scholarly journals Clinical Presentation, Management, and Outcomes of Patients With Brain Abscess due to Nocardia Species

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Cristina Corsini Campioli ◽  
Natalia E Castillo Almeida ◽  
John C O’Horo ◽  
Douglas Challener ◽  
John Raymond Go ◽  
...  
Keyword(s):  
Brain Abscess ◽  
Health Care Providers ◽  
Case Reports ◽  
Dual Therapy ◽  
Source Control ◽  
Care Providers ◽  
Nocardia Species ◽  
Cutaneous Infections ◽  
Small Series ◽  
Brain Abscesses

Abstract Background Nocardial brain abscesses are rare, and published literature describing brain abscesses due to Nocardia species is limited to individual case reports or small series. We report one of the largest contemporary retrospective studies describing risk factors, diagnostic evaluation, management, and outcomes of nocardial brain abscess. Methods Retrospective review of all adults with brain abscess due to culture-confirmed Nocardia species at our institution between January 1, 2009, and June 30, 2020. Results Overall, 24 patients had nocardial brain abscesses during the study period. The median age at presentation was 64 years, and 62.5% were immunocompromised. Pulmonary and cutaneous infections were the most common primary sites of nocardial infection. All 24 patients had magnetic resonance imaging performed, and the frontal lobe was the most commonly involved. The most common organism isolated was Nocardia farcinica, followed by Nocardia wallacei and Nocardia cyriacigeorgica. Thirteen patients were managed with antimicrobial therapy alone, while 11 had both medical and surgical management. In all patients, dual therapy was recommended for the initial 6 weeks of treatment, and 22 patients received at least 1 oral agent as part of their final antibiotic regimen, predominantly trimethoprim-sulfamethoxazole and linezolid. Fourteen patients achieved complete clinical and radiographic resolution of infection. Conclusions Nocardia is an important cause of brain abscess in the immunocompromised host. Early diagnostic and therapeutic aspiration may help health care providers confirm the diagnosis, choose an appropriate antimicrobial regimen, and achieve source control.

scholarly journals Case report: Chlorpromazine and deep venous thrombosis

2019 ◽  
Vol 11 (2) ◽  
pp. 16-19 ◽  
Author(s):  
Matthew Joseph Reed ◽  
Sean Comeau ◽  
Todd R. Wojtanowicz ◽  
Bharat Reddy Sampathi ◽  
Sofia Penev ◽  
...  
Keyword(s):  
Case Report ◽  
Health Care Providers ◽  
Case Reports ◽  
Manic Episode ◽  
Venous Stasis ◽  
Poor Sleep ◽  
Care Providers ◽  
Content Type ◽  
Difficulty Breathing ◽  
Typical Antipsychotics

Purpose Since the development of antipsychotic drugs in the 1950s, a variety of studies and case reports have been published that suggest an association between exposure to typical antipsychotics and venous thromboembolisms (VTE). Therefore, when starting treatment with antipsychotics, especially low-potency typical antipsychotics and clozapine, health-care providers must account for the patient’s existing VTE risk factors. Design/methodology/approach In this case report, the authors describe the development of a pulmonary embolism associated with use of chlorpromazine in the treatment of an acute manic episode in a 51-year-old female patient with bipolar disorder type 1. Findings The patient was brought to the emergency room by the police on a legal hold for bizarre behaviors at a bus stop, which included incessantly yelling at bystanders. The patient was found to have disorganized thoughts, poor sleep, rapid speech, labile mood, distractibility, auditory hallucinations and grandiose delusions. During the course of her stay, the patient received extensive IM chlorpromazine for extreme agitation, in addition to chlorpromazine 200 mg IM Q8H, which was later decreased to chlorpromazine 100 mg chlorpromazine IM/PO Q8H. On day 4 of the treatment, the patient experienced difficulty breathing, hypoxia and tachycardia and was found to have bilateral expiratory wheezes. CT angiography showed sub-segmental pulmonary embolus and the patient was transferred to MICU service. The patient was then intubated and started on heparin by the medical team. Over the course of the next day, her respiratory distress resolved and the patient was extubated. Originality/value It is possible that chlorpromazine may indeed increase VTEs, and there are various physiological postulations regarding the mechanism of action. However, multiple confounding variables existed in the authors’ report, including venous stasis and the use of restraints, tobacco and valproic acid. Each of these variables has been shown to increase VTE occurrence. Further controlled studies are necessary to identify the true relationship between antipsychotics and VTEs.

Nevus Lipomatosus Superficialis Unseen or Unrecognized: A Report of Eight Cases

2013 ◽  
Vol 17 (5) ◽  
pp. 335-339 ◽  
Author(s):  
Muthu Sendhil Kumaran ◽  
Tarun Narang ◽  
Sunil Dogra ◽  
Uma Nahar Saikia ◽  
Amarinder Jit Kanwar
Keyword(s):  
Treatment Outcome ◽  
Health Care Providers ◽  
Case Reports ◽  
Case Series ◽  
Care Providers ◽  
Reticular Dermis ◽  
Disease Characteristics ◽  
Long Term Follow Up

Background: Nevus lipomatosus superficialis (NLS) is a unique developmental anomaly or nevoid form of lipoma characterized by the ectopic presence of mature adipocytes in reticular dermis. The condition is rare; apart frrom isolated case reports, there are no large case series dealing with the clinicoepidemiologic characteristics and posttreatment long-term follow-up in patients with NLS and little published information on treatment outcome. Objective: To study the clinicoepidemiologic characteristics and long-term posttreatment follow-up in patients with NLS. Methods: This was an 11-year retrospective study analyzing disease characteristics and treatment outcome in eight patients with NLS. Results: There were eight (six males, two females) patients with NLS, of whom three were children. The classic variant of NLS was the predominant presentation. One patient demonstrated a combination of both classic and solitary variants. Most patients, especially those with solitary variants, were commonly misdiagnosed before presenting to us. Four patients, including two with the solitary variant, one each with the classic and the combined type, underwent surgical resection without any recurrence over 8 years of follow-up. Conclusions: The rare nature of the disorder, which is commonly misdiagnosed, and the absence of long-term follow-up data prompted us to share our experience about NLS to increase its awareness among health care providers.

Fatal outcomes of imported dengue fever in adult travelers from non-endemic areas are associated with primary infections

2021 ◽  
Author(s):  
Ralph Huits ◽  
Eli Schwartz
Keyword(s):  
Health Care Providers ◽  
Case Reports ◽  
Secondary Infection ◽  
Fatal Outcome ◽  
Case Fatality ◽  
Severe Dengue ◽  
Care Providers ◽  
Denv Serotypes ◽  
Secondary Infections ◽  
The Impact

Abstract Background The case-fatality rate of dengue in travelers is low. Secondary dengue virus (DENV) infections are considered a risk factor for fatal outcome in endemic populations; however, the impact of secondary infections on mortality in travelers has not been studied systematically. We performed a descriptive analysis of case reports of dengue fatalities in travelers. Methods We searched Medline for clinical case reports, using the free terms and MeSH headings: ‘Dengue’ OR ‘Severe Dengue’ AND ‘Travel-Related Illness’ OR ‘travel’ AND ‘Mortality’ OR ‘Fatal Outcome’. We analyzed case reports of fatal dengue in returning travelers published from 1995 to 2020, with the objective to detail risk factors for dengue mortality in this population. We verified the authors’ classifications of primary or secondary dengue infections; infections were considered as primary by absence of anti-DENV immunoglobulin (Ig)G or by IgM-to-IgG ratios greater than or equal to 1.8 in the first 7 days post symptom onset. Results We identified nine detailed reports of dengue with fatal outcome among travelers from non-endemic countries. Eight fatalities were female. The median age was 32 years (range 21–63). Out of nine fatal cases, seven travelers had a primary DENV infection, one had a secondary infection and, in one, these data were not reported. The infecting DENV serotypes were DENV-1 (n = 2), DENV-2 (n = 2) and DENV-3 (n = 3); DENV-1 or 2 (n = 1) and in one case, the serotype could not be determined. Conclusions Dengue-related deaths in travelers are rare. Most dengue cases in travelers are primary infections. Contrary to prevailing conceptions, we found that fatal outcomes of dengue in travelers from non-endemic countries were reported mainly with primary DENV infections. We alert health care providers that primary DENV infections are not always harmless and that in adult travelers from non-endemic countries, primary infections may contribute more to dengue-related mortality than secondary infections.

Impact of pharmacists in mental health over the past decade

2012 ◽  
Vol 1 (10) ◽  
pp. 252-260 ◽  
Author(s):  
Jennifer E. Thomas ◽  
Joshua Caballero
Keyword(s):  
Health Care Providers ◽  
Case Reports ◽  
Case Series ◽  
Cost Savings ◽  
Interdisciplinary Approach ◽  
Controlled Trials ◽  
Care Providers ◽  
The Past ◽  
Significant Difference ◽  
The Impact

Purpose: As healthcare moves towards an interdisciplinary approach to improve clinical outcomes, it has become increasingly important for health care providers to collaboratively work together. Pharmacists have been working with psychiatrists for several decades to improve patient outcomes. However, their utility in psychiatry has not been recently elucidated. The purpose of this article is to describe and evaluate the impact of pharmacists in psychiatric settings over the past ten years. Methods: A literature search was conducted using PubMed and CINAHL Plus with Full Text. Studies published between 2002 and 2011 were included. Additional studies were identified through references contained within the studies. Case reports and case series were excluded. Results: Seventeen studies met the inclusion criteria: 15 studies in outpatient settings, two in inpatient settings. Outcomes measured included: patient symptoms, economic outcomes, medication adherence, and patient satisfaction. The majority of studies found improvements (e.g., resolution of symptoms, cost savings). However, controlled trials found no significant difference in clinical improvement from pharmacists' interventions. Conclusion: Although the majority of studies suggest pharmacists provide positive outcomes, the trials vary widely in quality and measured outcomes. Additional controlled trials with more standardized methods are recommended to support the role of pharmacists in psychiatric settings.

scholarly journals LO20: Naloxone dosing for suspected opioid and ultra-potent opioid overdoses: A systematic review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S14
Author(s):  
J. Moe ◽  
J. Godwin ◽  
R. Purssell ◽  
F. O'Sullivan ◽  
J. Hau ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Clinical Response ◽  
Health Care Providers ◽  
Case Reports ◽  
Data Extraction ◽  
Cochrane Central Register ◽  
Care Providers ◽  
Number Of Patients ◽  
Study Characteristics

Introduction: Optimizing naloxone dosing in the context of increasing fentanyl and ultra-potent opioid (UPO) prevalence is an important consideration for emergency health care providers. The goal of this systematic review was to evaluate the association between initial and cumulative naloxone doses on effective reversal and adverse events in undifferentiated and fentanyl/UPO overdoses. Methods: We searched Embase, MEDLINE, Cochrane Central Register of Controlled Trials, DARE, CINAHL, Science Citation Index, reference lists, toxicology websites, and conference proceedings from July to October 2018 and back to 1972. Our search included pertinent indexing terms for UPOs. We included interventional and observational studies reporting on naloxone administration for opioid toxicity reversal in people ≥12 years old. Additionally, we accessed non-traditional evidence sources (case reports and series) given this rapidly changing field. We conducted inclusion screens, data extraction and quality assessments in duplicate. We summarized study characteristics and where reported, analyzed number of patients with clinical response. Response was defined as not receiving further naloxone doses and remaining alive. Results: We included 174 studies (108 case reports and series, 55 observational, 9 interventional) with 26,660 subjects (median age 35.1; 74.2% male). We observed lower response among patients exposed to fentanyl/UPO versus heroin for initial naloxone doses ≤0.4mg (56.8% versus 80.2%) and > 0.4mg (27.0% versus 82.1%). Mean cumulative doses were higher for fentanyl/UPO (2.10 mg, SD 1.80 mg) versus heroin (1.48 mg, SD 1.68 mg) overdoses. In North American studies the median cumulative dose used was higher for fentanyl/UPO versus heroin overdoses. A dose-response curve for fentanyl/UPO studies showed marked variability in doses among responders, indicating heterogeneity. Adverse events reporting was inconsistent; 10% of subjects experienced withdrawal based on studies in which they were reported. Conclusion: This is the first systematic review to summarize proportion of patients with clinical response by naloxone dose provided. While variable reporting, study quality, heterogeneity, and our outcome definitions limit the conclusions we can draw, it appears that higher initial doses and in some cases, higher cumulative naloxone doses were used and may be necessary to reverse toxicity due to fentanyl/UPO compared to other opioids. High-quality prospective studies assessing effectiveness and safety are needed.

scholarly journals COVID-19 and pregnant women – An overview on diagnosis, treatment approach with limitation, and clinical management

2021 ◽  
Author(s):  
Laxmi Pattanashetti ◽  
Santosh Patil ◽  
Sanath Nyamgouda ◽  
Mahendrakumar Bhagiratha ◽  
Pramod Gadad
Keyword(s):  
Pregnant Women ◽  
Health Care Providers ◽  
Case Reports ◽  
Treatment Protocol ◽  
Signs And Symptoms ◽  
Family Welfare ◽  
Care Providers ◽  
Short Period ◽  
The Government ◽  
Novel Coronavirus

Coronavirus disease or more popularly called COVID-19 is known to be caused by a novel coronavirus 2. The COVID-19 has been identified to be originated from Wuhan, Hubei, China. This pandemic started in December 2019, and since then it has spread across the world within a short period. The health and family welfare ministry of the Government of India reported 227,546 active, 9,997,272 discharged cases, and 150,114 deaths due to COVID-19 as of 06 January 2021. Indian Council of Medical Research (ICMR) reports that the cumulative testing status of SARS-CoV-2 (COVID-19) was 931,408 up to November 03, 2020. Currently, no specific anti-viral drug for COVID-19 management is recommended in the current scenario. Vulnerable populations such as pregnant women affected by COVID-19 infection need to be recognized and followed up for effective handling concerning morbidity and mortality. At present, very few case reports on COVID-19 infected pregnant women have been published in India and there is no proven exclusive treatment protocol. This article summarizes a review of signs and symptoms, etiopathogenesis, risk factors, diagnosis, and possible management of COVID-19 infection in pregnant women. This overview may be useful for health care providers for practical approach and limitation of drugs used in the current management and considers the choice of drugs with their special attention given to adverse effects to improvise maternal health, pregnancy, and birth outcomes.  

scholarly journals Community Presentations of Anaphylaxis in Tasmania: Who is administering the adrenaline?

2016 ◽  
Vol 13 (1) ◽  
Author(s):  
Dale Edwards ◽  
Melanie Blackhall ◽  
Rachael Berry
Keyword(s):  
Health Care ◽  
General Practitioners ◽  
Health Care Providers ◽  
Health Professionals ◽  
Case Reports ◽  
Retrospective Chart Review ◽  
Health Concern ◽  
Primary Data ◽  
Care Providers ◽  
Early Administration

Background: Anaphylaxis is a significant health concern within the community.  The early administration of adrenaline to patients experiencing anaphylaxis has long been recognised as the cornerstone of treatment.  Health-care providers, including general practitioners, nurses and paramedics, are well equipped to manage anaphylaxis through the administration of adrenaline.  Patients themselves also often have adrenaline auto injectors, allowing early self-management.  The objective of this study was to determine the rates of adrenaline administration and identify the administering persons for all anaphylaxis patients presenting to ambulance services in Tasmania from January 1st 2008 until December 31st 2011 by using a retrospective chart review.  Methods: Ambulance Tasmania electronic case reports (n=226 421) from the period January 1st 2008 to December 31st 2011 were searched for all cases fitting the parameters of anaphylaxis, allergy or allergic reaction.  Of these cases, 373 were given a final paramedic diagnosis of anaphylaxis and constituted the primary data for this report. Results: Ambulance Tasmania attended 373 patients during the study period that were given a final primary diagnosis of anaphylaxis - of these 59 (15.8%) were excluded, leaving 314 electronic records for analysis.  Of the cases identified, 71.7% (n=225) were administered adrenaline according to paramedic records.  Adrenaline was administered by a range of health professionals, including general practitioners (n=27), paramedics (n=159), ambulance volunteers (n=4), nurses (n=1) and other health professionals (n=3).  Adrenaline was self-administered by 12.4% (n=28) of patients, with an additional 11.6% (n=26) receiving adrenaline from a non-health care worker (layperson).  In 10.2% of cases (n=23) adrenaline was administered by more than one provider.  Administration of adrenaline prior to paramedic arrival was evident in fewer than 10% of cases treated with adrenaline (n=22). Conclusion: The early administration of adrenaline in anaphylaxis is often vital for patient recovery. This study shows that adrenaline is administered by a number of different providers, with early administration accounting for only 9.8% of presentations treated with adrenaline. These findings raise the question, is adrenaline being administered early enough and often enough to improve health outcomes?

scholarly journals SARS-CoV-2 Infection and Stroke: Coincident or Causal?

2020 ◽  
Author(s):  
Melanie Walker ◽  
Christopher C. Young ◽  
Malveeka Sharma ◽  
Michael R Levitt ◽  
David L Tirschwell ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Case Reports ◽  
Clinical Spectrum ◽  
Neurological Manifestations ◽  
Care Providers ◽  
Cerebrovascular Complications ◽  
Global Pandemic

Neurological manifestations of SARS-CoV-2 infection described in isolated case reports and single institutions do not accurately reflect the clinical spectrum of disease across all geographies in a global pandemic. Data collected during peak of the Covid-19 pandemic from stroke centers in five states reveal few similarities to what has recently been published. Given the diversity in phenotype, we caution policymakers and health care providers when considering cerebrovascular complications from SARS-CoV-2 infection.

The Use of Janus Kinase Inhibitors in Alopecia Areata: A Review of the Literature

2019 ◽  
Vol 23 (3) ◽  
pp. 289-297 ◽  
Author(s):  
Erika L. Crowley ◽  
Shamone C. Fine ◽  
Kathleen Kwan Katipunan ◽  
Melinda J. Gooderham
Keyword(s):  
Case Studies ◽  
Health Care Providers ◽  
Alopecia Areata ◽  
Kinase Inhibitors ◽  
Case Reports ◽  
Case Series ◽  
Janus Kinase ◽  
Care Providers ◽  
Jak Inhibitors ◽  
Open Label

Alopecia areata (AA) is a chronic, immune-mediated disorder that targets hair follicle epithelium, thereby restricting hair growth in localized patches. Although several therapies for AA have been tested, responses with traditional therapies have been limited. In recent years, numerous reports have been published of patients with AA responding to Janus kinase (JAK) inhibitors. This literature review aims to describe AA pathophysiology, explore how and why JAK inhibitors can be used for AA treatment, and review published case reports, case series, and open-label studies published to date. Pathogenesis of AA includes interactions between genetic, environmental, and immune factors and is mediated by the cytokines interferon-γ and interleukin (IL)-15. JAK inhibition resulting in hair regrowth in some cases supports that AA is associated with the Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway. The emergence of JAK inhibitors for AA therapy is changing the way health care providers think about and treat AA. A mixture of animal model studies and human case studies have reported the use of baricitinib (JAK 1/2), ruxolitinib (JAK 1/2), and tofacitinib (JAK 1/3) for the management of AA. JAK inhibition has shown potential as an effective AA therapy when used in case studies, case series, and open-label trials. Formal clinical trials are ongoing and will yield more definitive conclusions about the safety and efficacy of JAK inhibitors.

Biotin interference in immunoassay: a review for the laboratory scientist

2019 ◽  
Vol 56 (4) ◽  
pp. 424-430 ◽  
Author(s):  
Gordon Avery
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Case Reports ◽  
Scientific Committee ◽  
Care Providers ◽  
Safety Communication ◽  
Assay Format ◽  
Biotin Binding ◽  
Available Information ◽  
Laboratory Scientist

The recent FDA Biotin (Vitamin B7): Safety Communication – May Interfere with Lab Tests and A statement from the ACB Scientific Committee regarding biotin/vitamin B7 interference in immunoassays have raised into the laboratory consciousness the need to understand and to manage the issues around biotin interference with some immunoassays and to provide education and advice to health-care providers. In patients who are prescribed biotin or take biotin supplements, biotin has the potential to cause falsely low or falsely high results in immunoassays using streptavidin–biotin binding as part of the assay methodology. Streptavidin–biotin binding is used by many manufacturers; some manufacturers use it for most of their immunoassays, some for a few of their immunoassays and some manufacturers do not use this assay format at all. The direction and magnitude of interference and the concentration of biotin which affects an assay are highly variable and assay specific. There have been many papers and case reports published recently of biotin interference in immunoassay, and biotin interference is probably one of the most difficult types of inference to detect and to obviate. This review will assess the currently available information on this topic and review the steps the laboratory can take to reduce the risk of incorrect patient results being reported.

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