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1.
Pakistan Journal of Medical and Health Sciences ; 16(9):525-527, 2022.
Article in English | EMBASE | ID: covidwho-2164868

ABSTRACT

The aim of this descriptive case series was to determine the frequency of various gastrointestinal symptoms of the COVID-19 patients along with the respiratory symptoms. Secondary outcome was to determine the effect of various co-morbid conditions and various sign and symptoms on the length of hospital stay and outcome of disease Material: In this descriptive case series type study, carried out in the COVID ward in the Jinnah Hospital, Lahore, all patients diagnosed with COVID-19 by consultant physician in the out-patient department and ward were included. Written informed consent was taken from all the participants of the study after explaining the primary objective of the study. The study was carried out from 01-07-2019 to 31-12-2019. Primary objective of this study was to determine the various gastrointestinal symptoms of the COVID-19 patients along with the respiratory symptoms Results: Among the 386 patients enrolled in the study, 60% were male and 40% were female. Mean age of the patients was 54.14 SD 16.3 years, with around 71% cases of age above 45 years. Abdominal pain, anosmia and diarrhea were the most common GI complaints. Over all, 26% of the patients of COVID had GI symptoms. Conclusion(s): GI complaints such as anorexia, nausea, vomiting, diarrhea, and abdominal cramping have been documented in COVID-19 individuals even in the absence of respiratory problems. As a result, COVID-19 disease must be explored in individuals who have mostly GI complaints. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

2.
Eksperimental'naya i Klinicheskaya Gastroenterologiya ; 200(4):9-13, 2022.
Article in Russian | Scopus | ID: covidwho-2164637

ABSTRACT

The disease SARS-CoV-2 has various symptoms, including from the gastrointestinal tract. The long-term consequences of this infection require careful study and generalization. The purpose of the study: to clarify the frequency of gastrointestinal tract lesions in SARS-CoV-2 and its possible consequences. 503 patients with a positive test for COVID-19 were examined. A clinical examination, the study of clinical and biochemical blood tests, the level of fecal calprotectin, computed tomography of the chest, esophagogastroduodenoscopy (EGDS) and fibrocolonoscopy (FCS) with the study of biopsies of the colon mucosa were carried out. It was found that gastroenterological complaints were present in 58% of patients. Of these, the most common symptom is diarrhea and abdominal pain. Endoscopic examination of the upper gastrointestinal tract revealed most often erosive and ulcerative changes in the mucous membrane of the stomach and duodenum. In some patients, abdominal pain and dyspepsia persisted for 4-6 months after the coronavirus infection, and during FCS erosive changes of the colon mucosa with pronounced inflammatory infiltration, crypt abscesses were noted, which indicates the need for medical examination of persons who have undergone SARS CoV-2, with more thorough clarification of gastroenterological complaints and FCS if any. © 2022 Global Media Technologies. All rights reserved.

4.
Cirugia y cirujanos ; 90(S2):13-17, 2022.
Article in English | Scopus | ID: covidwho-2164568

ABSTRACT

BACKGROUND: In other countries, researchers have noticed diverse variations in the features of patients undergoing emergency surgery during the COVID-19 pandemic. In Mexico, there is not information about this issue. METHODS: Workers of the Mexican Government, who required emergency surgeries were studied by the general surgery service of a General Hospital administered by the Institute of Social Security and Services for State Workers Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), through the periods from March-August 2019 (non-exposed) and March-August 2020 (exposed). The analysis included: demographic data, laboratory information, post-operative diagnoses, symptoms' length, days of emergency stay, and post-operative stay. RESULTS: One hundred and ninety-three emergency surgeries were analyzed;106 in 2019 and 87 in 2020 (a decrease of 18%). Throughout the pandemic, the number of days between the symptoms' onset and surgery was greater: 2019, 7.6 ± 4.6 days;2020, 14 ± 6.7 days (p < 0.0001). In addition, cases of acute appendicitis decreased (2019-60.3%;2020-42.5%), and those of acute calculous cholecystitis increased (2019-12.2%;2020-24.1%). CONCLUSION: Through the COVID-19 pandemic, there were notable changes in the characteristics of Mexican Government's workers who warranted emergency surgery. Copyright: © 2022 Permanyer. ANTECEDENTES: En otros países, han notado diversos cambios en las características de los pacientes sometidos a cirugía de emergencia durante la pandemia de COVID-19. En México no existe información sobre este tema. MÉTODO: Estudiamos a los trabajadores del gobierno mexicano que requirieron tratamiento quirúrgico de emergencia por el servicio de cirugía general de un Hospital General del Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE), durante los periodos de marzo-agosto de 2019 (no expuestos) y marzo-agosto de 2020 (expuestos). El análisis incluyó: datos demográficos, datos de laboratorio, diagnósticos postoperatorios, duración de los síntomas, días de estancia en emergencias y estadía postoperatoria. RESULTADOS: Se analizaron 193 cirugías de emergencia;106 en 2019 y 87 en 2020 (una disminución del 18%). En la pandemia, el número de días entre el inicio de los síntomas y la cirugía fue mayor: 2019, 7.6 ± 4.6 días;2020, 14 ± 6.7 días (p < 0.0001). Además, disminuyeron los casos de apendicitis aguda (2019-60,3%;2020-42,5%) y aumentaron los de colecistitis litiásica aguda (2019-12,2%;2020-24,1%). CONCLUSIÓN: Durante la pandemia de COVID-19, hubo cambios notables en las características de los trabajadores del gobierno mexicano que ameritaron cirugías de emergencia.

6.
National Journal of Physiology, Pharmacy and Pharmacology ; 12(11):1854-1859, 2022.
Article in English | EMBASE | ID: covidwho-2164100

ABSTRACT

Background: Resistance to antibiotics is rising markedly. Factor which contributes to resistance is the rampant irrational use of antibiotics. The trend of prescribing antibiotics in intensive care units (ICUs) of eastern India is less explored. Aims and Objectives: The aim of the study was to describe and analyze the utilization of antibiotics as per the WHO/INRUD prescribing core indicators in an intensive and critical care unit (CCU) of a tertiary center in eastern India. Material(s) and Method(s): A prospective observational study was carried out on prescription pattern of antibiotics. Case records of patients with restricted antibiotic therapy were reviewed and evaluated using descriptive statistics. A total of 353 prescriptions were evaluated and analyzed. Result(s): Among the total 353 patients most common age group admitted was 41-60 years. Males were more in numbers. Myocardial infarction and post-operative complications were the most common cause of admission in ICU and CCU, respectively. Ceftriaxone (44%) and meropenem (37%) were the drugs used rampantly in ICU and CCU. More than 90% of prescriptions had injections and drugs were written in generic names. Almost 90% of patients in CCU had antibiotics in their prescription. Adverse events occurred in 14.7% of patients and thrombophlebitis was the most common adverse event occurred. Conclusion(s): The study has given us an overall impression of the antibiotics usage pattern in ICU and CCU of this teaching institution. The study has shown that antibiotics should be used judiciously in ICU and CCU. Policy can be made on the basis of the result of this study. Copyright © 2022 Pratap Chatterjee, et al.

7.
Journal of Pediatric Surgery Case Reports ; 88 (no pagination), 2023.
Article in English | EMBASE | ID: covidwho-2158795

ABSTRACT

Choledochal cysts are rare cystic dilations of the biliary tree that typically involve the extrahepatic bile duct and more infrequently, the intrahepatic bile ducts. Todani's classification of choledochal cysts is the most referenced system in which five types of choledochal cysts are described. Several new variants have been reported including dilations of the cystic duct and a double common bile duct. We describe a never reported variant involving dilation of the common bile duct, dilation of the cystic duct and an accessory right hepatic duct. Copyright © 2022 The Authors

8.
Hepatology ; 76(Supplement 1):S1460-S1461, 2022.
Article in English | EMBASE | ID: covidwho-2157769

ABSTRACT

Background: Drug-induced liver injury (DILI) is the leading cause of acute liver injury in Western countries. Herbal and dietary supplements are the second most common cause of idiosyncratic DILI. In this case study, a young male with history of hepatitis C infection with sustained viral response presented with acute liver injury. Method(s): Liver function tests were performed as below. CT scanning were reviewed by a radiologist. Liver biopsy was done with routine H&E staining and reviewed by a pathologist. Result(s): Our patient presented to an outpatient clinic with muscle cramping fatigue, and diffuse itching. He previously had icteric sclera, dark urine, and abdominal pain a month prior that resolved after a few weeks. Patient denied any recreational drug use in the past year and rarely drank alcohol. Patient was using protein shakes and, pre- and post-workout supplements he bought at GNC. His labs were notable for a total bilirubin was 2.8 mg/dL, aspartate aminotransferase (AST) was 76 U/L, alanine aminotransferase (ALT) 191 U/L and the level of alkaline phosphatase 103 U/L. INR was 0.9. Creatinine kinase level was 320 U/L. Acute hepatitis A, B, and C were negative. The following next ten days, he pruritis worsened and he reported a progressive rash in his trunk and extremities. HIV, TSH, EBV, CMV, and COVID-19 testing were also negative. Repeat labs revealed creatinine kinase level normalized. The total bilirubin had increased from 5.3 mg/dL to 8.2 mg/dL, including a direct bilirubin of 6.6 mg/dL. AST and ALT had decreased, and INR remained normal. CT scan of his abdomen did not show cholecystitis or choledocholithiasis. Live biopsy showed bland cholestasis and sinusoidal dilation (fig 1). Patient ultimately required plasmapheresis and diagnosis of anabolic-androgenic steroid-induced liver injury was made. Conclusion(s): This case highlights an important complication of OTC use spiked with unexpected substances. Anabolic-androgenic steroidinduced DILI is characterized by cholestatic liver injury pattern with bland cholestasis on liver biopsy. In this case, patient's presentation was pathognomonic for anabolic-androgenic steroid-induced DILI despite only using OTC workout supplements. As supplement use in the United States increases, product contamination may place patients at an increasing risk for DILI. It is crucial to report suspected cases of hepatotoxicity and advocate for regulatory change to improve the health and safety of athletes.

9.
Indian Pediatrics ; 59(12):936-938, 2022.
Article in English | MEDLINE | ID: covidwho-2157163

ABSTRACT

OBJECTIVES: We reviewed the cases of probable multisystem inflammatory syndrome in children (MIS-C) to identify those cases that mimicked surgical emergencies.

10.
Pakistan Journal of Medical and Health Sciences ; 16(10):122-124, 2022.
Article in English | EMBASE | ID: covidwho-2156409

ABSTRACT

Background: This cross-sectional study being instrumented by a close ended questionnaire was conducted to evaluate society's affirmation for being jabbed with COVID-19 vaccine, their acquisition towards immunization and associated anomalies in vaccinated people. According to the recent update from WHO, the glob is facing 5th wave of pandemic "Omicron". However, the problem is that vaccines were in trials. Majority of people were demonstrating reluctance for being immunization against COVID-19 due prevailing oddities after vaccination. Aim(s): To measure the possible adverse effects caused by the vaccination and society's participation towards immunization. Methodology: In this study we adapted cross sectional study design by means of convenience sampling. Study instrument was a close ended questionnaire. Data was collected from only vaccinated participants by visiting universities, medical personnel, colleges and other society sectors under the supervision of team members. Data transferred to software SPSS to extract the results. Cross tabulation was used for demographic analysis such as age, gender and vaccine type jabbed. Result(s): The most common adverse effects include inflammation at site of injection, fever, nausea and vomiting, diarrhea, abdominal pain, joint pain and numbness of limbs were highlighted. Mostly jabbed vaccine types include Sinopharm and Sinovac. Majority of respondents showed willingness for immunization however, only a small proportion was afraid for being vaccinated. The significance in our study that we have conducted study for acceptance of vaccine, intention of participants towards immunization and adverse events associated with different types of COVID-19 vaccines in vaccinated population residing in different towns of Lahore, Pakistan. Conclusion(s): In our local population, majority accepted the vaccine and didn't deny to administer the vaccine. Pain, redness, lethargy, nausea, vomiting, diarrhea, abdominal pain, numbness and arthritis were noted to be the most common side effects of COVID-19 vaccine. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

11.
Cir Cir ; 90(S2):13-17, 2022.
Article in English | PubMed | ID: covidwho-2156064

ABSTRACT

BACKGROUND: In other countries, researchers have noticed diverse variations in the features of patients undergoing emergency surgery during the COVID-19 pandemic. In Mexico, there is not information about this issue. METHODS: Workers of the Mexican Government, who required emergency surgeries were studied by the general surgery service of a General Hospital administered by the Institute of Social Security and Services for State Workers Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), through the periods from March-August 2019 (non-exposed) and March-August 2020 (exposed). The analysis included: demographic data, laboratory information, post-operative diagnoses, symptoms' length, days of emergency stay, and post-operative stay. RESULTS: One hundred and ninety-three emergency surgeries were analyzed;106 in 2019 and 87 in 2020 (a decrease of 18%). Throughout the pandemic, the number of days between the symptoms' onset and surgery was greater: 2019, 7.6 ± 4.6 days;2020, 14 ± 6.7 days (p < 0.0001). In addition, cases of acute appendicitis decreased (2019-60.3%;2020-42.5%), and those of acute calculous cholecystitis increased (2019-12.2%;2020-24.1%). CONCLUSION: Through the COVID-19 pandemic, there were notable changes in the characteristics of Mexican Government's workers who warranted emergency surgery.

12.
European Psychiatry ; 65(Supplement 1):S841, 2022.
Article in English | EMBASE | ID: covidwho-2154164

ABSTRACT

Introduction: Alcohol-based hand sanitizers containing ethanol or is opropanol are being used in order to prevent person-to-person transmission during the COVID-19. Early signs and symptoms of this ingestion include nausea, vomiting, headache, abdominal pain, blurred vision, loss of coordination, and decreased level of consciousness. After hand sanitizer ingestion we have to suspect about methanol poisoning, monitoring the start of anion-gap metabolic acidosis, seizures, and blindness is essential. Treatment includes supportive care, acidosis correction, and the administration of an alcohol dehydrogenase inhibitor. In servere cases hemodialysis may be required. Objective(s): To present a case of an 29-year-old woman who was taken to the emergency department after voluntary ingestion of alcohol-based hand sanitizer in a suicide attempt. To describe the most common side effects of hand sanitizer ingestion and the literature review. Method(s): Clinical case presentation and literature review of similar cases. Result(s): A 29-year-old woman, with diagnosis of borderline personality disorder and previous suicide attempts was taken to the emergency department after 3 hours of voluntary ingestion of an unknown quantity of alcohol-based hand sanitizer. Initial laboratory findings showed laboratory a blood methanol concentration of 66 mg/dL, with an anion gap of 30 mEq/L, arterial blood pH of 7.2, serum bicarbonate concentration of 12 mEq/L. Patient complained of abdominal pain and nervoussness. Conclusion(s): Most common signs and symptoms of alcohol-based hand sanitizer ingestion include nausea, vomiting, headache, abdominal pain, blurred vision, loss of coordination, and decreased level of consciousness. Treatment includes supportive care, acidosis correction, the administration of an alcohol dehydrogenase inhibitor and sometimes may be required.

13.
European Psychiatry ; 65(Supplement 1):S133, 2022.
Article in English | EMBASE | ID: covidwho-2153821

ABSTRACT

Introduction: Cognitive functioning and psychological well-being are considered negatively affected by COVID-19. An estimated 15%-40% of COVID-19 patients report disrupted cognitive performance. Higher rates of anxiety, depression and sleep disturbances are also reported post infection. Objective(s): We examined the profile of cognitive changes in a group of adults with a confirmed COVID-19 diagnosis, compared to those without a COVID-19 diagnosis (cross-sectional betweensubjects investigation);and for a subgroup, compared to their pre-COVID-19 cognitive function (longitudinal within-subjects investigation). Method(s): One hundred and twenty-one adults (57 with no known history of COVID-19;64 with confirmed COVID-19;17/64 with long COVID symptoms) were assessed online for psychological well-being and cognitive function (attention, processing speed, working memory, episodic memory and executive function). Pre-COVID-19 cognitive data were available for 56 of 121 adults (24 adults with a confirmed diagnosis of COVID-19;22 with no known history of COVID-19) through the MyCognition database. Result(s): The COVID-19 group showed reduced processing speed in both cross-sectional and longitudinal investigations, and also showed significant attentional impairment when examined crosssectionally. Five long COVID symptoms (abdominal pain, chest pain, sore eyes/conjunctivitis, sore throat and vomiting/nausea) were associated with reduced performance in multiple cognitive domains. Higher levels of depression and anxiety were also present in the COVID-19 group but these symptoms were mostly unrelated to cognitive performance. Conclusion(s): COVID-19 survivors, especially those with long COVID symptoms, are very likely to experience cognitive disruption. Measures need to be implemented to support their cognitive recovery in addition to the physical recovery.

14.
Journal of the American Society of Nephrology ; 33:618, 2022.
Article in English | EMBASE | ID: covidwho-2124835

ABSTRACT

Introduction: The systemic vasculitides are classified based on the size of the vessels involved and ANCA vasculitis is the most common to involve the small vessels of the kidney. Granulomatous tubulointerstitial nephritis (TIN) without glomerular involvement has been described in ANCA vasculitis but is not commonly reported with medium vessel vasculitis. We present a case of necrotizing granulomatous TIN associated with systemic polyarteritis nodosa (PAN). Case Description: A 71-year-old female was admitted with a two-day history of purpuric lower extremity rash, abdominal pain, and AKI (serum creatinine 1.8 mg/dL from baseline 0.6 mg/dL). There was initially concern for IgA vasculitis and prednisone was started. A skin biopsy revealed leukocytoclastic vasculitis but negative IF. A kidney biopsy was notable for necrotizing granulomatous TIN but otherwise unremarkable appearance of the glomeruli. As her AKI and overall clinical status worsened, she was started on HD. Due to worsening liver function, a liver biopsy was done showing neutrophilic inflammation but no granulomas. Rheumatologic workup notable only for ANA 1:360 (normal complements, negative ANCA, MPO, PR3, RF, cryoglobulins). Infectious workup (TB, fungal, and parasitic) was unremarkable. There was neither NSAID nor antibiotic exposure prior to the kidney biopsy. Only home medication was losartan. She received dose 2 of Moderna COVID-19 vaccination 4 weeks prior. Her kidney function improved and dialysis was stopped, however, she developed a new foot drop. A sural nerve biopsy showed necrotizing vasculitis of a medium sized vessel. The clinical picture was felt to be most consistent with PAN. Her steroid dose was increased and she started Cytoxan per CYCLOPS protocol with subsequent clinical improvement. Discussion(s): There are few prior reports of isolated TIN associated with PAN and there are often confounding exposures that can potentially explain AIN. In the present case, the early histologic diagnosis of TIN in the absence of known exposures suggests the TIN is likely associated with, and potentially secondary to, the concurrent vasculitic process. Clinically, her presentation may represent a small and medium vessel vasculitis overlap syndrome as her pathology was not entirely consistent with an ANCA-negative pauci-immune vasculitis nor PAN. Alternatively, the TIN may simply be a response to the systemic inflammatory condition.

15.
Journal of the American Society of Nephrology ; 33:336, 2022.
Article in English | EMBASE | ID: covidwho-2124792

ABSTRACT

Introduction: To prevent the spread of the COVID-19 pandemic, vaccinations have been authorized for emergency use and implemented worldwide. As with the others, COVID-19 vaccines are known to cause mild and transient side effects such as fever, myalgia, and fatigue, but severe and consistent adverse events have rarely been reported. We present a case of de novo glomerulonephritis after injection of COVID-19 mRNA vaccine, BNT162b2 (BioNTech, Pfizer, NY, USA). Case Description: A 48-year-old man with no past medical history was referred for suddenly and persistently worsening renal insufficiency for only a month and a half after the second dose injection of the vaccine. He presented with arthralgia and skin rash a week after the vaccination. Abdominal pain and diarrhea started two weeks later, and he was admitted to the hospital for enteritis treatment. Upon colonoscopy, multiple ulceration and petechiae suggestive of vasculitis were observed in the terminal ileum. While taking prednisolone for a few weeks the gastrointestinal symptoms improved, but the renal function continues to deteriorate. A kidney biopsy was performed for the rapid decline in renal function accompanying nephrotic-range proteinuria (urine protein to creatinine ratio 3389mg/gCr), and anti-neutrophil cytoplasmic autoantibody (ANCA)-negative pauci-immune crescentic glomerulonephritis was diagnosed. He started treatment with high-dose steroid pulse therapy and oral cyclophosphamide, and then gradually took steroid tapering, showing improvement in proteinuria and renal function over several weeks. Discussion(s): To date, several cases of glomerulonephritis suspected to be related to the COVID-19 vaccine have been reported. This is the first case report of ANCAnegative pauci-immune crescentic glomerulonephritis with extrarenal involvement after COVID-19 mRNA vaccine injection. It is difficult to find definite evidence to suspect or prove the causal relationship, except when there is a temporal association after vaccination or when the disease manifestations are unusual compared to well-known pathologic findings. Further in-depth studies are needed for de novo glomerulonephritis that occurs after vaccination and COVID-19 infection.

16.
Journal of the American Society of Nephrology ; 33:885, 2022.
Article in English | EMBASE | ID: covidwho-2124744

ABSTRACT

Introduction: Development of vaccines against SARS-COV-2 has resulted in considerable reduction in severe complications and mortality. Several cases of glomerular disease have been recently reported such as Minimal Change disease and Focal Segmental Glomerulosclerosis. We describe a patient with autosomal dominant polycystic kidney disease (ADPKD) who developed nephrotic syndrome, soon after receiving COVID-19 vaccine. Case Description: 40-year-old male with history of chronic kidney disease stage-3 due to ADPKD diagnosed 20 years ago. Baseline serum creatinine 2 - 2.5 mg/dl and minimal proteinuria. Other comorbidities include well-controlled type 2 diabetes mellitus and hypertension. Received two doses of Covid-19 vaccine on February 25 and March 24, 2021. He had malaise, myalgia, and fatigue after vaccination. On April 2021, was noted to have 3+ protein on dipstick, no quantification done. In May of 2021 patient presented to hospital with heart failure and ejection fraction of 39% in association with acute coronary syndrome due to ST elevation myocardial infarction, underwent placement of a drug-eluting stent and placement on dual antiplatelet therapy (DAPT). He had 3+ protein on dipstick. In June 2021 developed abdominal pain with hematuria which was attributed to cyst-hemorrhage, underwent decortication of left renal cyst. However, the patient continued having gross hematuria requiring multiple blood transfusions and cessation of DAPT. Patient was admitted to UTSW in September 2021 and was noted to have nephrotic syndrome with proteinuria of 3925 mg, low serum albumin of 2.0 g/ dL and pedal edema concerning for podocytopathy associated with COVID-19 vaccine. Kidney biopsy was deferred due to active bleeding. Patient was empirically started on Prednisone 60mg with rapid taper. At discharge 12 days later, proteinuria was down to 0.6 g/g of creatinine, serum albumin 3.2 g/dL and hematuria resolved. On his last follow up, proteinuria was 0.3 g/g, serum albumin 3.6 g/dL and serum creatinine 2.67 mg/dl. Discussion(s): Millions of mRNA vaccines have been administered since the developement of the COVID-19 vaccine. Proposed mechanisms when mounting a response to the vaccine are toll-like receptors promoting podocyte damage in the glomeuruli. These glomerulpathies once noted have been treated with immunosupression and there has been remission reported.

17.
Journal of the American Society of Nephrology ; 33:740-741, 2022.
Article in English | EMBASE | ID: covidwho-2124505

ABSTRACT

Introduction: Although rare, it is important to consider colon necrosis, ulceration, and perforation in the management of patients with abdominal pain following kayexalate administration. We present a critically ill patient requiring partial hemicolectomy following kayexalate for hyperkalemia. Case Description: A 43-year-old male presented to the ER via EMS after being intubated emergently in the field. Was found to be COVID-19 positive and admitted to the ICU. Creatinine and potassium started trending up after day 5, requiring multiple doses of calcium gluconate, insulin, and dextrose, along with 4 doses of kayexalate 30 g over the second week. On the 10th day, he started spiking fever, having abdominal distension, and continued desaturating. Abdominal x-ray showed a large amount of free intraperitoneal air warranting emergent ex lap with partial right hemicolectomy and end ileostomy. Unfortunately, he was pronounced dead after a lengthy hospital stay of 55 days. The specimen showed perforation, mucosal necrosis, and acute serositis. It also showed Amphophilic crystals suggesting a diagnosis of kayexalate-induced colon ischemia and necrosis. Discussion(s): Kayexalate was approved by the FDA in 1958 and has been used to treat hyperkalemia. It can bind intraluminal calcium, leading to bowel obstruction or perforation, with a reported incidence of 0.14-1.8%. The identification of rhomboid or triangular, basophilic crystals with a mosaic pattern on H&E stain is pathognomonic for the presence of kayexalate. We present this case as a reminder of the rare yet devastating complications of kayexalate. For that reason, clinical suspicion should be raised in patients with abdominal pain following kayexalate. Kayexalate should only be used in patients who have life-threatening hyperkalemia where dialysis or newer cation exchangers (ie, patiromer or Lokelma) are not available, and other therapies to remove potassium have failed or are not possible. (Figure Presented).

18.
ANZ J Surg ; 2022 Nov 21.
Article in English | MEDLINE | ID: covidwho-2136649

ABSTRACT

BACKGROUNDS: Abdominal pain is one of the most common symptoms of multisystem inflammatory syndrome in children (MIS-C). Abdominal pain can vary from mild to severe and may present as acute abdomen. Severe abdominal pain in patients with MIS-C should be differentiated from surgical causes of acute abdomen to prevent unnecessary surgery. METHODS: The diagnosis of MIS-C was based on WHO and CDC recommended criteria. Records of children treated for MIS-C between September 2020 and January 2021 were reviewed retrospectively. RESULTS: In a short time, we encountered seven patients who were diagnosed with MIS-C and showed acute abdomen findings. There were four male and three female patients. The median age was 9 years. Fever, abdominal pain and distension were present in all. The median duration of symptoms was 4 days. Five patients had general abdominal tenderness mimicking acute abdomen. Three patients had right lower quadrant tenderness mimicking acute appendicitis. After the initiation of immunomodulatory therapy and antibiotics, the physical examination findings were improved step by step in all. The median time to initiate oral feeding was 2 days. The median length of hospitalization time was 8 days. CONCLUSION: Serial abdominal examinations performed by the same surgeon enabled us to follow these patients conservatively and thus avoid unnecessary surgical intervention.

19.
Clin Case Rep ; 10(11): e6628, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2127625

ABSTRACT

The case report describes a post-COVID-19 patient with severe right upper quadrant (RUQ) pain, moderate epigastric pain, high troponin levels, and nonspecific ST-segment and T-wave changes on electrocardiogram (ECG).

20.
British Journal of Surgery ; 109(Supplement 5):v82, 2022.
Article in English | EMBASE | ID: covidwho-2134957

ABSTRACT

Aim: Efficient analgesia administration is paramount to delivering good patient care and is an important factor in The safe assessment of patients. The aim of this audit was to assess analgesia prescribing and administration in The local Surgical Assessment Unit (SAU) and compare it with The standard of care set out by The Royal College of Emergency Medicine guidelines. Method(s): A retrospective audit was performed. Paper and electronic notes, including electronic prescribing data via HEpMA and pain scores were analysed for all patients referred with abdominal pain to SAU by Gp's between The 21st of October and The 30th of October 2021. Data was compared with The RCEM best practice guidelines. Result(s): A total of 33 patients were included. 39% of patients had a documented first pain score within 15 minutes of arrival, with a median time of 20 minutes. of all patients presenting with moderate to severe pain, none received analgesia within 20 minutes. Earliest analgesia administration for this group was 1 hour 42 minutes. Overall median time to first analgesia prescription was 2 hours and 4 minutes and median time to administration was 4 hours and 8 minutes. Conclusion(s): Since The COVID pandemic, NHS hospital staff-and bed shortages have put increased pressure on The delivery of safe patient care. This audit has found significant delays in both prescribing and administering analgesia for patients presenting to SAU. An electronic prescribing protocol was developed to increase efficiency in prescribing and another audit will be conducted to assess impact.

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