Curēus
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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.
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Case Reports
Sacral Erector Spinae Plane Block Provides Surgical Anesthesia in Ambulatory Anorectal Surgery: Two Case Reports.
Erector spinae plane block (ESPB) is a new and popular interfacial fascial plane block which has been used in many different surgeries. There are a few cases in which ultrasound-guided sacral ESPB was used for postoperative analgesia. This article presents the successful use of bi-level, bilateral sacral ESPB for main anesthetic method in anorectal surgery. Anesthetic level required for surgery was accomplished in 30 minutes, and none of the patients experienced pain throughout the surgery. ⋯ The patients, who were contacted later, indicated no need for any analgesic for 24 h postoperatively. To the best of our knowledge, this is the first case report in the literature where sacral ESPB is used as the sole anesthetic technique. The sacral ESPB can be considered in anorectal surgery as an alternative technique for spinal or general anesthesia.
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Many comparisons have been made on the effect and impact of COVID-19 on influenza pandemics of history. Therefore, it is reasonable to infer that the strategies utilized by healthcare providers to improve influenza vaccination rates can similarly be applied to the administration of a COVID-19 vaccine. The purpose of this study was to determine the rationale of low influenza vaccination rates in an urban allergy clinic and how to improve patient education and knowledge regarding the importance of influenza vaccination. A three-year comparison of interventions is presented as well as its application to future COVID-19 vaccinations. ⋯ As evidenced in the yearly battle with influenza and now the COVID-19 pandemic, it has become essential to identify and implement multi-level strategies to maximize vaccination rates, especially amid a global pandemic. With COVID-19 vaccines reaching emergency approval stages, it is important for healthcare providers to start creating workflows and strategies to address patient inquiries. The influenza vaccination quality improvement project presented here can be used as a guideline for future evaluations of COVID-19 vaccination efforts.
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Case Reports Retracted Publication
Ultrasound-Facilitated Catheter-Directed Thrombolysis via Dual Right Upper Extremity Venous Access Into the Basilic Vein in a Case of Submassive Pulmonary Embolism.
Traditionally, massive, life-threatening pulmonary embolism (PE) has been treated with systemic thrombolytic therapy while submassive and smaller acute PEs have been treated with systemic anticoagulation therapy. Given that thrombolytic therapy is associated with the risk of life-threatening complications including intracranial hemorrhage, it has not been routinely used or recommended for submassive PEs. In 2017, the Food and Drug administration (FDA) approved ultrasound-facilitated catheter-directed thrombolysis (USCDT) for acute massive and sub-massive pulmonary embolism. ⋯ We present a case of USCDT in a submassive PE patient with dual right upper extremity venous access where both sheaths were advanced into the basilic vein (due to anatomic variation). Based on recent clinical trial data suggesting that shorted duration USCDT is as effective as longer duration, tissue plasminogen activator (tPA) was infused in this case for 6 hours. This strategy for intervention can enhance patient comfort with USCDT therapy and can be particularly helpful in patients at high risk for access site complications and those unable to lie supine for the long duration of infusion therapy.