The Endgame

2021 ◽  
pp. 79-83
Author(s):  
Martha Gershun ◽  
John D. Lantos
Keyword(s):  
Blood Pressure ◽  
Glucose Tolerance ◽  
Kidney Function ◽  
Antihypertensive Medication ◽  
Salt Intake ◽  
Psychological Screening ◽  
X Ray ◽  
Blood Tests ◽  
Kidney Paired Donation ◽  
Chest X Ray

This chapter begins with detailing the author's final results following her three-day grueling tests for glucose tolerance, psychological screening, kidney function, EKG, and a chest X-ray. The author found out that there was an issue with her blood pressure. It then outlines the four available choices she could take: to end the process, to lose some weight and reduce salt intake and retest in a few months, to start on a very low dose of antihypertensive medication and retest in two weeks, and finally, to take her current results to the Transplant Selection Committee and hope for the best. Ultimately, the chapter presents an alternative plan, to become part of the Kidney Paired Donation program, if the new blood tests ruled the author unable to donate directly to the intended recipient.

scholarly journals Syncope Caused by Huge Hiatal Hernia

2011 ◽  
Vol 2011 ◽  
pp. 1-2 ◽  
Author(s):  
Gabriel Vanerio
Keyword(s):  
Blood Pressure ◽  
Hiatal Hernia ◽  
Normal Sinus Rhythm ◽  
White Female ◽  
Loss Of Consciousness ◽  
X Ray ◽  
Normal Sinus ◽  
Carbonated Soft Drinks ◽  
Chest X Ray ◽  
Careful History

A 84-year-old white female had a brief loss of consciousness while playing bridge. A few minutes before the episode she had eaten pizza and significant amount of carbonated soft drinks. After recovery, her friends noticed that she was alert, but pale and sweating. Upon arrival at the emergency room, sitting blood pressure was 160/60 mmHg with a normal sinus rhythm. A chest X-Ray was performed, which was essential to make the diagnosis. The X-Ray showed a large retrocardiac opacity with air and liquid level compatible with a giant hiatus hernia. After a copious snack the hiatal hernia compressed the left atrium, decreasing the left cardiac output, elucidating the mechanism of the syncopal episode. In patients presenting with swallow syncope (particularly after a copious meal, validating the importance of a careful history), a chest X-Ray should be always be performed.

scholarly journals Sotrovimab: is it effective in early treatment of mild and moderate COVID-19 infections? A retrospective study

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Ahmed Elesdoudy
Keyword(s):  
Kidney Function ◽  
United Arab Emirates ◽  
Early Treatment ◽  
Vital Signs ◽  
Laboratory Studies ◽  
Kidney Function Tests ◽  
X Ray ◽  
Function Tests ◽  
Significant Difference ◽  
Chest X Ray

Abstract Background The monoclonal antibody sotrovimab is manufactured to antagonize many types of coronaviruses including the SARS-CoV-2. It is used mainly to treat mild and moderate COVID-19 infection and to prevent the progression of the disease from critical disease to severe. Objectives To assess the effectiveness of sotrovimab in the early treatment of mild and moderate COVID-19 infections and prevention of disease progression to severe and critical disease. Methods This study was performed on 220 outpatients who have already received sotrovimab in Obaidullah Hospital, United Arab Emirates. All patients underwent the following before receiving sotrovimab: routine laboratory studies (CBC, liver function tests, and kidney function tests) and other laboratory tests (C reactive protein (CRP), D dimer, and chest x-ray). All patients received sotrovimab in a dose of 500 mg once intravenous infusion over 30 min. All laboratory studies and CXR are repeated after 1 week of receiving the dose of sotrovimab. Results The outcome was 43 patients deteriorated (19.5%) and 177 patients improved (80.5%). The progress of patients’ symptoms after receiving sotrovimab where the shortness of breath (SOB) deteriorated in 43 patients (19.5%) and improved in 177 patients (80.5%). The cough symptom deteriorated in 43 patients (19.5%), improved in 177 patients (80.5%). The progress of patients' radiology (chest x-ray) where it is deteriorated in 43 patients (19.5%) and improved in 177 patients (80.5%). The rate of hospitalization after receiving sotrovimab where 41 patients were hospitalized (18.6%) and 179 patients were not hospitalized (81.4%). There was a statistically significant difference before and after using sotrovimab in vital signs, inflammatory markers, kidney function tests, electrolytes, endocrine functions, and hepatic profile. Conclusion Among adults with mild and moderate COVID-19, the use of sotrovimab significantly improved resolution of symptoms, outcome, radiology, or laboratory marker and decreased hospitalization. The findings support using sotrovimab in the early treatment of mild and moderate COVID-19. Wide-scale studies may be required for clarifying the effects of sotrovimab in the treatment of mild and moderate COVID-19 infections.

Successful Treatment of Refractory Aquagenic Pruritus with Naltrexone

2005 ◽  
Vol 9 (5) ◽  
pp. 215-216 ◽  
Author(s):  
Sarah Ingber ◽  
Paul D. Cohen
Keyword(s):  
Protein Electrophoresis ◽  
Endogenous Opiates ◽  
X Ray ◽  
Multiple Treatment ◽  
Blood Tests ◽  
Underlying Causes ◽  
Bath Water ◽  
Chest X Ray ◽  
Polycythemia Rubra Vera ◽  
Uvb Phototherapy

Background: Aquagenic pruritus is an intense prickling sensation that develops in affected individuals immediately after contact with water at any temperature. It is most commonly associated with polycythemia rubra vera. Common but often ineffective treatments include anticholinergics and antihistamines. Other moderately successful treatments include capsaicin cream, UVB phototherapy, and sodium bicarbonate bath water. Objective: In this case report we describe a 55-year-old female with severe itching following showers. Underlying causes were ruled out with a series of blood tests, a chest X-ray, and serum protein electrophoresis. After multiple treatment failures, her itching was relieved with naltrexone. Conclusion: Endogenous opiates, like naltrexone, can modify pruritus by influencing the peripheral and central sensation of itch. It has been found to be successful in suppressing the perception of pruritus from many diverse origins including aquagenic pruritus.

scholarly journals Intracardiac Migration of the Ureteral Double-J Stent during Percutaneous Nephrolithotomy

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 939
Author(s):  
Chun-Kai Chang ◽  
Yi-Hsuan Wu ◽  
Ming-Chen Paul Shih ◽  
Jiun-Hung Geng
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stones ◽  
X Ray ◽  
One Stage ◽  
Medical Issues ◽  
Double J Stent ◽  
Chest X Ray ◽  
To Receive

The complications of percutaneous nephrolithotomy (PNL) include hemorrhage, damage to adjuvant organs, and other medical issues, although intracardiac migration of ureteral double-J stent has never been found during PNL and delaying the diagnosis might cause mortality. We report the case of a 60-year-old male who was admitted to receive one-stage PNL for right renal stones. During operation, an unexpected atrial fibrillation with a drop in blood pressure was suddenly encountered and the chest X-ray subsequently showed that the ureteral double-J had penetrated deep into the heart. Emergent endovascular intervention was performed to remove the stent and the patient was uneventfully discharged 2 days later.

scholarly journals Pleuritic chest pain: infection, infarction or musculoskeletal?

2002 ◽  
Vol 1 (2) ◽  
pp. 64-66
Author(s):  
S Gill ◽  
◽  
A Pope ◽  
Keyword(s):  
Pulmonary Embolism ◽  
Chest Pain ◽  
Initial Presentation ◽  
Pulmonary Emboli ◽  
Pleuritic Chest Pain ◽  
X Ray ◽  
Blood Tests ◽  
Chest X Ray ◽  
Initial Blood ◽  
D Dimer

A 52 year old patient, originally thought to have musculoskeletal chest pain was found to have features consistent with infective pleurisy on initial blood tests and chest x-ray, with a negative d-dimer indicating a low likelihood of pulmonary embolism. Two weeks later he represented with continued symptoms and investigations revealed extensive pulmonary emboli, which were thought to have developed after his initial presentation.

scholarly journals The use of a new semi-quantitative rapid test for procalcitonin in the diagnosis of multisegmental community-acquired pneumonia

2021 ◽  
Vol 93 (3) ◽  
pp. 279-282
Author(s):  
Sabina S. Bayramova ◽  
Konstantin Yu. Nikolayev ◽  
Oksana V. Tsygankova
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Respiratory Failure ◽  
Rapid Test ◽  
Community Acquired Pneumonia ◽  
Procalcitonin Level ◽  
X Ray ◽  
Erythrocyte Sedimentation ◽  
Chest X Ray ◽  
The Mean

Aim. Evaluation of the possibilities of a new semi-quantitative rapid test for procalcitonin in the diagnosis of multisegmental community-acquired pneumonia. Materials and methods. A one-stage comparative study involved 123 patients hospitalized in a hospital with a confirmed diagnosis of community-acquired pneumonia. The mean age of the patients was 49.521.0 (MSD) years. On the first day of hospitalization, all patients underwent a general clinical examination, chest x-ray, and a plasma procalcitonin level was determined using a semi-quantitative rapid test. Results. Indicators of a new semi-quantitative rapid test for procalcitonin of at least 2 ng/ml are directly related to laboratory and instrumental indicators reflecting the severity of community-acquired pneumonia, namely, the severity of respiratory failure (p=0.001), respiratory rate (p=0.001), and heart rate contractions (p=0.001), systolic blood pressure (p=0.025), oxygen saturation (p=0,001), erythrocyte sedimentation rate (p=0.021), fibrinogen (p=0.003) and high CRB-65 scores (p=0.001). They are also associated with multisegmental community-acquired pneumonia (2=4.7; p=0.030) and complications of this disease, such as hydrothorax (p=0.029) and death (2=22.1; p=0.001). Conclusion. Using a new semi-quantitative rapid test for procalcitonin allows you to optimize the diagnosis of complications of community-acquired pneumonia and determine the high risk of multisegmental pneumonia.

073 Alemtuzumab induced allergic inflammatory syndrome (ALIAS) with eosinophilic acalculous cholecystitis: a report of two cases

2018 ◽  
Vol 89 (6) ◽  
pp. A30.1-A30 ◽  
Author(s):  
Ariadna Fontes-Villalba ◽  
John DE Parratt
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Signs ◽  
Young Patients ◽  
Lower Lobe ◽  
Acalculous Cholecystitis ◽  
X Ray ◽  
Blood Tests ◽  
Chest X Ray ◽  
The Right ◽  
Inflammatory Syndrome

IntroductionAlemtuzumab, a humanised monoclonal antibody directed at CD52, is a highly active treatment for multiple sclerosis (MS) that induces rapid depetion of circulating lymphocytes. Infusion-associated reactions and autoimmune disorders are established adverse effects. We describe two cases of alemtuzumab associated allergic inflammatory syndrome involving the lungs and gallbladder in two young patients after their first course of Alemtuzumab.Case 1 A 26 year old female with relapsing-remitting MS (RRMS) received her first course of alemtuzumab. On the fourth day of treatment, she developed bronchospasm, chest pain and an interstitial infiltrate in the right lower lobe on chest X-ray. She had right upper quadrant pain and a positive Murphy’s sign and ‘gallbladder sludge’ on ultrasound. Blood tests showed lymphopenia and eosinophilia. The patient was diagnosed with acalculous cholecystitis. Antibiotic therapy was initiated but laparoscopic cholecystectomy was required. The pathology demonstrated eosinophilic cholecystitis.Case 2 A 29 year old man with RRMS was switched to alemtuzumab due to positive JCV antibody status. He had an episode of hemoptysis on the fifth day of the infusion. Two days later, haemoptysis was accompanied by chest tightness. Physical examination revealed a palpable liver and positive Murphy sign. Blood tests were remarkable for abnormal liver enzymes. Signs of interstitial changes in the right lower lobe were observed on a chest X-ray. The patient was diagnosed with acalculous cholecystitis and antibiotic therapy was initiated. The infiltrate resolved and the clinical signs quickly improved.ConclusionThe characteristics of this condition are acute onset (within days of alemtuzumab) and non-infective inflammation of the lung (right lower lobe in these cases) and gallbladder. The pathology in one case indicates this is likely to be a drug related, allergic phenomenon with extensive eosinophilic infiltration of the gallbladder.

scholarly journals Just the facts: What drugs are safe and effective for COVID-19?

CJEM ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 591-594
Author(s):  
Brit Long ◽  
Stephen Y. Liang ◽  
Hans Rosenberg ◽  
Christopher Hicks ◽  
Michael Gottlieb
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Oxygen Saturation ◽  
Medical History ◽  
Face Mask ◽  
Therapeutic Agents ◽  
Past Medical History ◽  
Oxygen Supplementation ◽  
X Ray ◽  
Chest X Ray

A 53-year-old male presents with cough, fever, and myalgias for 7 days. Vitals include temperature, 38.0°C; heart rate, 110; blood pressure, 118/70 mm Hg; respiration rate, 28; and oxygen saturation 83% on room air. His only past medical history is hypertension. Your community is in the midst of the coronavirus disease 2019 (COVID-19) pandemic. The patient is hypoxic but responds to oxygen supplementation with nasal cannula and a face mask. His chest x-ray demonstrates multifocal infiltrates. Are there any therapeutic agents currently available for COVID-19?

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