#Case report

[emgoesmed]

5/3/2023

I’m studying before clinic this morning at this cute cafe I found. Then I’ll go to my school’s poster session this afternoon. A solid Thursday schedule ☺️

[megachirottera]

Il secolo di prove che i vaccini causano morti infantili

C’è un secolo di prove che collegano i vaccini alla morte infantile improvvisa e numerosi attivisti hanno cercato di costringere il governo federale a indagare per decenni Source: 24 ago 2022; by A Midwestern Doctor on The Forgotten Side of Medicine Continue reading Untitled

[wizard-laundry]

QUICK REMINDER

In the US: threatening government officials is a felony under federal law (the president in particular is protected under 18 U.S.C. § 871). Even memes.

be careful with your jokes if they spill over to active officials.

[indigo6f00ff]

need to share an experience i had 30 minutes ago

(edit: thanks to @walks-the-ages for providing and reminding me to put alt text, sorry it slips my mind alot lol)

[ikiprian]

Mr. Fenton is a competent teacher. Almost too competent.

If Mr. Daniel Fenton had any more than a BS (with a minor in education), Tim would’ve flagged his profile as a potential Rogue. That’s the way of most charismatic academics, at least in Gotham. (Got a PhD? Instant watchlist.) Instead, he’s Gotham Academy’s newest celebrity, as a young, passionate, out-of-towner substitute while the chemistry teacher’s on maternity leave.

Tim gets the hype. Fenton seems to genuinely love teaching, and is invested in the welfare of the student body. He hands out bananas during exam week, hosts a “study habits seminar” each month to coach effective learning strategies, and the third time Tim falls asleep in his class, he even pulls Tim aside to ask if he’s doing okay. With all the late work he accepts and the protein bars he sneaks Tim, he’s every teen vigilante’s dream teacher. He could’ve been Tim’s favorite.

In fact, Mr. Fenton was Tim’s favorite. Up until Tim walks into Mr. Fenton’s chemistry classroom for a forgotten textbook, an hour after the final bell.

On the board where tallied scores for today’s review game had been kept, “THE CHEMISTRY BEHIND DR. CRANE’S FEAR GAS: ANXIOGENICS, NERI’S, & YOU,” is now scrawled. A detailed diagram of the human endocrine system projects in front of a small crowd of adoring and attentive students.

Fenton is wrist-deep in the skull cavity of an anatomical model. A short tug, and out pops the brain.

It’s plastic. It’s fake.

Tim identifies the nearest emergency exit.

Fenton turns to the door, and in the dark classroom with the projector illuminating half his face, his eyes almost seem to flash red. “What’s up, Tim?” he asks. His friendly grin is too big for his face. “I didn’t know you wanted to join the Just Science League!”

[OR: Danny’s a science teacher at Tim’s school. Gotham’s a pretty wild place, even for someone who grew up a superhero in a ghost-infested town, so he takes it upon himself to start a club teaching kids how to manage themselves in the event of a crisis. These Gothamites are pretty hardy, but a little extra training never hurt anybody! And he suspects one of his students might be a teen vigilante, like he’d been, back in the day. As a senior super, it's Danny’s duty look out for him! Surely, this is the subtlest and most appropriate way to give the kid pointers.]

[Tim immediately assumes supervillain.]

[ijcimr]

Combined cervical laceration and bladder rupture: a case report of an unusual complication of precipitated labor by Dr Fatemeh Darsareh in International Journal of Clinical Images and Medical Reviews 

Abstract

Cases of bladder rupture have been rarely reported following vaginal childbirth. To the best of our knowledge, however, no cases of combined cervical laceration and bladder rupture have been reported to date. We present the first case of a 31-year-old woman with gestational diabetes who suffered a combined cervical laceration and bladder rupture after childbirth. Precipitated labor caused by oxytocin induction resulted in vaginal and cervical lacerations. The bladder rupture was confirmed by cystography. A team of obstetricians and urologists performed the laparotomy. The patient was kept under observation for two weeks before being discharged with no serious complications.

Keywords: Bladder rupture; Cervical lacerations; Precipitated labor; Childbirth trauma; Case report.

Introduction

Spontaneous bladder rupture following normal vaginal delivery is a surgical postpartum emergency. Previous cesarean section, vacuum/forceps-assisted vaginal deliveries, and distended bladder compressed by engaged head in birth canal are all risk factors for bladder injuries in healthy parturient women 1. Cases of bladder rupture, accompanied by uterine rupture, have been rarely reported following vaginal birth after cesarean section 2. To the best of our knowledge, however, no cases of combined cervical laceration and bladder rupture have been reported to date. We present the first case of spontaneous bladder rupture with cervical laceration after a precipitated vaginal delivery.

Case Presentation

A 31-year-old, G2P1L0D1, woman with gestational diabetes, was admitted to our maternity ward at 38 weeks of pregnancy for elective induction of labor to terminate her pregnancy.  She had a history of preterm birth and was a known case of minor thalassemia. The induction of labor began at 5:00 a.m. with oxytocin, and contractions began approximately two hours later. Table 1 depicts the progress of labor. During her labor, the patient urinated once. Finally, at 10:40 a.m., she gave birth to a baby boy weighing 3700 grams with an Apgar score of 7/9.  Excessive vaginal bleeding was observed following placental expulsion. The examination revealed an extensive laceration in the vagina and cervix that was repaired by the obstetrician and midwife. The patient was catheterized and was being closely monitored. A urologist was consulted due to the oliguria and hematuria (100 cc output with gross hematuria within 5 hours of childbirth). Cystography, as recommended by the urologist, revealed the bladder rupture. The patient was prepared for a laparotomy immediately. The laparotomy was performed by a team of obstetricians and urologists. Several hematomas were discovered in the uterine body and the broad ligament that the team decided not to manipulate because it did not grow during the surgery. A bladder rupture was found at the dome of bladder that was repaired in two layers. One pack cell unit and two FFP units were transfused. A peritoneal drain was placed posterior to the bladder and the skin incision was closed in layers. The patient was observed for two weeks. The result of the ultrasound revealed the shrinking of the hematoma. The blood and renal tests were normal. The catheter was removed after 2 weeks and the patient was discharged.

Table 1: The progress of labor

Discussion

Precipitate labor is defined as the expulsion of the fetus within three hours of the start of contractions. Few studies have found that precipitated labor is harmful to both the mother and the newborn. Precipitated labor, which is most commonly associated with placental abruption and induction of labor, is a significant risk factor for maternal complications 3. Maternal morbidities reported included extensive birth canal lacerations, uterine rupture, placenta retention, the need for revision of uterine cavity, post-partum hemorrhage, and blood transfusions 3,4. The lower urinary tract's anatomic proximity to the reproductive tract predisposes it to iatrogenic injury during obstetric procedures. The bladder and lower ureter are two of the most commonly involved organs. Because the dome of the bladder is the weakest area, most bladder ruptures occur through the peritoneal cavity 5. In our case, in addition to deep vaginal tears and extensive cervical laceration, bladder rupture occurred, but the diagnosis was delayed by a few hours. Given the nonspecific clinical features of bladder rupture, the diagnosis should be approached with caution. Oliguria and gross hematuria after a traumatic childbirth increase the likelihood of bladder rupture. In such cases, a cystogram is thought to be the best method for early detection.

In our case the patient had induced labour with oxytocin. The use of oxytocin to induce labour can result in tachy-systole and thus shorter deliveries. So in our case we believe that the power of uterine contractions and quick descent of passenger (3700 grams fetus) were the main risk factors of precipitated labour and the complications accompanied with it. A distended bladder during labor, particularly in our case, where the fetus descended quickly, could also be a factor in bladder rupture. Although the patient urinated normally during labor, it was critical to ensure that the bladder was empty, especially during the active phase of labor, to avoid bladder damage.

CONCLUSIONS

Bladder and cervical rupture should be considered, after precipitated vaginal delivery. When there is gross hematuria, a urinary catheter should be inserted to monitor the hematuria and urine output. If the hematuria persists and other associated symptoms appear, cystography is a useful tool for determining the severity of the bladder injury and determining the cause.

Funding

This study received no specific funding from public, commercial, or not-for-profit funding agencies.

Conflict of Interest

Authors had no conflicts of interest to declare.

Patient consent

Obtained.

For more details: https://ijcimr.org/editorial-board/ 

[hinamie]

every so often i have to relearn how to draw yuuji or he starts fighting me

[emgoesmed]

4/10/2023

Despite 4 days off from the hospital I still feel so tired 🥲

Spent the mini vacation decorating the apartment, assembling furniture, dog sitting, and submitting a poster for my school’s poster day.

Today’s another busy day, with early morning rounds in the hospital followed by driving almost an hour to another site to take a practical exam.

Wish me luck!

[casestudies-crimson]

Non-genetically Editing Dysbiotic Microbiome Using Probiotic-specific Prebiotics for Treatments of Human Skin Diseases_Crimson publishers

Abstract

External interruption in the balance of microbes in the microbiome can lead to a dysbiotic microbiome which has been linked to a variety of human diseases. Antibiotics have been widely used for treatments of infectious diseases in humans, but they are generally not pathogen specific and run a risk of yielding antibiotic-resistant microbes. Inappropriate use of antibiotics may disrupt the homeostasis of human microbiome, causing dysbiotic microbiome and abolishing natural and self-curative of human body. Here, we review a new approach by using bacterial specific prebiotics to amplify the fermentation activity of probiotic bacteria against pathogens and keep the microbiome balanced for optimal health. The pros and cons of using skin prebiotic as a new modality for improvement of skin health are compared to other treatments including antibiotics, vaccines, bacteriophages, genetically modified/engineering bacteria and live skin probiotic bacteria.

Read More About this Article: https://crimsonpublishers.com/aics/fulltext/AICS.000538.php

Read More Crimson Publishers Google Scholar Articles: https://crimsonpublishers.com/aics/

[carriesthewind]

"Reviewers told the report’s authors that AI summaries often missed emphasis, nuance and context; included incorrect information or missed relevant information; and sometimes focused on auxiliary points or introduced irrelevant information. Three of the five reviewers said they guessed that they were reviewing AI content.

The reviewers’ overall feedback was that they felt AI summaries may be counterproductive and create further work because of the need to fact-check and refer to original submissions which communicated the message better and more concisely."

Fascinating (the full report is linked in the article). I've seen this kind of summarization being touted as a potential use of LLMs that's given a lot more credibility than more generative prompts. But a major theme of the assessors was that the LLM summaries missed nuance and context that made them effectively useless as summaries. (ex: “The summary does not highlight [FIRM]’s central point…”)

The report emphasizes that better prompting can produce better results, and that new models are likely to improve the capabilities, but I must admit serious skepticism. To put it bluntly, I've seen enough law students try to summarize court rulings to say with confidence that in order to reliably summarize something, you must understand it. A clever reader who is good at pattern recognition can often put together a good-enough summary without really understanding the case, just by skimming the case and grabbing and repeating the bits that look important. And this will work...a lot of the time. Until it really, really doesn't. And those cases where the skim-and-grab method won't work aren't obvious from the outside. And I just don't see a path forward right now for the LLMs to do anything other than skim-and-grab.

Moreover, something that isn't even mentioned in the test is the absence of possibility of follow up. If a human has summarized a document for me and I don't understand something, I can go to the human and say, "hey, what's up with this?" It may be faster and easier than reading the original doc myself, or they can point me to the place in the doc that lead them to a conclusion, or I can even expand my understanding by seeing an interpretation that isn't intuitive to me. I can't do that with an LLM. And again, I can't really see a path forward no matter how advanced the programing is, because the LLM can't actually think.

[lilidawnonthemoon]

[wishfulsketching]

Mind yo own business, Harvey!

(are those open-plan cells really the best idea?)

[pubricas]

Mothers with Mental Health Issues Involved in Child Welfare

Many moms with mental health problems get caught up in the child welfare system and fear having their children taken away from them. This study intended to determine the common mental health difficulties among mothers and their children in child abuse cases initiated for investigation. With numerous potentially confounding variables maintained constant, a strong link was discovered between maternal mental health concerns and child maltreatment investigation outcomes. Support for moms with mental health concerns requires a wide range of multidisciplinary treatments. Effective mental health treatment is important, but it isn't enough. Trauma healing, social relationship building, and poverty alleviation are all important. Systemic advocacy is required to guarantee that women with mental health concerns can access a wide range of services.

Introduction

The mental disease affects people of all ages, jobs, levels of education, socioeconomic status, cultures and Food and Nutraceuticals. Mental illness will touch most people at some time in their lives, whether through a family member, a friend, or a coworker. According to the US Surgeon General's Report on Mental Health, over 20% of the adult population suffers from a diagnosable mental condition each year (US Department of Health and Human Services). Many moms have mental health problems, including but not limited to those with psychiatric diagnoses. These women endure various obstacles that may influence their ability to parent. Many people take other stresses in addition to their condition, such as poverty, social isolation, and a lack of support. Substance misuse and domestic violence can exacerbate the difficulties that these women endure. Despite these difficulties, many of these mothers find enormous joy and pleasure in their roles, citing enhanced self-esteem and favorable effects on their mental health.

Child Welfare Investigation

Child protection authorities are more likely to examine parents with mental health difficulties than parents without mental health concerns. For 4,827 Medicaid-eligible women between the ages of 15 and 45, data from the Medicaid eligibility and claims system in Philadelphia was integrated with data from the child welfare system from 1995 to 2000. Mothers with a mental health diagnosis were nearly three times as likely as mothers without a diagnosis to have engaged with the child welfare system after adjusting for various potentially confounding characteristics such as race and age.

The core data for the Incidence Study of Reported Child Abuse and Neglect was collected. The study had three goals:

(1) to look into the prevalence of mothers with mental health issues in child maltreatment investigations in Canada;

(2) to profile cases involving mothers with mental health issues, including alleged maltreatment type, child, caregiver, and family/household risk factors; and

(3) to look into the outcomes of child protection investigations involving mothers with mental health issues. The investigating medical data collection child protection professional's evaluation and other information available, such as whether the mother had a verified mental health diagnosis and was receiving mental health care, were used to specify maternal mental health concerns. Child factors such as age, sex, aboriginal status, language, and functional impairments (i.e., physical, cognitive, emotional, and behavioral disorders) are predictor variables. Caregivers' risk factors include childhood maltreatment, drug and alcohol abuse, social isolation/lack of social supports, and domestic violence exposure; household socioeconomic characteristics, such as household structure, maternal educational attainment, employment, income, and housing; and child protection concern/s, such as alleged maltreatment type.

Source and Reason for Referral

There was no primary source of referrals to child welfare authorities for children whose mothers had mental health problems. 19 distinct sources, including families, friends/neighbors, doctors, and mental health experts. The 'police' and school were the most prevalent referral sources. The police and the school referred 22.1 and 18.9 %  of all referrals to child welfare agencies involving mothers with mental health difficulties. The kid was the source of referral in 1.4 percent of cases. Recommendations were made for a variety of reasons. In 59.8% of instances involving mothers with mental health difficulties, suspected mistreatment was the initial cause for referral. In another 14.8 % of cases, domestic violence was the primary cause for referral. 

Child Protection Concerns

Neglect (47 percent) and physical abuse (47 %) were the most prevalent child safety concerns in situations involving moms with mental health disorders (32 %). In instances involving moms with mental health concerns, neglect and emotional mistreatment allegations were substantially more prevalent than in other cases. For example, maternal mental health difficulties tend to raise the likelihood of reported emotional abuse by more than double. On the other hand, physical and sexual abuse allegations were far less prevalent in these situations.

Household Socioeconomic Characteristics

Mothers with mental health disorders were over-represented on all indices of household socioeconomic disadvantage. Almost half of the women with mental health concerns (49%) were single mothers, and nearly half (48%) did not have a high school diploma. More than half of the moms with mental health concerns (63 %) had low earnings (under $24,999), and more than one in five lived in social/public housing or shelters.

Caregiver Risk Factors

Few social supports (64 %), drug and alcohol use (60%), maltreatment as a child (50 %), and marital violence were the most frequent caregiver risk factors in instances involving mothers with mental health concerns, in that order (48 % ). Each of the six caregiver risk variables was more prevalent in situations involving moms with a mental illness.

Child Welfare Investigation

Outcomes 62 % of inquiries involved moms with mental health difficulties, and 44 % of all other instances found maltreatment. After adjusting for claimed maltreatment type, child, caregiver risk, and household socioeconomic variables, maternal mental health difficulties were a significant predictor of substantiation. Only concerns with child functioning and domestic violence were more powerful predictors of substantiation.

This exploratory review showed that nearly one in every five child abuse investigations includes moms diagnosed with mental health concerns. Furthermore, the study shows that these moms and their children have distinct outcomes: mistreatment is more likely to be proven, their children are more likely to be removed, their cases are more likely to be kept open, and they are more likely to file a court application. Consistent with previous research, significant links were found between maternal mental health issues, socioeconomic disadvantage (lower educational attainment, low income, public housing, low employment), and other caregiver risk factors such as exposure to domestic violence and fewer social supports. The differences in results reported in this study were somewhat explained by these various disadvantages, but not entirely: The adjusted odds ratios are significantly higher.

Conclusion

Overall, the conclusions of this study indicate that mothers with mental health disorders are involved in a significant minority of all child maltreatment instances investigated in Canada. Furthermore, the research reveals that these moms are virtually always confronted with a slew of environmental and personal issues, which may exacerbate the difficulty they already encounter in living with their disease while balancing their parental responsibilities. The demands of these moms are frequently distinct from those of other mothers, and many of these requirements result from environmental, societal, and personal circumstances that are typically exclusive to this group of women. Early intervention is critical, and it should focus on assisting these women in effectively managing their illnesses and symptoms and giving them the tools needed to ease their suffering.

References

Black, T., Trocme´, N., Fallon, B., & MacLaurin, B. (2008). The Canadian child welfare system response to exposure to domestic violence investigations. Child Abuse and Neglect, 32, 393–404.

Brunt, C. C. (2004). Parental psychiatric disorder and the law: The American case. In M. G}opfert, J. Webster, & M. V. Seeman (Eds.), Parental psychiatric disorder: Distressed parents and their families (pp. 257–270). Cambridge: Cambridge University Press.

Diaz-Caneja, A., & Johnson, S. (2004). The views and experiences of severely mentally ill mothers. Social Psychiatry and Psychiatric Epidemiology, 39, 472–482.

Westad, Callie, and David McConnell. "Child welfare involvement of mothers with mental health issues." Community mental health journal 48.1 (2012): 29-37.

[jcrmhscasereports]

Aspiration pneumonia due to anesthesia digestive endoscopy under COVID-19: a case report by Xin Wang in Journal of Clinical Case Reports Medical Images and Health Sciences

ABSTRACT

Background: Digestive endoscopy is an important test for early cancer screening. The most serious complication during the examination was aspiration pneumonia. However, these patients currently do not receive much attention.

Case report: A woman was brought to the Emergency Department because of fever. Chest computed tomography revealed consolidation of the lower left lung, so the patient was diagnosed with aspiration pneumonia after anesthesia digestive endoscopy. we collected Bronchoalveolar lavage (BALF) for testing of metagenomic next generation sequencing (mNGS). The result of mNGS was normal. After 7 days of medical treatment, the pneumonia subsided.

Conclusion: This case reminded us that digestive endoscopy under sedation carried a risk of aspiration pneumonia in even healthy patients. When COVID-19 prevalent, we should make a definitive diagnosis of patients with fever as soon as possible and improve etiological tests to prevent delays.

Keywords: Aspiration pneumonia, Digestive endoscopy, Case report

INTRODUCTION

Digestive endoscopy is an important test for early cancer screening. As the test is uncomfortable so more and more people choose general anesthesia. The most serious complication during the examination was aspiration pneumonia due to reflux and aspiration.

However, these patients do not currently attract much attention, especially from anesthesiologists. Here, we report a healthy nurse who had undergone digestive endoscopy, aspiration pneumonia developed during induction of general anesthesia under COVID-19.

CASE REPORT

A woman was brought to the Emergency Department of the Center Hospital of Jinan because of fever. She got aspirated and developed severe shortness and chest pain. History of anesthesia digestive endoscopy 1 day ago, accompanied by vomiting. Her past medical history was unremarkable, she denied cigarette smoking, and has no history of allergy, anaphylaxis or bronchial asthma. Upon arrival at the hospital, she was connected to the monitor and put on humidified oxygen. On examination, she was severely distressed, blood pressure of 120/60mmHg, pulse rate of 108 beats per minute, oxygen saturation of 95% at room air, and respiratory rate of 26 breaths per minute, temperature of 39 degrees. On physical examination, wet rales were heard in the lower left lung. Blood gas analysis showed pH 7.45, partial pressure of carbon- dioxide 36.00 mmHg and partial pressure of oxygen 71.00 mmHg with 2 L/min oxygen via nasal cannula. The peripheral white blood cell count (9940/μL) and C-reactive protein level (78.5mg/h) were slightly high. The results of blood coagulation function test, biochemistry tests, myocardial enzymes, urinalysis and stool analysis were normal. Chest computed tomography revealed consolidation of the lower left lung. (Fig. 1)

Under COVID-19, in order to rule out the atypical pathogen infection and assist the patient in expulsion of inhaled substances, we performed tracheoscopy. Flexible bronchoscope showed injured and edematous surfaces of the large airways. Bronchoalveolar lavage was performed from the posterior segmental bronchus of the upper lower of her left lung. A cell count of the bronchoalveolar lavage fluid (BALF) revealed57.5% macrophages, 28.0% neutrophils, 11.0% lymphocytes, and 3.5% eosinophils. The total BALF cell count was 4.2 × 106/mL. No bacteria or fungus was isolated from cultures of BALF. we collected BALF for testing of metagenomic next generation sequencing (mNGS). The result of mNGS was normal.

During hospitalization, the patient received piperacillin/ tazobactam to prevent bacterial pneumonia，hormonal anti-inflammatory and bronchodilators to improve the bronchospasm or wheezing.

After 7 days of medical treatment, the pneumonia subsided, blood, sputum cultures revealed negative findings. and she was discharged in a stable condition. The Fig. 2 was the chest CT of review.

DISCUSSION

The possibility of aspiration pneumonia was considered based on the rapid onset of the patient, the absence of previous upper respiratory infection and chest CT findings. The patient's clinical manifestations, chest CT and hematological examination results further confirmed the hypothesis. The patient's symptoms improved after early treatment with oxygen therapy, anti-infection and hormone anti-inflammatory therapy, which was also consistent with previous research results (1).

Chest CT of aspiration pneumonia often shows multifocal consolidation or patchy ground-glass opacity (2). Because the patient was in left decubitus at the time of digestive endoscopy, so gastric contents flowed back into the left side, then large exudate shadows can be seen in the lower lobe of the left lung. We all know, Aspiration of large amounts of gastric acid will result in the induction of a chemical injury to the airways and lung parenchyma. Aspiration is recognized as an independent risk factor for the subsequent development of pneumonia or acute lung injury or acute respiratory distress syndrome (ALI/ARDS). (3)

Our patient developed dyspnea and hypoxemia. In order to prevent further exacerbation of lung injury, we treated with hydrocortisone. The other study suggested that, in bronchi-aspiration, Steroids are not proven to improve outcome or reduce mortality (4). After hormone therapy, the patient's symptoms of dyspnea and hypoxemia were significantly improved. There were any adverse reactions. However, it remains to be discussed whether hormones can be used as a routine treatment for aspiration pneumonia.

Conflict of interest statement

All authors have read and approve the final manuscript.

Author contribution statement    

Wang Jing wrote the manuscript, conceived and designed the report; Cui JY collected and prepared the images; Wang X reviewed and confirmed the final version of the manuscript.

Ethics statement

The authors declare that appropriate written informed consent was obtained for the publication of this manuscript and accompanying images.

For more information: https://jmedcasereportsimages.org/about-us/

For more submission : https://jmedcasereportsimages.org/

[contusmpublications]

[hoofpeet]

Our ex landlord owes us 3 times the security deposit we paid him lmaooooo get FUCKED💥💥💥💥💥💥💥💥💥💥💥💥💥