A triple tunnel from the mid-calf to the femoral vein in patient with severe dementia.

Achieving the ideal exit site is the new philosophy for complicated vascular access patients. Recent publications have described multiple venous access solutions such as tunneling to the scapular region, the chest to the arm, and from the femoral vein to the abdominal and patellar region. In the patients afflicted with delirium, dementia, or confusion even these sites may not be sufficient.

Is There a Need for Recovery Room Radiographs Following Uncomplicated Primary Total Knee Arthroplasty?

Introduction Total knee arthroplasty (TKA) is one of the most common orthopedic procedures performed in the United States. Obtaining radiographs in the post-anesthesia care unit (PACU) has been the standard of care at most hospitals. The purpose of this study was to examine the utility and cost-effectiveness of immediate, postoperative radiographs in regards to operative decision-making to prevent complications within 90 days after primary TKA.

"Purse-String" Capsular Closure for Decreasing Dislocation Rates in Proximal Femur Replacements.

Hip joint dislocation is the most common complication after a proximal femur replacement. As the utilization of proximal femur replacements continues to increase, it becomes imperative for surgeons to find the optimal method to decrease postoperative dislocation and its sequelae. These cases often involve extensive soft-tissue deficits that require reconstruction to provide postoperative strength and stability.

More Than Just an Ulcer: A Case of HIV-Associated Iliac Aneurysms Presenting With a Leg Ulcer.

The incidence of symptomatic vasculitis in human immunodeficiency virus (HIV)-infected patients is approximately 1%, and it commonly presents as arterial occlusive disease or aneurysmal disease. Early diagnosis of vascular complications in those patients is essential; however, it is extremely challenging. Iliac aneurysms are usually silent, and because of their deep location, detection of these aneurysms is typically difficult.

An Unusual Presentation of Influenza-Induced Myositis.

Post-influenza myositis is considered a distinct clinical entity and is associated with muscle pain and elevated muscle enzymes during convalescence. Although the exact mechanism of muscle injury in acute viral myositis is unknown, there are possible mechanisms proposed in the literature. The progression of viral myositis to rhabdomyolysis, although uncommon, can be life-threatening and has been reported with many viruses, most commonly influenza.

Sociocultural barriers to hepatitis B health literacy in an immigrant population: a focus group study in Korean Americans.

Background: Chronic hepatitis B (CHB) is a major global health issue disproportionately affecting Asian Americans and other immigrant populations in the United States. Despite the high risk of morbid complications from CHB, the majority of individuals with CHB do not access healthcare due to a complex of barriers. These barriers influence health literacy which may affect behaviors linked to hepatitis B care.

COVID-19 Induced Bilateral Lower Limb Ischemia and Visceral Infarcts.

Emerging cases of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) have been associated with a variety of disorders including respiratory failure, immune reactive syndrome, multiorgan failure, and hypercoagulable states. COVID-19 induces a severe global inflammatory response which can result in endothelial damage leading to hypercoagulability. Most COVID-19 cases of hypercoagulable states reported venous thrombosis.

Gardener's Nightmare: A Rare Case of Myroides-Induced Septic Shock.

Myroides species, an uncommon clinical isolate, generally found in contaminated sources of environment, is an emerging source of infections, especially amongst immunocompromised patients. Though only 54 cases have been reported to our knowledge, the emergence of pan-resistance to antibiotics remains a concern that may burden healthcare and require awareness. We present the case of an elderly female who despite being home-bound, without any environmental exposure, contracted Myroides septicemia that progressed to septic shock and showed resistance to usual empiric antibiotics.

Post-Operative Pyoderma Gangrenosum: A Long Journey for a Patient with Myelodysplastic Syndrome.

Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis, characterized by painful and erythematous papules, pustules or vesicles that rapidly become ulcerative and necrotic. These ulcers have multiple sub-types and can develop anywhere on the body. There are different postulations as to the mechanisms of development for each sub-type.

Does Percutaneous Lumbosacral Pedicle Screw Instrumentation Prevent Long-Term Adjacent Segment Disease after Lumbar Fusion?

Study Design: Retrospective cohort study.

Purpose: To assess long-term clinical outcomes of adjacent segment disease (ASD) in patients who underwent lumbar interbody fusion with percutaneous pedicle screw (PS) instrumentation.

Overview Of Literature: ASD is a well-known sequela of spinal fusion, and is reported to occur at a rate of 2%-3% per year.

FOAM Impact: The Influence of Open-access Medical Education on Practice Uptake.

Objectives: The FOAM Impact study sought to examine baseline rates of intravenous (IV) lidocaine usage for the treatment of renal colic and to compare rates of use between FOAM utilizers and nonutilizers. We sought to measure the effect of FOAM resources on clinical practice by timing the release of FOAM content with publication of the LIDOKET trial.

Methods: A cross-sectional before-and-after survey was conducted and disseminated on two social media platforms.

Nail Salon a Potential Source of a Rare Mycobacterium Fortuitum Infection In Proximal Tibia Megaprosthesis? A Case Report.

Mycobacterium Fortuitum (M. Fortuitum) is a type of opportunistic pathogen commonly found in water/soil and belongs to the nontuberculosis mycobacteria (NTM) family. Prosthetic joint infection due to M.

Transient Brugada Pattern Induced by Loperamide Abuse.

Brugada syndrome (BrS) is classically a malignant, genetically determined, arrhythmic syndrome manifesting as syncope or sudden cardiac death (SCD) in individuals with structurally normal hearts.An exceedingly rare cause of an induced electrocardiogram (ECG) pattern mimicking BrS is secondary to loperamide abuse. The following case describes the onset of a transient Brugada pattern secondary to loperamide abuse in a young healthy male.

Suction Assisted Laryngoscopy and Airway Decontamination (SALAD): A technique for improved emergency airway management.

Emergency airway management is often complicated by the presence of blood, emesis or other contaminants in the airway. Traditional airway management education has lacked task-specific training focused on mitigating massive airway contamination. The Suction Assisted Laryngoscopy and Airway Decontamination (SALAD) technique was developed in order to address the problem of massive airway contamination both in simulation training and in vivo.

Risk Factors for Neonatal/Maternal Morbidity and Mortality in African American Women with Placental Abruption.

: Risk factors for neonatal/maternal morbidity and mortality in placental abruption have been incompletely studied in the current literature. Most of the research overlooked the African American population as mostly Caucasian populations are selected. We aimed to find which risk factor influence the neonatal and maternal outcome in cases of placental abruption occurring in African American pregnant women in an inner-city urban setting.

A Rare Case of Cerebral Amyloidoma Mimicking a Hemorrhagic Malignant Central Nervous System Neoplasm.

Cerebral amyloidoma is a rare form of amyloidosis with a localized tumor like an amyloid deposition in the brain composed of insoluble fibrillary protein with cross beta-sheet conformation. Its usual presentation includes vision loss, seizures, behavioral changes, cognitive decline, and recurrent headaches. It has a benign course with a slow progression, and it is not associated with dissemination.

A rare case of hypokalemic ventricular tachycardia in a patient with thyrotoxic periodic paralysis.

Thyrotoxic periodic paralysis (TPP) is a potentially fatal complication of hyperthyroidism, characterized by recurrent muscle paralysis and hypokalemia. We present a case of a 32-year-old apparently healthy male patient, who presented with acute paraparesis associated with hypokalemia (K: 1.6 mmol/L), complicated by ventricular tachycardia (VT).

Gender differences in the revascularization rates and in-hospital outcomes in hospitalizations with ST segment elevation myocardial infarction.

Background: Gender differences have been noted in patients presenting with ST segment elevated myocardial infarction (STEMI) but the reason remained poorly defined. We hypothesize that women presenting with STEMI are associated with poor reperfusion strategies which leads to worse in-hospital outcomes. Our goal is to identify age-stratified gender differences in revascularizations and in-hospital outcomes in patients presented with STEMI.

Primary Arthroscopic Repair of the Anterior Cruciate Ligament: A Systematic Review of Clinical Outcomes.

Purpose: To describe the clinical outcomes after primary arthroscopic anterior cruciate ligament (ACL) repair.

Methods: A systematic review of the PubMed, Embase, and Cochrane Library databases was performed according to the PRISMA guidelines. All English-language literature published from 2000 to 2018 that reported the clinical outcomes after primary arthroscopic repair (AR) of complete tear of the ACL (without augmentation) with a minimum 2-year follow-up was reviewed by 2 independent reviewers.

Evidence-Informed Practice: Diagnostic Questions in Urinary Tract Infections in the Elderly.

Introduction: Routine interventions in the practice of medicine often lack definitive evidence or are based on evidence that is either not high quality or of only modest-to-marginal effect sizes. An abnormal urinalysis in an elderly patient presenting to the emergency department (ED) with non-specific symptoms represents one condition that requires an evidence-informed approach to diagnosis and management of either asymptomatic bacteriuria or urinary tract infection (UTI). The emergency provider often will not have access to urine cultures, and the risks associated with antibiotic use in the elderly are not without potentially significant side effects.

Meta-Analysis Comparing Usefulness of Beta Blockers to Preserve Left Ventricular Function During Anthracycline Therapy.

The purpose of this analysis was to evaluate the cardioprotective benefit of β blockers in preventing anthracycline-induced cardiotoxicity (AIC) in breast cancer patients. Anthracyclines are the cornerstone treatment for breast cancer. Yet, their use has declined in the last decade due to associated AIC.

Medical Missions in Jordan: A Series of Upper-Extremity Orthopedic Injuries.

Worldwide, a great deal of disability is caused by musculoskeletal injuries from high-energy trauma. In nations affected by war, blast injuries associated with mines, missiles, high-powered gunshots, and bombings are one cause of these injuries. Medical missions carried out by those from developed nations is one way to address this.