Curēus
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Postmastectomy pain syndrome (PMPS) is a common complication after breast cancer surgery and is often challenging to manage. Treatment options include medication management, physical therapy, and interventional procedures. ⋯ We describe the utilization of the ESP block for significant neuropathic breast pain after total mastectomy. Our case demonstrates the utility of this block for women suffering from severe PMPS.
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An 18-year-old female presented with left eye periorbital swelling, erythema, and pain for three days. Computed tomographic images showed swelling of the medial rectus muscle, and she was diagnosed with orbital cellulitis and initiated on empiric antibiotics. Over the next 48 hours, she did not clinically improve, resulting in an MRI and further workup of infectious, oncologic, endocrinologic, and rheumatologic etiologies was unrevealing and ruled-out malignancy, sarcoidosis, Wegner's, and thyroid eye disease. ⋯ Therefore, the patient was empirically treated with intravenous steroids that produced pronounced improvement within 24 hours. The patient was discharged in improved condition with a prednisone taper and rheumatology follow-up. Idiopathic orbital inflammation is a rare diagnosis of exclusion in pediatrics that merits prompt consideration and work-up if treatment for orbital cellulitis does not progress as expected.
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Background Malnutrition is a less commonly recognized risk factor for various infections. It encompasses both undernutrition or protein-energy malnutrition (PEM) and overnutrition, including obesity. This study aimed to evaluate whether PEM impacts bacterial pneumonia (BP) and, if so, to quantify the degree of impact on inpatient outcomes. ⋯ Patients with PEM had a higher adjusted odds ratio (aOR) of inpatient mortality (adjusted odds ratio (aOR): 2.31, 95% confidence interval (CI): 2.14 - 2.48, p<0.001) as compared to non-PEM patients. PEM was also associated with higher odds of sepsis (aOR: 2.24, 95% CI: 2.04 - 2.46, p<0.001), septic shock (aOR: 3.29, 95% CI: 2.82 - 3.85, p<0.001), requiring mechanical ventilation (aOR: 2.51, 95% CI: 2.31 - 2.71, p<0.001), requiring vasopressors (aOR: 2.90, 95% CI: 2.20 - 3.83, p<0.001), acute respiratory distress syndrome (ARDS) (aOR: 1.63, 95% CI: 1.33 - 2.00, p<0.001), acute kidney failure (AKI) (aOR: 1.24, 95% CI: 1.18 - 1.29, p<0.001), deep vein thrombosis (DVT) (aOR: 1.80, 95% CI: 1.62 - 2.00, p<0.001), and pulmonary embolism (PE) (aOR: 1.25, 95% CI: 1.08 - 1.45, p=0.003). Conclusion The study concluded that PEM was an independent mortality predictor for those with BP, with an increased risk of systemic complications, as well as increased healthcare utilization costs.
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Multiple studies have reported the metabolic benefits of high-intensity exercise programs like CrossFit. If these high-intensity exercises are not done in a proper structured pattern, adverse outcomes like rhabdomyolysis can occur. Here we discuss a case of a patient who undertook one session of CrossFit exercise and developed exertional rhabdomyolysis. ⋯ He was treated with aggressive intravenous fluids and oral hydration therapy. He did not develop any complication and he was discharged on the sixth day. This case report demonstrates a possible preventable rhabdomyolysis that developed secondary to undue participation in CrossFit exercise.
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Background and objective Neutrophils are primarily responsible for activating the immune system, and systemic inflammation destroys CD4+ T lymphocytes and increases suppressor CD8+ T lymphocytes, thereby leading to an increased neutrophil-to-lymphocyte ratio (NLR). An increase in the apoptosis of lymphocytes leads to lymphopenia and elevated thrombopoietin (THPO) promotes megakaryocyte production. The reflections of these inflammatory changes can be vital in gauging the progression of the disease. This study aimed at examining the prognostic value of normal and derived neutrophil-to-lymphocyte, lymphocyte-to-monocyte, platelet-to-lymphocyte, and mean platelet volume (MPV)-to-platelet count ratios in patients with coronavirus disease 2019 (COVID-19). ⋯ This is an investigation modality that is widely accessible even in remote areas and resource-limited settings. Conclusion These hematological ratios can facilitate in categorizing the disease severity and progression in patients, thereby enabling us to make appropriate and informed clinical decisions. Since the second wave of the novel coronavirus is on the verge of arrival, it is imperative to channel resources for the patients early in their disease course to ultimately prevent complications and reduce mortality.