What Is Uncommon Can Be Critical: A Case of Quinolone-Induced Acute Liver Failure.

Many drugs are known to potentially cause liver injury; however, only a few reports investigate the association between levofloxacin and acute liver failure (ALF).  The case describes a 65-year-old man who was admitted with primary diagnoses of cerebrovascular accident (CVA) and acute coronary syndrome (ACS) who developed an upper respiratory tract infection for which he was started on levofloxacin. Following its administration, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) increased more than 100-fold above the upper limit of normal.

Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer.

Introduction: Infection control in patients with perforated peptic ulcers (PPU) commonly includes empiric antifungals (AF). We investigated the variation in the use of empiric AF and explored the association between their use and the subsequent development of organ space infection (OSI).

Methods: This was a secondary analysis of a multicenter, case-control study of patients treated for PPU at nine institutions between 2011 and 2018.

Emergency department management of syncope.

Syncope is the transient loss of consciousness and postural tone, with spontaneous recovery. It accounts for approximately 1% of all emergency department visits and $5.6 billion in healthcare costs annually.

Foix-Chavany-Marie syndrome due to unilateral anterior opercular infarction with leukoaraiosis.

Foix-Chavany-Marie syndrome (FCMS) is a cortical-subcortical pseudobulbar palsy characterized by automatic voluntary dissociation of facio-masticatory-pharyngo-glosso-laryngeal movements. FCMS is typically caused by vascular insults on the bilateral anterior opercular or adjacent subcortical areas. Acute onset of FCMS secondary to a unilateral lesion is extremely rare.

Acute lung toxicity by nitrofurantoin.

Nitrofurantoin is a synthetic derivative of imidazolinedione, used to treat uncomplicated urinary tract infections. It acts by inhibiting bacterial DNA, RNA and cell wall protein synthesis. It is used prophylactically as a urinary anti-infective agent against most gram-positive organism and for long-term suppression of infections.

Evaluation of Factors Associated With Fracture and Loss of Bone Mineral Density Within 1 Year After Liver Transplantation.

Objective: Orthotopic liver transplant recipients are at high risk of fragility fractures both in pre-liver transplant (pre-LT) and in the immediate posttransplant (post-LT) period. The aims of this study were to identify risk factors associated with post-LT fracture and identify factors that contribute to changes in bone mineral density (BMD) in post-LT as they relate to the risk of fracture in the immediate post-LT period.

Methods: We conducted a retrospective cohort study of first-time LT recipients who had BMD testing within 2-year pre-LT and 1-year post-LT.

Potential Bias of Patient Payer Category on CG-CAHPS Scores and Its Impact on Physician Reimbursement.

Introduction: Patient satisfaction scores play an ever increasing role in physician reimbursement. Positive scores contribute to a physician earning up to 9% reimbursement bonuses, while negative scores may contribute up to 9% reduction in reimbursement. This method of reimbursement modification is already standard within the Centers for Medicare and Medicaid Services and is quickly catching on with commercial payers.

Monson small-incision lenticule extraction fixation device.

Small-incision lenticule extraction (SMILE) is a stromal based, flapless, minimally invasive form of laser vision correction for the treatment of myopia and myopic astigmatism. SMILE surgery is a more technical procedure compared with other refractive surgeries and generally has a longer skill mastery acquisition period. Thus far, no new stabilization devices or techniques have been proposed.

Clinical outcomes of patients with and without chronic kidney disease undergoing endovascular revascularization of infrainguinal peripheral artery disease: Insights from the XLPAD registry.

Objectives: The purpose of the present study was to define clinical outcomes of chronic kidney disease (CKD) patients undergoing endovascular revascularization of infrainguinal peripheral artery disease (PAD).

Background: CKD is an established predictor of advanced PAD. However, clinical outcomes for these patients following endovascular revascularization remain inadequately defined.

PRK Enhancement for Residual Refractive Error After Primary PRK: A Retrospective Study.

Introduction: The efficacy and safety of photorefractive keratectomy (PRK) has been well documented, but outcomes of PRK enhancement following PRK remain understudied. This study aimed to evaluate the safety, efficacy, and predictability of PRK enhancement in patients with residual refractive error after primary PRK and compare these results to prior studies as well as Food and Drug Administration (FDA) safety and efficacy clinical endpoints.

Methods: This non-randomized, retrospective chart analysis included eyes with a history of PRK that underwent PRK enhancement at a single center.

Pharmacokinetics of 17 alpha hydroxyprogesterone caproate in singleton pregnancy and its influence of maternal body size measures.

Background: Reducing spontaneous preterm deliveries is a worldwide public health priority. Although many interventions have been studied, 1 of the most effective treatments to decrease recurrent preterm birth is the use of weekly 17 alpha hydroxy progesterone caproate. Previous studies on the influence of excessive adipose tissue and obesity on the use of 17 alpha hydroxyprogesterone caproate for the prevention of recurrent spontaneous preterm deliveries have shown conflicting findings.

Excisional Goniotomy in Latino Patients with Open-Angle Glaucoma: Outcomes Through 24 Months.

Purpose: To characterize the efficacy of combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade (KDB-phaco) in eyes of Latino adults with cataract and open-angle glaucoma (OAG).

Methods: Health records of consecutive Latino patients undergoing KDB-phaco were retrospectively reviewed. Intraocular pressure (IOP) and IOP-lowering medication use were recorded at baseline and each postoperative visit through up to 24 months.

Analysis of Frontal Sinus Fracture Management and Resource Utilization.

Frontal sinus fractures require a large amount of force and often occur in the context of a major trauma. Many patients with these fractures are assessed in an emergent setting where stabilization takes precedence. Delayed diagnosis and treatment of a sinus fracture can result in life-threatening conditions, such as a cerebrospinal fluid (CSF) leak.

The safety profile of Bald's eyesalve for the treatment of bacterial infections.

The rise in antimicrobial resistance has prompted the development of alternatives to combat bacterial infections. Bald's eyesalve, a remedy used in the Early Medieval period, has previously been shown to have efficacy against Staphylococcus aureus in in vitro and in vivo models of chronic wounds. However, the safety profile of Bald's eyesalve has not yet been demonstrated, and this is vital before testing in humans.

Complete resolution of arrhythmia-induced hydrops fetalis in utero.

A 21-year-old G3P2011 Caucasian woman at 27 weeks' gestation presented with fetal tachyarrhythmia between 240 and 270 beats per minute. Fetal supraventricular tachycardia, abdominal ascites, pleural effusion and pericardial effusion indicated hydrops fetalis. Management with digoxin and flecainide converted the fetus to sinus rhythm and resolved the ascites and pleural effusion within 4 days of treatment.

Sevoflurane-Induced Thrombocytopenia in Post-Robotic-Assisted Paraesophageal Hernia Repair.

Background: Transient transaminitis is an expected outcome from liver retraction after foregut surgeries. However, severe thrombocytopenia is usually not a sequela of that. We present a case in which sevoflurane is suspected of inducing thrombocytopenia as it was the only newly introduced medication to the patient during the hospital course.

Parastomal Varices with Recurrent Bleeding in the Absence of Liver Cirrhosis.

Gastrointestinal (GI) bleeding is a common problem in patients with portal hypertension. One of the most common causes of GI bleeding are varices (e.g.

Triceps Tendon Rupture - A Novel Repair of an Uncommon Injury.

Introduction: Triceps tendon rupture is a rare injury accounting for <1% of all tendon injuries with varying repair techniques described. We present this novel repair to supplement available literature and help optimize the clinical outcomes for affected patients. We report this technique because it is unique in that we augmented our surgical fixation with a subtle variation in the described technique by repairing the deep portion of the triceps tendon as a separate step, maximizing the recreation of the anatomic footprint of the triceps.

Impact of a Pharmacist-Driven Protocol to Improve Guideline-Concordant Prescribing of Diabetes Medications in Patients With Atherosclerotic Cardiovascular Disease: A Pilot Study.

Purpose: To determine whether a pharmacist-driven protocol improves guideline-concordant prescribing of diabetes medications in patients with atherosclerotic cardiovascular disease (ASCVD).

Methods: A retrospective pre- and post-intervention study was conducted at a university-based family medicine clinic. A pharmacist-driven protocol was implemented which involved the creation of an algorithm recommending specific diabetes medications in patients with ASCVD.

Effect of Operative Timing and Bone Grafting on Postoperative Cephalometric Indices in Nonsyndromic Sagittal Synostosis.

Surgical repair of sagittal suture craniosynostosis is highly variable, and optimal timing/use of bone grafts remains a subset of parameters that continue to be studied. We sought to compare cephalometric outcomes of early surgical intervention without bone grafting compared to later intervention with bone grafting. Patients undergoing primary surgical repair of nonsyndromic sagittal suture craniosynostosis between 2015 and 2019 were followed with preoperative measurements of cephalic index along with postoperative measurements at 6 months to 1 year, respectively.