A Case of Infantile Perianal Pyramidal Protrusion Masquerading As Imperforate Anus at Birth.

Infantile perianal pyramidal protrusion (IPPP) is an uncommon and underreported benign cutaneous lesion characterized by a protrusion from the anal orifice. It is also believed to be often mistaken for other conditions. The unawareness of this lesion may be responsible for underreporting and an excessive concern both in providers and in parents.

Vitamin D status in very low birth weight infants and response to vitamin D intake during their NICU stays: a prospective cohort study.

Objective: To evaluate vitamin D status in very low birth weight (VLBW) infants and response to vitamin D intake.

Study Design: In this prospective cohort study of VLBW infants, 25-hydroxyvitamin D [25(OH)D] was measured regularly starting at birth. Daily vitamin D intake was estimated from parenteral and enteral sources.

Risk factors for blood transfusion in Cesarean section: A systematic review and meta-analysis.

Objective: The current study has been conducted to identify the risk factors associated with blood transfusion in women undergoing cesarean section (C-section). A detailed account of the risk factors associated withblood transfusion will ultimately prevent unnecessary crossmatching in hospitals , leading to the conservation of declining blood supplies and resources without subjugating the quality of care.

Material And Methods: We performed a rigorous literature search using electronic databases, including PubMed, Cochrane CENTRAL, and Embase, for studies evaluating the risk factors for blood transfusion in C-section published until March 31, 2021.

Streptococcus intermedius Pleuropulmonary Disease: A Not So Commonly Seen Radiological Picture.

A () associated pleuropulmonary infection (PPI) is a rare presentation. Cases have been reported in the last decade in which was identified in pleural fluid cultures and lung biopsies in patients presenting with complicated pleural effusions and empyema. However, there are data lacking on predisposing factors, mode of dissemination, and treatment strategies for these patients.

Exhaustion of coronary vasodilatory reserve in the resting state: Clinical characteristics and long-term outcomes after intervention.

Objectives/background: Resting coronary blood flow approximates flow with maximal vasodilation in very severe coronary stenosis. We studied the incidence of exhausted vasodilatory reserve by FFR, its clinical characteristics and long-term prognosis after FFR guided percutaneous coronary intervention (PCI).

Methods: Consecutive patients undergoing FFR-guided PCI for coronary stenosis with reduced resting blood flow (baseline Pd/Pa < 0.

Survey of Nurses' Experiences Applying The Joint Commission's Medication Management Titration Standards.

Background: Critical care nurses titrate continuous infusions of medications to achieve clinical end points. In 2017, The Joint Commission (TJC) placed restrictions on titration practice, decreasing nurses' autonomous decision-making.

Objectives: To describe the practice and perceptions of nurses regarding the 2017 TJC accreditation/regulatory standards for titration of continuous medication infusions.

Cardiac Arrest in an Extensive Pulmonary Tuberculosis Patient.

Tuberculosis (TB) disease affects a large population worldwide but is often missed. Early diagnosis can be challenging at times due to failure to include TB in the differential diagnoses. Tuberculosis is a treatable disease but it can lead to undesirable consequences if left untreated.

Painless loss of vision: rapid diagnosis of a central retinal artery occlusion utilizing point-of-care ultrasound.

Point-of-care ultrasound (POCUS) has become an essential part of the evaluation of vision loss among emergency physicians in the emergency department (ED). It is frequently used to evaluate for vitreous hemorrhage, foreign bodies, retinal detachment, optic neuritis and posterior vitreous detachment; however, it can also be used to evaluate for a central retinal artery occlusion (CRAO). A POCUS can reveal a hyperechoic density in the optic nerve sheath just proximal to the retinal surface, and this is referred to as a retrobulbar 'spot sign' (RBSS).

Pulmonary Embolism in COVID-19 and the Unanswered Questions.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has ravaged the global society as we know it. As almost a dozen pharmaceutical agents go into randomized controlled clinical trials, multiple studies have surfaced trying to associate a hypercoagulable state to coronavirus disease 2019 (COVID-19) patients. We report two COVID-19 cases who presented with occlusive pulmonary embolism (PE) strongly supporting a hypercoagulable state incurred by SARS-CoV-2.

Tracking the Progression of Triple Negative Mammary Tumors over Time by Chemometric Analysis of Urinary Volatile Organic Compounds.

Previous studies have shown that volatile organic compounds (VOCs) are potential biomarkers of breast cancer. An unanswered question is how urinary VOCs change over time as tumors progress. To explore this, BALB/c mice were injected with 4T1.

Functional testicular torsion secondary to an incarcerated inguinal hernia in a 4-month old: complete recovery at 18-hours.

One of the most common urological emergencies encountered in pediatric patients in the emergency department (ED) is the acute scrotum. We present the case of a 4-month-old male that presented to our community ED with scrotal swelling and vomiting of 16-hours duration. He was diagnosed with a functional testicular torsion from an incarcerated inguinal hernia, transferred to a hospital with pediatric urological capabilities and was taken to the operating room ~2 hours later.

Severe methemoglobinemia secondary to isobutyl nitrite toxicity: the case of the 'Gold Rush'.

Isobutyl nitrite is one of the popular recreational drugs with high abuse potential that is known to cause methemoglobinemia. While inhaling this recreational drug, often referred to as a 'popper', is the typical route of administration, oral ingestion can produce a more rapid and fulminant course of methemoglobinemia. We present the case of a 69-year-old male that presented to our emergency department in extreme, life-threatening methemoglobinemia due to the ingestion of isobutyl nitrite that he obtained from an adult novelty store.

Evaluation of the ventriculocholecystic shunt-an overview of present practice in adult and pediatric hydrocephalus.

In the context of hydrocephalus, there are a multitude of therapeutic options that can be explored in order to improve patient outcomes. Although the peritoneum is the current elected clinical solution, various receptacles have been utilized when experiencing contraindications. Along with the ventriculoatrial or ventriculopleural, the ventriculocholecystic shunt was also described as an alternative.

An Unfortunate Case of Reactivation of Tuberculosis in a Postpartum Female.

Tuberculosis (TB) is a widely prevalent disease, especially in resource-limited settings. It poses a big burden to the community and is a significant cause of morbidity and mortality in pregnant females due to their immunosuppressed state. During pregnancy, the immune system is suppressed to prevent fetal rejection, and it gets reconstituted postpartum.

Novel Presentation of Pulmonary Atypical Carcinoid Tumor as Acute Pancreatitis.

Pulmonary neuroendocrine tumors (NETs) are a group of rare tumors that pose a high financial burden on patients and the United States healthcare system. The usual presenting symptoms include cough or wheezing, hemoptysis, or chest pain. Due to bronchial obstruction, patients may also present with recurrent pneumonia.

No significant effect of caffeine on five kilometer running performance after muscle damage.

Caffeine has documented hypoalgesic effects during exercise. However, there is a lack of research focusing on caffeine's potential analgesic effects to ameliorate delayed onset muscle soreness. A placebo controlled randomized cross-over trial was carried out to determine if 5 mg/kg of body weight (mg/kgBW) of caffeine attenuates muscle pain and improves 5 k running performance following delayed onset muscle soreness.

A Rare Case Study About Necrotizing Granulomatous Sarcoidosis.

Sarcoidosis is a granulomatous disorder with an elusive etiology and pathogenesis. Classically, sarcoidosis is associated with non-caseating granulomas composed of mononuclear phagocytes, lymphocytes, and multinucleated giant cells. Necrotizing granulomas can also be associated with sarcoidosis but is scarcely reported in the medical literature.

Exogenous Lipoid Pneumonia Complicated by Mineral Oil Aspiration in a Patient With Chronic Constipation: A Case Report and Review.

Exogenous lipoid pneumonia is a rare and frequently misdiagnosed lung disease. It occurs as an inflammatory reaction secondary to either aspiration or inhalation of lipids. Our patient had a history significant for recurrent pneumonia and the use of mineral oil for chronic constipation.

Accidental Central Venous Catheter Placement in the Internal Thoracic Vein: A Case Report.

Central venous catheter (CVC) placement is an essential component of critical care medicine. CVC malposition is a known complication of internal jugular vein (IJV) cannulation. However, catheterization of the internal thoracic vein (ITV) is much rarer.

Delayed Recurrence of Chromophobe Renal Cell Carcinoma Presenting as Metastatic Duodenal Ulcer.

Renal cancers are one of the common causes of cancer-related morbidity and mortality worldwide. Most primary cases are localized at presentation and are treated with partial or radical nephrectomy with curative intent. However, renal cell carcinoma (RCC) is known for its potential recurrence, sometimes several years after initial management.

Vaping-Induced Lung Injury: An Uncharted Territory.

Vaping-associated lung injury (VALI) presents with symptoms ranging from lower respiratory tract involvement (shortness of breath, fever, and cough) to gastrointestinal involvement (vomiting and diarrhea). Based on the longitudinal analysis, VALI is associated with increased risk for respiratory disease, making it paramount for medical professionals to understand this disease process and be familiar with its varied presentations. Our case study is a presentation of two relatively young patients with VALI, with a varied clinical course and distinct levels of severity.

Calcifying Fibrous Tumor Complicated by Empyema.

Calcifying fibrous tumor (CFT) is a rare, benign proliferation of fibroblasts and inflammatory cells that is non-invasive and usually arises in deep tissue structures. Due to its overall paucity, no accurate incidence has been reported yet. We understand this disease via a handful of case studies published in the medical literature, first of them being from 1988.

Medical Management of COVID-19: Evidence and Experience.

Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and this infectious disease is termed COVID-19 in short. On a global scale, as of June 1, 2020, the World Health Organization (WHO) published statistics of 6,057,853 infected patients and 371,166 deaths worldwide. Despite reported observational data about the experimental use of certain drugs, there is no conclusively proven curative therapy for COVID-19 as of now; however, remdesivir received emergency use authorization (EUA) by the Food and Drug Administration (FDA) recently for use in patients hospitalized with COVID-19.

Perspectives of Inpatients With Cancer on Engagement in Fall Prevention.

Purpose: To explore perspectives of hospitalized adults with cancer regarding engagement in fall prevention plans. The primary aim was to discover new knowledge about patients' perspectives and improve the design of fall prevention strategies. A secondary aim was to compare fall-related perspectives of patients who had and who had not fallen.

Atypical Presentation of Novel Coronavirus Disease 2019 in a Peritoneal Dialysis Patient.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a rapidly spreading disease causing increased morbidity and mortality across the globe. There is limited available knowledge regarding the natural history of the SARS-CoV-2 infection. Other factors that are also making this infection spread like a pandemic include global travelers, lack of proven treatment, asymptomatic carriers, potential reinfection, underprepared global health care systems, and lack of public awareness and efforts to prevent further spread.