Challenges in Diagnosing Varicella-Zoster Virus Encephalitis in an Immunocompromised Patient.

Varicella-zoster virus (VZV) is a virus of the alphaherpesvirus family that is one of the common causes of infectious encephalitis worldwide, especially among those who are immunocompromised. In this case report, we discuss a case of a 55-year-old female with end-stage renal disease presenting with altered mental status and weakness. She was recently diagnosed with herpes zoster on oral acyclovir and multiple scattered dermatomal rashes on presentation.

Transition to Perioperative Specialty Practice: A Solution to RN Outward Migration.

Frontline nurses are exiting the workforce, fueling a crisis in health care. Years of chronic staffing shortages, trauma experienced during the COVID-19 pandemic, and faculty shortages resulting in lessened ability to produce new nurses are complicating the ability of hospitals and health systems to provide high-quality care at a time when hundreds of thousands of nurses are predicted to leave the profession. A solution to this problem, which may produce internal "churn," can also create the opportunity for an internal pipeline of transition to specialty practice-recovering nurses who otherwise might be lost.

Importance of concomitant functional mitral regurgitation on survival in severe aortic stenosis patients undergoing aortic valve replacement.

Background: Mitral regurgitation (MR) is commonly seen in patients with severe aortic stenosis (AS) undergoing aortic valve replacement (AVR). But the long-term implications of MR in AS are unknown.

Aim: To investigate MR's impact on survival of patients undergoing surgical AVR for severe AS.

Intraperitoneal hemorrhage secondary to ruptured omental artery aneurysm associated with polyarteritis nodosa: a case report.

Background: Polyarteritis nodsa (PAN) is a rare disease characterized by acute focal inflammatory damage to small and medium arteries. PAN complicated by ruptured aneurysm is an infrequent presentation with the most affected arteries being the renal and mesenteric arteries.

Case Presentation: A 76-year-old female presented with a low-grade fever, generalized body aches, and abdominal pain.

Patterns of Care in Patients with Basilar Artery Occlusion (BAO): A Population-Based Study.

Basilar artery occlusion (BAO) is associated with high morbidity and mortality. Endovascular therapy (EVT) has been shown to be beneficial in acute BAO patients. This retrospective observational study used the National Inpatient Sample (NIS) database to identify BAO patients using the International Classification of Diseases (ICD).

Current Management of Heart Failure with Preserved Ejection Fraction.

Heart failure with preserved ejection fraction (HFpEF) encompasses nearly half of heart failure (HF) worldwide, and still remains a poor prognostic indicator. It commonly coexists in patients with vascular disease and needs to be recognized and managed appropriately to reduce morbidity and mortality. Due to the heterogeneity of HFpEF as a disease process, targeted pharmacotherapy to this date has not shown a survival benefit among this population.

Cranial Nerve Palsy Secondary to Botulism After Black Tar Heroin Use.

Introduction: Wound botulism (WB) is an uncommon but severe neuromuscular illness caused by the bacterium in an infected wound. There has been a dramatic increase in WB associated with black tar heroin injection in California.

Case Description: A 50-year-old male with heroin abuse presented to the emergency department with a 2-day history of dysphagia and dysarthria.

Management of ST Elevation Myocardial Infarction (STEMI) in Different Settings.

ST-segment elevation myocardial infarction (STEMI) is a life-threatening condition that requires emergent, complex, well-coordinated treatment. Although the primary goal of treatment is simple to describe-reperfusion as quickly as possible-the management process is complicated and is affected by multiple factors including location, patient, and practitioner characteristics. Hence, this narrative review will discuss the recommended management and treatment strategies of STEMI in the circumstances.

Functional Assessment of Coronary Artery Lesions-Old and New Kids on the Block.

Angiography is inaccurate in assessing functional significance of coronary lesions, and often stenoses deemed severe on angiographic assessment do not restrict coronary blood flow at rest or with maximal dilatation. Angiography-guided revascularization has not shown improvement in hard clinical outcomes in stable ischemic heart disease (SIHD). Most current guidelines for SIHD recommend invasive functional assessment of lesions to guide revascularization if prior evidence of ischemia is not available.

Intercostal Hernia due to Forceful Coughing With Protrusion of the Lung.

Intercostal herniation is an abnormal protrusion of lung tissue through the boundaries of the thoracic cavity. It is commonly seen after chest trauma or thoracic surgery but rarely occurs spontaneously. We report a male patient who presented with an intercostal herniation after vigorous coughing for over 2 weeks.

Treatment of Chylothorax After Coronary Artery Bypass Grafting.

Chylothorax after coronary artery bypass grafting is a rare complication. The treatment protocol is not well described because of its rarity. The current treatment options for chylothorax include conservative medical treatment or an interventional approach (ie, thoracic duct embolization or surgical ligation of the thoracic duct).

"Contrecoup" Paravalvular Leak Closure.

Paravalvular aortic regurgitation affects some patients after surgically implanted prosthesis. The number of patients affected is likely to increase with increased utilization of nonsurgical valve replacement techniques. These patients are at increased risk of persistent clinical symptoms often requiring repair.

Transarterial embolization for management of severe postcoital bleeding.

Objectives: Postcoital bleeding is an uncommon cause of gynecologic hemorrhage; however, it can be severe in a majority of cases necessitating surgical management.

Methods: We report a case of severe postcoital bleeding in a young woman requiring blood transfusion.

Results: Hemostasis was achieved using subselective embolization of cervical artery by metallic coils.

Use of Unique Doppler Flow-Pattern for the Diagnosis of Left Ventricular Diverticulum.

Isolated congenital left ventricular diverticulum (LV) is reportedly a rare finding. It is frequently associated with other congenital defects involving heart, pericardium, sternum, diaphragm, and abdominal wall. It is an outpouching from the ventricle and has all three layers of left ventricular free walls.

Continuous EEG monitoring in the neuroscience intensive care unit and emergency department.

This article reviews established, emergent, and potential applications of continuous EEG (CEEG) monitoring in the Neuroscience Intensive Care Unit (NICU) and Emergency Department. In each application, its goal as a neurophysiologic monitor is to extend our powers of observation to detect abnormalities at a reversible stage and to guide timely and physiologically sound interventions. Since this subject was reviewed 5 years ago, the use of CEEG monitoring has become more widespread.

Neurophysiologic monitoring in the neuroscience intensive care unit.

Neurologically critically ill patients, more often than others, are unable to communicate and, for a crucial period of time, have the vital functions of their brains hidden in the "black box" of the cranial vault behind a curtain of ambiguity and immobility. Customarily--and naively--we have relied upon beside clinical observations to pierce these barriers. Recent insights lead us to conclude that these "neurochecks" no longer suffice.

Round ligament synthetic graft colpopexy.

Massive vaginal prolapse in ten post-hysterectomy women was treated by expanded polytetrafluoroethylene graft along the course of the round ligaments to anchor the vaginal vault to the lateral abdominal wall. Concurrent enterocele repair was done as well as other indicated abdominal or vaginal operations. Satisfactory coitus was reported in all cases.

A source of hope for at-risk youth. A hospital's community outreach efforts provide an alternative for troubled teens.

In 1990 St. Bernardine Medical Center, San Bernardino, CA, initiated a mission project to reach out to youth and families in the hospital's service area. Increased unemployment, escalating crime, and a failing social structure had left many San Bernardino residents with few resources for breaking out of a cycle of crime and poverty fostered by their environment.

Continuous EEG and evoked potential monitoring in the neuroscience intensive care unit.

As with other methods long used in intensive care units (ICU) and operating rooms (OR), the goal of neuroscience ICU continuous EEG (NICU-CEEG) and evoked potential (NICU-EP) monitoring is to extend our powers of observation to detect abnormalities at a reversible stage. EEG is an appropriate monitoring tool because it is linked to cerebral metabolism, is sensitive to ischemia and hypoxemia, correlates with cerebral topography, detects neuronal dysfunction at a reversible stage, and is the best method for detecting seizure activity. When applied systematically, it can impact medical decision-making in 81% of monitored patients.