Clinical medicine (London, England)
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Multicenter Study
Increased frequency of pneumothorax and pneumomediastinum in COVID-19 patients admitted in the ICU: A multicentre study from Mumbai, India.
There are limited data regarding the incidence of pneumothorax in COVID-19 patients as well as the impact of the same on patient outcomes. ⋯ Our study demonstrates that air leaks occur with a higher frequency in patients with COVID-19 than in other ICU patients. When present, such air leaks contributed to poor outcomes with almost 74% mortality rates in these patients.
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An increasingly common scenario on the acute medical take is that of 'possible pulmonary embolism'. The aim of this article is to update the reader about the available clinical decision tools that can help to avoid the over investigation of such patients, as well as other tools that can support an outpatient management strategy in appropriate patient groups. ⋯ We address the evidence on the long-term risk of venous thromboembolism recurrence and show how this can be used to make decisions about duration of anticoagulation. Finally, we discuss a number of special scenarios, including the implications of incidentally discovered isolated subsegmental pulmonary embolus and the management of pulmonary embolus in malignancy and pregnancy.
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A 36-year-old woman presented with a subacute, relapsing myelitis, manifesting as bilateral ascending lower limb paraesthesia, partially responsive to steroids. Imaging demonstrated a longitudinal spinal cord lesion, with a unique and characteristic sign (the 'trident sign') on axial views, which is specific to a diagnosis of neurosarcoidosis. This case highlights the importance of using this feature to distinguish a longitudinal cord lesion of sarcoidosis from other differentials.
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Based on five stakeholders (the central government, local governments, hospitals, businesses and local communities), the Republic of Korea must shift from its current indecisive approach to a decisive approach to the COVID-19 outbreak. Other nations should also consider the issue of decisiveness before it is too late.
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Case Reports
Lessons of the month 2: Retinal vasculitis: a first presentation of Takayasu's arteritis.
Takayasu's arteritis is a chronic, systemic, large-vessel vasculitis affecting the aorta and its primary branches. However, coronary, renal and pulmonary arteries and small vessel involvement has been documented. We describe a rare case of Takayasu's arteritis with extensive supra-aortic arch disease, manifesting with bilateral occlusive retinal vasculitis as a first presentation. This is elicited by fundus findings of vascular sheathing and fundus fluoresceine angiography evidence of retinal vessel occlusion and peripheral capillary non-perfusion.