Health system impact of COVID-19 on urban slum population of Bangladesh: a mixed-method rapid assessment study.

Objective: We aimed to rapidly assess the health system impact of COVID-19 in the urban slums of Bangladesh.

Design: A cross-sectional survey among 476 households was conducted during October-December 2020 in five selected urban slums of Dhaka North, Dhaka South and Gazipur City Corporation. In-depth interviews with purposively selected 22 slum dwellers and key informant interviews with 16 local healthcare providers and four policymakers and technical experts were also conducted.

Natural disasters and acute myocardial infarction.

Natural disasters are devastating to not only our physical property but also to our health. There have been several studies over the last few decades that have correlated different types of natural disasters with acute myocardial infarctions (AMIs). Since the early 1930's singular meteorological events have been reported to have some association and effect on cardiovascular (CV) mortality and morbidity.

Management of Atrio-Esophageal Fistula Following Left Atrial Ablation.

Currently, no guidelines have been established for the treatment of atrio-esophageal fistula (AEF) secondary to left atrial ablation therapy. After comprehensive literature review, we aim to make suggestions on the management of this complex complication and also present a case series. We performed a review of the existing literature on AEF in the setting of atrial ablation.

Establishing a gradient between partial pressure of arterial carbon dioxide and end-tidal carbon dioxide in patients with acute respiratory distress syndrome.

End-tidal carbon dioxide (ETCO) monitoring is useful in many situations. However, ETCO monitoring is unreliable in patients with acute respiratory distress syndrome (ARDS) due to widespread lung inflammation. In our study, we attempt to establish the gradient between the arterial pressure of carbon dioxide (PaCO) and ETCO in patients with ARDS, which we defined as the PaETCO gradient.

Two Cases of Acute Renal Infarction in the Setting of Atrial Fibrillation.

Background: Acute renal infarction (ARI) is an uncommon and often overlooked diagnosis in patients presenting with acute kidney injury and abdominal pain.

Case Reports: We present 2 cases of ARI in the setting of atrial fibrillation along with a review of medical literature pertaining to ARI.

Conclusion: This article should aid clinicians in the diagnosis of ARI.

Pulmonary Hypertension in a Patient With Congenital Heart Defects and Heterotaxy Syndrome.

Background: Heterotaxy syndrome, also called isomerism, is a condition in which abdominal and thoracic organs are located in abnormal body positions. Pulmonary hypertension (PHTN) is an uncommon clinical feature of heterotaxy syndrome.

Case Report: We describe the case of a 26-year-old male who developed PHTN as a rare manifestation of heterotaxy syndrome.

Lactic Acidosis Induced by Linezolid Mimics Symptoms of an Acute Intracranial Bleed: A Case Report and Literature Review.

Lactic acidosis is common and most often associated with disturbed acid-base balance. Rarely, it can be a life-threatening medication side effect. Hence, determining the etiology of lactic acidosis early in patients is paramount in choosing the correct therapeutic intervention.

Safety of percutaneous endoscopic gastrostomy tube placement in patients with continuous-flow ventricular assist devices.

In this retrospective study, the safety of percutaneous endoscopic gastrostomy (PEG) tube placement was evaluated as maintaining adequate nutritional support for patients with left ventricular assist devices is crucial. Nineteen patients who underwent PEG tube placement were followed for an average of 40 days. Overall, minor complications such as infections, bleeding, and PEG tube malposition occurred in just 19% of patients while the rate of major complications such as perforation was 5%.

Tissue Plasminogen Activator Use in Cardiac Arrest Secondary to Fulminant Pulmonary Embolism.

Background: Tissue plasminogen activator (tPA) is used emergently to dissolve thrombi in the treatment of fulminant pulmonary embolism. Currently, there is a relative contraindication to tPA in the setting of traumatic or prolonged cardiopulmonary resuscitation > 10 minutes because of the risk of massive hemorrhage.

Methods: Our single-center, retrospective study investigated patients experiencing cardiac arrest (CA) secondary to pulmonary embolus.

In Search for Equilibrium: Immunosuppression Versus Opportunistic Infection.

Post-transplant immunosuppression is necessary to prevent organ rejection. Immunosuppression itself can introduce complications arising from opportunistic infections. We present a case of disseminated blastomycosis manifested only as a skin lesion in an asymptomatic patient post-orthotopic heart transplantation.

Clostridium septicum Aortitis of the Infrarenal Abdominal Aorta.

Clostridium septicum aortitis is a rare infection that has a strong association with occult colonic malignancy. There is also emerging evidence to support the combination of medical and surgical management over medical management alone. To the best of our knowledge, we report the 40th known case of C.

Impact of Chest Pain Protocol Targeting Intermediate Cardiac Risk Patients in an Observation Unit of an Academic Tertiary Care Center.

Background: Chest pain (CP) is a frequent cause of emergency room visits in United States and adds a huge financial burden to our healthcare cost. With the addition of observation units, standard CP protocols have shown to decrease length of stay (LOS) and cost per discharge (CPD). We report our experience with the development and implementation of "CP protocol for intermediate cardiac risk patients" and its impact on healthcare resource utilization at our medical center.

A Case of Tumor Lysis Syndrome in a Patient with Pancreatic Adenocarcinoma Treated with Low-Dose Gemcitabine.

Background: Tumor lysis syndrome (TLS) is a common adverse consequence of treatment of high-grade hematologic malignancies that has been known to occur rarely in some solid tumors, including small cell lung cancer, breast cancer, colorectal cancer, neuroblastoma, ovarian cancer, and hepatocellular carcinoma.

Case Report: We present a case of TLS in a patient with pancreatic adenocarcinoma treated with one small dose of gemcitabine. To our knowledge, this phenomenon has only been described once prior in the medical literature and never with a reduced dose of chemotherapy.

Correlation Between Partial Pressure of Arterial Carbon Dioxide and End Tidal Carbon Dioxide in Patients with Severe Alcohol Withdrawal.

Background: Respiratory depression is a common adverse effect of benzodiazepine administration to patients with severe alcoholic withdrawal. This study was conducted to assess the value of end tidal carbon dioxide (ETCO2) levels compared to partial pressure of arterial carbon dioxide (PaCO2) levels in monitoring respiratory depression secondary to benzodiazepine treatment in patients with severe alcohol withdrawal.

Methods: We retrospectively analyzed 36 patients admitted to the intensive care unit for severe alcohol withdrawal who had been administered sedative agents.

A Rare Case of Cardiac Tamponade Induced by Chronic Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease primarily involving the joint synovium. RA is a systemic disease which has many known extra-articular manifestations. We present a unique case of a patient with long standing RA who presented with a primary complaint of chest and back pain.

Diphenhydramine and QT prolongation - A rare cardiac side effect of a drug used in common practice.

There have been few cases in recent times where QT interval prolongation has been studied with regards to the use of diphenhydramine. We present a case of a patient who presented because of shortness of breath and needed emergent hemodialysis; during the course of which he developed prolonged QT interval on electrocardiography, which was correlated interestingly with the use of diphenhydramine. Pruritus is a common symptom experienced by dialysis patients.

Billing and coding knowledge: a comparative survey of professional coders, practicing orthopedic surgeons, and orthopedic residents.

Medical knowledge and surgical skills are necessary to become an effective orthopedic surgeon. To run an efficient practice, the surgeon must also possess a basic understanding of medical business practices, including billing and coding. In this study, we surveyed and compared the level of billing and coding knowledge among current orthopedic residents PGY3 and higher, academic and private practice attending orthopedic surgeons, and orthopedic coding professionals.

Monitoring quantity and characteristics of municipal solid waste in Dhaka City.

A reliable estimate of the quantity of solid waste generation in the city is very important for proper solid waste planning and management. However, reported estimates of solid waste generation vary widely and lead to questionability. The reported values have been derived on the assumption of demography, standard rate of waste generation by households, density values, number of trucks engaged for waste transportation and monitoring of truck movement at dump sites, etc.