An Unusual Presentation of Blastomycosis-Like Pyoderma Gangrenosum

2021 ◽  
Vol 33 (6) ◽  
pp. 203-206
Author(s):  
Richard Simman ◽  
Darren Gordon ◽  
Mary Steven ◽  
Amy Lynn
Keyword(s):  
Case Report ◽  
Pyoderma Gangrenosum ◽  
Health Care Providers ◽  
Complex Disease ◽  
Surgical Excision ◽  
Final Diagnosis ◽  
High Dose ◽  
Pathology Report ◽  
Care Providers ◽  
Inappropriate Treatment

Introduction. Pyoderma gangrenosum (PG) is a complex disease that has the potential to mimic a wide variety of diseases and disorders. Pyoderma is a disease of exclusion, but it has many variants, including ulcerative, bullous, and pustular forms. Owing to the complexity of the disease, careful diagnosis is important because inappropriate treatment can result in wound recurrence. Case Report. A 74-year-old female presented to the clinic with a presumed diagnosis of squamous cell carcinoma on biopsy but with an abnormal presentation mimicking a blastomycosis lesion. After surgical excision of the lesion in the operating room, the final pathology report confirmed the diagnosis of blastomycosis-like pyoderma gangrenosum. The patient was treated with high-dose prednisone and skin grafts, which resulted in resolution of the wound. Conclusions. This case report highlights the need to involve a wide array of health care providers in the management of complex and recurring wounds as well as the need to consider a wide and diverse differential diagnosis when determining the final diagnosis of complex wounds.

Guidelines for the Reporting of Nongynecologic Cytopathology Specimens

2009 ◽  
Vol 133 (11) ◽  
pp. 1743-1756
Author(s):  
Barbara A. Crothers ◽  
William D. Tench ◽  
Mary R. Schwartz ◽  
Joel S. Bentz ◽  
Ann T. Moriarty ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Ad Hoc ◽  
Clinical Laboratory ◽  
Needle Aspiration ◽  
Health Care Team ◽  
Major Elements ◽  
Pathology Report ◽  
Care Providers ◽  
Healthcare Organizations

Abstract Context.—Gynecologic cytology terminology and report formatting have been nationally standardized since the implementation of The Bethesda System of 1988, but standard reporting for nongynecologic cytology has never been formally addressed on the same scale. Objectives.—To promote patient safety through uniform reporting in nongynecologic cytology (including fine-needle aspiration cytology) and to improve communication between laboratories and health care providers. Data Sources.—Sources include the College of American Pathologists Cytopathology Resource Committee; the College of American Pathologists Council on Scientific Affairs Ad Hoc Committee on Pathology Report Standardization; the College of American Pathologists Laboratory Accreditation Program inspection checklists; the Joint Commission for Accreditation of Healthcare Organizations; and the Clinical Laboratory Improvement Amendments of 1988. Conclusions.—We describe the major elements of quality nongynecologic cytology reporting and discuss areas of controversy in cytology reporting. Standardized nongynecologic specimen reporting will expand the concept of common report elements already widely implemented in gynecologic cytology reporting. The intent is to improve communication with the health care team while remaining in compliance with federal mandates and accreditation guidelines.

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.

scholarly journals Pharmacist’s Intervention Considering the Prognosis for a Terminal Cancer Patient: A Case Report

Pharmacy ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 212
Author(s):  
Masahiro Okada ◽  
Kazuko Okazaki ◽  
Keisuke Kimura ◽  
Hiroki Sugihara ◽  
Fumiyoshi Murakami ◽  
...  
Keyword(s):  
Case Report ◽  
Health Care Providers ◽  
Prognostic Index ◽  
Oral Intake ◽  
Sigmoid Colon Cancer ◽  
Care Providers ◽  
Abdominal Wall Metastasis ◽  
First Case ◽  
Prognostic Prediction ◽  
Loss Of Appetite

Prognostic prediction has been reported to affect the decision of doctors and non-physician health care providers such as nurses, social workers, pastors, and hospice volunteers on the selection of appropriate medical interventions. This was a case of a 65-year-old woman who presented with a poor oral intake. The patient had a history of sigmoid colon cancer with abdominal wall metastasis and peritoneal dissemination. On the day of admission, nausea, anorexia, and malaise were noted, requiring immediate intervention. The patient’s prognosis was predicted using the Palliative Prognostic Index. The pharmacist suggested the use of dexamethasone tablets in order to alleviate the patient’s symptoms. Indeed, the administration of dexamethasone alleviated the symptoms of nausea, loss of appetite, and malaise. To the best of our knowledge, this is the first case report to demonstrate that prognosis prediction is important not only for other medical staff but also for pharmacists when deciding the need to initiate a treatment and continue such treatment, and when providing pharmacist interventions.

25 Cerebellar cognitive affective syndrome – a case report of diagnosis and management using selective serotonin and norepinephrine reuptake inhibitors

2020 ◽  
Vol 91 (8) ◽  
pp. e18.1-e18
Author(s):  
B Sridharan ◽  
YW Liao
Keyword(s):  
Case Report ◽  
Emotional Regulation ◽  
Complex Disease ◽  
Functional Independence ◽  
Selective Serotonin ◽  
High Dose ◽  
Cerebellar Cognitive Affective Syndrome ◽  
History Of ◽  
Cerebellar Haemangioblastoma ◽  
Norepinephrine Reuptake

Objectives/aimsThe objective of this case is to describe and report on a case of Cerebellar Cognitive Affective Syndrome (CCAS) which improved after the use of high dose venlafaxine therapy. To our knowledge, there are only a few case reports discussing on the effectiveness of various drug therapies in CCAS patients and none had reported on the use of Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRI).MethodsWe describe a 55-year-old male with a history of partially excised grade 1 left cerebellar haemangioblastoma in 2005 followed by Gamma Knife in 2006.Unfortunately, he suffered a recurrence in 2018 requiring embolisation of the haemangioblastoma followed with surgery to resect the tumour. He presented to our specialist neuropsychiatric unit following episodes of new acute unprovoked behavioural changes after surgery. During these episodes, he would become verbally abusive, refuse to engage in any rehab activity, refuse any oral intake, become sexually disinhibited, and experience distressing hallucinations. On the neuropsychiatric ward, he continued to have episodes of severe emotional regulation difficulties. There were no obvious triggers identified and it was noted that the peaks and troughs in his behaviour lasted for a few days before self-resolving and did not follow any particular pattern. In between these episodes, the patient was pleasant, engaging in physiotherapy, and conversed normally with staff.ResultsHe scored a total of 4 out of 10 on the CCAS-scale. A diagnosis of CCAS was concluded given the extensive history of cerebellar injury, nature of presenting complain, and his CCAS-scale score. He was started on high dose SNRI (Venlafaxine XL 150 mg BD). On repeating the CCAS-scale after being on SNRI for 4 months, his score was worse at 6 out of 10. However, we observed a decrease in the frequency, duration, and severity of behavioural change after commencement of SNRI. He benefited greatly from physiotherapy on the ward however despite our best efforts functional independence was not regained. He had to be transferred with the aid of 2 members of staff and mobilises with the aid of an electronic wheelchair.ConclusionsCCAS is a complex disease and the management is yet to be agreed on by the neuropsychiatry community. Our case report illustrated the therapeutic benefit of venlafaxine in the treatment of severe emotional regulation difficulties associated with resection of a cerebellar haemangioblastoma. Furthermore, patients with cerebellar injuries should be managed in a multi-disciplinary manner with input from neurology, neuropsychiatry, neuropsychology, occupational therapist, and physiotherapist.

scholarly journals Home Management of the Device Detected Atrial Fibrillation during COVID-19 Pandemic: A Case Report

2021 ◽  
Vol 9 (C) ◽  
pp. 170-173
Author(s):  
Idaliya Rakhimova ◽  
Talgat Khaibullin ◽  
Yerbol Smail ◽  
Zhanar Urazalina ◽  
Vitalii Koval`chuk ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Health Care Providers ◽  
Remote Monitoring ◽  
Beta Blockers ◽  
Oral Anticoagulants ◽  
Home Monitoring ◽  
Phone Call ◽  
Care Providers ◽  
Remote Monitoring System

BACKGROUND: Patients with heart failure (HF) and implanted heart devices constitute a vulnerable category during the coronavirus disease –2019 (COVID-19) pandemic. The remote monitoring function allows the physician to detect atrial fibrillation (AF) in these patients and to prevent thromboembolic complications by prescribing anticoagulants. Under quarantine conditions, such patients can receive fully remote consultation and treatment, which will protect them from the risk of infection, and also reduce the burden on medical institutions. CASE REPORT: A 56-year-old man presented to the clinic with shortness of breath when climbing the second floor, moderate non-specific fatigue, general weakness, and a decrease in exercise tolerance. The patient received standard treatment for HF for at least 3 months (ACEI, beta blockers, MR antagonists, and loop diuretics) in individually selected adequate doses. ECG on admission showed a QRS of 150 ms, left bundle branch block (LBBB). Echo showed dilatation of all heart chambers, diffuse hypokinesis of the walls with akinesis of the apical, middle anterior LV segments, as well as hypokinesis of the basal, middle apical, and anterior septal segment of the LV. The ejection fraction was reduced to 35%. RV function is reduced. After a detailed discussion with the team, it was decided to do implantation of a cardioverter-defibrillator with resynchronization function, equipped with remote monitoring (Biotronik, and Home monitoring). Date of implantation is June 19, 2014. Due to the fact that the patient was connected to the remote monitoring system, May 5, 2020, he was diagnosed with asymptomatic AF. The episode lasted 1 min 22 s. On the following days of monitoring, episodes of AF were also recorded. The duration of the episodes ranged from a few seconds to 12 h/day. The patient received a doctor’s consultation through phone call, his risk of stroke was four when assessed using the CHA2DS2VASc scale. In treatment, it was recommended to add antiarrhythmic drugs (amiodarone 600 mg a day) and oral anticoagulants (rivaroxaban 20 mg × 1 time/day). Later, periodic IEGM showed absence of AF. CONCLUSION: In the context of the COVID-19 pandemic, health-care providers should rethink their approach to managing patients with implanted heart devices. Modern cardiovascular implantable electronic devices allow the physician to monitor the status of patients and immediately respond to situations requiring a change in treatment. Consultations can be carried out completely online.

scholarly journals COVID-19: a case report

ANALES RANM ◽  
2020 ◽  
Vol 137 (137(02)) ◽  
pp. 147-149
Author(s):  
Jesús Mateos Nozal ◽  
Beatriz Montero Errasquín ◽  
Alfonso J. Cruz Jentoft
Keyword(s):  
Health Care ◽  
Case Report ◽  
Health Care Providers ◽  
Health Care Workers ◽  
Care Providers ◽  
Daily Work ◽  
Care Workers ◽  
High Incidence

COVID-19 pandemic is relentlessly spreading worldwide since it was described in Wuhan in december 2019. A high incidence in health care workers has been described in Spain. The number or articles discussing this condition is exponentially growing, but few published cases report on what physicians have faced in their daily work. It is key that health care providers learn how to convey the severity that COVID-19 can reach, in order to raise awareness on the importance of prevention.

Melanoma survivor treatment severity and correlates of psychosocial and physical health.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20026-e20026
Author(s):  
Kelly Bugos ◽  
Arianna Aldridge Gerry ◽  
Oxana Palesh ◽  
Susan M. Swetter ◽  
Katherine L. McGurk ◽  
...  
Keyword(s):  
Lymph Node ◽  
Health Care Providers ◽  
Cutaneous Melanoma ◽  
Surgical Excision ◽  
Physical Symptoms ◽  
Lymph Node Biopsy ◽  
Additional Treatment ◽  
Cancer Center ◽  
Care Providers ◽  
Psychosocial Needs

e20026 Background: Melanoma survivors’ psychosocial needs and physical symptoms are not well understood, despite nearly 1 million melanoma survivors in the US. In addition, there is a paucity of support available as it is generally believed that cutaneous melanoma survivors don’t suffer long term health consequences. Methods: As part of the new Stanford Cancer Survivorship Program, melanoma survivors previously treated at Stanford Cancer Center were asked to complete a quality improvement survey to explore the value of a melanoma survivorship clinic. 21% of 893 invited survivors responded to the electronic survey. We compared survivors based on treatments received: surgical excision only (SX) vs. surgical excision plus (SX+) one or more of the following: sentinel lymph node biopsy, lymph node dissection, skin graft, interferon, chemotherapy, or radiation therapy. Results: 161 melanoma survivors (SX+: 32% vs. SX: 68%) completed the survey. Those who received surgery plus additional treatment were predominantly male (SX+: 68% vs. SX: 32%, p = 0.003) and slightly older (SX+: 67 years vs. SX: 60 years, p = 0.004). Survivors who received SX+ reported greater fatigue (p < 0.001), weight loss (p < 0.001), arm or leg swelling (p < 0.001), weakness (p = 0.001), numbness/tingling (p = 0.009), pain (p = 0.015), and nausea and/or vomiting (p = 0.039) than SX survivors. Similarly, SX+ survivors reported reduced vitality (24% vs. 6%, p = 0.004), worse social functioning (12% vs. 5%, p = 0.032), and worse sexual functioning (20% vs. 6%, p = 0.017) following treatment. Related to patient care, health care providers were less likely to address these symptoms in SX survivors relative to SX+ survivors (75% vs. 57%, p = 0.019). More SX than SX+ survivors wanted education on how to protect their skin from further damage (24% vs. 8%, p= 0.016). Conclusions: Melanoma survivors receiving SX+ for more advanced disease experienced greater psychosocial and physical symptoms following treatment. However, survivors treated with excision alone for cutaneous melanoma wanted provider attention for their treatment-related symptoms and improved education on skin protection.

Probable Nonconvulsive Status Epilepticus With the Use of High-Dose Continuous Infusion Ceftazidime

2016 ◽  
Vol 29 (6) ◽  
pp. 564-568 ◽  
Author(s):  
Reagan D. Collins ◽  
Frank P. Tverdek ◽  
Jeffrey J. Bruno ◽  
Elizabeth A. Coyle
Keyword(s):  
Status Epilepticus ◽  
Continuous Infusion ◽  
Health Care Providers ◽  
Bacterial Infections ◽  
Multidrug Resistant ◽  
Nonconvulsive Status Epilepticus ◽  
High Dose ◽  
Care Providers ◽  
Beta Lactam ◽  
Beta Lactams

Multidrug resistant (MDR) bacterial infections are a major concern of health care providers due to their increasing incidence and associated mortality. In some cases, few or no antibiotics have preserved activity. Beta-lactam administration via continuous infusion can optimize time over minimum inhibitory concentration (MIC). In some cases, use of high-dose continuous infusion (HDCI) may be necessary to achieve serum levels in excess of nonsusceptible MIC values. The use of HDCI beta-lactams is not without risk, specifically neurotoxic adverse effects, which appear dose related. We describe a 64-year-old male who experienced myoclonus and nonconvulsive status epilepticus while receiving HDCI ceftazidime for treatment of multidrug resistant Pseudomonas aeruginosa bacteremia. This report serves as a cautionary example of the potential toxicities associated with HDCI beta-lactams and supports the importance of risk–benefit analysis prior to and during treatment. Additionally, the use of serum drug level monitoring may be necessary to better prevent or predict toxicity.

scholarly journals Pacing Spikes All Over

2017 ◽  
Vol 11 ◽  
pp. 117954681771447 ◽  
Author(s):  
Mohammed Shurrab ◽  
Teresa Pagacz ◽  
Ayelet Shauer ◽  
Ilan Lashevsky ◽  
David Newman ◽  
...  
Keyword(s):  
Health Care ◽  
Case Report ◽  
Health Care Providers ◽  
Cross Talk ◽  
Care Providers ◽  
Pacemaker Algorithm

Ventricular safety pacing (VSP) is used to avoid cross talk by delivering ventricular stimulus shortly after an atrial-paced event if ventricular-sensed event occurs. Although VSP is a protective feature that exists for decades in different pacing devices, there are some reports of unfavorable outcomes of this algorithm. More so, health care providers sometimes face difficulties in interpreting and dealing with VSP strips. This case report discusses an important pacemaker algorithm and encourages further attention to possible pitfalls and hence avoids unnecessary interventions.

scholarly journals Rare Osteochondroma of the Posterior Talar Process: A Case Report

2020 ◽  
Author(s):  
Luan Pham ◽  
Daniel Wu
Keyword(s):  
Case Report ◽  
Bone Tumors ◽  
Surgical Excision ◽  
Current Understanding ◽  
Pathology Report ◽  
Cartilage Formation ◽  
Benign Bone Tumors ◽  
Healthy Female

Osteochondromas are benign bone tumors that arise from divergent cartilage formation most commonly in childhood versus adulthood. We report the case of a 42-year-old healthy female who presented with a unusual solitary posterolateral ankle mass with associated pain and ankle impingement with 6 weeks follow up. The patient was successfully treated with open surgical excision with bone with pathology diagnosis of benign osteochondroma. The patient returned to normal baseline function with no pain at 6 weeks follow up. Open posterior ankle incision approach performed to remove suspicious enlarged bony growth from posterior talar process sent to pathology. Pathology report returned benign osteochondroma of the posterior talar process and patient subsequently had routine healing of post op incision site and return to full function without pain or disability at 6 weeks follow up. This case study adds to the current understanding, incidence, occurrence, and treatment of rare osteochondromas occurring in the posterior talar process.

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