Curēus
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Stereotactic navigation and functional magnetic resonance imaging (fMRI) are increasingly used as important tools for intraoperative guidance and preoperative mapping for lesions in eloquent areas. We report a case in which a WHO grade II oligodendroglioma in Broca's area with functional activation was successfully resected with the support of blood-oxygen-level-dependent imaging (BOLD)-fMRI mapping in a patient who refused an awake craniotomy. This case highlights key principles of tumor surgery navigation. Specifically, it calls into question the utility of awake craniotomy in this modern era. Ultimately, fMRI is an important tool for tumor resections and can limit the need for more expensive or invasive measures.
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Background Cardiopulmonary arrest is an uncommon event in pediatric patients. Additionally, physicians-in-training see far fewer cardiopulmonary arrest events. Therefore, they have limited confidence in their resuscitation skills. ⋯ Results A total of 13 patients in the pre-intervention period and 19 patients in the post-intervention period were included. The results showed a significant improvement in team performance represented by a decrease in CPR initiation time post-intervention and improvement in AHA adherence; however, the results did not show a significant difference in the survival rate or mortality within 28 days of the cardiopulmonary arrest event between the pre- and post-intervention groups. Conclusions Mock code simulation was a helpful tool to enhance team performance and improve the quality of cardiac resuscitation and cardiac arrest recognition, while its impact on the survival rate was not significant in our study.
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Case Reports
Postpartum Transient Hypervagotonic Sinus Node Dysfunction Leading to Sinus Bradycardia: A Case Report.
Sinus bradycardia is common in children and adults, especially during sleep. The heart rate can drop below 30 beats per minute. ⋯ The increased vagal tone has been associated with profound bradycardia in various pathophysiologic settings including pain. Herein, we report the first case of a young Caucasian female with transient symptomatic bradycardia due to postpartum hypervagotonic sinus node dysfunction (SND).
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Case Reports
Early Use of Tocilizumab May Prevent Clinical Deterioration in Select COVID-19 Patients: A Case Series.
Coronavirus disease 2019 (COVID-19) is a respiratory viral illness caused by the novel severe acute respiratory syndrome coronavirus 2. It is known to cause severe illness in certain patients, who develop acute respiratory distress syndrome (ARDS) often requiring intubation and mechanical ventilation adding to significant morbidity and mortality. Tocilizumab is an interleukin-6 inhibitor that has shown promise in improving outcomes in patients with COVID-19. ⋯ Tocilizumab was administered in the early phase of the disease before intubation. Patients improved clinically and ultimately did not require intubation. Our findings suggest that early use of tocilizumab might be beneficial in preventing clinical deterioration and intubation in select COVID-19 patients.
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Netherton syndrome (NS) is a rare form of skin disorder characterized by extensive skin desquamation, hair shaft abnormality and atopic manifestations. We report a case of a two-year-old girl brought to our dermatology clinic by her mother, who had a generalized scaly skin lesion that started at birth. ⋯ A skin examination revealed diffuse serpiginous erythematous pruritic plaques, surrounded by double-edged scales beside her hair shaft defects. The patient was diagnosed with NS, and we began treatment using topical emollients, antibiotic and corticosteroid.