Curēus
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Daptomycin is a cyclic lipopeptide antibiotic with great efficacy targeting gram-positive cocci, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus. Acute eosinophilic pneumonia is a rare complication of daptomycin therapy, with a poorly understood etiology thought to involve the accumulation of the drug in pulmonary surfactant inducing inflammation. We present a 56-year-old male with a history of spinal epidural abscess being treated with intravenous daptomycin, who presented to the emergency department with fever, developed worsening shortness of breath, and was subsequently discovered to have eosinophilia of pulmonary secretions via bronchoalveolar lavage. Daptomycin was discontinued, and he underwent treatment with corticosteroids, resulting in full resolution of symptoms. ⋯ Identification may be further complicated by the fact that symptoms can present anywhere from days to weeks after starting the therapy. This complication is very responsive to treatment with corticosteroids and cessation of daptomycin, but recognition is essential. With an increasing use of daptomycin subsequent to continued emergence of antibiotic resistance, it is essential that physicians are aware of this rare complication of daptomycin therapy.
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Introduction There is a high prevalence of hypertensive crisis with myocardial injury, as evidenced by elevation in cardiac troponin levels. The risk factors predisposing patients to developing a myocardial injury, detectable troponin, and increase in serial troponin in this population are not known. Methods A retrospective study was designed to include all patients, presenting to the emergency room, diagnosed with hypertensive crisis, using International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes between 2016-2018 (n=467). ⋯ Conclusion About one-third of patients with the hypertensive crisis have detectable troponin. Still, among these, less than half have troponin levels >99th percentile URL, and the majority of these patients have minimal changes in serial troponin. Low BMI was associated with higher initial and serial troponin levels, and this obesity paradox was stronger among females and older patients.
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Background Graves' disease is the most common cause of thyrotoxicosis. It can be treated using three different modalities, which include anti-thyroid drugs (ATD), radioactive iodine (RAI), and near-total thyroidectomy. This cohort study aimed to assess the treatment modality preferred at King Abdulaziz Medical City (KAMC) and to compare the treatment options in relation to the prognosis of the disease. ⋯ Conclusion ATD was the treatment modality mostly used for Graves' disease in our center. It resulted in a remission rate of 53%, which is higher than reported in national studies. Although the rate of remission post RAI ablation was as high as 95%, most patients developed hypothyroidism.
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Objective The aim of the current study is to determine the feasibility and accuracy of ultrasound-guided core biopsy for staging the axilla in clinically node-negative patients with invasive breast cancer. Introduction Historically, in breast cancer patients, axillary lymph node dissection was performed to stage axilla. Because of the high morbidity of axillary lymph node dissection, sentinel lymph node biopsy (SLNB) became the standard of care in patients with clinically node-negative breast cancer. ⋯ Results The sensitivity of ultrasound-guided core biopsy was 88%, specificity 100%, positive predictive values (PPV) 100%, negative predictive values (NPV) 89.28%, diagnostic accuracy 94%. Conclusion In conclusion, the present study demonstrated high accuracy of ultrasound-guided axillary lymph node core biopsy in breast cancer patients with clinically node-negative axilla. Positive core biopsy results can thus obviate the need for sentinel lymph node biopsy and allow breast surgeons to directly proceed to axillary lymph node dissection.
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Background Evaluation of the Zip surgical skin closure device (Zip) versus metal staples regarding patient satisfaction and cosmesis after total knee arthroplasty (TKA). Methods Patients undergoing TKA at Einstein Medical Center Montgomery were randomized to receive skin closure using Zip or staples. Patient satisfaction was assessed by surveys at discharge, three weeks and six weeks post-operatively. ⋯ Conclusion Satisfaction with the closure method and patient and physician assessments of cosmesis were superior with Zip. Orthopedic surgeons strive to optimize TKA patient satisfaction. Skin closure can influence patient satisfaction as the memory of their recovery fades and the scar remains the most visible reminder of their experience.