scholarly journals A delayed presentation of splenic laceration and hemoperitoneum following an elective colonoscopy: A rare complication with uncertain risk factors

2018 ◽  
Vol 6 ◽  
pp. 2050313X1879106 ◽  
Author(s):  
Allison N Zhang ◽  
Jagannath M Sherigar ◽  
Debra Guss ◽  
Smruti R Mohanty
Keyword(s):  
Risk Factors ◽  
Perceived Risk ◽  
Splenic Injury ◽  
Clinical Presentation ◽  
Rare Complication ◽  
Consent Process ◽  
Delayed Presentation ◽  
Abdominal Adhesions

Splenic laceration is a rare yet often underreported complication of colonoscopy that is infrequently discussed with the patient during the consent process. Most cases present within 48 h after the inciting colonoscopy; a delayed presentation is rare. We present a case of splenic laceration with hemoperitoneum that manifested 5 days after the initial colonoscopy. The patient was treated conservatively. Traditionally perceived risk factors such as intra-abdominal adhesions, splenomegaly, anticoagulation use, biopsy, polypectomy, a technically challenging procedure, and anesthesia assistance have not been clearly shown to increase the incidence of splenic injury following a colonoscopy. Since the risk factors of splenic injury remain unclear, the clinical presentation is nonspecific, and the consequences can be serious, the endoscopist should make an effort to inform the patient of this rare complication before the procedure.

Clinical Presentation, Quality of Care, Risk Factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries

2019 ◽  
Vol 17 (4) ◽  
pp. 388-395 ◽  
Author(s):  
Abdulla Shehab ◽  
Khalid F. AlHabib ◽  
Akshaya S. Bhagavathula ◽  
Ahmad Hersi ◽  
Hussam Alfaleh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Quality Of Care ◽  
Middle East ◽  
Clinical Presentation ◽  
Middle Eastern ◽  
High Morbidity ◽  
Inhospital Mortality ◽  
Acute Stemi

Background: Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. Aims: To examine the clinical presentation, patient management, quality of care, risk factors and inhospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. Methods: Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups. Results: Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When thrombolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher inhospital mortality among women than men (6.4 vs. 4.6%), (p=0.145). Conclusion: Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce the high morbidity and mortality of STEMI in our women.

scholarly journals Multidisciplinary Practice Variations of Anti-Thrombotic Strategies for Free Tissue Transfers

2021 ◽  
pp. 229255032110247
Author(s):  
Minh N. Q. Huynh ◽  
Vinai Bhagirath ◽  
Michael Gupta ◽  
Ronen Avram ◽  
Kevin Cheung
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Perceived Risk ◽  
Management Strategies ◽  
Free Flaps ◽  
Low Molecular Weight ◽  
National Surveys ◽  
Flap Failure ◽  
Multidisciplinary Practice ◽  
Practice Variations

Background: Venous thrombosis, the leading cause of free flap failure, may have devastating consequences. Many anti-thrombotic agents and protocols have been described for prophylaxis and treatment of venous thrombosis in free flaps. Methods: National surveys were distributed to microsurgeons (of both Plastics and ENT training) and hematology and thrombosis specialists. Data were collected on routine screening practices, perceived risk factors for flap failure, and pre-, intra-, and post-operative anti-thrombotic strategies. Results: There were 722 surveys distributed with 132 (18%) respondents, consisting of 102 surgeons and 30 hematologists. Sixty-five surgeons and 9 hematologists routinely performed or managed patients with free flaps. The top 3 perceived risk factors for flap failure according to surgeons were medical co-morbidities, past arterial thrombosis, and thrombophilia. Hematologists, however, reported diabetes, smoking, and medical co-morbidities as the most important risk factors. Fifty-four percent of physicians routinely used unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) as a preoperative agent. Surgeons routinely flushed the flap with heparin (37%), used UFH IV (6%), or both (8%) intra-operatively. Surgeons used a range of post-operative agents such as UFH, LMWH, aspirin, and dextran while hematologists preferred LMWH. There was variation of management strategies if flap thrombosis occurred. Different strategies consisted of changing recipient vessels, UFH IV, flushing the flap, adding post-operative agents, or a combination of strategies. Conclusions: There are diverse practice variations in anti-thrombotic strategies for free tissue transfers and a difference in perceived risk factors for flap failure that may affect patient management.

scholarly journals NCMP-14. SKULL BASE OSTEOMYELITIS DUE TO COMMUNITY-ACQUIRED ASPERGILLUS FUMIGATUS MIMICKING RECURRENT CHONDROSARCOMA

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii125-ii126
Author(s):  
Kevin Lillehei ◽  
B K Kleinschmidt-Demasters
Keyword(s):  
Risk Factors ◽  
Aspergillus Fumigatus ◽  
Skull Base ◽  
Replacement Therapy ◽  
Perceived Risk ◽  
Opportunistic Infections ◽  
Low Grade ◽  
Recurrent Tumor ◽  
Her Family ◽  
Patient Use

Abstract Skull base chondrosarcomas are often low grade tumors that do not metastasize, but are locally invasive and often recur locally. Thus, when patients with these tumors re-present with new onset symptoms, even decades later, recurrent tumor is presumed. A 50 year old woman with skull base chondrosarcoma initially diagnosed 30 years prior developed the subacute onset of worsening confusion and vision, with progressive blindness. Imaging disclosed a bony-erosive skull base mass without associated sinusitis/sinus opacification; additional small cerebral infarcts were identified. She had been on physiologic replacement therapy for panhypopituitarism since the original surgery, but had not received recent radiation therapy or chemotherapy and did not have neutropenia. RESULTS: Biopsy disclosed a chronic inflammation and necrotic debris; only on permanent sections were septated, 45-degree angle-branching fungi identified in one area. These had morphological features of, and were polymerase chain reaction-proven, Aspergillus fumigatus. No recurrent tumor was present. Given the lack of perceived risk factors, further questioning of the patient and her mother disclosed that precisely 1 year prior to surgery she and her family had participated in “cleaning out an old very dirty and dusty barn” in southern Colorado without the use of face masks; only the proband experienced sequelae. Anti-fungal therapy (voriconazole) was recommended although patient use was intermittent and symptoms have progressed. CONCLUSION: Community-acquired Aspergillus infections due to exposure to silage or barn detritus contaminated by fungal hyphae is almost never seen today, in comparison to opportunistic infections due to known risk factors of neutropenia and/or steroid usage. Replacement therapy may have added to this patient’s risk. Infections all too often mimic recurrent tumor.

scholarly journals Identifying Risk Factors Affecting the Usage of Digital and Social Media: A Preliminary Qualitative Study in the Dental Profession and Dental Education

2021 ◽  
Vol 9 (5) ◽  
pp. 53
Author(s):  
Rayan Sharka ◽  
Jonathan P. San Diego ◽  
Melanie Nasseripour ◽  
Avijit Banerjee
Keyword(s):  
Risk Factors ◽  
Qualitative Study ◽  
Perceived Risk ◽  
Dental Education ◽  
Dental Students ◽  
General Context ◽  
Structured Interviews ◽  
Factors Affecting ◽  
The Uk ◽  
Dental Professionals

Aims: This study aimed to identify the risk factors of using DSM to provide an insight into the inherent implications this has on dental professionals in practice and trainee professionals’ education. Materials and methods: Twenty-one participants (10 dental professionals and 11 undergraduate and postgraduate dental students) participated in this qualitative study using semi-structured interviews in a dental school in the UK. The interviews were analysed and categorised into themes, some of which were identified from previous literature (e.g., privacy and psychological risks) and others emerged from the data (e.g., deceptive and misleading information). Results: The thematic analysis of interview transcripts identified nine perceived risk themes. Three themes were associated with the use of DSM in the general context, and six themes were related to the use of DSM in professional and education context. Conclusions: This study provided evidence to understand the risk factors of using DSM in dental education and the profession, but the magnitude of these risks on the uptake and usefulness of DSM needs to be assessed.

scholarly journals Neuropathic Pain in Children with Sickle Cell Disease: The Hidden Side of the Vaso-Occlusive Crisis

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 84
Author(s):  
Jeanne Sigalla ◽  
Nathalie Duparc Alegria ◽  
Enora Le Roux ◽  
Artemis Toumazi ◽  
Anne-Françoise Thiollier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Neuropathic Pain ◽  
Sickle Cell Disease ◽  
Sex Ratio ◽  
Prospective Study ◽  
Sickle Cell ◽  
Clinical Presentation ◽  
Early Stage ◽  
Cell Disease ◽  
A Prospective Study

The majority of hospitalizations of patients with sickle cell disease (SCD) are related to painful vaso-occlusive crises (VOCs). Although the pain of VOC is classically nociceptive, neuropathic pain (NP) has also been demonstrated in SCD patients. The aim of our study is to specify the prevalence of NP during VOCs in SCD children using a dedicated scale and to measure its characteristics. We performed a prospective study that included SCD children hospitalized for an acute VOC. The presence of NP was sought with the DN4 scale on the second and fourth days of hospitalization. A total of 54 SCD children were included in the study. Overall, 41% of the patients (n = 22) experienced neuropathic pain during the VOC, mostly at an early stage (Day 2). The median age, the sex ratio, the location of the pain, and the morphine consumption were similar for patients with and without NP. Our study shows that neuropathic pain is very common during VOCs in SCD children. The absence of identified risk factors should prompt us to be vigilant regardless of the patient’s age, sex, and clinical presentation.

Acute Diplopia Following Rhinoplasty: Clearing the Air

2021 ◽  
pp. 229255032110270
Author(s):  
Ashley N. Boustany ◽  
Carly D. Comer ◽  
Harsha Gopal ◽  
Samuel J. Lin ◽  
Sumner A. Slavin
Keyword(s):  
Rare Complication ◽  
Therapeutic Interventions ◽  
Medical Attention ◽  
Delayed Presentation ◽  
Patient Evaluation ◽  
Acute Stroke Patient ◽  
Dry Eyes ◽  
Orbital Emphysema ◽  
Complete History ◽  
Binocular Diplopia

Diplopia after rhinoplasty is a rare complication that requires immediate medical attention. Workup should include a complete history and physical examination, appropriate imaging, and consultation with ophthalmology. Diagnosis may be challenging due to the wide differential ranging from dry eyes to orbital emphysema to an acute stroke. Patient evaluation should be expedient, though thorough to facilitate time-sensitive therapeutic interventions. Here, we present a case of transient binocular diplopia presenting 2 days after closed septorhinoplasty. The visual symptoms were attributed to either intra-orbital emphysema or a decompensated exophoria. This is the second documented case of orbital emphysema after rhinoplasty presenting with diplopia. It is the only case with a delayed presentation as well as the only case that resolved after positional maneuvers.

scholarly journals Neurilemmomas of the Hand—A Review of the Clinical Presentation, Surgical Outcome, and Potential Risk Factors

2017 ◽  
Vol 22 ◽  
pp. 48-51
Author(s):  
Ka-Chun Jonathan Chan ◽  
Fu-Keung Ip ◽  
Tak-Chuen Wong ◽  
Oi-Yee Prisilla Leung ◽  
Sze-Yan Chan
Keyword(s):  
Risk Factors ◽  
Potential Risk ◽  
Surgical Outcome ◽  
Clinical Presentation ◽  
Potential Risk Factors

The Diagnostic Assessment of Suspected Pulmonary Embolism on the Acute Medical Take: An Evidence Based Guide

2007 ◽  
Vol 6 (1) ◽  
pp. 20-26
Author(s):  
Alastair Proudfoot ◽  
◽  
Derek Bell ◽  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Clinical Presentation ◽  
Diagnostic Assessment ◽  
Evidence Based ◽  
Suspected Pulmonary Embolism ◽  
The Subject ◽  
Adjusted Incidence ◽  
Age And Sex

Pulmonary Embolism is a common cardiopulmonary illness with an age and sex adjusted incidence of around 117 cases per 100 000 person years. The clinical presentation is extremely heterogeneous and non specific. Risk factors for venous thromboembolism are well established. When combined with presenting features and investigations. a multimodality algorithm has led to significant changes in the diagnostic approach of suspected PE. While the best combination of tests for any individual patient remains the subject of controversy this article aims to rationalise the acute physician’s approach to diagnosis and use of available investigations.

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