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2022 ◽  
Vol 3 (1) ◽  
pp. 01-05
Author(s):  
Yasser Mohammed Hassanain Elsayed

Rationale: A novel COVID-19 is a multi-systemic critical worldwide pandemic infection. Certainly, associated multiple electrolytes imbalance in COVID-19 pneumonia is a remarkable decisive event. Camel-hump T-wave, Tee-Pee sign, and Wavy triple sign (Yasser’s sign)are novel highly significant descriptive electrocardiographic signs that are seen in calcium and potassium disturbance. There is an established and strong relationship between and electrocardiographic abnormalities and electrolytes imbalance. COVID-19 pneumonia and cerebrovascular stroke are commonly seen in a patient with Coronavirus infection. Patient concerns: A 69-year-old married worker Egyptian male patient was presented to the emergency department with COVID-19 pneumonia and cerebrovascular stroke. Diagnosis: COVID-19 pneumonia with lacunar infarction, hypocalcemia, and hyperkalemia. Interventions: Chest CT scan, brain CT scan, electrocardiography, oxygenation, and echocardiography. Outcomes: Initial bad and deterioration outcome but, the dramatic outcome had happened after later management. Lessons: The understanding of electrocardiographic signs regarding metabolic disorders such as electrolytes imbalance and other associated systemic diseases is very important. Elderly male sex, heavy smoker, COVID-19 pneumonia, cerebrovascular stroke, chronic renal impairment, ischemic heart disease, hypokalemia, hypocalcemia, and hypernatremia represent bad prognostic points and is indicating a high-risk condition.


2022 ◽  
Vol 3 (1) ◽  
pp. 01-04
Author(s):  
Yasser Mohammed Hassanain Elsayed

Rationale: The term “fragmentation of the QRS complex” denotes the existence of high-frequency potentials (spikes) in the QRS-complex. It is either a marker for cardiac structural diseases inducing biventricular hypertrophy or any condition interfering with the normally homogeneous depolarization status inside the myocardium. An associated right ventricular infarction with inferior infarction maybe carry a risk impact and serious complications. Patient concerns: A 64-year-old married, farmer, heavy smoker, Egyptian male patient presented with acute severe chest pain and inferior with right ventricular ST-segment elevation myocardial infarction and fragmentation of the QRS complex. Diagnosis: QRS-complex fragmentations and right ventricular infarction in the presence of inferior infarction with the triple-vessels disease. Interventions: Electrocardiography, oxygenation, streptokinase intravenous infusion, echocardiography, and percutaneous transluminal coronary angioplasty. Outcomes: Dramatic response of acute inferior with right ventricular ST-segment elevation myocardial infarction and QRS-complex fragmentations to streptokinase. Lessons: Despite the presence of inferior and right ventricular ST-segment elevation myocardial infarction with QRS-complex fragmentations, but there is no correlation with the severity of the disease. Dramatic clinical and electrocardiographic response signifying the role of streptokinase and fibrinolytic. The presence of fragmentation of the QRS-complex may have a bidirectional impact from seriousness to complications.


2022 ◽  
pp. 149-158
Author(s):  
Mondoni Michele ◽  
Carlucci Paolo ◽  
Sorino Claudio ◽  
Marchetti Giampietro ◽  
Feller-Kopman David

2021 ◽  
Author(s):  
Cristine Delnevo ◽  
Michelle Jeong ◽  
Arjun Teotia ◽  
Michelle T Bover Manderski ◽  
Binu Singh ◽  
...  

Importance: Physicians play a primary role in smoking cessation, and their communication regarding e-cigarettes needs to be understood. Objective: To examine physician-patient communication regarding e-cigarettes. Design: A national, repeated cross-sectional survey in 2018 and 2019 was conducted. Setting: Participants were invited by mail; surveys were completed online. Participants: Response rates were 51.8% (2018) and 59.1% (2019), resulting in 2,058 board-certified physicians from family medicine, internal medicine, obstetrics/gynecology, cardiology, pulmonary/critical care, and hematology/oncology. Exposures: Physician demographics, tobacco use, medical specialty, and harm-reduction beliefs (i.e., not all tobacco products equally harmful); two hypothetical clinical scenarios. Main outcomes and measures: Physicians' self-reported e-cigarette communication behaviors (being asked about e-cigarettes by patients and recommending e-cigarettes to patients), and hypothetical e-cigarette communication in two clinical scenarios. Results: Among 2,058 physicians, the mean age was 51.6 years and 41.5% were female. Over 60% of physicians believed all tobacco products are equally harmful. Overall, 69.8% of physicians reported ever being asked about e-cigarettes by their patients (35.9% in the past 30 days), while 21.7% reported ever recommending e-cigarettes to a patient (9.8% in the past 30 days). Pulmonologists (adjusted odds ratio [AOR], 2.14, 95% CI, 1.10-4.16) and cardiologists (AOR, 2.04; 95% CI, 1.03-4.05), as well as physicians who implemented the US Public Health Service Clinical Practice Guidelines (AOR, 1.77; 95% CI, 1.12-2.80) had greater odds of recommending e-cigarettes to patients. Physicians who endorsed a harm-reduction perspective (AOR, 3.04, 95% CI, 2.15-4.31) and had ever smoked cigarettes (AOR, 1.98; 95% CI, 1.27-3.08) were significantly more likely to recommend e-cigarettes. Being asked about e-cigarettes by patients was a strong predictor of physicians' recommending (AOR,16.6; 95% CI, 10.3-26.7). In clinical scenarios, physicians were overall more likely to recommend e-cigarettes for cessation to an older, heavy smoker with multiple unsuccessful quit attempts than a younger, light smoker with no prior cessation treatments (49.3% vs. 15.2%, p<.001). Conclusions and relevance: Findings suggest physicians may recommend e-cigarettes for cessation under certain circumstances. Given the role of e-cigarettes in FDA's comprehensive nicotine policy, there is need for continued physician education regarding e-cigarette efficacy, particularly correcting misperceptions regarding harm reduction.


2021 ◽  
pp. 42-44
Author(s):  
Jofin George ◽  
Damini Somayaji ◽  
Akshada Vernekar ◽  
Uday C Kakodkar

Lung Cancer is the most common cancer worldwide with most cases being detected at Stage IV. Among these, metastases to the clivus are rare with only very few cases reported in literature. The long course of the abducent nerve in relation to the clivus, makes it susceptible for metastases and subsequent lateral rectus palsy. We present the case of a heavy smoker, 64 years old man who presented with headache and diplopia, on evaluation diagnosed as bronchogenic carcinoma with clival metastases on magnetic resonance imaging(MRI).


2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Romy G. Younan ◽  
Roy A. Raad ◽  
Bassem Y. Sawan ◽  
Rabih Said

Abstract Background Treatment with immune checkpoint inhibitors has revolutionized cancer treatment over the past several years. Despite their clinical benefits, a wide range of immune-mediated toxicities can be observed including hematological toxicities. Although, the majority can easily be managed, immune-mediated adverse events rarely can be severe and difficult to approach. Herein, we are reporting a case of very severe aplastic anemia secondary to ipilimumab (I) and nivolumab (N) treatment that failed various treatment including intensive immune suppressive therapy. Case presentation We described a case of a 45-year old white male, heavy smoker presented to the clinic complaining of left flank pain. He was found to have a metastatic renal cell carcinoma for which he was treated with dual immunotherapy and later complicated by severe immune related adverse events. The patient later died after failing intensive immune suppressive therapy. Conclusion Immunotherapy has become an established pillar of cancer treatment improving the prognosis of many patients with variant malignancies. Yet, lethal adverse events can occur in rare cases. It is our duty, as physicians, to remain alert and cautious.


2021 ◽  
Vol 12 ◽  
Author(s):  
Jose Rodriguez Cruz ◽  
Johan Sahlsten Schölin ◽  
Stephan Hjorth

This case report describes a 30-year old male diagnosed with schizophrenia at the age of 23, and with a long history of drug abuse. He had previously received a wide range of antipsychotic drug treatment regimens, all with some degree of effect, but never with complete symptom relief. He was also suffering from persistent cognitive and negative symptoms. At the time of admission in our clinic, he was on Quetiapine (QUE) and Haloperidol (HAL). It was therefore decided to substitute HAL for Cariprazine (CAR)—an agent with a novel pharmacological and clinical profile—in the hope of gaining increased efficacy, particularly in the cognitive and negative symptom domains. Within 3 weeks of the switch from HAL to CAR the patient clearly improved, and notably so in the aforementioned symptom areas. A number of subsequent adjustments of antipsychotic dosages and adjunct medications during the ensuing months resulted in an apparently more stable alleviation of positive as well as negative and cognitive symptoms, including markedly improved personal and social capabilities. Interestingly, some time after initiating CAR treatment the patient also reported that from being a heavy smoker (60 cig/d) he had cut down and eventually ceased smoking entirely; furthermore, he has remained clean of other substance abuse since his first admission in 2020. The joint treatment with CAR in combination with QUE thus seems to have improved the patient's cognitive functioning as well as possibly his susceptibility to substance abuse.


2021 ◽  
Vol 31 (2) ◽  
pp. 31
Author(s):  
Yohanes Widyakusuma Eka Saputra ◽  
Kristanti Wanito Wigati ◽  
Rina Yudiwati ◽  
Ni Wajan Tirthaningsih

Background: The habit of smoking tobacco is a lifestyle that has become a necessity for some people. Sometimes, social needs is the main reason for someone to have a smoking habit. Based on this problem, the level of cigarette consumption in the community has increased. Nowadays, the total number of couples visiting an infertility clinic is on the rise. This have led to an assumption among the community that smoking tobacco is one of the main factors causing male infertility. Objective: to compare light smokers and heavy smokers towards the results of semen analysis in infertile male patients. Materials and Methods: This study was an observational analytics, with a retrospective-cross sectional. The instrument used in this study was taken from medical records of the patients who visited the Andrology Clinic of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, for the period from January to December 2017. The observed semen analysis parameters were concentration, motility, and morphology for microscopic examination and liquefaction, pH, and volume for macroscopic examination, by following the inclusion and exclusion criteria. Results: Ninety-two samples of infertile male participants (50 light smokers and 42 heavy smokers) were included in this study. Semen analysis on its concentration, motility, spermatozoa morphology, as well as liquefaction, pH, and volume) towards the number of cigarette consumption showed no significant difference (p>0.05) between light smokers and moderate smokers. Conclusion: There was no significant difference between the light smoker and heavy smoker groups on the results of the semen analysis.


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