Fifth Day Of Hospitalization Research Articles

Successful outcome birth in full term pregnancy velamentous insertion of the umbilical cord – vasa previa

Disclosure of incident on our successful outcome childbirth in term pregnancy velamentous insertion of the umbilical cord – vasa previa. Pregnant firstborn with free individuals and obstetrical history covering the 39th week of pregnancy is introduced in Maternity Clinic of our with symptomatology of automatic start birth. Sudden and to thoroughly grade vaginal hemorrhage found immediately after technical rupture of fetal membranes accompanied by decelerations of the fetal heartbeat raised the possible diagnosis of velamentous insertion of the umbilical cord – vasa previa and the interest undergone emergency cesarean section. After removal of the fetus and placenta was there synovial adherence cord. The caesarean section was performed smoothly with physiological loss blood. There was no need for blood transfusion in neonates, as well as it did not take neonatal support. Following a smooth postoperative course left together with the postpartum at fifth day of hospitalization. At this paper on the basis of current data a brief literature review of rare disease entities this respect mainly the diagnosis, treatment and prognosis.

Reversal of Severe Methanol Induced Visual Impairment Due to Prompt Hemodialysis

We report a case series of recovery from severe visual impairment due to methanol intoxication following treatment with fomepizol and prompt hemodialysis. Three adult males presented to our hospital few hours after unintended methanol intoxication. All patients reported weakness and dizziness, two of them suffered visual impairment with visual acuity loss and one of them presented complete blindness and unresponsive dilated pupils. Fundoscopy examination revealed edema of the disk margin. Their laboratory findings included severe high anion gap metabolic acidosis with elevated osmolar gap and methanol levels. All three patients were treated with fomepizole, folic acid IV, and 2-3 sessions of hemodialysis four hours each. The first session of dialysis was performed about 16 h after the methanol ingestion. They all exhibited a full recovery including the patient with the blindness who reported normal vision 20/20 with normal fundoscopic examination on discharge at the fifth day of hospitalization. This case report confirms the effectiveness of the combined treatment based on early dialysis with fomepizol in reversing the retinal impairment in methanol intoxication. The reversibility of retinal end organ damage demonstrated here raises doubts about the common thought regarding the poor outcome of methanol induced retinal end organ damage.

Comparison of two suicide attempts with long-acting insulin – The rare way to commit suicide

Introduction. In previous years, the number of suicide attempts has increased in Europe. Intoxication with hypoglycemic drugs, including insulin is a rare a tool for attempting suicide that may lead to a severe patient status. Aim. The aim of the study was to assess the severity of insulin poisoning with examples of two patients. Methods. The analysis of clinical history of patients and review of available literature. Results. A 22-year-old patient was hospitalized in the Department of Toxicology and Cardiology due to a suicide attempt in the way of insulin poisoning; time of poisoning was unknown, and the level of glucose was indeterminable. The patient was treated with intensive specific pharmacotherapy. After hospitalization, which lasted 5 months, the patient’s condition had been stabilized but with no verbal contact and quadriplegic paralysis. Another patient was a 41-year-old woman hospitalized two times in the Department of Toxicology and Cardiology due to the insulin poisonings. In each case of hospitalization of this woman, severe recurrent hypoglycemia was observed up to 25 mg% until the fifth day of hospitalization and the treatment used improved the patient’s condition and there was no development of serious complications. Conclusion. Normally effective treatment at the right time can recover the patient completely.

Suspected toxicity by biological waste and air sac nematode infestation in a free-living peregrine falcon (Falco peregrinus)

This case report describes an uncommon complex of mortality in a free living peregrine falcon (Falco peregrinus). The bird was found rinsed with biologic waste and the integument was mildly inflamed. No respiratory signs were detected at first. In addition, no alterations were detected during. During orthopaedic, neurologic, ophthalmologic and radiographic examinations. Parasitological pharyngeal and faecal examination revealed Capillaria spp. and Serratospiculum spp. eggs. The therapeutic scheme included stress reduction, supportive therapy with fluids, antifungals, antibiotics, anti-inflammatory, antiparasitic agents and nutritional management. Cleaning with dishwashing gel to remove the biological waste took place, but its removal was partial. Despite the intensive care, the patient developed respiratory distress and succumbed on the fifth day of hospitalization. Pathological examination revealed adult Serratospiculum tendo parasites in the air sacs and Capillaria spp. in the large intestine. Bacteriological and mycological cultures revealed significant growth of Klebsiella pneumoniae isolated from the skin, heart, lung, liver, kidney and intestine and a mild presence of Candida albicans in the large intestine. Their probable role was judged as secondary. Mild multifocal haemorrhages with heterophilic and lymphohistiocytic infiltrates, fibrin and rod‑like bacteria were detected in the skin histopathologically, confirming the clinical integument inflammation. Cause of death was asphyxia caused by oedema, haemorrhages and blood congestion of the lung. The contribution of S. tendo in the initial spill event and case evolution is discussed. This unusual case highlights the complexity of the wildlife cases, with which avian or small animal clinicians (consulting rehabilitation centres or falconers) might be confronted. Although the application of ancillary and advanced diagnostic tools, the in-depth knowledge of the species and the intensive monitoring are important, this might lead to an unrewarding outcome. Financial constraints in wildlife casualty cases urge the critical choice of diagnostic, therapeutic and post-mortem laboratory testing. Serratospiculum tendo should be considered in the differential diagnosis of acute respiratory distress in free-living peregrine falcons, presented in rehabilitation centres or in private practise by falconers in Greece and Europe.

Serum ghrelin, but not obestatin, is a potential predictor of acute pancreatitis severity.

The roles of ghrelin and obestatin in AP remain controversial.This study investigates the effects and the predictive value of serum ghrelin and obestatin levels in the early stage of AP.A total of 193 consecutive patients with AP and 24 healthy controls were included. Patients were divided into mild acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP) groups. Serum levels of ghrelin and obestatin were measured on the first, third, and fifth days of hospitalization. The predictive value of serum ghrelin and obestatin levels on the first day in AP was examined using receiver-operating characteristic (ROC) curves.On the first day of hospitalization, the mean serum ghrelin level was significantly lower in patients with AP than in controls (P < .01). The serum ghrelin concentration decreased with increasing AP severity and was lower in patients with SAP than in those with MAP and MSAP (P < .05). It increased gradually from the first to the fifth day after treatment. ROC curves demonstrated that the serum ghrelin level on the first day had some predictive value for AP severity (area under the ROC curve = 0.646), with an optimal cut-off value of 87.83 pg/mL. Logistic regression showed that the serum ghrelin level had independent predictive value for non-MAP (odds ratio = 10.94; 95% confidence interval, 5.08–23.55; P < .01). The serum obestatin level did not differ significantly between patients with AP and controls and had the limited predictive value for non-MAP (area under the ROC curve = 0.564). However, the serum obestatin concentration showed a “warning” effect regarding AP etiology; on the first day of treatment, it was significantly lower in patients with AP of hypertriglyceridemic etiology than in those with AP of biliary, alcohol-related, and other etiologies (P = .05, P = .031, and P = .029, respectively).Serum ghrelin and obestatin levels may be related to the progression of AP in the early stage. Only the serum ghrelin level is a potential predictor of AP severity in the early stage. Obestatin may be involved in the pathogenesis of AP caused by hypertriglyceridemia.

A Case of Acute Myocarditis and Rhabdomyolysis after a Scorpion Sting

Introduction: Scorpion stings continue to be a current public health problem in tropical regions of the world. Local effects are usually seen, but fatal cardiovascular complications may occur, albeit rarely, from scorpion stings. The purpose of this case is to emphasize that rhabdomyolysis and myocarditis can occur in patients admitted to a hospital with a scorpion sting.Case Report: A 30-year-old male patient presented to our emergency department (ED) with complaints of pain and redness in the bite site after being stung by a scorpion. His blood pressure was 180/100 mmHg and heart rate was 130/min. Electrocardiography (ECG) showed a sinus tachycardia. Laboratory tests revealed the following values: creatinine: 1.71 mg/dL, creatinin kinase (CK): 2129 U/L, creatinin kinase–myocardial band (CK-MB): 43.24 ng/mL, and troponin: 22.59 ng/mL. After catheterization of the bladder, dark brown urine was seen. There were no pathological findings in coronary angiography, but the left ventricular ejection fraction was detected as 45%. The clinically stable patient was discharged on the fifth day of hospitalization. There were no abnormal findings in the latest tests of laboratory parameters.Conclusion: Scorpion stings can cause death due to toxic effects on the cardiovascular system. Observations for possible complications from a scorpion sting, such as the possibility of myocarditis, should be kept in mind in patients admitted to the ED with complaints of a scorpion sting

Pulmonary thromboembolism and sudden death in psychiatric patients: Two cases reports

Introduction. Pulmonary thromboembolism occurs usually by running a thrombus from the deep veins of the legs rarely periprostatic or periuteric veins. Virchow's triad of necessary conditions for the occurrence of thrombosis involves disruption of blood flow, disruption of blood chemistry and damage to the vessel wall. Venous thrombosis is often associated with the implementation of antipsychotic therapy. Case report. We reported two cases of sudden death of psychiatric patients who were in both cases fixed during hospitalization. The first case was a 26-year-old woman treated a year with the diagnose of postpartum reactive psychosis. She was hospitalized because of mental state worsening with a dominant depressed mood, visual and auditory hallucinations. Her therapy was determined by diazepam, clozapine, haloperidol and lamotrigine. Suddenly, the patient died on the fifth day of hospitalization. The autopsy showed massive thromboembolism of the pulmonary artery branches. Toxicological analysis revealed the presence of therapeutic doses of antipsychotics. The second case was a-45-yearold men, a long-time alcoholic. On admission, the diagnosis of delirium tremens was established, and diazepam and haloperidol were administered. On the fifth day of hospitalization, he suddenly died. The autopsy showed thromboembolism of the branch of the pulmonary artery. Toxicological analysis established the presence of nordiazepam in urine (0.06 mg/L). Both patients were fixed during hospitalization. Conclusion. Both presented psychiatric patients were younger than 50 years, were not overweight, did not have changes of the venous blood vessels. Nowadays, when the issue of medical responsibility often arises in these and similar cases of sudden death in patients treated in psychiatric clinics, the questions on medical malpractice could be expected.

Acute cardiac failure during influence A (H1N1) treated with noninvasive ventilation

The female patient, 64 year old, was hospitalized in the intensive care unit of Clinic for Pulmonology, Clinical Center Kragujevac, due to fever, dry cough, dyspnea, fatigue and swelling of lower limbs. The symptoms started abruptly, 4 days before the admittance to the hospital. Upon admission, somnolence and signs of central cyanosis were noted. Auscultatory finding on the lungs was characterized by bilateral inspiratory crackles, while cardiac sound was silent, HR-120/min, TA-110/60mmHg. Analysis of arterial blood gases registered acute respiratory failure: pO2=5.1kPa, pCO2= 9.2kPa, pH=7.45, SAT=62%. Chest X-ray showed bilateral condensations in the lung parenchyma, predominantly in parahilar area. Cardiac shadow was enlarged. Laboratory tests showed increased value of pro-BNP (4086 pg/ mL) (reference values: < 125 pg/mL - negative; 125-400 pg/ mL - intermediate; > 450 pg/ml - heart failure). Echocardiographic exam upon admittance showed dilated cardiac cavities, global hypokinesis and ejection fraction of 35%. Noninvasive ventilation (NIV) treatment was started (BiLEVEL, IPAP 26cmH2O, EPAP 6cmH2O) at first continuously and then only during the night, with intense cardio-diuretic therapy. On the fifth day of hospitalization, the results of virology analyses confirmed influenza A (H1N1) infection. On the 6th day, gas exchange was normalized, complete radiological regression occurred, as well as normalization of echocardiographic exam finding. Our case shows that influenza A (H1N1) virus infection may be complicated by acute cardiac failure. If started on time, NIV treatment with simultaneous cardio-diuretic therapy, could have a positive impact on the resolution of acute heart failure during H1N1 virus infection.

Existe associação entre massa e força muscular esquelética em idosos hospitalizados?

Resumo Introdução: Massa e força muscular esquelética são variáveis que contribuem para o diagnóstico de sarcopenia. Objetivo: Avaliar a associação entre força e massa muscular esquelética em idosos hospitalizados. Método: Estudo transversal, realizado em hospital privado na cidade de Salvador-BA. Foram incluídos idosos ≥60 anos, entre o 1o e o 5o dia de internação hospitalar e que estivessem sem sedação e/ou drogas vasoativas. A massa muscular foi obtida por meio de equação antropométrica e a variável força por meio da força de preensão palmar. Fraqueza muscular foi identificada se &lt;20 kgf para mulheres e &lt;30 kgf para homens e a massa muscular reduzida quando o índice de massa muscular foi ≤8,9 kg/m2 para homens e ≤6,37 kg/m2 para mulheres. A correlação de Pearson foi utilizada para avaliar a relação entre massa e força e a acurácia para avaliar a capacidade da massa predizer força. Resultados: Entre os 110 idosos avaliados, houve moderada correlação entre massa e força (R=0,691; p=0,001). Entretanto, a acurácia foi fraca da massa para predizer força muscular (acurácia=0,30; IC 95% = 0,19-0,41; p=0,001). Os idosos com fraqueza eram mais velhos que os sem fraqueza, sem diferença nas outras variáveis. Conclusão: Existe uma relação linear entre massa e força muscular esquelética, porém a massa não prediz força, o que sugere que as duas medidas continuem sendo realizadas de forma independente.

RETROPERITONEOSCOPIC HEMINEPHRECTOMY: INITIAL EXPERIENCE IN CIPTO MANGUNKUSUMO HOSPITAL JAKARTA

Objective: To explain efficacy and feasibility of heminephrectomy laparoscopic with retroperitoneal approach in double collecting system patients with non-functional upper moiety. Material &amp; methods: Three cases in Cipto Mangunkusumo Hospital’s urology outpatient clinic from July 2013 - January 2014 with double collecting system and non-functional upper moiety. Laparoscopic heminephrectomy with retroperitoneal approach were done to these patients. Results: Surgery was done within 200 - 240 minutes with minimal bleeding and no significant complication. There was no significant hemodynamic disturbance observed during surgery. Patients were able to mobilize and to get immediate oral intake. Pains were minimal and can be treated with first-line analgesics. The patients were discharged on the fourth and fifth day of hospitalization. Conclusion: We are reporting our initial experience doing retroperitoneoscopic heminephrectomy in double collecting system patient. This procedure was feasible and produced good outcomes for the patients.

“Right place at the right time” impacts outcomes for acute intestinal obstruction

The purpose of this study was to measure how the duration of nonoperative intervention for intestinal obstruction impacted patient outcomes and whether hospital characteristics influenced the timing of operative intervention. The State Inpatient Database (Florida) of the Health Care Utilization Project and the Annual Survey database of the American Hospital Association were linked from 2006 to 2011. Included were patients ≥18 years of age with a primary diagnosis of intestinal obstruction. Patient factors included age, sex, socioeconomic factors, and comorbid conditions. A total of 116,195 patients met our inclusion criteria, and 43,079 underwent operative intervention (37.1%). Patients who required operative correction of the intestinal obstruction after the fifth day of hospitalization, compared with patients who underwent an operation on the day of admission, had increases in mortality (6.1% vs 1.8%, P < .001), complication rates (15.4% vs 4.0%, P < .001), and postoperative hospital stay (9 vs 5 days, P < .001). Patients cared for at a large teaching facility (with surgery residents) had increased odds of early operative intervention by 23% (odds ratio 1.23, [1.20-1.28]), whereas patients at low-volume hospitals had decreased odds of early intervention (odds ratio 0.88, [0.73-0.91]). Initial nonoperative treatment in patients with uncomplicated intestinal obstruction is an important strategy, but the odds of having an adverse event increase as intestinal obstruction is delayed. Importantly, the presence of surgery residents and increasing bed size are hospital characteristics associated with earlier operative intervention, suggesting a quality benefit for care at large teaching hospitals.

Frequency of sarcopenia and associated factors among hospitalized elderly patients.

BackgroundSarcopenia is an important public health problem that affects mainly elders, and has negative consequences, such as disability and even death. Due to the lack of studies evaluating sarcopenia in elderly persons hospitalized in Brazil, the aim of the present study was to describe the frequency of sarcopenia and associated factors among elders in a hospital in the city of Salvador - Brazil.MethodsThis cross-sectional study included 110 hospitalized elderly patients in a multi-specialty hospital in Salvador-BA, Brazil. Inclusion criteria: were elders aged ≥60 years between the first and fifth day of hospitalization; who were able to walk without external assistance; with medical permission to walk, and who did not take vasoactive and inotropic drugs. The diagnosis of sarcopenia was determined by combining the reduction in skeletal muscle mass with muscle weakness (women, <20 kg; men, <30 kg) and/or poor physical performance (gait speed ≤0.8 m/s). To obtain reduced skeletal muscle mass, the skeletal muscle mass index ≤6.37 kg/m2 for women and ≤8.90 kg/m2 for men was used. Cognitive function, Charlson index, admission profile (clinical and surgical), smoking, falls suffered in the last year and physical inactivity prior to admission were also evaluated. The frequency of sarcopenia was described in percentages with their respective confidence intervals and logistic regression was performed for multivariate analysis of factors associated with sarcopenia.ResultsAmong the 110 patients included, the frequency of sarcopenia was 21.8%, with 10.0% being of the severe type. There was a predominance of clinical profile (59.1%), such as heart disease (20.0%), pneumonia (13.6%) and skin infections (9.1%), with a Charlson index of 5.4 ± 1.8. The factors associated with sarcopenia were age (OR = 1.14; 95% CI = 1.06 to 1.23), clinical profile on admission (OR = 5.15; 95% CI = 1.16–22.9) and smoking (OR = 7.8; 95% CI = 1.53–39.9).ConclusionsThe frequency of sarcopenia in elderly hospitalized patients was high (1 in 5 elderly) and anthropometric equation can be a viable and inexpensive alternative to screening and programming intervention in this population.

Bladder diverticulum and sepsis: Case report

Introduction: Bladder diverticula are rare both in adults and in children and may be congenital or acquired, are rare in females. Objective: To describe the case of occasional finding of bladder diverticulum in women, which developed into sepsis. Case report: Patient MIB, 81, female was admitted to the Cariri Regional Hospital after a fall from height resulting in trochanteric fracture of left femur .No fifth day of hospitalization, the patient developed an abdominal mass in pit right iliac, associated the signs of inflammation and painful abdomen. Computed tomography of the abdomen with contrast revealed a cystic collection of air-fluid content and inflammatory aspect in the right lower abdomen measuring approximately 212 mL volume with continuity with the bladder. Discussion: bladder diverticula are usually asymptomatic, and occasionally found more commonly in men. It is a rare condition in women and its clinical presentation is associated with infection or neoplasia. There are reports of peritonitis after spontaneous perforation of the diverticulum, however, its evolution to sepsis is rare. Conclusion: bladder diverticulum in women and evolving to sepsis without drilling is a rare condition, with few reports in the literature.

Impact of Regular Nursing Rounds on Patient Satisfaction with Nursing Care

The purpose of the study was to determine the impact of regular nursing rounds on patient satisfaction with nursing care. This was a controlled clinical trial in which 100 hospitalized patients in a medical surgical ward were allocated to control and experimental groups through convenience sampling. The experimental group received regular nursing rounds every 1-2 hours. Routine care was performed for the control group. Patient satisfaction with the quality of nursing care was assessed on the second and fifth days of hospitalization in both groups using Patient Satisfaction with Nursing Care Quality Questionnaire. On the second day, patient satisfaction scores of the two groups had no significant difference (p = .499). However, the intervention was associated with statistically significant increased patient satisfaction in the experimental group compared to the control group (p < .001). Implementing regular nursing rounds had a positive impact on patient satisfaction. This method may hence improve patient-nurse interactions and promote the quality of nursing care and patient satisfaction.

Clinical and prognostic value of elevated CA125 levels in patients with coronary heart disease.

The aims of this study were to explore the association between serum level of carbohydrate antigen 125 (CA125) and coronary heart disease (CHD), and to evaluate its role in the short-term prognosis of CHD patients. A total of 150 patients were enrolled in the study and divided into an acute coronary syndrome (ACS) group (n=40), a stable CHD group (n=64), and a control group (n=46) according to clinical presentation and angiographic results. Fasting blood samples were collected at two time points, on admission and on the fifth day after hospitalization for the measurement of serum CA125 and other biomarkers. Serum CA125 levels in both CHD subgroups were significantly higher than the control group on admission (p < 0.01 for the ACS group and p < 0.05 for the stable CHD group). The differences remained significant on the fifth day after hospitalization (both p < 0.05), and the CA125 levels in the ACS group were higher than in the stable CHD group on the fifth day (p < 0.05). The CA125 levels were positively correlated with pro-brain natriuretic peptide (pro-BNP), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), and negatively correlated with left ventricular ejection fraction (LVEF). Compared with the other patients, serum CA125 levels on admission were significantly elevated in the patients who suffered from heart failure events during a 3-month follow-up (p = 0.037). The CA125 level on the fifth day of hospitalization in these patients stayed at a significantly higher level than the other patients (p = 0.002). The serum CA125 levels were significantly related with cardiac function in CHD patients. Serum CA125 levels that remain elevated after CHD onset could be helpful for predicting the short-term risk of heart failure events in CHD patients.

Isolated adrenocorticotropic hormone deficiency development during chemotherapy for gastric cancer: a case report

IntroductionIsolated adrenocorticotropic hormone deficiency is an endocrinological disorder characterized by loss of adrenocorticotropic hormone and resultant adrenal insufficiency. Affected patients often present with fatigue, anorexia, and hyponatremia. Although the number of reported cases has been recently increasing, isolated adrenocorticotropic hormone deficiency combined with malignant neoplasia is very rare. Here we describe a patient with gastric cancer who developed unexpected isolated adrenocorticotropic hormone deficiency during chemotherapy.Case presentationA 72-year-old Japanese man was admitted to our hospital because of febrile neutropenia due to chemotherapy for gastric cancer recurrence. Although the neutropenia and fever immediately improved, he became unable to take any oral medications and was bedridden 1 week after admission. His serum sodium level abruptly decreased to 122mEq/L on the fifth day of hospitalization. We performed endocrinological studies to investigate the cause of his hyponatremia and plasma hyposmolality. His plasma adrenocorticotropic hormone and cortisol levels were very low. However, his serum levels of all other anterior pituitary hormones were slightly elevated. We then performed a corticotropin-releasing hormone test, which showed that neither his plasma adrenocorticotropic hormone nor cortisol level responded to corticotropin-releasing hormone stimulation. We definitively diagnosed isolated adrenocorticotropic hormone deficiency based on these findings. Hydrocortisone replacement therapy was begun at 20mg/day, resulting in a marked improvement in his anorexia and general fatigue within a few days. His serum sodium level was also normalized immediately after the administration of hydrocortisone. He was discharged from our hospital on the 50th day of hospitalization.ConclusionsThe present case is the second report of a patient with concurrent isolated adrenocorticotropic hormone deficiency and gastric cancer and the first report of a patient diagnosed with isolated adrenocorticotropic hormone deficiency during the course of chemotherapy for a solid malignant neoplasm. Although the symptoms and signs described in the present report are common observations during chemotherapy, it is important to consider not only the adverse effects of antineoplastic agents, but also isolated adrenocorticotropic hormone deficiency as a differential diagnosis. Hydrocortisone replacement therapy for isolated adrenocorticotropic hormone deficiency effectively avoids the unnecessary cessation of chemotherapy.

Pneumopericardium secondary to oesophageal stent invasion.

A 64-year-old gentleman presented with acute shortness of breath. He had been diagnosed with stage III oesophageal cancer one year back. Six months prior to his admission, he had undergone oesophageal stenting and percutaneous endoscopic gastrostomy (PEG) tube placement. On the day of his presentation, he suddenly developed respiratory distress during an attempt which was made to feed him through the PEG tube. His chest X-ray revealed a left lower lobe infiltrate and he was started on antibiotics which were appropriate for aspiration pneumonia. His CT angiogram was negative for pulmonary embolism, but it revealed a pneumopericardium [Table/Fig-1A]. His bedside transthoracic echocardiogram revealed a moderate sized pericardial effusion with air bubbles, which was consistent with pneumopericardium [Table/Fig-1B]. In barium oesophagogram findings, an extravasation of contrast into the left main stem bronchus was seen, which was consistent with an oesophagobronchial fistula [Table/Fig-1C], which was secondary to stent eroding into the left main stem bronchus. He died on the fifth day of hospitalization while he was under comfort care. [Table/Fig-1A]: CT scan of chest with contrast shows pneumopericardium as depicted by the red arrow [Table/Fig-1B]: Transthoracic echocardiogram shows air bubbles (red arrow) in the pericardium [Table/Fig-1C]: Esophagogram shows the stent in the esophagus (red arrow) and contrast leaking into the left main stem bronchus (green arrow) Notes Financial or Other Competing Interests None.

New Delhi Metallo-β-Lactamase-1 in Carbapenem-ResistantSalmonellaStrain, China

New Delhi Metallo-β-Lactamase-1 in Carbapenem-Resistant<i>Salmonella</i>Strain, China

Iatrogenic Tracheal Rupture in a Child

Tracheal rupture is rare in childhood, and optimal treatment is not clear. A 14-year-old boy was admitted to a local hospital after sudden loss of consciousness. He underwent endotracheal intubation and was referred to our hospital. The patient's history revealed that he had voluntarily inhaled butane gas. The physical examination was consistent with coma and cardiogenic shock, and the chest radiograph showed pulmonary edema. The patient was admitted to the intensive care unit, and diuretic and inotropic therapy was started. In the third hour of monitoring of the patient under mechanical ventilation, subcutaneous emphysema and pneumothorax at the right hemithorax were observed without deterioration of the vital functions. Thoracic computed tomography scan findings were consistent with tracheal rupture. The patient was monitored conservatively without surgery. On the fifth day of hospitalization, his tube was removed, and he was discharged on the 12th day with a positive prognosis. In this study, a tracheal rupture case after endotracheal intubation is presented in which the patient recovered completely with conservative therapy.

Gray Hausdorff distance measure for medical image comparison in dermatology: Evaluation of treatment effectiveness by image similarity

In clinical dermatology, the stabilization of the overall skin condition can be in many cases the earliest qualitative measure of the effectiveness of the therapeutic intervention. Subjective image comparisons, that offer empirical 'qualitative' judgments of degrees of image similarities, are traditionally employed by the involved physicians. To quantify, by means of an image similarity metric, the degree of stabilization of an expanding skin disease, and to identify the situation of 'no further change' of the skin condition of the patient, providing thus the physician with an early, objective measure of the efficacy of the used therapy. For treatment assessment, a variant of gray Hausdorff distance metric was employed to compare images of lesional skin segments of a patient, taken at different time points during a therapeutic course. Prior to image comparison, an effective preprocessing scheme was adapted to constrain wide pose and light variations. The proposed similarity algorithm was tested on raw clinical image data sets of patients diagnosed with toxic epidermal necrolysis, a life-threatening condition with rapid evolution. Fine tuning of algorithm's parameters was optimized using Precision-Recall curves. Proposed image comparison method resulted in a high-degree of image similarity (about 96%) between pictures taken at second and fifth day of hospitalization. Current similarity results substantiate a significant agreement between the computer-treatment assessment, by means of image comparison, and the corresponding clinical experts' review of skin condition. Objective evidence of 'no further change' situation may provide (a) intuitive clinical decision support to dermatologists in assessing aggressive skin conditions, where the timely evaluation of treatment response is of vital importance and (b) a versatile end-point measure for corresponding therapeutic clinical trials.