Haemolytic crisis of hereditary spherocytosis

alkiviadis.1961 shared this article with you from Inoreader Haemolytic crisis of hereditary spherocytosis Via Postgraduate Medical Journal Online First   A 23-year-old man presented to the emergency department with a 2-day history of fever, nausea, conjunctival pallor and new yellowing of the skin. His medical history was unremarkable. Physical examination demonstrated mild jaundice of the sclera and skin and a palpable spleen. Laboratory testing showed a haemoglobin of 6.6 g/L (reference range 13.7–16.8 g/L), total bilirubin of 7.03 mg/dL (0.4–1.5 mg/dL), direct bilirubin of 0.67 mg/dL (0–0.4 mg/dL) and a reticulocyte fraction of 2.8% (0 .67–1.92%). Ultrasonography (US) and enhanced CT revealed splenomegaly and non-obstructing gallstones (figure 1). A peripheral blood smear test showed spherocytosis. (figure 2). He disclosed that his family history was notable for splenectomy in his father due to hereditary spherocytosis. A diagnosis of haemolytic crisis of hereditary spherocytosis was made based on these clinical findings. The patient received 2 units of packed red blood cells soon after the admission. Hereditary spherocytosis is the most... View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effects of the Mediterranean diet adherence on body composition, blood parameters and quality of life in adults

alkiviadis.1961 shared this article with you from Inoreader Effects of the Mediterranean diet adherence on body composition, blood parameters and quality of life in adults Via Postgraduate Medical Journal Online First Background It has been reported that Mediterranean diet (MD) may improve quality of life and may reduce the risk of chronic diseases such as metabolic syndrome, type 2 diabetes, cardiovascular diseases (CVD), some neurodegenerative diseases and cancer. Therefore, this study aimed to determine adults' adherence to the MD and evaluate the effect of the adherence to the MD on anthropometric measurements, specific biochemical parameters and quality of life. Methods A total of 142 volunteer adults were includ ed. Food frequency questionnaire, MD adherence with 14-item scale, quality of life, anthropometric measurements via bioelectrical impedance analysis and certain blood parameters were evaluated. Results Out of 14 points, the mean MD adherence score of the participants was 6.89. The mean fat mass was significantly higher in those with low MD adherence (p=0.024). The results of other anthropometric measurements (except height) were higher in those with low MD adherence, though results were non-significant. The participants with high adherence to the MD had lower levels of fasting blood glucose (FBG) (p=0.041), insulin (p=0.019) and triglyceride (TG) (p=0.012) compared with those with lower adherence. No significant relationship was found between the MD and quality of life and other blood parameters. Conclusion According to our study, MD adherence was associated with decreased fat mass, FBG, insulin and TG levels which suggests that the MD may be useful in the treatment of som e chronic diseases such as obesity, diabetes, metabolic syndrome and CVD. However, more clinical trials may be performed to determine the relationship between MD and chronic diseases. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Improving postoperative mobilisation rates in patients undergoing elective major hepatopancreatobiliary surgery

alkiviadis.1961 shared this article with you from Inoreader Improving postoperative mobilisation rates in patients undergoing elective major hepatopancreatobiliary surgery Via Postgraduate Medical Journal Online First Background Early mobilisation reduces postoperative complications such as pneumonia, deep vein thrombosis and hospital length of stay. Many authors have reported poor compliance with early mobilisation within Enhanced Recovery After Surgery initiatives. Objectives The primary objective was to increase postoperative day (POD) 2 mobilisation rate from 23% to 75% in patients undergoing elective major hepatopancreatobiliary (HPB) surgery within 6 months. Methods We report a multidisciplinary team cl inical practice improvement project (CPIP) to improve postoperative mobilisation of patients undergoing elective major HPB surgery. We identified the common barriers to mobilisation and analysed using the fishbone or cause-and-effect diagram and Pareto chart. A series of Plan–Do–Study–Act cycles followed this. We tracked the rate of early mobilisation and mean distance walked. In the post hoc analysis, we examined the potential cost savings based on reduced hospital length of stay. Results Mobilisation rate on POD 2 following elective major HPB surgery improved from 23% to 78.9%, and this sustained at 6 months after the CPIP. Wound pain was the most common reason for failure to ambulate on POD 2. Hospital length of stay reduced from a median of 8 days to 6 days with an estimated cost saving of S$2228 per hospital stay. Conclusion Multidisciplinary quality improvement intervention effort resulted in an improved POD 2 mobilisation rate for patients who underw ent elective major HPB surgery. This observed outcome was sustained at 6 months after completion of the CPIP with potential cost savings. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

'The photographic negative of pulmonary oedema in COVID-19 pneumonia

alkiviadis.1961 shared this article with you from Inoreader 'The photographic negative of pulmonary oedema in COVID-19 pneumonia Via Postgraduate Medical Journal Online First A 53-year-old man presented to the emergency room (ER) with fever, dry cough and shortness of breath for 6 days. Clinically he had tachycardia (114 beats per minute), tachypnoea (30 per minute) and was maintaining oxygen saturation of 88% on room air. He had acute respiratory distress syndrome (ARDS) (PaO2/FiO2 of 0.28), and there was no leucopaenia or lymphopaenia. Chest X-ray revealed peripheral consolidations with base towards pleura and sparing of peri-hilar region consistent with a r everse batwing appearance (figure 1). The patient's nasopharyngeal swab was tested for SARS Cov-2 RT-PCR, and it was positive. He was diagnosed to have COVID-19 pneumonia and started on oxygen supplementation and supportive care. The patient gradually improved and was discharged. In resource-constrained settings, a chest radiograph is the only investigation available for most patients. The findings have been used to support the diagnosis, determine the severity, guide the treatment and... View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Iatrogenic extracranial internal carotid artery aneurysm

alkiviadis.1961 shared this article with you from Inoreader Iatrogenic extracranial internal carotid artery aneurysm Via Postgraduate Medical Journal Online First A previously healthy 25-year-old female was presented to the otorhinolaryngology outpatient clinic, complaining of painless progressive pulsatile swelling over the left side of the neck for 1 month. The patient gave a history of fine-needle aspiration cytology (FNAC) of left cervical lymph node a month ago at a peripheral hospital for reactive cervical lymphadenopathy. She noted the onset of swelling 2–3 days after the FNAC which progressively increased to the current size. Examination showed a fir m, non-tender, pulsatile swelling of size 10 x 8 cm over the left side of the neck (figure 1A), with visible pulsations and bruit on auscultation. Laryngoscopy showed a left lateral pharyngeal wall bulge without any airway compromise. MRI of the neck revealed a well-defined heterointense lesion noted arising from the left proximal internal carotid artery (ICA) displacing external carotid artery anteriorly and a peripheral T2 hyperintense thrombus with central flow voids likely an... View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Octreotide Infusion for the Treatment of Congenital Chylothorax

Alexandros G.Sfakianakis shared this article with you from Inoreader Octreotide Infusion for the Treatment of Congenital Chylothorax Μέσω Hindawi Publishing Corporation Congenital chylothorax is an uncommon cause of pleural effusion in the pediatric age group, and it should be kept in consideration when evaluating a neonate with pleural effusion, as it is the commonest cause of pleural effusion in this age group (Tutor, 2014). No commonly accepted guidelines have been published so far regarding the management of congenital chylothorax in the neonate, but trials of octreotide have appeared to be promising (Bellini et al., 2018). We present a neonate with congenital chylothorax successfully treated with octreotide infusion. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Three-Decade Evaluation of Cerebrospinal Fluid Pressure in Open-Angle Glaucoma at a Tertiary Care Center

Alexandros G.Sfakianakis shared this article with you from Inoreader Three-Decade Evaluation of Cerebrospinal Fluid Pressure in Open-Angle Glaucoma at a Tertiary Care Center Μέσω Hindawi Publishing Corporation Elevated intraocular pressure (IOP) is the most prevalent risk factor for primary open-angle glaucoma. However, IOP alone does not fully describe a mechanical basis for disease in patients with normal tension glaucoma or primary open-angle glaucoma. The translaminar pressure difference (TLPD) theory proposes that the pressure gradient generated by the difference of IOP and cerebrospinal fluid pressure (CSFp) acting at the level of the optic nerve can lead to cupping and glaucoma when IOP is higher than normal and/or CSFp is lower than normal. The study results to date have generally supported the TLPD theory; however, varying methods, populations, and sample sizes make it difficult to compare results. To further assess whether there is an association between low CSFp and open-angle glaucoma, 30 years of cl inical data that assess 96,543 lumbar punctures were analyzed. Patients with open-angle glaucoma showed a significantly lower CSFp than randomly selected normal control patients (9.9 ± 3 mm·Hg (n = 86) versus 12.1 ± 3.6 mm·Hg (n = 114), ) following adjustment for age and sex. This retrospective study provides strong evidence for an association between open-angle glaucoma and low CSFp. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.