Evaluation of the effectiveness of an automated sepsis predictive tool on patient outcomes.

Purpose: To evaluate the effectiveness of a multidisciplinary, hospital-wide program as part of an electronic sepsis alert tool.

Materials And Methods: We used data from 15 hospitals about adult patients with severe sepsis or septic shock. Nine intervention hospitals implemented an Epic sepsis prediction tool, education, and standardized order sets (six control hospitals did not).

Burden of arrhythmias and predictors of mortality among multiple myeloma patients with arrhythmias.

Arrhythmias are a major cardiac complication reported among patients with multiple myeloma (MM), but these have not been further characterized in this population. We explored the prevalence of arrhythmias and examined the predictors of mortality among patients with MM with arrhythmias. The National Inpatient Sample data collected between 2016 and 2018 were used to conduct retrospective analyses.

Hemoperitoneum after Ovulation in Systemic Lupus Erythematosus and Autoimmune Thrombocytopenia.

Background: Three prior cases of hemoperitoneum associated with immune thrombocytopenia (ITP) have been reported in adolescents. This reports a case of hemoperitoneum after ovulation in an adult.

Case: A 34-year-old nulligravida presented with abdominal pain after a heavy period and rebound tenderness.

From anemia to polycythemia in 4 weeks.

Primary polycythemia (PCV) may coexist in otherwise asymptomatic patients particularly in the presence of unsuspecting conditions such as Thrombotic thrombocytopenic purpura (TTP). In presumed "idiopathic TTP," autoimmune conditions such as rheumatoid arthritis (RA) should be investigated as a possible etiology for TTP. Standardization of targeted therapy with immunomodulatory agents may be recommended for this subset of patients.

Papillary Fibroelastoma as a Cause of Cardiogenic Embolic Stroke in a -Thalassemia Patient: Case Report and Literature Review.

We describe a case of a young male without stroke risk factors who presented with a sudden onset of left-sided weakness, left hand numbness, and left eye blurriness. CT scan of the head without contrast and diffusion-weighted MRI of the brain with contrast revealed an ischemic stroke in the right middle cerebral artery distribution. Transesophageal echocardiography (TEE) revealed a mobile pedunculated mass on the posterior surface of the mitral valve.

The potential role of HER2 upregulation in metastatic breast cancer to the uterus: a case report.

Abnormal uterine bleeding in a patient on maintenance hormonal therapy for breast cancer should raise concern for endometrial abnormalities including rare uterine metastasis from the breast. Hormonal receptor profile changes in metastatic lesions favoring human epidermal growth factor receptor 2 (HER2) overexpression may be involved in the pathogenesis of metastasis to the uterus.

The description of a method for accurately estimating creatinine clearance in acute kidney injury.

Background: Acute kidney injury (AKI) is a common and serious condition encountered in hospitalized patients. The severity of kidney injury is defined by the RIFLE, AKIN, and KDIGO criteria which attempt to establish the degree of renal impairment. The KDIGO guidelines state that the creatinine clearance should be measured whenever possible in AKI and that the serum creatinine concentration and creatinine clearance remain the best clinical indicators of renal function.

Targeted treatments for multiple myeloma: specific role of carfilzomib.

Carfilzomib is a selective, irreversible proteasome inhibitor, initially approved in the US in 2012 as single-agent therapy for relapsed and refractory multiple myeloma. Numerous Phase II studies have evaluated carfilzomib in the relapsed and refractory as well as the newly diagnosed setting, and Phase III studies are entering their final analysis. Data continue to grow to support its use as both single-agent therapy and in combination with immunomodulatory and other novel agents.

A simple method to detect recovery of glomerular filtration rate following acute kidney injury.

In acute kidney injury (AKI), elevated plasma creatinine is diagnostic of an earlier loss of glomerular filtration rate (GFR) but not of the concomitant GFR. Only subsequent creatinine changes will inform if GFR had already recovered or not. We hypothesized that the creatinine excretion rate to production rate ratio would provide this information.

Isolated port-site metastasis after robotic hysterectomy for stage IA endometrial adenocarcinoma.

Background: Port-site metastasis is a known complication of laparoscopic surgery, although it has been described less in robotic surgery. There are limited reports of such occurrences in current literature.

Cases: Two patients underwent robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection for stage IA endometrial cancer.

Effect of maternal weight on accuracy of maternal and physician estimate of fetal weight.

Objective: To test if maternal and physician clinical fetal weight estimates differ significantly from actual birth weight and if it is affected by maternal weight.

Study Design: A total of 112 term gravidas who presented for induction or elective cesarean were prospectively observed. Prior to physician evaluation, each subject estimated the weight of her baby.

Economics of less invasive spinal surgery: an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period.

Background: There is great debate about the costs and benefits of technology-driven medical interventions such as instrumented lumbar fusion. With most analyses using charge data, the actual costs incurred by medical institutions performing these procedures are not well understood. The object of the current study was to examine the differences in hospital operating costs between open and minimally invasive spine surgery (MIS) during the perioperative period.

An under recognized cause of chest pain.

Aortic intramural hematoma (IMH) is related to but is pathologically distinct from aortic dissection. In this potentially lethal entity, there is hemorrhage into the aortic media in the absence of an intimal tear. With recent advances in imaging techniques, IMH is now increasingly recognized.

Clinical and bacteriological characteristics of Klebsiella pneumoniae causing liver abscess with less frequently observed multi-locus sequences type, ST163, from Singapore and Missouri, US.

Background: Klebsiella pneumoniae is the major cause of liver abscesses in several Asian countries. Differences in the type of circulating Klebsiella strains and/or the genetic make up of the host seem to be plausible explanations for this.

Methods: Two recent K.

Prolonged renal failure post-percutaneous mechanical thrombectomy.

Percutaneous mechanical thrombectomy (PMT) has been gaining acceptance as a preferred approach for the treatment of acute deep venous thrombosis (DVT). In addition to treating acute DVT and decreasing the risk of pulmonary embolism, it has been reported that direct extraction of the thrombus decreases the risk of post-thrombotic syndrome (PTS), the economic impact of managing which is reported to account for 75% of the total cost of management of DVT patients. PMT combines localized thrombolysis with mechanical thrombectomy.

Stiff person syndrome and pregnancy.

Background: Stiff person syndrome, also known as Moersche-Woltman syndrome, is a debilitating disorder that is rarely seen in the pregnant patient. It is characterized by muscle spasms triggered by startle, voluntary movement, or tactile or emotional stimuli, occurring predominantly in the axial musculature.

Case: A woman diagnosed with stiff person syndrome became pregnant 2 months after her diagnosis.

Extensive Deep Venous Thrombosis in a Patient with Neurolept Malignant Syndrome despite Being on Prophylaxis.

The risk of venous thromboembolism (VTE) in patients with Neuroleptic malignant syndrome (NMS) and those on antipsychotic medications is well established. We present here a case whereby the patient had NMS and developed extensive deep venous thrombosis (DVT) despite being on standard DVT Prophylaxis. Our case illustrates that empiric intravenous heparin for the initial few days after the onset of NMS may be considered in those with high risk of VTE, as in such patients standard DVT prophylaxis may not be sufficient.

Peripheral arterial thrombosis with presence of anti-centromere antibodies and polycythemia vera.

Digital gangrene due to arterial thrombosis can occur due to a variety of causes. There have been reports of patients who have presented with digital gangrene with no known predisposing factors, but with positive anti-centromere antibodies (ACA). Despite that they did not have features suggestive of disorders like Scleroderma or CREST syndrome.