Small Bowel Obstruction: A Rare Presentation of the Inferior Pancreaticoduodenal Artery Pseudoaneurysm Bleed.

Intra-abdominal and intramural hematomas are well-known complications of pseudoaneurysms. We present a case of small bowel obstruction as a result of external mechanical compression from hematoma. Bleeding was localized to the pseudoaneurysm of the gastroduodenal artery and inferior pancreaticoduodenal artery. Angiography was used to control the bleeding with coil embolization. This rare clinical manifestation represents just one of the symptoms associated with pseudoaneurysms of the gastrointestinal tract. Therapeutic options are discussed along with a review of the literature.

A Case of Anti-glomerular Basement Disease Without Pulmonary Involvement.

Anti-glomerular basement membrane disease is a rare but classic example of an antibody-mediated disease. The scale of injury that it entails depends on the site where the antibodies are deposited, with some patients presenting with a composite of pulmonary and renal damage. In other scenarios, the renal system is the main site of affliction with patients deteriorating to a status of acute renal failure within days of diagnosis. Due to the paucity of its incidence, we present our findings of anti-glomerular basement disease with pulmonary sparing. Herein, we also review the array of different physical findings, different forms of perpetrating antibodies, the diagnostic tools at our disposal, and the treatment modalities utilized to prevent catastrophic tissue injuries.

Challenges in managing graft-versus-host disease in developing countries: a perspective.

Hematopoietic cell transplant (HCT) activity is increasing worldwide due to safer techniques, widening indications, and more availability of donors. New HCT centers have recently been established in many developing countries including Asian and African countries. Due to limited resources, logistic, political, and social issues in developing countries, the treatment of orphan diseases like graft-versus-host disease (GVHD) can be challenging. We intended to delineate the current issues that institutions and clinicians face in managing GVHD. We conducted a comprehensive systematic electronic review of peer-reviewed published articles on GVHD management in developing countries. We used PubMed, Cochrane, and Embase databases as our primary source of data. Studies that were included described the treatments for both acute and chronic GVHD. Consensus on the use of high-dose methyl-prednisone and prednisolone as the initial therapy was widely accepted and used in practice. Socio-economic factors were found to be the major factor involved in GVHD management in lower income patients. Delayed diagnosis and treatment, lack of availability of healthcare professionals, lack of knowledge among cancer patients, and poverty are major concerns in the developing world. For optimal management, HCT programs should develop systems in place for long-term follow-up of HCT survivors and have a low threshold to initiate treatments for GVHD early. Awareness and health policy programs must be initiated at the grass-root level for long-term management of these survivors in developing countries.

The Dilemma of Inadvertent Pontine Demyelinosis: A Review of Literature.

Osmotic demyelination syndrome is classically associated with a swift adjustment of previously low serum sodium levels which lead to cellular dehydration and subsequent neurological insult. We also review the epidemiology, different postulations to explain the underlying pathophysiology, current diagnostic modalities, subsequent therapeutic interventions used to manage this phenomenon, and the resultant prognosis of this ailment.

Well-being Assessment of Medical Professionals in Progressive Levels of Training: Derived from the WHO-5 Well-being Index.

The provision of quality health care is of utmost importance for a physician. Over the years, there has been much debate regarding work-life imbalance and physician burnout, which may, in turn, have adverse effects on the quality of care. Medical school students, residents, interview candidates for residency, and internal medicine faculty are all under a varying degree of stress, which may impact their personal and professional lives. We distributed questionnaires to investigate our hypothesis: Progression in training years leads to a decline in well-being. The main objective of our assessment was to help devise interventions to improve the quality of training and the productivity of internal medicine physicians. Understanding the emotional functioning of physicians will help us improve the learning environment and, in turn, have a positive impact in the future for medical professionals. Medical students are burdened with excessive loans for undergraduate and graduate studies, which contributes to higher rates of burnout, depression, and suicide among medical professionals, which can lead to a direct and negative impact on quality of care. Our study showed that well-being scores declined with increasing financial stress; they were also affected by the visa status and training background of our subjects as medical students.

Early Screening Strategies for Diabetes Mellitus by Leveraging Dental Visits Using Optimal Screening Tools Available Onsite.

Diabetes mellitus (DM) continues to be a major health concern in the Western hemisphere, and the management of type 2 DM (T2DM) is an ongoing challenge for the American healthcare system despite major advances in DM research. T2DM imparts a massive economic burden, and a major challenge in managing T2DM continues to be timely screening. Adults are more likely to visit a dentist than a primary care physician. This study was designed to compare current screening standards recommended by the American Diabetes Association with the use of gingival-crevicular blood and its compatibility with traditional methods using a fingerstick. Patients routinely presenting to the dental clinic were offered participation in the trial and, after informed consent, checked for blood glucose levels using the fingerstick method as a control. The control values were compared to the results of the gingival-crevicular blood glucose test obtained during the dental procedure from the same patient (i.e., patients were their own controls). A total of 226 study participants were included. Of these, 127 (56.1%) participants were women, whereas 99 (43.9%) participants were men. The sample size was derived using the Slovin's equation (Power = 80%) statistical test. We used the Pearson coefficient test to measure the statistical difference between the two tests. We found no significant difference in glucose readings between the fingerstick method and the gingival methods of collection (t = -1.134, P = 0.258). A small sample was also tested for glycosylated hemoglobin (HbA1c) using the same sample collecting methods. However, due to the cost restraints involved in using HbA1c kits, a statistically significant cohort could not be collected. By incorporating this interdisciplinary approach, testing for DM during routine dental visits can be a vital resource for the early diagnosis of DM, potentially leading to significant savings in future healthcare costs.

A Unique Case of Acute Cerebral Venous Sinus Thrombosis Secondary to Primary Varicella Zoster Virus Infection.

Primary varicella zoster virus (VZV) infection, predominantly in the pediatric population, presents with pyrexia and a classic pruritic vesicular rash. In adults, although less common, it is more severe and linked to more complications. Neurological complications, which account for less than 1% of all VZV complications, include meningitis, encephalitis, arterial vasculopathy, and venous thrombosis. We present a case of a 39-year-old male who developed extensive cerebral venous sinus thrombosis following primary VZV infection. Venous thrombosis in VZV has been suggested to be caused by autoantibodies against protein S, pre-existing hypercoagulability, or endothelial damage. The patient was acutely managed using intravenous acyclovir and heparin. Long-term anticoagulation therapy with warfarin was continued after discharge. We concluded that clinicians should be aware of the rare complications of this common pathology so that a timely diagnosis can be made, followed by prompt management. Further studies need to be done to better understand acute cerebral venous sinus thrombosis secondary to VZV.