MedRophine Science

2021-05-01 19:25:19 Autoantibodies to interferon γ, part of the first line of defense in the human immune response, constitutes a rare form of an acquired immunodeficiency in HIV-uninfected adults that can predispose to disseminated atypical mycobacterial infection. Particularly, this has been described in people of Southeast Asian origin. In this case report we describe a previously healthy, Laotian man who presented with skin lesions consistent with Sweet syndrome that were later found to be precipitated by disseminated atypical mycobacterial disease. Extensive immunological workup revealed the patient to have autoantibodies to interferon γ, rendering him susceptible to this infection. Our report demonstrates a complex case with a multilayered diagnosis while inviting perspective from multiple specialties. This enigmatic case emphasizes the importance of a broad differential with special attention to demographics while demonstrating the difficulty in treating certain atypical infections that are inherently multidrug resistant باز کردن / نظر دهید

2021-05-01 19:16:11 Hemophagocytic lymphohistiocytosis in SARS-CoV-2 infection A previously healthy 55-year-old woman presented with fever, malaise, and a mild cough. Chest radiograph revealed bilateral patchy infiltrates. A nasopharyngeal swab tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA. Progressive respiratory insufficiency necessitated intubation on admission day 3. She developed profound normocytic anemia (hemoglobin, 6.8 g/dL) and thrombocytopenia (23 × 103/µL) that were refractory to platelet and erythrocyte transfusions. Ferritin levels increased sharply, peaking at admission day 8 (19 558 ng/mL). Bone marrow examination revealed striking hemophagocytosis and erythroid hyperplasia. Hemophagocytosis refers to the pathologic finding of macrophage engulfment of host blood cells (panel A, engulfment of a granulocyte; panels B-F, engulfment of various erythroid precursors; panel G, engulfment of a megakaryocyte nucleus; all panels, original magnification ×100, May-Grünwald-Giemsa stain باز کردن / نظر دهید

2021-04-28 09:41:35 55 yrs Male admitted for covid positive...in hospital....ct score 16....now fill better...last 7 days...but he has 6 day before..brain infarct occur...now...right hand have..finger become black.....and increase...look like gangrene...D dimer is 6000...so pls suggest for what is line treatment reqwired...pls suggest.for gangrene باز کردن / نظر دهید

2021-04-27 09:01:50 Read the full case here:

Subacute Thyroiditis and Heart Failure in a Patient Presenting With COVID-19 باز کردن / نظر دهید

2021-04-27 09:01:09
67-year-old male was admitted with shortness of breath and diarrhea. His COVID-19 polymerase chain reaction test was positive, and he was found to be in acute heart failure. Troponin levels were elevated, echocardiogram showed ejection fraction of 24%, and his electrocardiogram was normal. Inflammatory markers were elevated. Further testing revealed suppressed thyroid-stimulating hormone and elevated free thyroxine (T4). Differential diagnosis at this point included possible myocarditis from the viral illness, exacerbation of heart failure from the viral infection or from thyrotoxicosis was considered. Patient’s heart failure improved with initiation of heart failure therapies; however, biochemically, his thyroid function tests (TFTs) did not improve, despite empiric methimazole. Thyroid antibody tests were unremarkable. Thyroid ultrasound showed mildly enlarged thyroid gland with no increased vascularity and 5-mm bilateral cysts. Thyroid dysfunction was attributed to subacute thyroiditis..... باز کردن / نظر دهید

2021-04-25 08:12:50 35 yo male. Hx of IV substance abuse. Significant RHF r/t Wide open TR d/t 3 cm vegetation on Tricuspid. Multiple septic PEs. Vegetation removed from tricuspid valve via angiovac. باز کردن / نظر دهید

2021-04-23 10:19:26 82-year-old female patient with a history of left arm overexertion, without trauma or pain. Subsequently, a large hematoma appears on the anterolateral face, as well as functional impotence to raise the arm. Ultrasound revealed a biceps tendon cut below the bicipital groove, with effusion around the synovial sheath. Note the alteration of the muscle fiber pattern, from parallel to disorganized.

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Write your opinions in the comments below the post for us. باز کردن / نظر دهید

2021-04-23 10:14:12 EKGs in chronological order. 1st is field ekg, 2nd is approx 15 mins after 1st, 3rd is approx 1 hr from first, 4th is at transfer receiving approx 2 hrs from 1st ekg, and last ekg is approx 6-7 hrs from 1st ekg. Enzymes never bumped. Receiving diagnosed as brugada pattern type 2-3 related to etoh. From the field lots of consideration here. This patient is young, reporting no hx or family hx and intoxicated. This could potentially bias you into thinking this cannot be an MI, however given ethnicity it’s also possible the pt does have underlying hx that’s gone undiagnosed, also a thought was perhaps the bac level was masking pain. A field activation is appropriate here given the high lateral changes with reciprocal changes.
From the referring, this is a small critical access facility with a 4 bed er and no specialty; I think you could make an argument for a sit and watch approach but also moving to cards/cath was appropriate. Remember enzymes even trop can take a few hours to bump. باز کردن / نظر دهید

2021-04-22 18:01:47 Endo Resto Dental Filling Composite Direct Restoration Upper Molar

Thanks to : Dr Sorena Mahmoudi ( second semester of dental student) for sharing this case with us. باز کردن / نظر دهید

2021-04-19 08:20:21 Textbook case.
Leukemia means "white blood" in Ancient Greek. This patient had a WBC of 230/nl - relapsed CML in blast crisis while on bosutinib (allogenic HSCT 21 years ago). Massive tumor lysis syndrome with AKI, Hgb 4, heavy cutaneous bleeding. I forgot to discard this blood sample at our blood gas analyzer and came back 2 hours later for another ABG...this is how it looked like. You can literally see the leukemia. باز کردن / نظر دهید