalty building. It will also help towards the Hospitality 2.0 vision of balancing digitisation with human connections. This empirical assessment aims to advance sector transformation and next-generation experience elevation through prudent prioritisation guided by evidence-based user willingness going beyond speculative innovation. [ABSTRACT FROM AUTHOR]

We developed humanized biosimulator to predict the risk of coronary obstruction among high-risk patients undergoing valve-in-valve (ViV) procedures. In this case, based on unchanged instantaneous wave-free ratio values measured during a ViV simulation session, the procedure was performed safely in the patient the day afterward, without coronary artery issues and with good hemodynamic results. (Level of Difficulty: Advanced.)

Objective: Patients with profound cardiogenic shock may require venoarterial (VA) extracorporeal membrane oxygenation (ECMO) for circulatory support most commonly via the femoral vessels. The rate of cardiac recovery in this population remains low, possibly because peripheral VA-ECMO increases ventricular afterload. Whether direct ventricular unloading in peripheral VA-ECMO enhances cardiac recovery is unknown, but is being more frequently utilized. A randomized trial is warranted to evaluate the clinical effectiveness of percutaneous left ventricle venting to enhance cardiac recovery in the setting of VA-ECMO. Methods: We describe the rationale, design, and initial testing of a randomized controlled trial of VA-ECMO with and without percutaneous left ventricle venting using a percutaneous micro-axial ventricular assist device. Results: This is an ongoing prospective randomized controlled trial in adult patients with primary cardiac failure presenting in cardiogenic shock requiring peripheral VA-ECMO, designed to test the safety and effectiveness of percutaneous left ventricle venting in improving the rate of cardiac recovery. Conclusions: The results of this nonindustry-sponsored trial will provide critical information on whether left ventricle unloading in peripheral VA-ECMO is safe and effective.

Objectives We aimed to evaluate the use of intravenous levetiracetam as the first-line treatment of neonatal seizures compared with phenobarbital. Methods The study was conducted on 104 neonates (0-28 days) with clinical seizures after inclusion criteria. They were assigned in equal ratio into 2 groups; 1 included neonates who received phenobarbitone, and the other included neonates who received levetiracetam. Neonates were loaded with 20 mg/kg of intravenous drug-A (phenobarbitone) or drug-B (levetiracetam). In persistent seizures, a second loading dose of the same drug was given. Crossover to other drugs occurred if seizures persisted after the second dose of the same drug. The proportion of neonates who achieved cessation of seizures following the first or second loading dose of either drug-A or drug-B (PB or LEV) was the main outcome measure provided that they remained free of seizure for the following 24 hours. Results After 1 or 2 doses of Levetiracatam or Phenobarbitone, clinical seizures stopped (and remained seizure-free for 24 hours) in 41 (78.84%) and 34 (65.38%) patients, respectively ( P = .01). Neonates in the LEV group showed better seizure control than neonates in the PB group (RR = 0.57; 95% CI (0.17, 0.80). We did not report any adverse drug reactions in the LEV group. However, 12 (23.07%) neonates developed adverse drug reactions in the PB Group. Conclusion Levetiracetam is considered an effective and safe drug as a first-line AED in neonatal seizures.

Pulmonary emboli are associated with high morbidity and mortality, prompting early diagnostic and therapeutic considerations. Utilization of rapid point-of-care ultrasound (POCUS) to assess for signs of pulmonary emboli can provide valuable information to support immediate treatment. We present a case of suspected pulmonary embolism in the setting of pharmacological prophylaxis for venous thromboembolism with identification of right heart strain on bedside POCUS exam. Early treatment with anticoagulation was initiated considering the clinical presentation and POCUS findings. CT angiogram of the chest revealed bilateral pulmonary emboli, confirming our suspicion. Utilizing POCUS in a case of suspected pulmonary emboli can aid in clinical decision making.

Background: To explore evolving surgical techniques and outcomes for aortic arch surgery. Methods: A total of 2435 consecutive patients underwent aortic arch repair with hypothermic circulatory arrest between 2008 and 2018 in 12 institutions across Canada. Trends in patient characteristics, surgical techniques, and in-hospital outcomes, including major morbidity or mortality, were examined. Results: From 2008 to 2018, the age of patients (62.3 ± 13.2 years) and the proportion of women (30.2%) undergoing arch surgery did not change significantly. Aortic diameters at operation decreased (2008: 58 ± 13 mm; 2018: 53 ± 11 mm; P < 0.01). Surgeons performed more valve-sparing root replacements (2008: 0%; 2018: 15%; P < 0.001) and fewer Bentall procedures (2008: 27%; 2018: 20%; P < 0.01). Total arch replacement rates were similar (P = 0.18); however, elephant trunk (2008: 9.5%; 2018: 19%; P < 0.001) and frozen elephant trunk (2008: 3.1%; 2018: 15%; P < 0.001) repair rates have increased. Over time, higher nadir temperatures (2008: 18 [17-21]°C; 2018: 25 [23-28]°C; P < 0.001), and more frequent antegrade cerebral perfusion (2008: 61%; 2018: 83%; P < 0.001) were used. For elective cases, in-hospital mortality rates declined (2008: 6.8%; 2018: 1.2%; P = < 0.01), as did major morbidity or mortality (2008: 24%; 2018: 13%; P < 0.001) and transfusion rates (2008: 61%; 2018: 41%; P < 0.001), but stroke rates remained constant (2008: 6.8%; 2018: 5.3%; P = 0.12). Outcomes remained the same over time for urgent or emergent cases. Conclusions: Outcomes have improved over the past decade in Canada for elective aortic arch surgery, in the context of operating on smaller aortas, and more frequent use of moderate hypothermia and antegrade cerebral perfusion. Further research is needed to improve stroke rates and outcomes in the emergency setting. Résumé: Introduction: Examiner l’évolution des techniques chirurgicales et les résultats de l'intervention chirurgicale de l'arc aortique. Méthodes: Un total de 2 435 patients consécutifs ont subi une réparation de l'arc aortique en arrêt circulatoire en hypothermie entre 2008 et 2018 dans 12 établissements du Canada. Nous avons examiné les tendances en ce qui concerne les caractéristiques des patients, les techniques chirurgicales et les résultats cliniques intrahospitaliers, y compris les principales causes de morbidité ou de mortalité. Résultats: De 2008 à 2018, l’âge des patients (62,3 ± 13,2 ans) et la proportion de femmes (30,2 %) subissant l'intervention chirurgicale de l'arc n'a pas montré de changement significatif. Les diamètres aortiques à l'opération ont diminué (2008 : 58 ± 13 mm; 2018 : 53 ± 11 mm; P

OBJECTIVES:. To describe ventilation strategies used during extracorporeal membrane oxygenation (ECMO) for neonatal respiratory failure among level IV neonatal ICUs (NICUs). DESIGN:. Cross-sectional electronic survey. SETTING:. Email-based Research Electronic Data Capture survey. PATIENTS:. Neonates undergoing ECMO for respiratory failure at level IV NICUs. INTERVENTIONS:. A 40-question survey was sent to site sponsors of regional referral neonatal ECMO centers participating in the Children’s Hospitals Neonatal Consortium. Reminder emails were sent at 2- and 4-week intervals. MEASUREMENTS AND MAIN RESULTS:. Twenty ECMO centers responded to the survey. Most primarily use venoarterial ECMO (65%); this percentage is higher (90%) for congenital diaphragmatic hernia. Sixty-five percent reported following protocol-based guidelines, with neonatologists primarily responsible for ventilator management (80%). The primary mode of ventilation was pressure control (90%), with synchronized intermittent mechanical ventilation (SIMV) comprising 80%. Common settings included peak inspiratory pressure (PIP) of 16–20 cm H2O (55%), positive end-expiratory pressure (PEEP) of 9–10 cm H2O (40%), I-time 0.5 seconds (55%), rate of 10–15 (60%), and Fio2 22–30% (65%). A minority of sites use high-frequency ventilation (HFV) as the primary mode (5%). During ECMO, 55% of sites target some degree of lung aeration to avoid complete atelectasis. Fifty-five percent discontinue inhaled nitric oxide (iNO) during ECMO, while 60% use iNO when trialing off ECMO. Nonventilator practices to facilitate decannulation include bronchoscopy (50%), exogenous surfactant (25%), and noninhaled pulmonary vasodilators (50%). Common ventilator thresholds for decannulation include PEEP of 6–7 (45%), PIP of 21–25 (55%), and tidal volume 5–5.9 mL/kg (50%). CONCLUSIONS:. The majority of level IV NICUs follow internal protocols for ventilator management during neonatal respiratory ECMO, and neonatologists primarily direct management in the NICU. While most centers use pressure-controlled SIMV, there is considerable variability in the range of settings used, with few centers using HFV primarily. Future studies should focus on identifying respiratory management practices that improve outcomes for neonatal ECMO patients.

Free-floating right-heart thrombus (FFRHT) in the context of a pulmonary embolism (PE) is a rare but serious encounter with no guidelines addressing its management. We performed a systematic review and meta-analysis addressing prevalence, clinical behavior, and outcomes of FFRHT associated with PE. Among the included 397 patients with FFRHT and PE, dyspnea was the main presenting symptom (73.3%). Obstructive shock was documented in 48.9% of cases. Treatment with thrombolytic therapy, surgical thrombectomy, and percutaneous thrombectomy was documented in 43.8%, 32.7%, and 6.5% of patients, respectively. The overall mortality rate was 20.4%. Syncope ( p : 0.027), chest pain ( p : 0.006), and obstructive shock ( p : 0.037) were significantly associated with mortality. Use of thrombolytic therapy was significantly associated with survival ( p : 0.008). A multivariate logistic regression model to determine mortality predictors revealed that syncope (OR: 1.97, 95% CI: 1.06–3.65, p : 0.03), and obstructive shock (OR: 2.23, 95% CI: 1.20–4.14, p : 0.01) were associated with increased death odds. Treatment with thrombolytic therapy (OR: 0.22, 95% CI: 0.086–0.57, p : 0.002) or surgical thrombectomy (OR: 0.35, 95% CI: 0.137–0.9, p : 0.03) were associated with reduced death odds. Meta-analysis of observational studies revealed a pooled prevalence of FFRHT among all PE cases of 8.1%, and overall mortality of 23%. Although uncommon, the presence of FFRHT in the context of PE is associated with high obstructive shock and mortality rates. Favorable survival odds are observed with thrombolytic therapy and surgical thrombectomy. Data are derived from case reports and observational studies. Clinical trials elucidating these findings are needed.

Background: Primary care physicians (PCPs) are often gatekeepers to specialist care. This study assessed the relationship between PCP density and total knee (TKA) and total hip arthroplasty (THA) outcomes. Methods: We obtained patient-level data from an institutional registry on patients undergoing elective primary TKA and THA for osteoarthritis, including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at baseline and 2 years. Using geocoding, we identified the number of PCPs in the patient’s census tract (communities). We used Augmented Inverse Probability Weighting and Cross-validated Targeted Minimum Loss-Based Estimation to compare provider density and outcomes adjusting for potential confounders. Results: Our sample included 3606 TKA and 4295 THA cases. The median number of PCPs in each community was similar for both procedures: TKA 2 (interquartile range 1, 6) and for THA 2 (interquartile range 1, 7). Baseline and 2-year follow-up WOMAC pain, function, and stiffness scores were not statistically significantly different comparing communities with more than median number of PCPs to those with less than median number of PCPs. In sensitivity analyses, adding 1 PCP to a community with zero PCPs would not have statistically significantly improved baseline or 2-year follow-up WOMAC pain, function, and stiffness scores. Conclusions: In this sample of patients who underwent elective TKA or THA for osteoarthritis, we found no statistically significant association between PCP density and pain, function, or stiffness outcomes at baseline or 2 years. Further studies should examine what other provider factors affect access and outcomes in THA and TKA.

Familial Mediterranean Fever (FMF) is an autosomal recessive disorder that is characterised by recurrent attacks of fever and painful polyserositis mainly affecting the peritoneum, synovium and pleura that usually begins in childhood. Even though diagnostic criteria have been proposed, conclusive imaging findings or haematological markers for the diagnosis or follow-up of FMF are still lacking. In this case report we present the 18F-FDG PET-CT findings in a 55 year old female during an attack of FMF. We briefly discuss the added value of 18F-FDG PET-CT in the diagnosis and the work-up of FMF, which may open up new applications for 18F-FDG PET-CT in non-infectious inflammatory diseases.

Pleomorphic adenoma is the most common type of benign salivary neoplasm, which typically occurs in major salivary glands such as the parotid gland. This type of tumor is rarely found in the upper respiratory system, specifically within the nasal cavity. We present a rare case of pleomorphic adenoma of the left sided nasal septum occurring in a 47-year-old male who originally presented with chronic left nasal obstruction, congestion, and epistaxis. Diagnosis was made with tissue sampling in conjunction with computed tomography and magnetic resonance imaging, and the patient underwent surgical excision and reconstruction with the Head and Neck Surgical Oncology, Skull Base Surgery, and Facial Plastic Surgery teams. Although pleomorphic adenoma is rare within the nasal cavity, it should be considered in the differential diagnosis as a potential cause of nasal mass or obstruction.

Abstract. Hematologic reference intervals vary with gender, age, ethnicity, and geographic area. Therefore, local or national laboratory reference ranges are essential to enhance the accuracy when diagnosing health conditions. Still, no comprehensive list of reference ranges tailored to the Arab population living in Qatar. Accordingly, this study aims at establishing a hematology reference guide for Arabs in Qatar. This is a retrospective study where 750 healthy volunteers (18–69 years) from 2015 to 2019 were included, analyzed by an automated hematology analyzer. Arab adults were divided into African (Egypt, Libya, Tunisia, Morocco) and Asian (Syria, Lebanon, Jordon, Palestine, Qatar). The Cell-Dyn and Sysmex were used for measuring hematological parameters. The mean +/- 2SD were established for all the study groups. Arab males had significantly higher Hb, Hct, red cell distribution width, absolute neutrophil count, lymphocytes, and monocyte counts than females. Asian-Arab males had significantly higher Hb concentration and higher WBC, lymphocytes, and eosinophils than African Arabs. Asian-Arab young (>18: 40 years). African-Arab young males had significantly higher lymphocytes and lower monocytes than older males. Asian-Arab young females had higher WBC and absolute neutrophil count than older Asian Arabs. The findings of this study will help in establishing specific reference intervals in the Arab world. The differences in hematology reference intervals considering age, gender, and geographical location highlight the importance of establishing blood reference intervals in each country considering the ethnic diversity of each country.

الملخص: تعتبر متلازمة اليد الغريبة من مضاعفات السكتة الدماغية النادرة. بالرغم من أن حدوث المتلازمة بعد السكتة الدماغية غير شائع، إلإ أنها يمكن أن تسبب أثرا معطلا على نمط الحياة والوظيفة لدى المرضى بعد السكتة الدماغية. ومن الصعب التفريق بين متلازمة اليد الغريبة والجلطة المخية النصف كروية غير السائدة مع أعراض العمى الشقي وإهمال النصف الأيسر، حيث إن المرضى بمتلازمة اليد الغريبة يمكن أيضا أن يكون لديهم إهمال وكذلك أعراض سلوكية، إذا كانت تشمل الفص الجبهي. نحن هنا نصف حالة لرجل عمره ٦٢عاما أُدخل إلى قسم إعادة التأهيل وتم علاجه من الإهمال وتعذر الأداء بعد السكتة الدماغية للشريان الدماغي الأوسط الأيمن. بعد المزيد من التقييم، تم تشخيص المريض بمتلازمة اليد الغريبة. وظيفيا، تم تحسنه واختفت الأعراض بعد أربعة أشهر من السكتة الدماغية. في وصف هذه الحالة، قمنا بإبراز صفات متلازمة اليد الغريبة ونهج علاجها الفريد Abstract: Alien hand syndrome (AHS) is a rare post-stroke complication. Although the occurrence of AHS after stroke is rare, it can have a disabling impact on the lifestyle and career of the patients post stroke. It is difficult to distinguish AHS from the non-dominant hemispheric infarction with symptoms of hemianopia and left hemineglect, as patients with AHS can also have neglect as well as behaviour symptoms if the frontal lobe is involved. We report the case of a 62-year-old gentleman who was admitted to the rehabilitation ward and was treated for neglect and apraxia following right middle cerebral artery stroke. After further re-evaluation, the patient was diagnosed with AHS. Functionally, he improved and the symptoms disappeared four months after the stroke. In this case report, we highlight the features of AHS and provide a unique management approach.

The study characterises the straw-colour in groundwater of coastal areas of Bangladesh. The study design was exploratory to have a better understanding of straw colouration. Findings indicate that the straw-colour is an entirely true colour in Alpha-Hazen Scale due to dissolved organic components tannin/lignin with different functional groups. The concentration of different parameters of water influences the intensity of the colour. The intensity of straw-colour has a significant positive correlation with depth and has spatial variation within the study sites. Borehole sediment sample analysis confirms the presence of organic particles. People who drink straw-coloured water in Barguna Upazila for a relatively more extended period show signs and symptoms of kidney-related disorders. A further detailed study with chemical analysis of straw-coloured water by NMR and GCMS should help identify the exact structure of the organic elements and public health vulnerabilities that a cohort study should firm.

Introduction: Abdominal aortic aneurysm (AAA) is a condition that has considerable socioeconomic impact and an eventual rupture is associated with high mortality and morbidity. Despite decades of research, surgical repair remains the treatment of choice and no medical therapy is currently available. Animal models and, in particular, murine models, of AAA are a vital tool for experimental in vivo research. However, each of the different models has individual limitations and provide only partial mimicry of human disease. This narrative review addresses the translational potential of the available mouse models, highlighting unanswered questions from a clinical perspective. It is based on a thorough presentation of the available literature and more than a decade of personal experience, with most of the available models in experimental and translational AAA research. Results: From all the models published, only the four inducible models, namely the angiotensin II model (AngII), the porcine pancreatic elastase perfusion model (PPE), the external periadventitial elastase application (ePPE), and the CaCl2 model have been widely used by different independent research groups. Although the angiotensin II model provides features of dissection and aneurysm formation, the PPE model shows reliable features of human AAA, especially beyond day 7 after induction, but remains technically challenging. The translational value of ePPE as a model and the combination with β-aminopropionitrile to induce rupture and intraluminal thrombus formation is promising, but warrants further mechanistic insights. Finally, the external CaCl2 application is known to produce inflammatory vascular wall thickening. Unmet translational research questions include the origin of AAA development, monitoring aneurysm growth, gender issues, and novel surgical therapies as well as novel nonsurgical therapies. Conclusion: New imaging techniques, experimental therapeutic alternatives, and endovascular treatment options provide a plethora of research topics to strengthen the individual features of currently available mouse models, creating the possibility of shedding new light on translational research questions.

Multiple endocrine neoplasia type 1 (MEN1) is a complex, autosomal dominant inherited syndrome characterized by 3 different tumors (parathyroid, anterior pituitary, and pancreatic islet). The diagnosis is defined clinically by the presence of 2 or more primary tumors. We report the case of a 35 years old patient who presented with recurrent renal stones and imaging findings for MEN1. Computed tomography pancreas revealed a mass in the tail which was confirmed by magnetic resonance imaging. Ultrasound of her neck showed a mass on the left side and MIBI scan diagnosed a parathyroid adenoma which was later pathologically confirmed.

No abstract available. Manuscript truncated after 150 words. To the Editor: In the September 2022 issue the Southwest Journal of Pulmonary Critical Care and Sleep published an interesting article authored by Punatar et al. detailing a case of severe dysphagia that was secondary to isolated epiglottic calcifications seen on computed tomography and flexible fiberoptic laryngoscopy (1). The epiglottis plays a critical role in the prevention of aspiration and coordination of swallowing. Calcifications can severely alter its flexibility and limit oral intake. Isolated calcifications of the epiglottis and sequential dysphagia is not a common entity. With the increasing rates of chronic and end-stage renal disease, this letter is focused on increasing the awareness of extra-osseous manifestations of secondary hyperparathyroidism. Secondary hyperparathyroidism is characterized by adaptive parathyroid gland hyperplasia to increase the production of parathyroid hormone. Etiologies include vitamin D deficiency and chronic kidney disease. Vitamin D deficiency can be seen in about 50% of the world population and chronic …

Objectives. This study was carried out to delineate the patients’ characteristics and the imaging findings and their relation to some biochemical markers of 31 critically ill patients with MIS-C. Design. A retrospective cross-sectional study including all critically ill MIS-C patients admitted to the PICU from June 23rd to July 22nd, 2020. Results. Eighteen males and 13 females, with a median age of 9 years (interquartile range 6-11) presented mainly with fever (100%) and hypotension (100%). Abnormalities in the chest computed tomography were detected in 22 cases (71%). Consolidation and architecture distortion were detected in 58.1% of patients; bilateral lesions and lower lobe infiltrates, each, was evident in 64.5% of patients, while the peripheral distribution of lesions was seen in 71% of the cases. Pleural thickening and effusion, each, was found in 51.6% of the patients. In this small case series, the presence of high ferritin was significantly associated with the bilaterality of the lesions. Elevated C-reactive protein was associated with the peripheral distribution of the lesions. Thrombocytopenia and hypoalbuminemia were significantly correlated with the CT disease stage and CT severity score respectively. Conclusions. Although a few children in this group of MIS-C patients presented with respiratory manifestations, yet, most of them demonstrated significant radiological lung involvement, which necessitates a longer-term follow-up.

Carotid blowout syndrome is described as rupture of the carotid artery most commonly following head and neck dissection. It is an uncommon complication that can be fatal if not diagnosed and managed promptly. This report will discuss the case of a 45-year-old male, who developed carotid blowout syndrome following receiving several therapies for his laryngeal cancer. It will include how careful assessment of the patient's current state and taking into consideration his previous history and risk factors can lead to a case-tailored management plan to be performed in a timely manner, maximizing the chances of a successful life-saving procedure.

This case series summarizes our experience of delayed acute myocardial infarction presentations during the coronavirus disease-2019 pandemic predominantly driven by patient fear of contracting the virus in the hospital. Many presented with complications rarely seen in the primary percutaneous coronary intervention era including ventricular septal rupture, left ventricular pseudoaneurysm, and right ventricular infarction. (Level of Difficulty: Beginner.)

الملخص: أهداف البحث: منذ منتصف مارس ٢٠٢٠، ونسبة انتشار جائحة الحمة التاجية لعام ٢٠١٩ في ازدياد شديد وذلك نتيجة لسرعة انتشار المرض والفحص الموسع والإبلاغ عن المرض، ويتم تحديث الدليل الدولي التوجيهي الموجز بشأن تدابير وطرق مكافحة المرض بشكل متكرر لمساعدة الدول وحكوماتها لاتخاذ التدابير المثلى ضد الجائحة وحماية شعوبها. يهدف هذا البحث لإجراء مسح سريع لتحديد الوعي بجائحة الحمة التاجية لعام ٢٠١٩ في المملكة العربية السعودية ولقياس الاستجابة لإجراءات التخفيف المتخذة للحد من انتشاره. طرق البحث: أجريت دراسة استقصائية الكترونية وتحليل الردود الأولى التي بلغ عددها ٣٨٨ ردا لنشر تقرير أولي لهذه الدراسة ، وتكونت الاستبانة من ٢٧ سؤالا ومقسمة إلى ٣ أقسام هي الديموغرافية والوعي والاستجابة لاستراتيجيات التخفيف، وسلوكيات المشاركين الذاتية بشأن الحمة التاجية لعام ٢٠١٩، وتمت مقارنة وعي الناس باستجاباتهم لتدابير التخفيف. النتائج: وجد أن ٨٩.٧٪ يفهمون معنى الجائحة، في حين أن ٨٢.٢٪ اختاروا كبار السن على نحو صحيح كفئات شديدة الخطورة للإصابة بالعدوى. وأجاب ٩٦.١٪ من مجموع المشاركين بأن البقاء في المنزل هو أحد استراتيجيات التخفيف التي يتخذونها، ويفضل ما يقارب من ٣٥٪ تناول أدوية خافضة الحرارة من تلقاء أنفسهم. وقد تبين أن مستوى التعليم العالي، وساعات العمل الأطول يرتبطان بشكل كبير بالاستجابة الإيجابية لتدابير التخفيف. الاستنتاجات: اتضح من هذه الدراسة وجود معرفة جيدة، واستجابة مناسبة لتدابير التخفيف من حدة جائحة الحمة التاجية لعام ٢٠١٩ خلال فترة الارتفاع السريع بين عامة السكان في المملكة العربية السعودية، وعلى الرغم من ذلك، وجدنا أن ثلث المشاركين في هذا البحث يلجؤون للتطبيب الذاتى عن طريق تناول الأدوية من تلقاء أنفسهم دون وصفة طبية. Abstract: Objectives: Since March 2020, a rapid increase has been observed in the prevalence of the COVID-19 pandemic, which has essentially resulted from increased disease transmission and intensified testing and reporting. The international guidelines for the prevention and treatment of the COVID-19 pandemic have been frequently updated. Such guidelines assist the governmental regulatory bodies in taking optimal measures and safeguarding their citizens against the pandemic. We conducted a short survey with a Saudi cohort to understand the awareness about COVID-19 and estimate the responses for mitigation strategies. Methods: An electronic survey was conducted, and the first 388 responses were analysed for publishing an initial report. The questionnaire comprised 27 items and was divided into three sections, namely demographic, awareness, and response to mitigation strategies and participants' self-perceived behaviours regarding COVID-19. The perceptions of the participants were compared with their responses to mitigation measures. Results: In our study, 89.7% understood the meaning of pandemic, while 82.2% correctly identified that the elderly belonged to a high-risk group for the COVID-19 infection. As many as 96.1% agreed that staying at home was one of the mitigation strategies. Nearly 35% preferred self-medication. Higher educational level (OR: 2.09, 95% CI: 1.02–4.29) and longer working hours were found to be significantly associated with a positive response to mitigation measures with p

Inflammatory myofibroblastic tumor (IMT) is a rare pathologic entity that has been mostly described in the lung. It has been reported in nearly every organ, with occurrence in the kidney being extremely rare. IMT has nonspecific clinical and radiological findings and often mimics a malignant process. This is a case discussing the radiologic and pathologic findings of a renal IMT in a 35-year-old female who underwent radical nephrectomy for a right renal pelvis mass that was mistaken for transitional cell carcinoma.

The brachial artery is the most common injured vessel in the upper extremity. Although vascular injury following blunt trauma is rare, it is a condition to be considered because it can easily be overlooked unless the clinician has a high suspicion. In this paper, we present a blunt trauma case with brachial arterial injury, upper extremity ischemia, and the need for urgent management to salvage the limb. A 28-year-old male had a right arm swelling, pain, and paleness accompanied by a weak pulse in the right radial artery and right-hand numbness. Following resuscitation, preoperative Doppler ultrasound revealed to the brachial artery injury. The right brachial artery had an occlusion with a thrombus. In spectral Doppler analysis, there were demonstrated parvus et tardus waveform in the distal arteries. Doppler ultrasound provided crucial information to make an accurate and rapid management decision.

Background. Data about vaccine efficacy in solid organ transplant patients are limited. We previously reported our initial observation of a 6.2% immunogenicity rate in kidney transplant recipients (KTRs) after administration of 1 dose of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine. We sought to report our observations of anti-SARS-CoV-2 antibody in KTRs after 2 doses of the SARS-CoV-2 mRNA vaccine. Methods. We identified 105 KTRs who received 2 doses of the Pfizer-BioNTech or Moderna mRNA-1273 vaccine per availability and had anti-SARS-CoV-2 labs obtained at least 2 wk following administration of the second dose. Antibody testing was performed using 3 clinically validated qualitative and semiquantitative assays. Results. KTRs had a 36.2% antibody response rate, whereas an age ≥68 years and a longer time from transplant were factors associated with antibody response. Conclusions. The low antibody response in KTRs may be associated with the immunosuppressive state. More data are needed to evaluate if KTRs may require higher vaccine doses or an additional booster dose to increase their ability to mount an immune response to the SARS-CoV-2 vaccine.

Introduction:. Pain and discomfort are frequently experienced following mastectomy with concomitant breast implant- or tissue expander-based alloplastic breast reconstruction (AlBR). Unfortunately, postoperative opioids have decreased efficacy in AlBR, short-term complication profiles, and are fraught by long-term dependence. This systematic review aims to identify opioid-sparing pain management strategies in AlBR. Methods:. A systematic literature search of MEDLINE, Embase, Web of Science, and Cochrane Central Register was performed in September 2018. PRISMA guidelines were followed, and the review was prospectively registered in PROSPERO (CRD42018107911). The search identified 1184 articles. Inclusion criteria were defined as patients 18 years or older undergoing AlBR. Results:. Fourteen articles were identified assessing opioid-sparing strategies in AlBR. This literature included articles evaluating enhanced recovery protocols (two), intercostal blocks (two), paravertebral blocks (four), liposomal bupivacaine (three), diclofenac (one), and local anesthesia infusion pumps (two). The literature included five randomized trials and nine cohort studies. Study characteristics, bias (low to high risk), and reporting outcomes were extensively heterogeneous between articles. Qualitative analysis suggests reduced opioid utilization in enhanced recovery after surgery (ERAS) pathways, paravertebral blocks, and use of liposomal bupivacaine. Conclusions:. A variety of opioid-sparing strategies are described for pain management in AlBR. Multimodal analgesia should be provided via ERAS pathways as they appear to reduce pain and spare opioid use. Targeted paravertebral blocks and liposomal bupivacaine field blocks appear to be beneficial in sparing opioids and should be considered as essential components of ERAS protocols. Additional prospective, randomized trials are necessary to delineate the efficacy of other studied modalities.

Background. The coronavirus 2019 (COVID-19) pandemic has disrupted health systems worldwide, including solid organ donation and transplantation programs. Guidance on how best to screen patients who are potential organ donors to minimize the risks of COVID-19 as well as how best to manage immunosuppression and reduce the risk of COVID-19 and manage infection in solid organ transplant recipients (SOTr) is needed. Methods. Iterative literature searches were conducted, the last being January 2021, by a team of 3 information specialists. Stakeholders representing key groups undertook the systematic reviews and generation of recommendations using a rapid response approach that respected the Appraisal of Guidelines for Research and Evaluation II and Grading of Recommendations, Assessment, Development and Evaluations frameworks. Results. The systematic reviews addressed multiple questions of interest. In this guidance document, we make 4 strong recommendations, 7 weak recommendations, 3 good practice statements, and 3 statements of “no recommendation.” Conclusions. SOTr and patients on the waitlist are populations of interest in the COVID-19 pandemic. Currently, there is a paucity of high-quality evidence to guide decisions around deceased donation assessments and the management of SOTr and waitlist patients. Inclusion of these populations in clinical trials of therapeutic interventions, including vaccine candidates, is essential to guide best practices.