International journal of general medicine
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Case Reports
Intrapleural hemorrhage due to alteplase use in a 6-year-old boy with pleural effusion.
Intrapleural fibrinolytics have been used successfully worldwide for the management of complicated pleural effusions and empyema. Bleeding complications are usually mentioned as rare side effects, but there is no clear information in the literature addressing the alarming outcome that might result following the use of alteplase as a fibrinolytic in the management of complicated parapneumonic effusions. We present a rare, if not unique, case of intrapleural hemorrhage requiring transfusion after alteplase use as a fibrinolytic in a 6-year-old male with complicated parapneumonic effusion. ⋯ Although intrapleural and systemic hemorrhage are rare side effects of intrapleural fibrinolytic use, the health care provider must be watchful for these potentially life-threatening complications. Further studies are needed to understand not only the efficacy of fibrinolytics but also their safety, especially in children.
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In spite of the large body of evidence available in the literature, definition and treatment of Post-Herpetic Neuralgia (PHN) are still lacking a consistent and universally recognized standardization. Furthermore, many issues concerning diagnosis, prediction and prevention of PHN need to be clarified in view of recent contributions. ⋯ Further efforts are needed to improve the management of PHN. Potentially relevant interventions may include early antiviral therapy of acute HZ, prevention of HZ by adult vaccination, as well as new therapeutic approaches for patients experiencing PHN.
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Early studies of community-acquired pneumonia showed that nonsurvivors had higher blood urea nitrogen levels and lower serum albumin levels than survivors. Therefore, elevation of the blood urea nitrogen to serum albumin (B/A) ratio may identify patients with community-acquired pneumonia who are becoming critically ill. This study investigated the correlation between commonly used laboratory markers, in particular the B/A ratio, and clinical outcomes of community-acquired pneumonia. ⋯ The B/A ratio is a simple but independent predictor of mortality and severity of community-acquired pneumonia.
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Little has been done to investigate the application of injury specific qualitative research methods in the field of burn injuries. The aim of this study was to use an analytical tool (Haddon's matrix) through qualitative research methods to better understand people's perceptions about burn injuries. ⋯ Haddon's matrix is applicable in a qualitative research methodology both at data collection and data analysis phases. The study using Haddon's matrix through a qualitative research methodology yielded substantially rich information regarding burn injuries that may possibly be useful for prevention or future quantitative research.
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Since August Bier reported the first case in 1898, post-dural puncture headache (PDPH) has been a problem for patients following dural puncture. Clinical and laboratory research over the last 30 years has shown that use of smaller-gauge needles, particularly of the pencil-point design, are associated with a lower risk of PDPH than traditional cutting point needle tips (Quincke-point needle). A careful history can rule out other causes of headache. ⋯ In high-risk patients < 50 years, post-partum, in the event a large-gauge needle puncture is initiated, an epidural blood patch should be performed within 24-48 hours of dural puncture. The optimum volume of blood has been shown to be 12-20 mL for adult patients. Complications caused by autologous epidural blood patching (AEBP) are rare.