Curēus
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Platypnea-orthodeoxia syndrome (POS) is an extraordinary medical condition characterized by positional dyspnea (platypnea) and arterial desaturation or hypoxemia (orthodeoxia) in the setting of an upright position. The difficulty breathing is alleviated upon lying down. ⋯ POS can have an intracardiac or an extracardiac etiology. Herein we report a case of an 87-year-old man presenting with acute on chronic dyspnea who showed promising improvement in oxygen saturation after patent foramen ovale (PFO) closure.
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Purpose To assess the degree to which medical students choose to disengage from their regular preclinical curriculum and extracurricular activities in order to focus on United States Medical Licensing Examination (USMLE) Step 1 exam preparation, as well as learner-perceived effects of Step 1 preparation on their physical, social, and mental health. Method Online survey of medical students who have taken the USMLE Step 1 exam at a single large Midwestern academic medical center. Results The response rate was 54%. ⋯ Majorities of students identified Step 1 preparation as a cause of burnout (79%) or significant anxiety or depression (61%), for which nearly a third sought mental healthcare; students also reported Step 1 preparation as a cause of engaging in dangerous behaviors such as illicit prescription stimulant use as well as driving or providing patient care while impaired by fatigue. In narrative comments, students frequently described Step 1 to be a barrier to their development into effective clinicians, the traditional medical school curriculum to be a barrier to performance on Step 1, or both. Conclusions Medical students often prioritize Step 1 exam preparation over engaging with the standard preclinical curriculum, extracurricular opportunities, and activities to promote wellbeing. These findings have implications for the emphasis residency program directors place on single high-stakes standardized exams in the resident recruitment process.
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Introduction This study aimed to examine the anesthesia practices applied to the cases during the pandemic, to analyze the rate of the precautions taken in emergency/elective operations in non-COVID patients, what precautions were taken, what resources the clinics had, and the patient management in the perioperative period by organizing a survey among anesthesiologist in Turkey. Methods After obtaining approval from the Turkish Ministry of Health (2020-05-04T09_30_03) and the local ethics committee (GOKAEK-2020/10.09), a survey consisting of 21 questions was formed over the online survey inquiry (surveymonkey.com). The survey was conducted in Turkish. ⋯ Finally, it was found that 50.85% of the patients were taken to the recovery unit after being extubated, and 49.15% were sent directly to the service. Conclusion We can reveal that each clinic made arrangements according to its own conditions. We think that plans should be made to standardize clinical facilities and algorithms throughout the country. Apart from technological and financial facilities, we believe that the continuity of the training organized by national and international associations should be ensured so that anesthesiologists' knowledge, skills, and experience who manage this process can remain at the highest level.
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Case Reports
Severe Acute Respiratory Syndrome Coronavirus 2 Induced Focal Segmental Glomerulosclerosis.
Focal segmental glomerulosclerosis (FSGS) is a common cause of nephrotic syndrome affecting adults and children. Collapsing focal segmental glomerulosclerosis (FSGS), one of five histologic variants of FSGS is described as segmental or global collapse and sclerosis of the glomerular tufts and has been frequently associated with human immunodeficiency virus-associated nephropathy (HIVAN). Its association with other viral and non-viral causes, medications and other disease states has since been established. Due to its resistance to therapy, rapid progression to end-stage renal disease (ESRD) and overall poorer prognosis, identification with electron microscopy examination of the kidney biopsy sample is required during evaluation.
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Background Genito-pelvic pain/penetration disorder, commonly referred to as vaginismus, is a relatively common condition in women of childbearing age and has physical and psychological aspects. Various cognitive and behavioral therapies, dilatators, botulinum injections, and so on have been tried in the treatment. We hypothesize that the combination of sacral erector spinae plane (ESP) block and progressive dilatation treatment increases treatment quality. Methods We performed the sacral ESP block and progressive dilatation, which we added to multimodal treatment for resistant vaginismus cases. ⋯ Pregnancy occurred in eight patients after the initial one-month follow-up. Four of the 15 patients needed a second block. Conclusions The sacral ESP block added to the multimodal treatment protocol significantly improves treatment quality.