scholarly journals Rapidly Fatal COVID-19-associated Acute Necrotizing Encephalopathy in a Previously Healthy 26-year-old Man

2021 ◽  
Vol 23 (5) ◽  
pp. 138-143
Author(s):  
Robert Raschke ◽  
◽  
Cristan Jivcu
Keyword(s):  
Prior History ◽  
Significant Past Medical History ◽  
Acute Necrotizing Encephalopathy ◽  
The Past ◽  
Progressive Dyspnea ◽  
Chief Complaints ◽  
Acute Necrotizing ◽  
History Of ◽  
Oropharyngeal Swab ◽  
To Receive

No abstract available. Article truncated after 150 words. A 26-year-old man presented to our Emergency Department at 0200 on the day of admission with chief complaints of subjective fever, leg myalgias, and progressive dyspnea of one week duration. An oropharyngeal swab PCR had revealed SARS-CoV-2 RNA three days previously. He had not received a SARS CoV-2 vaccination, but had made an appointment to receive it just a few days prior to the onset of his symptoms. The patient had no significant past medical history, was taking no medications except for ibuprofen and acetaminophen over the past week, and did not take recreational drugs. He specifically denied headache and had no prior history of seizure. On admission, his HR was 150 bpm (sinus), RR 22, BP 105/46 mmHg, temp 40.2° C. and SpO2 92% on room air. He was ill-appearing, but alert and oriented, his neck was supple and lung auscultation revealed bilateral rhonchi, but physical examination was otherwise …

P1879Characterization of cardiac diagnostic care pathways by indication and physician specialty in a real-world dataset of 314,554 patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Landman ◽  
S Sarkar
Keyword(s):  
Ischemic Stroke ◽  
Care Pathway ◽  
Holter Monitoring ◽  
Prior History ◽  
Care Pathways ◽  
Loop Recorder ◽  
External Loop ◽  
History Of ◽  
To Receive ◽  
Term Monitoring

Abstract Background A variety of modalities exist for diagnosing cardiac arrhythmias via ambulatory ECG recording. These can range from short-term (i.e. ≤48 hours) holter monitoring, medium-term external monitoring for up to 30 days, and long-term monitoring via an implantable cardiovascular monitor (ICM). Purpose To quantify the prevalence of different diagnostic care pathways for cardiac arrhythmias in a large, real-world dataset. Methods A de-identified database of aggregated EHR data from 2015–2017 was used to identify patients with any procedure or service received for an ambulatory cardiac diagnostic monitor. Three categories of diagnostic monitoring technologies were identified: (1) Holter monitoring for up to 48 hours, (2) External ECG and event monitoring for up to 30 days via external loop recorder, mobile cardiac telemetry (MCT), or other external ECG recording device, and (3) ICMs. Patients with their first monitor in 2015 or later were selected. The number of patients that had their initial monitor in each of the different categories were quantified, as well as the number that followed a care pathway progression from shorter-term to longer-term monitoring. Patients were grouped by clinical history (syncope or ischemic stroke diagnosis codes in the 6 months prior) as well as by whether they had a clinical interaction with an electrophysiologist (EP) at any point in their care pathway. Results A total of 314,554 patients were identified with a mean follow-up duration of 340.1±232.5 days. The initial monitor type used across all patients was 68.8% holter, 27.7% extended holter/MCT/external loop recorder, and 3.5% ICMs. 5.1% of all patients received multiple categories of monitoring. 50,812 patients had a prior history of syncope, 46.4% of which were seen by an EP. 28,374 patients had a prior history of ischemic stroke, with 50.9% seen by an EP. The figure shows that patients seen by an EP are more likely to receive ICMs than those not seen by an EP (20.6% vs. 3.8% for syncope; 25.3% vs. 5.7% for stroke; both p<0.001). Patients seen by an EP are also more likely to receive multiple categories of progressively-longer monitoring than those not seen by an EP (10.4% vs. 4.6% for syncope; 8.3% vs. 4.0% for stroke; both p<0.001). Conclusion Cardiac diagnostic care pathways for syncope and ischemic stroke are significantly different between those patients that are seen by an EP versus those that are not. Relatively few patients overall received multiple types of cardiac diagnostic monitoring. Acknowledgement/Funding Medtronic

Saltation and suspension trajectories of solid grains in a water stream

1977 ◽  
Vol 284 (1321) ◽  
pp. 225-254 ◽  
Keyword(s):  
Velocity Gradient ◽  
High Speed ◽  
Prior History ◽  
Water Stream ◽  
The Past ◽  
The Coefficient Of Friction ◽  
Conservation Of Momentum ◽  
History Of ◽  
The Mean ◽  
Exposure Technique

This paper continues the investigation of the motion of solitary grains in a water stream, reported by Francis (1973)- The trajectories of solid grains are photographed by a multi-exposure technique as they are propelled by water streams along the bed of a laboratory channel. Many thousands of photographs were taken and analysed to determine the positions, velocities and accelerations of the grain. The technique does not take into account the possible effect, in multi-grain transport, of intergranular collisions. The three different modes of transport of grains were all observed — rolling, saltation and suspension, and the proportion of each found for a variety of transport stage w*/w*0. The development of suspension is much less rapid than the development of saltation from rolling, but even at the highest stage used, about 3.0, there is still a small amount of rolling. The trajectory dimensions and geometry are shown in relation to the stage which uniquely determines the geometry. Experiments where the grain is suddenly entrained from a stationary position show that several features of the subsequent trajectory are the same as those of a trajectory with a prior history of movement: thus it is inferred that the start of a trajectory is by way of hydrodynamic forces rather than by the conservation of momentum of previous trajectories. Impacts and trajectories were analysed for the coefficient of friction tan cc and for the height of the effective thrust. While tan a is shown to be rather larger than has been suspected in the past, the variation of yn throws light upon predominance of slow fluid near the bed rather than high speed inrushes of fast fluid. Better information is now available for finding the mean forward speed of grains compared to that presented in the earlier paper. There are grounds for believing the existence of a * shear-drift ’ force on grains when they are in a velocity gradient, giving a force opposing gravity: but there is no evidence of a proximity effect of the bed independent of the velocity gradient.

scholarly journals Acute Cardiogenic Shock Induced by Infusional 5-Fluorouracil

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Jeffrey Sulpher ◽  
Franco Dattilo ◽  
Susan Dent ◽  
Michele Turek ◽  
M. Neil Reaume ◽  
...  
Keyword(s):  
Wall Motion ◽  
Clinical Status ◽  
Metastatic Carcinoma ◽  
Prior History ◽  
History Of ◽  
St Elevation ◽  
Wall Motion Abnormalities ◽  
Carcinoma Of The Bladder ◽  
To Receive

A 49-year-old patient with metastatic carcinoma of the bladder and no prior history of heart disease presented with diffuse ST elevation, elevated troponins, and biventricular dysfunction requiring intensive care unit admission and inotropic support after receiving her first course of infusional 5-fluorouracil (5-FU). Over the course of several days, the patient’s cardiac function and clinical status returned to baseline. A follow-up echocardiogram performed 5 days after initial presentation revealed an ejection fraction of 59 percent, with no evidence of wall motion abnormalities. Subsequent 5-FU chemotherapy was discontinued, and the patient went on to receive second-line chemotherapy.

scholarly journals COVID-19–Associated Acute Asymmetric Hemorrhagic Necrotizing Encephalopathy: A Case Report

2022 ◽  
pp. 194187442110553
Author(s):  
Najo Jomaa ◽  
Tarek El Halabi ◽  
Jawad Melhem ◽  
Georgette Dib ◽  
Youssef Ghosn ◽  
...  
Keyword(s):  
Neurological Complications ◽  
Parahippocampal Gyrus ◽  
Biological Drugs ◽  
Acute Necrotizing Encephalopathy ◽  
Immune Mediated ◽  
Acute Necrotizing ◽  
History Of ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Background: Coronavirus disease 2019 (COVID-19) has been associated with many neurological complications affecting the central nervous system. Purpose: Our aim was to describe a case of COVID-19 associated with a probable variant of acute necrotizing encephalopathy (ANE). Results: A 60-year-old man who presented with a 3-day history of dyspnea, fever, and cough tested positive for severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2). Five days following his admission, the patient was intubated secondary to respiratory failure. Following his extubation 16 days later, he was found to have a left-sided weakness. Magnetic resonance imaging (MRI) of the brain showed hemorrhagic rim-enhancing lesions involving the right thalamus, left hippocampus, and left parahippocampal gyrus. These lesions showed decreased relative cerebral blood flow on MR perfusion and restricted on diffusion-weighted imaging. These neuroimaging findings were consistent with ANE. The left-sided weakness gradually improved over the subsequent weeks. Conclusions: We concluded that COVID-19 can be associated with ANE, a condition believed to be the result of an immune-mediated process with activation of the innate immune system. Future studies must address whether biological drugs targeting the pro-inflammatory cytokines could prevent the development of this condition.

scholarly journals In a Melting Pot of Autobiography: Pickthall’s With the Turk in Wartime and the Cause of Islam

2021 ◽  
Vol 5 (4) ◽  
pp. 2-16
Author(s):  
Ebtisam Ali Sadiq
Keyword(s):  
Twentieth Century ◽  
Short Stories ◽  
Literary History ◽  
English Literature ◽  
Literature Analysis ◽  
Melting Pot ◽  
Near Eastern ◽  
The Past ◽  
History Of ◽  
To Receive

Marmaduke Pickthall, a half-forgotten British novelist of the early twentieth century, has come back to the spotlight over the past few years. His Near Eastern novels and short stories have started to receive attention in contemporary scholarship but not his two autobiographies. This essay aims at tackling the more neglected piece of the two, With the Turk in Wartime, that deserves attention because of its intricate amalgamation of several features of the genre of autobiography as manifested across its history within the tradition of English literature. Analysis finds that Pickthall’s autobiography has some Romantic, Victorian, and Modern elements as well as some old characteristics of the genre elaborately interwoven into its structure. The study also traces the use that Pickthall makes of this unique autobiography and how the commingling of diverse elements allows him to turn a usually subjective genre into a public cause and dedicate it to the service of Islam. This essay highlights both the diversity that the literary history of the genre lends to Pickthall’s autobiography and the socio-political service it renders to the faith that the author has long esteemed and will ultimately convert to not long after writing this autobiography.

Immunogenicity of Subcutaneous Versus Intramuscular Oka/Merck Varicella Vaccination in Healthy Children

PEDIATRICS ◽  
1991 ◽  
Vol 88 (3) ◽  
pp. 604-607
Author(s):  
Penelope H. Dennehy ◽  
Keith S. Reisinger ◽  
Mark M. Blatter ◽  
Barbara A. Veloudis
Keyword(s):  
Geometric Mean ◽  
Varicella Vaccine ◽  
Varicella Vaccination ◽  
Prior History ◽  
Healthy Children ◽  
Geometric Mean Titer ◽  
Clinical Events ◽  
History Of ◽  
The Mean ◽  
To Receive

To compare the immunogenicity and safety of varicella vaccine by either subcutaneous or intramuscular injection, 166 healthy children aged 12 months to 10 years old who had no prior history of varicella were enrolled from two pediatric practices and randomly assigned to receive 0.5 mL of a single lot of varicella vaccine. Sera from the day of and 6 weeks postvaccination were tested for varicella antibody by gpELISA. Parents recorded clinical events occurring in the 6 weeks following vaccination. In the 132 evaluable children, the mean prevaccination titer was 0.3 gpELISA units for both groups. Sixty-three (97%) of the 65 receiving varicella vaccine by the subcutaneous route seroconverted compared with 67 (100%) of 67 immunized intramuscularly. Postvaccination geometric mean titer in the subcutaneous group was 6.9 ± 7.0 gpELISA units and did not differ significantly from the geometric mean titer of 10.5 ± 4.4 in the intramuscular group. Varicella vaccine was generally well tolerated by either route; 21% of both groups complained of reactions at the injection site and 7% had a varicella-like rash. Although varicella vaccine is recommended to be given subcutaneously, the results of this study indicate that inadvertent intramuscular administration of varicella vaccine is not reason for revaccination.

Documentation of landoltia (Landoltia punctata) resistance to diquat

Weed Science ◽  
2006 ◽  
Vol 54 (4) ◽  
pp. 615-619 ◽  
Author(s):  
Tyler J. Koschnick ◽  
William T. Haller ◽  
Les Glasgow
Keyword(s):  
Aquatic Plant ◽  
Resistance Mechanism ◽  
Photosynthetic Electron Transport ◽  
Prior History ◽  
Ion Leakage ◽  
Lake County ◽  
Static Tests ◽  
The Past ◽  
History Of ◽  
New Formulation

Landoltia was collected and cultured from a canal in Lake County, Florida, where diquat was used repeatedly during the past 20–30 yr for duckweed control. Recent applications of diquat failed to provide adequate control of duckweed, and a new commercial formulation of diquat was suspected. The new formulation was not the cause of reduced efficacy. Static exposures (48 h) to various concentrations of diquat were used to compare the susceptibility of the Lake County landoltia accession to one never exposed to diquat. These static tests indicated that landoltia, from a population with no prior history of herbicide treatment, was extremely susceptible to diquat. The accession from Lake County, FL had developed resistance to diquat, and was also cross resistant to paraquat. The resistance factor was 50 for diquat and 29 for paraquat. The Lake County accession also exhibited reduced ion leakage after diquat exposure under light and dark conditions. This suggests the resistance mechanism to the bipyridylium herbicides in landoltia is independent of photosynthetic electron transport. This research documents the first aquatic plant species that has developed resistance to the bipyridylium herbicides.

scholarly journals Tuberculosis-associated Fibrosing Mediastinitis: Case Report and Literature Review

2016 ◽  
Vol 6 ◽  
pp. 32 ◽  
Author(s):  
Ronald Tan ◽  
Joanne Martires ◽  
Nader Kamangar
Keyword(s):  
Soft Tissue ◽  
Clinical Presentation ◽  
Late Complication ◽  
Rare Condition ◽  
Prior History ◽  
Fibrosing Mediastinitis ◽  
Granulomatous Infection ◽  
Progressive Dyspnea ◽  
History Of ◽  
Active Processes

Fibrosing mediastinitis is a rare condition defined by the presence of fibrotic mediastinal infiltrates that obliterate normal fat planes. It is a late complication of a previous granulomatous infection, such as histoplasmosis or tuberculosis (TB). Due to its rarity, fibrosing mediastinitis is often under-recognized, and the clinical presentation is variable and dependent on the extent of infiltration or encasement of structures within the mediastinum. We present a case of fibrosing mediastinitis in a man with a prior history of TB, who presented with progressive dyspnea and was found to have chronic mediastinal soft tissue opacities and pulmonary hypertension. His diagnosis was delayed due to the lack of recognition of this clinical/radiographic entity. Fibrosing mediastinitis is a rare entity usually caused by granulomatous disease. Most cases develop as a late complication of histoplasmosis or TB. The presence of calcified mediastinal soft tissue infiltrates on advanced chest imaging can be diagnostic of fibrosing mediastinitis in patients with a prior history of a granulomatous infection once active processes such as malignancy are excluded.

scholarly journals Thyroid gossypiboma: a rare diagnosis with common presentation

2019 ◽  
Vol 6 (9) ◽  
pp. 3409
Author(s):  
Kush Raj Lohani ◽  
Kamal Kataria ◽  
Piyush Ranjan ◽  
Sarada Khadka ◽  
Jnaneshwari Jayaram
Keyword(s):  
Needle Aspiration ◽  
Working Environment ◽  
Prior History ◽  
Time Interval ◽  
The Past ◽  
Primary Surgery ◽  
High Clinical Suspicion ◽  
Thyroid Abscess ◽  
History Of ◽  
Surgery First

Gossypiboma is a surgical negligence and is commonly reported in major abdominal surgeries. It has rarely been reported after thyroid surgeries. We present gossypibomas found in two post-hemithyroidectomy patients who presented differently and at varied time interval after primary surgery. First patient is a middle-aged lady who presented with persistent discharging sinus from neck for the past 4 years. She underwent hemithyroidectomy in the past. Another patient is an elderly lady who presented with lump in the neck for the past 3 months. She also had history of thyroid surgery about 36 years back. With the working diagnosis of thyroid abscess and malignancy in the respective cases, extensive work up was done including imaging and needle aspiration. However, definitive diagnosis could only be made intra-operatively, where gauze piece was found embedded in the prior surgical site. Gossypibomas can present in a varied fashion that can be easily missed from clinical judgement and imaging. High clinical suspicion in patients with prior history of surgery presenting with chronic discharging sinus or lump is key to diagnosing gossypibomas. Safer working environment with safety checkpoints are warranted to avoiding such incidences.

scholarly journals 1494. Clinical Factors Associated with a Positive C. difficile PCR Test

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S544-S544
Author(s):  
Teresa Cushman ◽  
Michelle Barron ◽  
Jaron Arbet ◽  
Rachel Weber ◽  
Yaxu Zhuang ◽  
...  
Keyword(s):  
Hospital Length Of Stay ◽  
Positive Test ◽  
Prior History ◽  
Antibiotic Administration ◽  
Clinical Factors ◽  
Factors Associated ◽  
The Past ◽  
Test Order ◽  
History Of ◽  
Pcr Test

Abstract Background C. difficile infection (CDI) remains a significant cause of morbidity and mortality. The most appropriate clinical scenario for CDI testing is unclear. The IDSA/SHEA guideline recommends testing patients with unexplained new-onset ≥3 stools in 24 hours. This study sought to evaluate clinical factors associated with a positive C. difficile PCR test. Methods We conducted a retrospective cohort study of adults (age >18 years old) admitted to the University of Colorado Hospital for whom a C. difficile PCR, either as a standalone test or part of the Biofire® Filmarray® Gastrointestinal Panel (GI Panel), was ordered between October 1, 2015 and August 31, 2017. Data collected included time since admission to test order, hospital length of stay, history of CDI, antibiotic use in the past 90 days, clinical presentation in the 24 hours preceding test order (fever, leukocytosis, number of stools), and laxative or antibiotic administration within 24 hours of test order. Multivariate logistic regression was used to evaluate the association of the above variables with having a positive C. difficile PCR test. If multiple tests were ordered during a single hospital encounter, only the first test was included in our analysis. Results 3,070 tests were performed; of these, 72% were ordered in the first 72 hours of admission. Overall, 19% of tests were positive. After adjusting for clinical variables, patients with a prior history of C. difficile or who had received antibiotics in the past 24 hours were significantly more likely to have a positive test [OR 2.2 95% CI (1.54, 3.18) P < 0.0001] and [OR 16 95% CI (8.22, 31.41) P < 0.0001], respectively. Patients who used laxatives were significantly less likely to have a positive test [OR 0.75 95% CI (0.61, 0.91) P = 0.004]. The number of stools and presence of fever or leukocytosis were not significantly associated with a positive test. Conclusion Prior history of C. difficile and antibiotics use was highly associated with a positive C. difficile test, while laxatives use was associated with a negative test. The number of stools was not significantly associated with a positive C. difficile test, suggesting this may be less important clinical factor than previously believed; however, restricting testing in patients receiving laxatives is likely warranted. Disclosures All authors: No reported disclosures.

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