#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)

[marvelsmostwanted]

Today in 🍂✨October surprises✨🍂

• Secretary of Transportation Pete Buttigieg and Secretary of Labor Julie Su quietly assisted in winning labor rights for dockworkers, ending a strike that could have had catastrophic economic consequences. (10-4-24)

• In Springfield, Ohio, where Haitian migrants have been blamed for the disappearance of local animals with Trump claiming “‘migrants are walking off�� with geese in the town” and “they’re eating the dogs” - a lie also promoted by JD Vance, Ohio’s own sitting Senator, with no evidence - it turns out that the missing geese were actually the victims of a 64-year-old white man who was hunting illegally. (10-3-24)

• A Trump-appointed federal judge blocked Biden’s student loan forgiveness plan again after another judge reinstated it earlier this week. (10-3-24)

• Republicans and crazy Facebook uncles everywhere have spent this week spreading disinformation about the FEMA response to Hurricane Helene, including AI photos of Trump standing in floodwater and wild claims that Biden is sending money to undocumented immigrants. In reality, the Biden-Harris administration has provided substantial emergency assistance and both Biden and Harris have visited the region. Meanwhile, it turns out that Trump was the one who redirected money from disaster relief to send to ICE during his presidency. Shocker. (10-4-24)

• Seriously, though, Trump is not who you want to call in an emergency. Before allowing disaster relief to reach victims of wildfires in California, then-president Trump forced aides to show him an electoral map to see if he had voters there. He evidently intended to withhold the aid if he found out it was going to mostly Democratic voters. This would be a career-ending scandal in any other political era but alas, we are living in this one. (10-3-24)

• Finally, far-right extremist and Oklahoma superintendent of schools Ryan Walters intends to put Bibles in public schools, which is already disturbing, but in a stunning display of corruption, the only ones that meet his specifications are the so-called “Trump Bibles” that include the Constitution and Declaration of Independence. They go for $60 apiece and Trump gets fees from each one. (10-4-24)

No, wait, I’m going to say that one again:

In Oklahoma, taxpayers’ money will be used to put Trump Bibles in public schools. Their money will go directly to Trump. Not a joke!!! Not an exaggeration!!!

…Surely the voters who are still undecided are lying, right?? Right?!

30 days until Election Day.

Go to vote.org for a sample ballot, early voting dates, and more. Seriously, we have to win.

[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!

[forgettable-au]

END OF CHAPTER ONE

FORGETTABLE-AU (Page 65-72)

* Time to put this puzzle together.

[BEGINNING] [PREVIOUS] [CONTINUE]

[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/

[charlietheepicwriter7]

another misunderstandings au

Vlad goes slowly insane in space after Phantom Planet. He's finally snapped and is completely willing to kill both Jack and Maddie to get Danny where he wants him. He doesn't stay in space, eventually returning to the Zone and setting up shop in another dimension (DC Bludhaven; becoming a shady businessman once again) while keeping an eye on Danny.

Danny is having a great time. His family accepts him, he's a known hero, he's almost an adult. Sure, Dani destablized, but with his parents help he managed to save her! ...As a toddler. Then Clockwork dropped a deaged evil future self (as a baby) for him to raise. So it's not all great.

Then Vlad attacks. Everyone who Danny knows dies except for little Dani and Dan, and Vlad kidnaps him to a new dimension, where no one can help him. I can see Vlad not really recognizing the members of this new dimension as real and therefore, not a real threat. Danny is trapped in the penthouse bc of a ghost shield specific to his ecto-signature and forced to play house with an extremely unstable vlad who's willing to threaten the babies in order to force him to comply.

Then Vlad goes missing and Dick Grayson is assigned to the case

[lilidawnonthemoon]

[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.

[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/

[wishfulsketching]

Mind yo own business, Harvey!

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