Non-Small Cell Lung Cancer Presenting as a Facial Soft Tissue Metastasis in a Non-Smoker
Berman Zoe, Pearl Joshua and Wiesel Ory
Article Type: Case Report | First Published: December 12, 2018
Lung cancer is an aggressive disease with projections estimating that more than 150,000 Americans will die in 2018 from lung cancer. Mortality is associated with advanced stage of disease and metastatic disease. While the major sites of metastases are the solid organs, the rate of soft tissue metastases has been reported as 0.75-9%. In an asymptomatic patient who is a nonsmoker, there is low likelihood to diagnose early lung cancer unless found incidentally. We present a case of a 66-year-old ma...
Widened Mediastinum on Chest X-Ray as an Indicator of Mediastinal Injuries: A Relic of the Past?
Sunder Balasubramaniam, Rachel Yanlin Chen, Deng Tianshu and Teo Li Tserng
Article Type: Retrospective Study | First Published: December 12, 2018
The humble chest X ray (CXR) is an important factor in the assessment of the patient with traumatic injury. The Advanced Trauma Life Support (ATLS) programme recommends performing a CXR as part of the secondary survey, and this is widely used in Singapore. All general hospitals that receive trauma patients in Singapore have resuscitation bays capable of rapidly obtaining a CXR film using either a fixed radiology machine or a portable machine kept within the Emergency Department itself....
Stem Cell Therapy for Ischemic Stroke: From Bench to Bedside
Jolien De Meyer, Jolien De Pryck and Said Hachimi-Idrissi
Article Type: Original Article | First Published: December 01, 2018
Every year ischemic stroke takes many lives and leaves millions of people with neurological deficits. Currently the only approved therapy is recombinant tissue plasminogen activator, which should be administered within a narrow time window of 4.5 hours. Stem cell therapy was first initiated in several preclinical studies with promising results and lately in some clinical trials. Our research consists of 2 systematic reviews where preclinical and clinical studies were pooled. We provide a systemi...
Incidence of Venous Thromboembolism in Asian Trauma Patients - An Asian Trauma Centre Review
Wee Ming Tay, TS Go and LT Teo
Article Type: Research Article | First Published: November 24, 2018
To evaluate the incidence of venous thromboembolism (VTE) in Asian trauma patients and the relation to use of chemoprophylaxis with low molecular weight heparin (LMWH). The Tan Tock Seng trauma database between December 2011 and December 2012 was reviewed. All trauma patients with an injury severity score of 9 or more were included. All medical records were screened for Duplex ultrasound (US) of lower limbs, any computed tomography pulmonary angiogram (CTPA) performed and whether there was use o...
A Young Woman with Dyspnea Following Delivery- Cardiomyopathy, Pulmonary Embolism or Both?
Yonatan Gershinsky, David Leibowitz and Shaden Salameh
Article Type: Case Report | First Published: November 21, 2018
Postpartum cardiomyopathy is an important cause of heart failure in young women with an increasing rate in recent years. It may occur from the last month of pregnancy and up to five months after delivery. The etiology remains unclear and the disease has a high level of morbidity and mortality. Complications include CHF, arrhythmias, cardiogenic shock and thromboembolism. Treatment is similar to the treatment for CHF. Bromocriptine has shown encouraging preliminary results but is not standard the...
Role of Obstetric High Dependency and Intensive Care Unit in Improving Pregnancy Outcome and Reducing Maternal Mortality-A Study in Rural Central India
Surekha Tayade, Neha Gangane, Poonam Shivkumar, Dinesh Baswal, Apurva Ratnu, Himanshu Bhushan and Jaya Kore
Article Type: Research Article | First Published: November 19, 2018
To analyze the requirement of High Dependency Unit (HDU) and Intensive care Unit (ICU) in an obstetric population in terms of utilization rate, indications for admission, interventions required and gestational outcome. Retrospective observational study was carried out from October 2016 to September 2017 in Kasturba Hospital, Mother and Child Health Wing, Mahatma Gandhi Institute of Medical Sciences Sewagram placed in rural central India. Data related to indications for HDU/ICU admission, interve...
Regional Citrate Anticoagulation in Continuous Renal Replacement Therapies
Domingo Daga-Ruiz, Jonathan Pérez-Vacas, Fernando Segura-Gonzalez, Gonzalo Moratalla-Cecilia, Araceli Puerto-Morlan, Pilar Nuevo-Ortega and Alba Fernandez-Porcel
Article Type: Original Article | First Published: November 16, 2018
We designed this Observational prospective cohort study to assess the safety, effectiveness and efficiency of the introduction of Regional Citrate Anticoagulation (RCA) as election strategy for Continuous Renal Replacement Therapies (CRRT). All patients in need of CRRT without contraindications to the use of RCA were included. It was necessary to adapt and implement the original RCA protocol, for the first time in a Spanish ICU. A total of 90 patients between October 2016 and October 2017 were i...
Intravenous Subdissociative-Dose Ketamine versus Morphine for Acute Traumatic Pain in Geriatric Patients in the Emergency Department: A Case Series
Sergey Motov, Jefferson Drapkin, Antonios Likourezos, Peter Flom, Catsim Fassassi, John Marshall and Ronald Simon
Article Type: Case series | First Published: November 12, 2018
We compare analgesic efficacy and safety of sub-dissociative dose ketamine (SDK) to morphine for managing acute traumatic pain in geriatric emergency department (ED) patients. A subset of geriatric patients from a randomized double-blind trail experiencing moderate to severe acute traumatic pain who received SDK at 0.3 mg/kg or morphine at 0.1 mg/kg by short intravenous infusion over 15 minutes was analyzed at 15, 30, 60, 90, and 120 minutes post-medication administration. Primary outcome was re...
Thinking Outside the
Catsim Fassassi and Ronald Simon
Article Type: Case report | First Published: November 02, 2018
35-year-old woman with a past psychiatric history and alcohol abuse was found unresponsive on the bathroom floor by her boyfriend. EMS was called, and chest compressions were commenced by the boyfriend while awaiting EMS arrival. EMS found the patient to be in PEA and continued CPR on scene and during transport. ROSC was achieved while en route to the hospital. On arrival to the ED she was initially normotensive but quickly decompensated requiring aggressive fluid resuscitation and vasopressors....
Utility of an Emergency Department Chest Pain Protocol in Ruling Out Acute Coronary Syndrome
Shieh Mei Lai, Poongkulali Anaikatti, Pravin Thiruchelvam, Siang Chew Chai, Thon Hon Yong, Yew Seong Goh, Sheldon Lee, Rahul Goswami, Charlene Jin Yee Liew and Pak Liang Goh
Article Type: Original Article | First Published: October 12, 2018
To assess the safety and efficacy of an Emergency Department Chest Pain Protocol in ruling out Acute Coronary Syndrome in a regional hospital in Singapore. An audit was carried out of the cases admitted to our Short Stay Unit (SSU) under the Chest Pain Protocol from June to November 2014. Patients presenting with chest pain and possible acute coronary syndrome, but with normal initial electrocardiogram (ECG) and troponin level, could undergo this rule-out protocol, which comprised serial ECGs an...
Acidosis and ketonuria in an 8-Year-Old Male
Caitlin Gilman and Tanya Chadha
Article Type: Case Report | First Published: October 12, 2018
The patient is an 8-year-old Caucasian male with no significant past medical history referred to the emergency department by his pediatrician for possible appendicitis. The day prior to presentation, his mother noted decreased energy and appetite. He went to sleep soon after arriving home from school and woke up twice overnight with non-bloody, non-bilious emesis. He began complaining of right-sided back and abdominal pain in the morning and was brought to his pediatrician, where he was immediat...
The Role of Probiotics in Critically Ill Adult Patients with Pneumonia
Julie Kalabalik and Ayse Elif Ozdener
Article Type: Review Article | First Published: October 12, 2018
There is increased interest in the role of the gastrointestinal (GI) or gut microbiome and its role in prevention and treatment of disease. The gut microbiome alone consists of approximately 400 strains of bacteria, fungi, and parasites. Anaerobes are the predominant type of microorganism in the GI tract with Firmicutes and Bacteroidetes being the dominant phyla. The gut microbiome is involved in metabolism, host protection, and immune function. It plays an important role in metabolism of nondig...
Things to Keep in Mind in High Flow Therapy: As Usual the Devil is in the Detail
Salvador Diaz-Lobato, Jose Manuel Carratala Perales, Jose miguel Alonso Inigo, Sagrario Mayoralas Alises, Barbara Segovia, Noelia Escalier, Maria Ines Mattioli, Ana Jaureguizar and Diurbis Velasco
Article Type: Original Article | First Published: October 12, 2018
High-flow nasal cannula oxygen therapy (HFNC) has revolutionized the treatment of patients with respiratory failure in different settings. Several mechanisms of action explain us why HFNC has become a first line therapy for these patients. Some authors have referred to the adverse effects that can occur when we use HFNC and its limitations. However, there are numerous aspects that we should consider when prescribing this treatment and that are not documented in the literature to date. In a Task ...
Caring Critically Ill Patients in the General Wards in Tanzania: Experience of Nurses and Physicians
Lilian T Mselle and Halima Msengi
Article Type: Research Article | First Published: October 12, 2018
Studies in Tanzania have reported that many hospitals in the country have no intensive care unit (ICU) where critically ill patients could be managed thus critically ill patients are cared for with other non-critical patients. The aim of this study is to describe nurses and physicians' experience of caring critically ill patients in the general wards at the Regional hospital. A descriptive qualitative design was used. Purposeful sampling method was used to enroll 10 nurses and 5 physicians worki...
Early Protocolized Bedside Ultrasound in Shock: Renal Function Improvements and Other Lessons Learned
Talayeh Rezayat, Igor Barjaktarevic, Ian Mecham, Lisa Yee, Ramy Salah, Lisa Zhu, Kereat Grewal, Jody Anderson, Nicholas J Jackson, David Elashoff and Elizabeth Turner
Article Type: Research Article | First Published: October 06, 2018
Rapid assessment and treatment of the critically ill in shock is crucial to survival. The RUSH (Rapid Ultrasound in Shock and Hypotension) exam uses Ultrasound (US) to determine the etiology of undifferentiated shock, but data to demonstrate impact of focused US on clinical outcomes is sparse. This study aimed to assess the clinical impact of early incorporation of the RUSH US exam in the care of patients with new onset shock on a population level....
Penile Fracture: Report of Eight Cases and Review of Literatures Reported in China
Xuelu Zhou and Shangjun Zhou
Article Type: Research Article | First Published: August 29, 2018
In 113 publications 984 cases (including our eight cases) were retrieved. An annual incidence in China has been estimated between 0.002/million and 0.2/million male populations. The commonest causes were coitus and masturbation. Clinical features were the classical triad of "cracking" sound, immediate detumescence and pain. Swelling, ecchymosis and deformity were present in the majority of patients. Diagnosis was made mainly on clinical grounds; ultrasonography can be very helpful in equivocal c...
Sphingomonas Paucimobilis Bacteremia in a Hemodialysis Patient and Literature Review
Sevtap Gursoy, Kadriye Kart Yasar, N Didem Sari, Nuray Kuvat and Savas Ozturk
Article Type: Case Report | First Published: August 11, 2018
Sphingomonas paucimobilis is an aerobic, non-fermentative gram-negative motile bacterium that may be an unusual infectious agent for immunocompromised host. Intravascular instrumentations are commonly applied in the hemodialysis patients. These procedures have an increased risk for infection with unusual, rare and opportunistic pathogens....
Effects of the Miyakejima Volcano Eruption on Public Health
Mikio Shiozawa, Alan Kawarai Lefor, Naohiro Sata, Yoshikazu Yasuda and Hideo Nagai
Article Type: Original Research Article | First Published: August 06, 2018
In June 2000, the Miyakejima volcano suddenly erupted, forcing evacuation of all inhabitants. We undertook this study to evaluate the effects on the health of inhabitants after their returning to the island 4 years after the eruption. We examined 269 inhabitants, who visited the Miyakejima Central Clinic, and specifically discussed symptoms related to exposure and anxiety related to the disaster....
Clinical Characteristics and Predictors of Recurrence and Surgical Management of Pneumothorax
Chihiro Nakano, Toru Yamagishi, Norio Kodaka, Kayo Watanabe, Kumiko Kishimoto, Takeshi Oshio, Kumiko Niitsuma, Nagashige Shimada and Hiroto Matsuse
Article Type: Original Article | First Published: July 30, 2018
Most cases of pneumothorax comprise primary spontaneous pneumothorax (PSP), which usually occurs in young, tall men and results from rupture of subpleural blebs or bullae. Secondary spontaneous pneumothorax (SSP), on the other hand, is associated with an underlying lung disease, such as emphysema or asthma; acute or chronic infections; lung cancer; and congenital disease, including cystic fibrosis, catamenial pneumothorax, and lymphangioleiomyomatosis....
Clinical Profile and Outcomes of Elderly Patients in an Asian Intensive Care Unit: A Retrospective Observational Study
Shahla Siddiqui and Robin Choo
Article Type: Original Article | First Published: July 14, 2018
Over the last decade an increasing number of elderly patients are being admitted to the Intensive care units across the World. With a rapidly ageing population Asian countries face a tremendous burden of care for these patients. Family expectations have also increased with more demanding aggressive life support even in the older patients. Patients are generally getting less frail as they age and with the improvement in technology and advancements in medical science the outcomes of these patients...