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 Smartphone remote monitoring app to follow-up colorectal cancer survivors: a requirement analysis (Preprint)

2020 ◽  
Author(s):  
Seyed Mohammad Ayyoubzadeh ◽  
Mohammad Shirkhoda ◽  
Sharareh R. Niakan Kalhori ◽  
Niloofar Mohammadzadeh ◽  
Somayyeh Zakerabasali
Keyword(s):  
Colorectal Cancer ◽  
Cancer Survivors ◽  
Health Care Providers ◽  
Remote Monitoring ◽  
Care Providers ◽  
Remote Monitoring System ◽  
Colorectal Cancer Survivors ◽  
Multiple Challenges ◽  
Colorectal Cancer Patients

BACKGROUND Colorectal survivors face multiple challenges after discharge. eHealth may potentially support them by providing tools such as smartphone apps. They have lots of capabilities to exchange information and could be used for remote monitoring of these patients. OBJECTIVE In this study, we addressed the required features for apps designed to follow-up colorectal cancer patients according to survivors' and clinical experts' views. METHODS A mixed method study was conducted. Features of related apps were extracted through the literature; the features were categorized and then they were modified. A questionnaire is designed containing the features listed and prioritized based on the MoSCoW (Must have, should have, could have, won’t have) technique and an open question for each category. The link to the questionnaire was shared among clinical experts in Iran. The answers were analyzed using CVR (Content validity ratio) and based on the value of this measure, the minimum feature set of a monitoring app for colorectal cancer patient’s follow-up was addressed. Also, a telephone interview with colorectal survivors was conducted to collect their viewpoints regarding a remote monitoring system for colorectal cancer cases. RESULTS The questionnaire contained ten sections evaluating nine categories of features. Eighteen experts filled the questionnaire. the minimum features of the app identified as patient information registration, sign and symptoms monitoring, education, reminders, and patient evaluation (0.42<CVR<0.85). Features including physical activity, personalized advice, and the social network did not get the minimum score (-0.11<CVR<0.39). Nine colorectal cancer survivors were interviewed. Information registration, sign and symptoms monitoring, education, and personalized advice were the features with high priority from the survivors’ perspective. Scheduling, shopping, and financial support features were emphasized by survivors in the interview. CONCLUSIONS The requirements set could be used for designing an app for the targeted population. and/or patients affected by other cancers. As the views of both sides of survivors as clinical experts were considered in this study, the remote system may fulfill the need for follow up of survivors more strongly. This eases the patient and health care providers’ communication and interaction CLINICALTRIAL

scholarly journals Safety and timing of resuming dabigatran after major gastrointestinal bleeding reversed by idarucizumab

2018 ◽  
Vol 6 ◽  
pp. 2050313X1775333 ◽  
Author(s):  
Gian Galeazzo Riario Sforza ◽  
Francesco Gentile ◽  
Fabio Stock ◽  
Francesco Caggiano ◽  
Enrica Chiocca ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Major Bleeding ◽  
Acute Treatment ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Oral Vitamin ◽  
Bleeding Events ◽  
Massive Rectal Bleeding

The recent introduction of direct oral anticoagulants, including rivaroxaban, dabigatran, apixaban, and edoxaban, for the acute treatment and secondary prevention of venous thromboembolism and in atrial fibrillation has been shown to provide greater clinical benefit than oral vitamin K antagonists. However, direct oral anticoagulants are associated with adverse events, the most common being major bleeding; such events require the reversal of the anticoagulant effects by specific agents. In this case report, we describe an 87-year-old female with atrial fibrillation treated with dabigatran who had massive rectal bleeding. Idarucizumab 5 g (2 × 2.5 g/50 mL) was successfully used to reverse dabigatran effect; subsequent to this, treatment with dabigatran was resumed, and there were no further bleeding events. This suggests that dabigatran can be safely restarted after major bleeding, but this outcome needs to be confirmed in studies involving larger groups of patients.

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.

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.

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.

scholarly journals Intracranial Hemorrhage following Lumbar Puncture in a Patient on Apixaban

2019 ◽  
Vol 11 (3) ◽  
pp. 277-283 ◽  
Author(s):  
Priyanka Vijapura ◽  
Michael J. Maniaci
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Lumbar Puncture ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Evidence Based ◽  
Nonvalvular Atrial Fibrillation ◽  
Practice Recommendations ◽  
Diagnostic Lumbar Puncture ◽  
Evidence Based Guidelines

Currently, clinical practice recommendations regarding patients in need of emergent lumbar puncture who are taking direct oral anticoagulants (DOACs) are based upon expert opinion, as evidence-based guidelines are unavailable. We present the case of an 80-year-old Caucasian lady who underwent diagnostic lumbar puncture for presumed meningitis while on therapeutic apixaban for nonvalvular atrial fibrillation. She was subsequently found to have bilateral subdural hematomas. This case report reviews both the current criteria for computerized tomography brain imaging prior to lumbar puncture as well as the bleeding risks of lumbar puncture while on a DOAC.

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