Proceedings (Baylor University. Medical Center)
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Proc (Bayl Univ Med Cent) · Nov 2020
Case ReportsDevelopment of Terry's nails after a gastrointestinal bleed.
Terry's nails are characterized by white opacification of the nails with effacement of the lunula and distal sparing. Described originally in 1954 by Dr. Richard Terry as a common fingernail abnormality in patients with hepatic cirrhosis, Terry's nails are now a known sequelae of other conditions such as congestive heart failure, chronic kidney disease, diabetes mellitus, and malnutrition. ⋯ Treatment of the underlying disease may result in resolution. We present a case of a 77-year-old man who developed Terry's nails following an acute gastrointestinal bleed and subsequent hemorrhagic shock. The development of Terry's nails after a gastrointestinal bleed has not been previously reported.
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Currently, the world is facing a global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19. So far, there are no clear recommendations regarding hospital discharge and aftercare for COVID-19. Here, we briefly discuss the current understanding of recommendations for discharge criteria, discharge treatment regimens, and follow-up.
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Proc (Bayl Univ Med Cent) · Jul 2020
ReviewHidradenitis suppurativa for the nondermatology clinician.
Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory skin condition resulting in the formation of nodules, sinus tracts, and abscesses typically in intertriginous regions. HS management is often difficult and involves a multimodal approach, evaluating the benefit of both medical and surgical treatment options, along with treating associated pain and medical comorbidities that present concomitantly with the disease. In this article, we synthesize for the nondermatology clinician the evidence for various HS treatments, along with the diagnostic and therapeutic guidelines for HS published by the British Association of Dermatologists, US and Canadian HS Foundations, HS ALLIANCE, Canadian Dermatology Association, and Brazilian Society of Dermatology. Management of HS requires an individualized, patient-centered approach due to the lack of rigorous evidence for many interventions.
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Proc (Bayl Univ Med Cent) · Jul 2020
The use of adjunct anesthetic medication with regional anesthesia and rates of general anesthesia for 1867 cesarean deliveries from 2014 to 2018 in a community hospital.
The number of cesarean deliveries performed with a general anesthetic decreased when regional anesthesia for cesarean delivery was reported to be associated with lower maternal mortality. Anesthetic adjunct administration for cesarean deliveries performed with regional anesthesia is typically not reported alongside general anesthesia rates for cesarean delivery. This retrospective study analyzed rates of general anesthesia and systemic anesthetic adjunct administration for cesarean deliveries performed under regional anesthesia at a community hospital from 2014 to 2018. ⋯ Of the subjects, 104 (5.6%) received general anesthesia and 333 (17.8%) received regional anesthesia with at least one systemic anesthetic adjunct. These adjuncts included a variety of intravenous agents-midazolam (1.7%), fentanyl (5.2%), morphine (6.6%), propofol (7.9%), and ketamine (1.7%)-as well as inhaled nitrous oxide (1.4%) and sevoflurane (0.1%). These data on anesthetic adjunct administration with regional anesthesia provide clinical context for the rates of general anesthesia reported for cesarean delivery.
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Proc (Bayl Univ Med Cent) · Jul 2020
Case ReportsSubsternal goiter excision in a Jehovah's Witness.
Jehovah's Witnesses present a unique challenge in oral and head and neck surgery. We report a case of a substernal goiter excised on a Jehovah's Witness without the use of blood transfusion, in accordance with the patient's beliefs. Additionally, we review the literature on the care of this patient population, focusing on preoperative optimization, perioperative management, and postoperative care.