ABSTRACT
Streptococcus intermedius is a beta-hemolytic, non-motile, catalase-negative, gram-positive member of the Streptococcus anginosus group. When compared to other members of this group like S. anginosus and Streptococcus constellatus, S. intermedius infections are more substantial. In this case, we present a 47-year-old male patient who was found to have S. intermedius abscesses in his lungs, liver, and brain. The treatment of choice for these abscesses is a combination of drainage, surgery, and antibiotic therapy.
ABSTRACT
Solitary fibrous tumors (SFTs) are a rare group of spindle cell neoplasm of submesothelial origin with malignant potential and can present as hypoglycemia secondary to excess secretion of insulin-like growth factor II (IGF-II) from the tumor. Early diagnosis and treatment are very important in such cases to prevent hypoxic injury to the brain secondary to hypoglycemia. Here, we are presenting a case of a 45-year-old male patient, who presented with recurrent episodes of hypoglycemia spells, and later on, it was diagnosed that hypoglycemic spells were secondary to fibroma.
ABSTRACT
Various studies have suggested the possible cardiovascular (CV) protective effects of the pneumococcal vaccine (PV). Therefore, we conducted a meta-analysis to assess the association between recipients of PV with mortality and CV outcomes among patients with and without established cardiovascular disease. We performed a systematic literature search in PubMed, Embase, and Scopus for studies evaluating the effect of PV on mortality and CV outcomes. A total of 15 studies with 347,444 patients were included in the meta-analysis: 111,784 patients received PV (32%) and 235,660 patients were in the unvaccinated group (68%). Recipients of PV were associated with decreased all-cause mortality (HR, 0.76 (95% CI: 0.66 to 0.87), p < 0.001). PV was associated with a decrease in the incidence of myocardial infarction (MI) (HR, 0.73 (95% CI: 0.56−0.96), p = 0.02), without significant reduction in CV mortality (HR, 0.87 (95% CI: 0.72−1.07), p = 0.18) and stroke (HR, 1.01 (95% CI: 0.93−1.10), p = 0.82). Our study found PV was associated with decreased risk of all-cause mortality and MI. Future RCTs will be necessary to confirm benefits associated with receipt of PV.
ABSTRACT
BACKGROUND: Cannabis use has been steadily rising in the United States and can have multiple adverse effects, including cannabis-induced acute pancreatitis. This study aims to collate and highlight the significant demographics, clinical presentation, and outcomes in patients with cannabis-induced acute pancreatitis. METHOD: A systematic literature search of electronic databases for peer-reviewed articles was conducted. After an initial search, we found 792 articles through different electronic databases. After manually removing duplicates and articles that did not meet the criteria, 25 articles were included in our review. RESULTS: A total of 45 patients were studied, 35 (78%) cases were male and 10 (22%) cases were female, showing male predominance. The mean age of all participants was 29.2 ± 10.3 years. The most common presenting symptoms were abdominal pain 21 of 21 (100%), nausea 17 of 21 (81%), and vomiting 12 of 20 (60%). Ultrasound was normal in the majority of patients, with findings of mild pancreatitis. Computerized tomography scans revealed pancreatic edema and inflammation in 7 of 20 (35%) patients, and findings of necrotizing pancreatitis and complex fluid collection were visualized in 3 of 20 (15%) patients. Dilatation of intrahepatic or extrahepatic biliary ducts was not seen in any patients. The overall prognosis was good, with reported full recovery. CONCLUSIONS: Cannabis should be included in the differential diagnosis for the etiology of acute pancreatitis, which would help in early intervention and treatment for the mitigation of the rapidly progressive disease.
Subject(s)
Cannabis , Hallucinogens , Pancreatitis , Acute Disease , Adolescent , Adult , Analgesics/adverse effects , Cannabinoid Receptor Agonists , Cannabis/adverse effects , Female , Hallucinogens/adverse effects , Humans , Male , Pancreatitis/chemically induced , Young AdultABSTRACT
An increased rate of hospitalizations due to right-sided infective endocarditis is currently witnessed due to the rapid rise of IV drug use. In this case report, we aim to discuss the long-term outcome and highlight the various diagnostic approaches and management difficulties that are encountered in these cases.
ABSTRACT
Sarcoidosis is a disease with unknown aetiology and pathogenesis which affects young adults and is usually a non-necrotizing granulomatous disease seen in histology. Variants of the disease, such as necrotizing sarcoidosis, were first described by Liebow in 1973 and are rarely seen. This case report describes the case of a 60-year-old Bengali female who presented with vague symptoms and was found to have chronic granulomatous inflammation with foci of calcifications involving the lungs, liver and spleen consistent with necrotizing sarcoidosis.
ABSTRACT
We present a case report of a 2-year-old boy who presented to a local hospital to evaluate vague abdominal symptoms of one-month duration. The patient, therefore, had an open cystogastrostomy and drainage of the free abdominal fluid with minimal complications. He was monitored for several days after his surgery.
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We report an interesting case of a young man who revealed extensive spontaneous dissection of the RCA in diagnostic angiography. It was surprising that despite an extensive dissection, the patient remained hemodynamically stable on medical management throughout the procedure and during the post-procedure hospital stay.
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Basal cell carcinoma (BCC) is the most common cutaneous malignancy in the world, and the incidence of pulmonary metastasis is exceedingly rare. We present a case of middle-aged male with findings consistent with BCC with metastasis to the lungs managed with surgical resection and the use of targeted therapy using the hedgehog pathway inhibitor with improvement.
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A 30-year-old woman presented with low-grade dyspnea on exertion. Chest X-ray demonstrated enlarged cardiac silhouette but was insufficient to delineate the cause. Echocardiogram revealed the cause to be the giant left atrium from mitral stenosis.
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Reduction mammoplasty with free nipple graft can be a good choice for early pubertal patients requiring massive reduction given its low recurrence and greater patient satisfaction.
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ß-thalassemia heterozygosity can cause significant iron overload when accompanied by HFE gene mutations and inappropriate iron supplementation.
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Rare disease like primary spinal epidural diffuse large B-cell lymphoma should be considered as a differential diagnosis in patients presenting with back pain and rapid neurological deterioration in the lower extremities.
ABSTRACT
BACKGROUND: Medical students and residents were found to have suffered from depression, anxiety, and burnout in various studies. However, these entities have not been adequately explored in the context of Nepal. We proposed to determine the prevalence of depression, anxiety, burnout, their associated factors, and identify their predictors in a sample of medical students and residents in a Nepalese medical school. METHODS: It was a cross-sectional study with 651 medical students and residents chosen at random between December 2018 and February 2019. The validated Nepali version of Hospital Anxiety and Depression Scale, the Copenhagen Burnout Inventory, and Medical Students' Stressor Questionnaire were used to assess depression, anxiety, burnout, and stressors respectively. We used univariate and multivariable logistic regression analyses to identify the correlation of predictor variables with depression, anxiety, and burnout. RESULTS: The overall prevalence of burnout (48.8%; 95% CI 44.9-52.7) and anxiety (45.3%; 95% CI 41.4-49.2) was more than that of depression (31%; 95% CI 27.5-34.7). Burnout and depression were more prevalent in residents than in medical students (burnout: 64.5% vs 37.6%, P-value < 0.0001; depression: 33.7% vs 29.1%, P-value 0.21). Whereas, medical students were found more anxious than residents (46.3% versus 43.96%, P-value 0.55). Academic related stressors caused high-grade stress to participants. Multivariable model for depression significantly showed anxiety, personal burnout, and work-related burnout as risk enhancing correlates; satisfaction with academic performance as a protective correlate. Similarly, the multivariate model for anxiety significantly identified female gender, depression, personal burnout, teaching and learning related stressors, and past history of mental illness as risk enhancing correlates; being satisfied with academic performance, getting adequate sleep, and being a second-year resident as protective correlates. The logistic model for burnout significantly showed being a first-year resident, depression, anxiety, and drive and desire related stressors as positive predictors. None of the variables were identified as significant negative predictors of burnout. CONCLUSIONS: A high prevalence of depression, anxiety, and burnout was seen among medical students and residents. Most of them were stressed with academic-related factors. A strong correlation between teaching and learning-related stressors with depression and anxiety may be a call for an efficient and more student-friendly curriculum.
