A Case of Perforating Folliculitis in a Peritoneal Dialysis Patient.

Case Presentation: A 30-year-old male with a past medical history of hypertension and renal failure on peritoneal dialysis presented to the emergency department with a chief complaint of a rash on his anterior trunk for the prior three weeks. Dermatological examination revealed multiple, discrete folliculocentric, erythematous, and hyperpigmented papules, with scattered adjacent angulated erosions. Discussion: Perforating folliculitis is a rare and often difficult to diagnose skin condition classically seen in patients with chronic renal disease or underlying immunodeficiency.

How Chicago's Past Resulted in Disproportionate Lead Poisoning of Minority Children of the Present: A Narrative Review.

Chicago's lead problem has been shown to disproportionately affect populations of color and lower socioeconomic status (SES). The disproportionate effects on low-income areas and communities of color can be traced back to several key decisions in Chicago's history. A search of the National Library of Medicine's MEDLINE/PubMed as well as Google, and Google Scholar was performed to find all articles relating to lead poisoning in Chicago, lead utilization, Chicago's municipal and political history, and lead physiology between May 2020 and May 2023. Additionally, several studies and textbooks were reviewed regarding the latest advancements in lead poisoning. The study identified several key political moves over the course of Chicago's history that have resulted in disproportionate toxicity in minority populations and those of lower SES. Lead is more readily absorbed in the pediatric population. Additionally, prior regulations had published acceptable blood lead levels (BLLs) in children, but more recent evidence indicates a myriad of detrimental effects in BLLs below that cutoff. There is substantial evidence to suggest that there is no acceptable BLL. Lead toxicity is generally improving nationally but there still exists a considerable need for improvement. Programs should be expanded to ensure that individuals living in communities most at risk of lead exposure have the means to both, replace lead-contaminated infrastructure, and to be able to supply these communities with affordable housing. From a physician and clinician standpoint, knowing the increased risk of lead poisoning in these populations should prompt earlier testing.

An Unusual Presentation of Severe Ciguatera Poisoning: Case Report.

BACKGROUND Ciguatera poisoning is presently estimated to afflict approximately 16 000 people in the United States each year. Ciguatera toxicity is due to the ingestion of warm-water reef fish that are known to consume dinoflagellates that contain ciguatoxins (CTXs). Historically, the diagnosis of ciguatera poisoning is confirmed in the emergency department when this ingestion is followed by manifestations of neurologic and gastrointestinal organ symptoms. Some individuals also manifest cardiac symptoms. These symptoms can vary within each organ system in type and duration. CASE REPORT In this report, 2 patients (husband and wife) are presented that consumed the same barracuda, resulting in severe ciguatera poisoning diagnosed in the emergency department. One had the complete triad of symptoms of gastrointestinal (GI), neurologic, and cardiac involvement. The other patient lacked neurological symptoms but did experience severe gastrointestinal and cardiac symptoms. It was assumed by the inpatient team, the consulted infectious disease specialist, and, initially, the in-house toxicologist that the lack of neurologic symptoms excluded the diagnosis of ciguatera. CONCLUSIONS If these patients had presented separately, only the former would have been considered to have ciguatera poisoning. These 2 cases demonstrate the misunderstanding among healthcare practitioners of the literature on the diagnostic criteria. Therefore, this article aims to analyze ciguatera diagnosis in the emergency department, which will ultimately guide prognostics and management, particularly for severe cardiac symptoms.

Pediatric headache patient with cerebral abscesses: a brief review of the literature and case report.

BACKGROUND: Pediatric headache is a common cause of pediatric emergency department (ED) visits, and 8.8% of cases require imaging. Alarmingly, 12.5% of imaged cases have a pathologic cause. A pediatric patient with a complicated medical history presented to the pediatric ED with multiple cerebral abscesses. The possible causes and contributors to this rare cause of pediatric headache and a review of pediatric headache emergency management are presented.Case Presentation: A 12-year-old male patient with a complex medical and surgical history, including post-repair pulmonary valve stenosis, visited the pediatric ED for intractable and worsening left frontoparietal headache, refractory to ibuprofen, for 6 days. A physical examination revealed severe photophobia and restlessness secondary to severe head pain. Non-contrast brain computed tomography demonstrated two round, bilateral, parietal hypodense lesions with surrounding vasogenic edema. The lesions were consistent with abscesses on magnetic resonance imaging. Eventually, the patient underwent successful surgical abscess drainage and made a full recovery. The patient was lost to follow-up; therefore, no causative bacterial species was determined. CONCLUSION: Managing pediatric headache in emergency settings requires a robust history and physical examination. Cerebral abscesses are an infrequent but fatal cause of pediatric headache and therefore should be considered among the differential diagnoses.

Emergency department management of pediatric blunt thoracic injuries.

Pediatric chest trauma can present with a wide array of symptoms and with varying rates of morbidity and mortality. Children have unique thoracic anatomical and physiological characteristics, often necessitating diagnostic and management considerations that differ from management of blunt chest injury in adults. This review discusses diagnostic and treatment modalities for commonly encountered injuries in pediatric blunt thoracic trauma, such as pulmonary contusions, rib fractures, pneumothoraces, and hemothoraces. Rarely encountered but high-mortality injuries, including blunt cardiac injury, commotio cordis, tracheobronchial injury, and aortic injury, are also discussed.

A Patient With Foot Pain Found to Have Leriche Syndrome: A Case Report and Brief Review of the Literature.

Leriche syndrome, a rare and critical complication of peripheral arterial disease (PAD), affects the distal abdominal aorta (infrarenal) and, similar to PAD, is a result of plaque buildup in the arterial lumen. The Leriche syndrome triad includes claudication in the proximal lower extremity, decreased or absent femoral pulses, and, in some cases, impotence. This article presents a patient with an atypical presentation of foot pain who was subsequently found to have Leriche syndrome. The patient was a 59-year-old female, a former smoker, who presented to the emergency department (ED) with atraumatic, acute right foot pain. All right lower extremity pulses were faintly audible on bedside Doppler. Computed tomography with angiography of the abdominal aorta revealed a Leriche-type occlusion of the infrarenal abdominal aorta and left common iliac and a 10 cm right popliteal arterial occlusion. Pharmacological anticoagulation was initiated by the ED. Definitive treatment in this patient included catheter-directed tissue plasminogen activator lysis to the thrombus on the right and placement of kissing stents in the distal aorta without complication. The patient made an excellent recovery and had a complete resolution of her symptoms. PAD is an omnipresent condition and, when untreated, can result in a myriad of high mortality and morbidity conditions such as Leriche syndrome. Collateral vessel formation can make the symptoms of Leriche syndrome vague and inconsistent, often making early recognition difficult. Optimal outcomes hinge on the clinician's ability to efficiently recognize, diagnose, stabilize, and coordinate multidisciplinary involvement of vascular and interventional radiology specialties. Case reports such as this one help to illuminate some of the more infrequent presentations of Leriche syndrome.

A Review of CPR Augmentation Devices.

The study aims to assess cardiopulmonary resuscitation (CPR) outcomes in cardiac arrest patients when using CPR augmentation devices, such as the ZOLL ResQCPR system (Chelmsford, MA) or its components ResQPUMP and ResQPOD, which are manual active compression-decompression (ACD) device and impedance threshold device (ITD), respectively. The analysis included a Google Scholar-based literature review that took place between January 2015 and March 2023 and included recent publications with PubMed IDs or widely cited articles to assess the effectiveness of the ResQPUMP and ResQPOD or similar devices. This review also includes studies quoted by ZOLL, but those were not considered in our conclusion since the authors were employed by ZOLL. We found that in a study on human cadavers, the force of decompression increased the chest compliance of the chest wall by 30%-50% (p<0.05). Essentially, active compression-decompression improved the return of spontaneous circulation (ROSC) with meaningful neurologic outcomes by 50% in a blinded, randomized, and controlled human trial (n=1,653; p<0.02). The main study on the ResQPOD had a controversial human data pool with one randomized and controlled study arguing for no significant difference with or without the device (n=8,718; p=0.71). However, a post hoc analysis and the reorganization of the data by CPR quality demonstrated significance (n decreased to 2,799, reported in odds ratio without specific p-values). In conclusion to the limited number of studies presented, any manual ACD device is a great alternative to standard cardiopulmonary resuscitation regarding survivability with good neurologic function and should be utilized in prehospital emergency medical services and hospital emergency departments. ITDs are still controversial but promising with more future data.