Eighth Day Of Hospitalization Research Articles

Rare skin color changes in an acute pancreatitis patient undergoing maintenance hemodialysis

BackgroundSkin conditions are common in patients on maintenance hemodialysis and those with pancreatitis. However, there is a lack of research on dermatological issues in patients who have both hemodialysis and pancreatitis concurrently.Case presentationA 62-year-old male patient with a 4-year history of maintenance hemodialysis (MHD) presented with pain and was diagnosed with acute pancreatitis and gallbladder stones. Markedly elevated blood amylase, creatine kinase, and myoglobin were noted, alongside a purplish-red skin discoloration. Treatment included inhibition of digestive fluid secretion, anti-infection measures, blood purification, fasting, rehydration, and symptomatic care. Notably, continuous renal replacement therapy (CRRT) combined with hemoperfusion (HP) was employed. The patient’s dialysis effluent initially appeared red. Upon examination of the patient’s peripheral blood smear, red blood cell debris was not observed. The dialysis effluent (on Day 0) was analyzed, revealing no hemoglobin (0 g/L) but an elevated myoglobin concentration of 80.4 U/L. After the therapeutic intervention, the indicators, including the blood amylase, C-reactive protein, total bilirubin, creatine kinase, and myoglobin were improved. The patient experienced resolution of sternal and upper abdominal pain within two days. After four consecutive days of CRRT and HP treatment, the skin color returned to normal, alongside improved clarity of the dialysis effluent. Subsequently, the patient’s method of blood purification was reverted to conventional hemodialysis. On the eighth day of hospitalization, the patient resumed normal diet and was discharged.ConclusionsIn the case of the current patient with acute pancreatitis undergoing MHD, it is noteworthy to report the observation of a unique purplish-red skin discoloration. This phenomenon may be attributable to inflammation resulting from acute pancreatitis, and the retention of myoglobin within the body.

Persistence of the omphalomesenteric duct in adults: Case report and literature review

Introduction: Multiple pathologies can affect the umbilical cord, either due to infectious causes or malformation causes (acquired or congenital). However, the persistence of the omphalomesenteric duct and the urachus are the most frequent congenital malformations, especially in the pediatric setting, but not in the case of adults. Case report: The case of a 68-year-old male patient from a rural area, a farmer, with an enterocutaneous fistula, who received surgical treatment, is presented. He went to the consultation due to yellowish fluid leaking from the umbilical region, pain, and erythema, with a history of prostatectomy, osteoarthritis, and arterial hypertension. He was admitted with a diagnostic impression of cellulitis vs wall abscess. According to the assessment by the surgical team, a clear discharge of intestinal fluid was observed through the navel, for which reason emergency surgical resolution was decided for exploratory laparotomy. The patient reports discharge of yellowish fluid from the navel since childhood; there is a high suspicion of a picture compatible with the persistence of the omphalomesenteric duct in the adult. The patient underwent surgery with the following finding: A fully patent omphalomesenteric duct (enteroumbilical fistula) was found 70 cm from the ileocecal valve, plus incidental appendectomy. He was discharged on the eighth day of hospitalization, with a favorable evolution, outpatient treatment, and outpatient control. In addition, a bibliographical review in scientific databases such as Pubmed, Scopus, Proquest, Lilacs, Scielo, and Google Academic. Conclusions: surgical treatment with a favorable evolution, outpatient treatment, and outpatient control

Traumatic Carotid Artery Dissection — A Case Report

AbstractTraumatic carotid artery dissection (TCAD) usually occurs after a direct cervical trauma or blunt trauma that causes hyperextension and excessive rotation of the neck. The most frequent presentation of TCAD is stroke, with 80% of patients developing a stroke in the first week after the trauma. Recent data indicate that symptoms start later in non-survivors (19.5 hours after trauma) compared with survivors (12.5 hours). In this case report, a young boy, 14 years-old, developed TCAD after he fell from his bike. He developed ischemic stroke symptomatology in the eighth day of hospitalization, with full recovery of symtoms after acetylsalicylic acid (AAS) administration. The use of antithrombotic medication is recommended, aiming for better neurological outcomes and prevention of stroke in TCAD patients, as highlighted by our case. However, the treatment recommendations are based on observational studies and expert opinion, owing to the lack of concrete data on the treatment of carotid artery blunt trauma. New studies and data are required to improve diagnosis and treatment of TCAD.

Evaluation of Patients Presenting to the Emergency Department with Suicidal Drug Poisoning

Introduction: Drug intoxications may be associated with accidental or suicidal ingestion of toxic agents. In both cases, emergency treatment includes administration of the relevant antidote and gastric decontamination. If necessary, patients are followed up in wards and intensive care units, whereas a group of patients are discharged directly from the emergency department. Materials and Methods: The aim of this study was to conduct a retrospective evaluation of examination findings, laboratory investigations, duration of treatments, psychiatric follow-up studies, hospitalization rates and mortality rates in patients admitted to our emergency department due to drug intoxication between 2017 and 2018. Results: Of the 126 patients included in our study, 83 were female, with a mean age of 33.58 ± 13.58 years and a range of 18 to 92 years. Of all patients, 76 were hospitalized in the ward and 1 in the intensive care unit, while 49 were treated in the emergency department. One patient had mortality on the eighth day of hospitalization. Eighty-six patients had been on psychiatric treatment prior to admission, whereas 82 patients were referred to the psychiatry department after admission. The rate of psychiatric consultation was significantly higher in patients who were hospitalized in any department due to drug intoxication than in patients who were discharged directly from the emergency department (p <0.001). Conclusion: Drug intoxications continue to be a growing problem for physicians working in emergency departments in Turkey as well as in the world. The incidence of drug intoxications was higher in patients who had previously applied to psychiatry outpatient clinics than those who had not. Our study highlighted the shortcomings of physicians in emergency departments in referring this patient group to the psychiatry department. There is a duty for health professionals in emergency departments to direct patients to receive adequate psychosocial support.

Bilateral Recurrent Laryngeal Nerve Paralysis Manifesting as Long COVID

Management with ventilation is used for severe cases of coronavirus disease 2019 (COVID-19). After extubation, recurrent laryngeal nerve paralysis due to various factors may occur. Almost all cases of paralysis develop unilaterally; however, bilateral recurrent laryngeal nerve paralysis occurs rarely. Such cases may be fatal due to upper air obstruction, and patients are forced to adhere to restrictions after a tracheotomy. The present case illustrates bilateral recurrent laryngeal nerve paralysis that occurred 48 hours after withdrawal from the ventilator. A 75-year-old woman with a history of hypertension came to our hospital with a history of fever and cough for five days. She was diagnosed with pneumonia due to COVID-19 via polymerase chain reaction using her saliva, and ground-glass opacity was found in both lung fields on chest X-ray and computed tomography (CT). Mechanical ventilation, steroids, remdesivir, and baricitinib were administered. The patient's fever and oxygenation status improved with these treatments, and she was weaned from the ventilator on the eighth day of hospitalization. She had no symptoms immediately. However, 48 hours after extubation, bilateral recurrent laryngeal nerve paralysis was suspected. Thus, oral intubation was immediately introduced and a tracheostomy was performed. Vocal cord movement disorders continued for eight weeks, and during that period, the patient displayed hoarseness and suffered from dysphagia. We considered that nerve disorders from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in addition to the compression by the endotracheal tube, caused bilateral recurrent laryngeal nerve paralysis. The neural injury by SARS-CoV-2 may prolong and manifest as "Long COVID."

Transient Type 3 Renal Tubular Acidosis during Cyclic Vomiting Syndrome

Type 3 renal tubular acidosis is a pathological condition characterized by the simultaneous occurrence of distal renal tubular acidosis, which causes urinary acidification disorders, and proximal renal tubular acidosis, which causes impaired reabsorption of bicarbonate ions. Type 3 renal tubular acidosis is considered rare. A 5-year-old boy was admitted to our hospital because of frequent vomiting, poor vitality, and fever. He was diagnosed with cyclic vomiting syndrome. Type 3 renal tubular acidosis was also diagnosed because of severe mixed metabolic acidosis with impaired urinary acidification, a low tubular phosphorus reabsorption rate with hypophosphatemia, low-molecular-weight proteinuria, pan-aminoaciduria, and glucosuria. Fluid infusion was performed. On the second day of hospitalization, the vomiting disappeared and the patient was able to eat and drink. He was discharged on the eighth day of hospitalization. The laboratory test abnormalities associated with the renal tubular acidosis gradually improved, and testing at discharge on the eighth day of admission showed no metabolic acidosis, hypophosphatemia, low-molecular-weight proteinuria, or glucosuria. These findings suggested that the type 3 renal tubular acidosis was transient. Severe metabolic acidosis was observed in this patient because of both normal anion gap metabolic acidosis due to type 3 renal tubular acidosis and anion gap metabolic acidosis due to cyclic vomiting syndrome. Although type 3 tubular acidosis is rare, the resultant metabolic acidosis worsens when combined with a disease that causes metabolic acidosis. Type 3 tubular acidosis should be ruled out when severe metabolic acidosis is present.

SARS-CoV-2 infection in a child with Fanconi anemia and determined immunosuppressed status

Introduction. SARS-CoV-2 virus infection affects all age groups. In children, the infection mainly causes asymptomatic or mildly symptomatic forms of the disease, regardless of their immune status. Case presentation. We describe the case of a 7-year-old male child, known to have Fanconi anemia, scheduled for bone marrow transplantation. The patient comes from a family outbreak of COVID-19, which is why he was tested for SARS-CoV-2 infection. He is asymptomatic at the time of admission to our clinic. The clinical examination performed at the time of admission shows a patient in good general condition, afebrile, with pale skin and mucous membranes, without respiratory changes. Paraclinically, severe neutropenia, severe normochromic normocytic anemia and severe thrombocytopenia are detected, for which transfusions of erythrocyte mass and platelet mass are performed. Due to the immunocompromised status, antibiotic therapy is instituted. If necessary, symptomatic treatment is administered. The evolution is favorable, and the SARS-CoV-2 RT-PCR control test is negative on the eighth day of hospitalization. Conclusions. Immunocompromised status is not a major risk factor for severe COVID-19 in children.

Drug Reaction with Eosinophilia and Systemic Symptoms associada ao Alopurinol: um relato de caso

Objetivo: Relatar um caso de Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) associada ao Alopurinol, uma vez que se trata de uma condição clínica rara e está associada a elevada morbimortalidade. Detalhamento do caso: Paciente mulher, 69 anos, internada em hospital terciário do interior de São Paulo, com febre há 10 dias e exantema difuso por todo corpo associado a prurido generalizado. Aos exames laboratoriais, havia eosinofilia e leucocitose. Fazia uso do medicamento Alopurinol há três meses. Iniciou-se o tratamento com corticoterapia, apresentando melhora parcial do exantema. No oitavo dia de internação, foi feita a hipótese de síndrome DRESS e aumentada a dose de prednisona, com melhora completa do quadro. A biópsia de pele demonstrou achado histológico discretos e inespecíficos. Paciente recebeu alta com encaminhamento para seguimento ambulatorial, com a finalidade do desmame da corticoterapia. Considerações finais: O reconhecimento e tratamento precoces da doença são essenciais para melhorar o prognóstico dos pacientes doentes e consequentemente diminuir a morbimortalidade da doença.

Oncological emergency surgery for metachronous large and small bowel metastases after pancreaticoduodenectomy for pancreatic cancer: a case report

BackgroundA surgical case of metachronous metastases of pancreatic head cancer (PC) to the large and small bowel is extremely rare. Therefore, there are only a few reports about surgery for intestinal metastases from PC. An oncologic emergency is defined as an acute, potentially life-threatening condition in a cancer patient that developed directly or indirectly because of the malignant disease or cancer treatment.Case presentationA 63-year-old man with PC underwent pancreaticoduodenectomy after receiving neoadjuvant chemotherapy with gemcitabine and S-1. Histopathologically, the tumor was diagnosed as poorly differentiated, tubular adenocarcinoma, with pT2, N0, pStage IB according to the UICC classification, seventh edition. R0 was achieved. Three months after pancreatoduodenectomy, blood tests showed coagulation derangements with high C-reactive protein (CRP 11.30 mg/dl). Computed tomography (CT) scan revealed a 55-mm mass alongside the transverse colon. During 2 weeks of follow-up, the coagulation derangement and elevated CRP persisted. Repeat CT showed that the tumor enlarged to 65 mm, and an additional mass, 25 mm in diameter, was detected in the jejunum. He was hospitalized due to abdominal pain and diarrhea with persistent high fever and was inspected; however, there was no evidence for infections. With the understanding that his life-threatening symptoms were secondary to the underlying malignancy, extirpation of the tumors combined with partial resection of the transverse colon and the jejunum was performed on the eighth day of hospitalization, on an emergency basis.The lesions were identified as large and small bowel metastases from PC because histopathological examination revealed morphological features similar to the primary disease.Immediately after the emergency surgery, the fever resolved and the CRP level normalized. He was discharged and received nab-paclitaxel with gemcitabine chemotherapy for 2 months postoperatively. He selected for best supportive care after this. The patient died due to a relapse with mesenteric lymph node metastasis 7 months after the emergency surgery.ConclusionSurgery as an oncological emergency for selected patients could sometimes contribute to improving patient’s quality of life.

Takotsubo cardiomyopathy associated with sepsis due to Pseudomonas aeruginosa pneumonia<br>doi: 10.12662/2317-3076jhbs.v3i4.169.p242-244.2015

The authors describe a case report of a 71 year-old female patient admitted at the emergency service due to severe precordial chest pain associated with dyspnea and sweating. The electrocardiogram performed on admission showed ST elevation on V2 and V3 leads and the ventriculography revealed left ventricular apical ballooning, denoting the diagnosis of Takotsubo Cardiomyopathy. At the eighth day of hospitalization, although the heart function was recovered, the patient died due the clinical complications of a septic shock.

A Case of Idiopathic Acute Pancreatitis in the First Trimester of Pregnancy.

Acute pancreatitis is rare in pregnancy, with an estimated incidence of approximately 1 in 1000 to 1 in 10,000 pregnancies. Acute pancreatitis in pregnancy usually occurs in the third trimester. Here, we report a case of acute pancreatitis in the first trimester. A 36-year-old primigravida at 11 weeks of gestation complained of severe lower abdominal pain. The pain gradually worsened and migrated toward the epigastric region. She had no history of chronic alcoholism. Blood investigations showed elevated level of C-reactive protein (9.58 mg/dL), pancreatic amylase (170 IU/L), and lipase (332 IU/L). There was no gallstone and no abnormality in the pancreatic and biliary ducts on ultrasonography. Antinuclear antibody and IgG4 were negative and no evidence of hyperlipidemia or diabetes was found. There was also no evidence of viral infection. On the third day of hospitalization, she was diagnosed with severe acute pancreatitis on magnetic resonance imaging. Medical interventions were initiated with nafamostat mesilate and ulinastatin, and parenteral nutrition was administered through a central venous catheter. On the eighth day of hospitalization, her condition gradually improved with a decreased level of pancreatic amylase and the pain subsided. After conservative management, she did not have any recurrence during her pregnancy.

発症前後の経過を観察し得た食道粘膜剥離症の1例

A 54-year-old man suffered tonsillar pain, extending through the chest, resulting in an inability to eat or drink. Initial endoscopic examination showed a diffuse edematous swelling of the esophagus, with no abnormality in the mucosal surface. Inflammation or tumor of the esophagus was suspected, and conservative therapy was commenced. On the fourth day of hospitalization, the patient spat up some coagulated blood, after which his symptoms greatly improved. Esophageal endoscopy on the eighth day of hospitalization showed submucosal dissection in the upper part of the esophagus, with edema and bleeding in the false part of the esophagus. After endoscopic study, an upper GI series and CT were performed. These showed the false diverticulum in the esophagus, with no evidence of extravasation. Submucosal dissection of the esophagus was diagnosed, and conservative therapy continued. Endoscopic examination on the 16th day of hospitalization showed reduction of the edema and bleeding, with mucosal regeneration. Through such a clinical course, organic disease of the esophagus may occur before submucosal dissection.

Application of prospective nursing in preventing constipation of patients with acute myocardial infarction

Objective To explore the effect of prospective nursing on preventing constipation for patients with acute myocardial infarction(AMI). Methods 43 AMI patients during July 2008 and June 2010 in our hospital were classified as the observation group, besides the nursing routine of the acute myocardial infarction plus routine therapy to prevent constipation, prospective nursing was implemented.Through the retrospective analysis of medical record, 41 of AMI in our hospital during March 2006 and June 2008 were classified as the control group, they were given the nursing routine of the acute myocardial infarction plus routine therapy to prevent constipation and the nursing intervention after occurrence of constipation. The defecation condition was assessed for the two groups of patients on admission and the defecation and mortality rate was compared on the eighth day of hospitalization. Results There was significant difference in constipation and mortality rate between the two groups of patients during hospitalization. Conclusions The prospective nursing for AMI patients to prevent constipation can obviously reduce the incidence of constipation, thus to avoid serious complications caused by constipation and reduce mortality. Key words: Prospective nursing; Prevention; Myocardial infarction; Constipation

Severe Leptospirosis Similar to Pandemic (H1N1) 2009, Florida and Missouri, USA

Severe Leptospirosis Similar to Pandemic (H1N1) 2009, Florida and Missouri, USA

Acute Epidural Abscess Complicating Pneumococcal Meningitis in Adult

Acute spinal epidural abscesses rarely complicate bacterial meningitis in adults. We report an uncommon case of advanced pneumococcal meningitis complicated by acute lumbar epidural abscess in an adult. A 35-year-old man was admitted to the medical intensive care unit with pneumococcal meningitis. On the eighth day of hospitalization, he presented a cauda equine syndrome with flaccid paraplegia, saddle anesthesia, and bladder and bowel dysfunction. Magnetic resonance imaging (MRI) of the spine demonstrated a suppurative collection at L2-L3. Surgical decompression was performed, and antibiotherapy was followed for eight weeks. Clinical improvement was progressive over eight months. New onset neurologic deficits in a patient with pneumococcal meningitis should raise suspicion of acute epidural abscess.

Lung abscess and pleuritis caused by Lactobacillus rhamnosus in an immunocompetent patient

A 79-year-old man consulted us because of left chest pain and fever ranging from 38.0 to 38.9 °C. A chest computed tomography scan showed a mass lesion (φ40 mm) in the left lingular segment, and inflammatory markers were elevated. He was admitted with a diagnosis of lung abscess, and panipenem/betamipron was administered at a dose of 2 g/day, after which the symptoms showed slight transient resolution. However, his body temperature increased again, to more than 39.0 °C, on the eighth day of hospitalization, and a chest radiograph suggested pleuritis as a complication. The antibiotics were changed to teicoplanin (TEIC; 400 mg/day) and meropenem (2.0 g/day). Thoracic drainage and pleural lavage were initiated at the same time. Lactobacillus spp. was detected from the pleural effusion by culture and was considered to be the causative organism, and it was resistant to TEIC. Therefore, the antibiotic was changed, to clindamycin, to which the bacteria was susceptible. No subsequent fever or pleural fluid retention was observed. The patient’s course was good, and he was discharged on day 45 of hospitalization. Subsequently, the causative organism was identified as Lactobacillus rhamnosus by the 16s rRNA sequence. Lactobacillus rhamnosus is rarely pathogenic in humans. Lactobacillus rhamnosus infection mostly occurs in immunosuppressed patients, and only a few cases have been reported in immunocompetent patients. In the present case, the patient was not immunodeficient; however, his lung had an impaired local immunosystem, due to emphysema.

Air in the Portal and Mesenteric Veins

A 73-year-old man with history of smoking, hypertension, chronic obstructive pulmonary disease, and type 2 diabetes mellitus presented with respiratory distress. The trachea was intubated, and the patient was admitted to the intensive care unit. On the eighth day of hospitalization, atrial fibrillation developed, with associated hypotension, lactic acidosis, and mild elevation of liver enzymes (alanine aminotransferase, 190 U per liter; aspartate aminotransferase, 220 U per liter) and plasma amylase (140 mg per deciliter). The physical examination showed abdominal distention and regurgitation of enteral-tube nutrients. Computed tomography of the abdomen showed gas in the intrahepatic portal veins (Panel A, arrows), . . .

Acute kidney injury, hyperosmolality and metabolic acidosis associated with lorazepam

A 54-year-old male with a history of multiple admissions for alcohol intoxication was admitted to hospital with right flank pain. He received a high-dose lorazepam infusion for alcohol withdrawal during hospitalization and developed severe hyperosmolality, high anion gap metabolic acidosis, and acute kidney injury on his eighth day of hospitalization. Serum chemistries, arterial blood gas analysis, and measurement of serum propylene glycol, ethylene glycol and methanol levels. Propylene glycol toxicity. Discontinuation of lorazepam infusion, administration of fomepizole, hemodialysis for five consecutive days, hemodynamic support, and follow-up of serum osmolality as a measure of propylene glycol decay.

Carbamazepine-induced Stevens-Johnson Syndrome treated with IV steroids and IVIG

A 17-year-old female is presented who developed antiepileptic drug hypersensitivity syndrome after treatment with carbamazepine. The initial diagnoses were idiopathic thrombocytopenic purpura and toxic shock syndrome. The patient was treated with intravenous immunoglobulin and intravenous steroids. After a severe climax on days 2-4 she recovered completely and was discharged on the eighth day of hospitalization. Although we do not have direct proof, we believe that these treatment modalities, especially the IVIG, shortened and ameliorated the clinical course of the disease.

Value of antigen quantitation in Haemophilus influenzae type b meningitis

We studied Haemophilus influenzae type b meningitis in 68 patients to evaluate whether quantitative determination of PRP in body fluids obtained at admission or measurement of the duration of its presence helped identify patients at risk for complications. Geometric mean admission PRP concentrations in CSF, blood, and urine increased with severity of disease, but individual values varied greatly. Measurements of the duration of antigenemia and antigenuria also varied widely and were best predicted by the admission or peak PRP concentration. The mean duration of both antigenemia and antigenuria increased with severity of disease. In contrast, the elimination half-life of PRP did not differ significantly with severity of hospital course, peak PRP concentration in blood or urine, or patient age. Clearance from CSF could not be accurately assessed, but PRP was detectable in only six of 41 patients in whom spinal fluid was obtained after the eighth day of hospitalization; all had complicated courses. Although latex particle agglutination assay is a valuable aid in rapid diagnosis of invasive Hib infections, the predictive value of antigen quantitation at admission and the determination of its duration in body fluids is limited by the wide range of observed values.