LentiGlobin Administration to Sickle Cell Disease Patients: Effect on Serum Markers and Vaso-Occlusive Crisis.

LentiGlobin, an innovative gene therapy, introduces a modified beta-globin gene that yields an anti-sickling hemoglobin variant. It boosts total hemoglobin levels, mitigates hemolysis, curtails inflammation, and addresses iron overload by reducing transfusion requirements. These changes, in turn, provide insights into disease mechanisms and treatment outcomes. Alterations in serum markers, such as hemoglobin levels and inflammatory biomarkers, can illuminate the therapeutic effectiveness of LentiGlobin and its impact on mitigating complications such as vaso-occlusive crises. Therefore, the purpose of this narrative review is to discuss the effects of LentiGlobin administration on diverse serum biomarkers and its correlation with vaso-occlusive crises in individuals with sickle cell disease (SCD).

Postpartum Ovarian Vein Thrombosis: Case Report.

INTRODUCTION: Postpartum ovarian vein thrombosis (POVT) is an uncommon diagnosis that may lead to morbidity or mortality if unrecognized. CASE REPORT: This report discusses a single case of POVT in a community hospital, along with the treatment and clinical course. CONCLUSION: The mechanism is believed to be right-sided clot formation provoked by anatomical and hormonal changes of gestation. Diagnosis is challenging as most patients are previously healthy and symptoms are often vague. Although the differential is broad, modern imaging is sensitive and specific for diagnosis. Prompt treatment with broad-spectrum antibiotics and anticoagulation may reduce morbidity, and prognosis following treatment is excellent.

Case of Orbital Compartment Syndrome Post Cardiac Arrest.

Orbital compartment syndrome (OCS) is a rare ophthalmic surgical emergency in the setting of increased intraocular pressure (IOP) Irreversible vision loss can occur without immediate surgical treatment consisting of lateral cantholysis. We present a case of acute OCS discovered after cardiopulmonary resuscitation (CPR) with subsequent immediate lateral canthotomy and notable decrease in IOP. This in part demonstrates the importance of recognizing the clinical signs of OCS with or without trauma in the emergency department in addition with preparedness to perform a vision-saving procedure. Diagnosis is clinical and early recognition is essential. Index of suspicion for OCS in cardiac arrest without signs or history of trauma would typically be low, however, given the case presented, it was important for it to be excluded once the return of spontaneous circulation (ROSC) was achieved.

Acute Myeloid Leukemia Complicated by Hyperleukocytosis and Leukostasis in the Emergency Department.

Acute myeloid leukemia (AML) and other hematologic malignancies can be complicated by hyperleukocytosis, which leads to an increased risk for other severe complications such as tumor lysis syndrome, disseminated intravascular coagulation (DIC), and leukostasis. In this report, we present a case of a 65-year-old female with newly diagnosed AML complicated by leukostasis. We briefly review the clinical significance as well as initial diagnostic and therapeutic considerations pertaining to hyperleukocytosis and its associated complications.

The Diagnostic Challenge of the Pediatric Brain Abscess.

Pediatric brain abscess (PBA) is a rare condition that portends a high mortality rate if not recognized and treated early. The spectrum of clinical manifestations of this disease process is wide and can often be vague, making it difficult for timely diagnosis in the emergency department. We detail the presentation of a four-year-old male with autism and a four-day history of decreased activity after a fall with a critical and rapidly worsening clinical course. Subsequent operative intervention revealed a diagnosis of PBA. This case highlights the clinical challenges of diagnosing altered mental status in a developmentally challenged pediatric patient.

Bedside Ocular Ultrasound Diagnosis of a Traumatic Lens Dislocation.

Rapid identification of ophthalmologic emergencies can be challenging in the ED, and a missed or delayed diagnosis may have vision-threatening consequences. The application of ocular point-of-care ultrasound (POCUS) by the emergency physician (EP) can facilitate the timely recognition of a myriad of emergent eye conditions. This report describes a case in which EP-performed POCUS established the prompt diagnosis of a traumatic lens dislocation in a patient with chronic vision changes.

Recognizing Belhassen Ventricular Tachycardia and Preventing Its Misinterpretation as Supraventricular Tachycardia: An Unusual Case Report.

Belhassen ventricular tachycardia (BVT), also known as verapamil-sensitive ventricular tachycardia, is an infrequent finding that can be fatal unless recognized early and treated in a prompt manner. Most patients have insignificant presentation suggestive of the disease, but on electrocardiography (EKG), BVT is characterized by a complete right branch block (RBB) and a right axis deviation (RAD). In this case report, we describe an unusual case of a 35-year-old male patient who presented to the emergency department (ED) complaining of acute palpitations of two-hour duration; subsequent diagnostic testing revealed BVT in the patient.

Acute Appendicitis: Clinical Clues and Conundrums Related to the Greatest Misses.

Introduction In the United States (US), appendicitis is the most common acute abdominal emergency requiring surgery. Patients with appendicitis continue to display a complex and atypical range of clinical manifestations, providing a subsequent high risk for emergency physicians to miss acute abdominal pathology on a patient's initial visits. Due to the risk of potential perforation, the proper and timely clinical identification of acute appendicitis is vital. The current study aims to identify clinical characteristics that could be useful in identifying patients at risk for having acute appendicitis that was misdiagnosed on their initial visits. Methods Medical charts consisting of patients between the ages of 19 and 55 years on their second visit were flagged and reviewed by the emergency department quality assurance (EDQA) committee. The retrospective chart review included patients who presented to the emergency department (ED) with the chief complaint of an abdominal-related complaint, were discharged, returned within 72 hours, and were diagnosed with a pathologically confirmed appendicitis. All patients were managed operatively, with pathology results reviewed for evidence of acute appendicitis. Those with confirmed pathologic appendicitis upon return were considered to have a "misdiagnosis." Any patients managed nonoperatively and those with negative pathology were excluded from the study and considered not to have appendicitis. Results Fifty-five patients were identified through the EDQA committee from May 2011 to January 2014. After exclusion criteria were applied, 18 patients met the inclusion criteria for this study (7 males, 11 females). The mean age was 36.2 (range: 19-55). The most common presenting complaint on the initial visit was pain in the epigastric region of the abdomen (50%, n = 9). Twenty-two percent (n = 4) of patients had pain in the right lower quadrant documented in the physician's note on the initial visit and 83% (n = 15) had right lower quadrant pain documented on the second visit. Two patients (11%) did not have right lower quadrant tenderness on either visit. The most common discharge diagnosis on the initial visit was undifferentiated abdominal pain (50%), followed by gastritis (28%). Opioid pain medication was administered or prescribed to 39% (n = 7) of the patients. The average return time was 23.9 hours. Conclusion The administration of opioid pain medication is associated with many of the return visits to the emergency department for missed appendicitis. Finally, discharge diagnosis and planning are imperative, as detailed early appendicitis instructions or extended ED observation can include more cases and decrease litigation risk.