A Rare Case of Myxedema Coma Precipitated by a Single Dose of Haloperidol in a Patient With Paranoid Schizophrenia.

Myxedema coma is a rare and potentially life-threatening condition that occurs when severe hypothyroidism is untreated or inadequately managed. It is characterized by a rapid drop in mental status, hypothermia, respiratory failure, hypotension, and other symptoms of severe metabolic dysfunction. The condition primarily affects older women with a history of thyroid dysfunction but can occur in any age or gender group. A common trigger for this condition is seen with a drop in atmospheric temperatures or during the cold winter months. However, a rare, poorly documented trigger is recent antipsychotic use in severe hypothyroid states. The diagnosis of myxedema coma requires prompt recognition and treatment, as delays can result in significant morbidity and mortality which is the objective of this case report.

A Complex Presentation of Acute Postoperative Negative-Pressure Pulmonary Edema: A Case Report and Review of Literature.

Negative-pressure pulmonary edema (NPPE) is an uncommon diagnosis that requires a high clinical suspicion to recognize and manage and has high morbidity and mortality. It usually results secondary to markedly negative intrapleural pressure due to the forceful inspiration against the obstructed airway from upper airway infection, tumor, or laryngospasm. We present a case of a 27-year-old female with morbid obesity who underwent sleeve gastrectomy and developed NPPE upon emergence from anesthesia. The focus of supportive care should be on addressing the obstruction in the upper airway through either endotracheal intubation or cricothyroidotomy. Additionally, it is important to initiate lung-protective positive-pressure ventilation and promote diuresis, unless the patient is in a state of shock. The resolution of pulmonary edema is typically swift, partially due to the preservation of alveolar fluid clearance mechanisms. In the literature review, we delve into the clinical presentation, pathophysiology, and management of NPPE or post-obstructive pulmonary edema.

Third wave COVID-19 delta variant breakthrough infection in a Hispanic-dominant suburb of Miami, Florida: ethical dilemma and vaccination hesitancy.

Background and Aims: The peak of the third wave of COVID-19 infection was in the summer (August-September) of 2021, dominated by the Delta variant. Florida was the epicenter of the third wave with more than 151,449 cases in the first week of August with a positivity rate of 20%. The purpose of this study is to identify the percentage of COVID-19 infection in vaccinated patients in a minority population in south Florida and to elucidate the relationship, if any, between demographics and breakthrough infections, the rate of vaccine hesitancy, as well as the willingness to receive the monoclonal antibody REGEN-COV for the treatment of COVID-19. Methods: This cross-sectional study was performed at the Emergency Department, Larkin Community Hospital Palm Spring Campus, located in Hialeah, the fourth largest city in Florida. Hialeah is dominated (94.7%) by Hispanics and Latinos. This city represents a cross-sectional sample of US cities in general and Florida in specific. We enrolled 127 COVID-19 PCR-positive patients. Results: The infection in vaccinated patients (breakthrough) was found to be about one in three (34%). Despite the high infection rate and mounting death toll, about 73% of our unvaccinated patients answered no to the question 'knowing the consequences of being infected with COVID-19 and the fact that you are positive, would you have chosen to be vaccinated earlier?' However, about 27% of these patients agreed to receive the vaccine and 20.5% received the monoclonal antibody REGEN-COV. Conclusions: Our study revealed that vaccine hesitancy in South Florida continues to be a major challenge, especially with the emergence of mutations including Delta plus and Omicron.

Native right-sided endocarditis in intravenous drug user: A case report.

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.

Clinical Presentation of a Patient With Tuberculous Myocarditis: Case Report and Review of Literature.

Tuberculous myocarditis has a high mortality rate and is often associated with a delay in the diagnosis because of the low index of suspicion and insidious course. Most of the reported cases predominantly occur in young, immunocompetent patients. Delays in diagnosis may result in fatal complications. Through this case report, we aim to shed light on some of the clinical features of tuberculous myocarditis and promote a high index of suspicion for early diagnosis and timely management.

Usefulness of Electoral Models for COVID-19 Vaccine Distribution.

Purpose of Review: In response to the COVID-19 pandemic, there has been a remarkably accelerated development of vaccines worldwide. However, an effective distribution system is crucial for vaccination at a national level. Ecuador was one of the first Latin American countries to be most severely affected by the pandemic. It has been struggling to expand its vaccination drive and requires a strategy that provides an achievable vaccination rate and maintains its primary care services. This study aims to provide an efficient vaccination model to achieve herd immunity by utilizing the country's existing infrastructure (the centralized electoral system) for mass vaccination. Recent Findings: The national electoral data from 2017 and 2021 were used to create estimates for the proposed vaccination model. Two model variations, total personnel, needed, and the number of days needed to vaccinate 50%, 75%, and 100% of the population were considered. The numbers of vaccines needed, and vaccination sites were estimated based on the current number of registered voters and polling stations. The results from the proposed model show that 17,892,353 people can be vaccinated, at 40,093 polling stations, by 90,209 personnel if one vaccinator was available per polling station. Summary: Based on this model, even a conservative estimate shows that 12.56 days are needed to achieve herd immunity, and 16.74 days are needed to vaccinate the entire population of Ecuador. Additionally, we propose that this vaccination model can be used as a blueprint for any country to address similar catastrophes in the future. Supplementary Information: The online version contains supplementary material available at 10.1007/s40475-022-00251-y.

Lessons learnt from emergency medicine services during the COVID-19 pandemic: A case study of India and the United States.

India and the United States have both witnessed a high burden of COVID-19 infections since the pandemic was declared in early 2020. However, the COVID-19 restrictions have met with mixed responses in India and the US. Despite recommendations to continue social isolation and personal hygiene measures, India has not been able to curb the rise in daily cases. Our findings demonstrate the difference in the manner by which India and the US differ in their emergency handling of patients. We conducted a thorough review of the existing protocols and data concerning emergency responses in India and the US. The triage and care of suspected COVID-19 positive patients is different across India and the US. We find that there is a shortage of oxygenation, vaccination and other essential supplies in India. Further, the US is able to triage patients through telemedicine and EMS before suspected COVID-19 patients arrive, which is less prevalent in India. Our study identifies the importance of the emergency department (ED) as a critical contributor to the prevention and care of suspected and confirmed COVID-19 patients. Hospitals in India have been struggling to accommodate a huge influx of patients during its second wave with the ED playing a key link in their COVID-19 response.

Cerebral Venous Sinus Thrombosis in a Patient With Mild Symptoms of COVID-19 Pneumonia.

Although coronavirus disease 2019 (COVID-19) infection is mainly associated with pneumonia, several non-respiratory complications may also occur. Cerebral venous sinus thrombosis (CVST) is a rare but potentially fatal complication of COVID-19 infection. In order to increase awareness about such life-threatening complications to a large population of patients with otherwise mild COVID-19 infection, we present the clinical course of a 29-year-old unvaccinated female who developed CVST, with eight days of mild COVID-19 infection, that proved fatal despite adequate therapeutic measures. Clinicians should carefully consider the risk of thrombosis in patients who present with COVID-19 infection regardless of the intensity of the disease, including prophylaxis (to reduce the risk of hypercoagulable complications) and treatment beyond discharge. More data and research is needed to identify COVID-19 as an independent risk factor for thromboembolism so that future efforts can be aimed at appropriate management e.g. with prophylactic anticoagulants to avoid such complications. In case of unexplained neurological manifestations in patients with an active or recent COVID-19 infection, early investigations for cerebrovascular integrity should be done by using MRI and magnetic resonance angiography (MRA)/magnetic resonance venography (MRV).

Clinical Presentation of a COVID-19 Delta Variant Patient: Case Report and Literature Review.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes severe bilateral pneumonia and acute respiratory distress syndrome (ARDS) which can lead to difficulty breathing. Many cases require mechanical ventilation and intensive care unit management. The need for mechanical ventilation and ICU admission seems to be more evident in patients that were unvaccinated for COVID-19 at the time of admission. We discuss a case of a 63-year-old African-American woman who presented as a transfer to our hospital facility with acute hypoxic respiratory failure. She was already intubated and mechanically ventilated prior to her transfer. She had a one-week history of shortness of breath and cough productive of white, blood-tinged sputum. A two-day history of diarrhea was also reported before admission to the other hospital where she stayed for a week before transfer to our intensive care unit. She had no significant past medical history and was unvaccinated for COVID-19, and was suspected to be infected with the Delta strain of COVID-19. Her primary diagnosis at admission was COVID pneumonia and acute hypoxic respiratory failure. Her condition worsened over a period of one week. Chest X-Ray, at the time of arrival, showed bilateral patchy opacities consistent with COVID-19 pneumonia. After an extensive review of her labs and reports, the patient was attributed to be at a high risk for acute decompensation (or catastrophically ill), thus requiring critical care management. Over a course of 12 days, she was aggressively treated with antibiotics, steroids, remdesivir and tocilizumab. Her condition gradually deteriorated and she eventually passed away. It can be noted that most of the severe cases, especially ICU admissions, comprise people who are unvaccinated. We can safely conclude that although vaccination may not prevent re-infection, it does result in better clinical outcomes.

Hypoxic-Ischemic Encephalopathy-Induced Seizure in an 11-Year-Old Female.

Hypoxic-ischemic encephalopathy (HIE) typically manifests in the neonatal period. The degree of hypoxia following intrapartum asphyxia determines the structural changes in the brain, which can cause functional deficits in the affected child leading to developmental deficits and recurrent seizures. Management requires physical therapy, occupational therapy, and anti-seizure medications. We present a rare case of an 11-year-old female with a past medical history of epilepsy and cerebral atrophy secondary to hypoxic injury at birth. The patient presented to the hospital following a witnessed seizure and loss of consciousness for one hour. Given the past medical history and clinical findings, it was determined that a mild-to-moderate encephalopathic process resulted in a lower seizure threshold. HIE can manifest beyond the neonate years mainly due to the structural changes within the brain. Therefore, it is essential to understand aspects of HIE beyond the neonate years to manage this condition for a better patient outcome.