Toe Gangrene as the First Presenting Symptom of Essential Thrombocythemia: A Case Report.

Essential thrombocythemia is a myeloproliferative neoplasm. Thrombosis and bleeding complications are common with myeloproliferative neoplasms, particularly essential thrombocythemia and polycythemia vera. Here, we report the case of a 52-year-old female who presented initially with painful toe swelling and discoloration. Initial imaging showed a small abscess. An incision and drainage, and debridement of toe dry gangrene were performed twice in two months with no improvement in her complaint and worsening discoloration, ending in a toe amputation. Two years later, the patient was referred to a hematology clinic for a high platelet count. On review of her medical records, the patient had the same numbers during the initial presentation. The patient's condition was diagnosed retrogradely by a hematologist as essential thrombocythemia. This case sheds light on myeloproliferative neoplasm as a differential diagnosis in patients with atypical thrombosis. Thinking in such a way could have diagnosed our patient two years earlier.

Omicron-Induced Immune Thrombocytopenia: A Case Report.

Coronavirus disease 2019 is a systemic infection that significantly impacts the hematopoietic system and hemostasis. Among the hematological manifestations described, severe and symptomatic thrombocytopenia is rare. Immune thrombocytopenia (ITP), also known as idiopathic thrombocytopenic purpura or immune thrombocytopenic purpura, is an acquired thrombocytopenia caused by autoantibodies against platelet antigens. It is one of the more common causes of thrombocytopenia in otherwise asymptomatic adults. Here, we report the case of a patient who developed ITP after a severe acute respiratory syndrome coronavirus 2 infection to highlight the rarer hematological manifestations of the disease and the changes in treatment.

Rifampin-induced acute kidney injury and hemolysis: A case report and literature review of a rare condition.

Rifampicin is a bactericidal drug used in various infectious diseases, including tuberculosis (TB). Nephrotoxicity is a rare side effect of intermittent Rifampin use and even less commonly continued use. We report a case of Rifampin-induced acute tubular necrosis and hemolysis in a patient with latent TB with a relevant literature review.

Nurses' knowledge, perceived barriers, and practices regarding cancer pain management: a cross-sectional study from Palestine.

BACKGROUND: Accurate knowledge and good pain evaluation and documentation practices should be present for efficient pain management. In this study, we aimed to assess the knowledge and practices of nurses relating to the management of cancer pain in Palestine, and to determine the barriers to efficient pain control in cancer patients. METHODS: A cross-sectional survey took place at 8 hospitals across Northern West Bank. A convenience sample of 220 Nurses working in governmental and private hospitals in West Bank/Palestine was studied. For that purpose, a questionnaire was developed to assess knowledge, practices, perceived barriers, and delaying processes relating to cancer pain management (CPM). RESULTS: In total, 220 questionnaires were completed with a response rate of 88%. Participants' mean age was 30.34 years. Overall, 69.5% worked in governmental hospitals, 26.8% worked in the private sector and the remainder worked in both governmental and private sectors. The correct response rate to questions that assess knowledge relating to cancer pain control was calculated and a mean knowledge score was found to be 5.1 with a standard deviation of 2.1. A relationship between the knowledge score and the sample characteristics was made and showed that males scored significantly higher (p = 0.001) than females with median scores of 6 [4-7] and 5 [3-6] for males and females, respectively. Inadequate pain assessment (76.8%), insufficient knowledge of pain control (70.5%) and strict regulation on opioid use (69.5%) were the most frequently perceived barriers. Nurses reported that they would assess pain on every round and check all items related to pain assessment. Contacting the physician for the prescription of opioids was cited as the main delaying process by 56.4% of participants. CONCLUSIONS: This study allowed us to recognise the knowledge deficit and the barriers to effective management. On the other hand, the analysis has shown good pain documentation practices among nurses. Those knowledge deficits demonstrate the need for more education about CPM. The improvement of coordination and communication between physicians and nurses seems to play a crucial role in CPM, as contacting physicians was cited as the most delaying process in CPM by nurses.

Physicians' knowledge, perceived barriers, and practices regarding cancer pain management: a cross-sectional study from Palestine

Background: Pain continues to be a prevalent yet undertreated problem among cancer patients. Achieving adequate control of cancer pain is influenced by physicians' knowledge and practices, which have been found to be inadequate by many studies. In this study, we aimed to examine knowledge and practices, as well as perceived barriers relating to the management of cancer pain among Palestinian physicians. Methods: This cross-sectional study took place at eight hospitals in the northern West Bank in Palestine. A questionnaire was developed and distributed to physicians who were responsible for the care of cancer patients. The questionnaire assessed knowledge, perceived barriers, assessment practices, pain documentation, and delaying processes relating to cancer pain management (CPM). Results: In total, we analysed 109 questionnaires. The mean age of the participants was 32.3 ± 7.0 years and 73.4% had less than 10 years of professional experience. After analysing the data, we found physicians' knowledge to be inadequate, with a mean knowledge score of 6.2 ± 1.9 out of 14. The barriers that were perceived by the highest percentages of physicians to affect CPM were inadequate pain assessment (89%), insufficient experience (79.8%), and insufficient knowledge (76.1%), all of which are staff-related. However, 65% reported assessing pain on every round and 70% asked about all items related to the nature of pain. Finally, obtaining opioids from the pharmacy was the most recognized delaying step in CPM. Conclusions: Despite reporting good practices, physicians showed substantial knowledge deficits regarding CPM. Besides, many barriers appear to impede effective CPM. Therefore, appropriate educational programmes and policy changes are recommended in order to improve professional performance as well as patient care (AU)