Bleeding from the Nose
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Next-Generation Sequencing for Hypothesis-Free Genomic Detection
Frickmann et al. BMC Microbiology (2019) 19:75 https://doi.org/10.1186/s12866-019-1448-0 RESEARCH ARTICLE Open Access Next-generation sequencing for hypothesis- free genomic detection of invasive tropical infections in poly-microbially contaminated, formalin-fixed, paraffin-embedded tissue samples – a proof-of-principle assessment Hagen Frickmann1,2* , Carsten Künne3, Ralf Matthias Hagen4, Andreas Podbielski2, Jana Normann2, Sven Poppert5,6, Mario Looso3 and Bernd Kreikemeyer2 Abstract Background: The potential of next-generation sequencing (NGS) for hypothesis-free pathogen diagnosis from (poly-)microbially contaminated, formalin-fixed, paraffin embedded tissue samples from patients with invasive fungal infections and amebiasis was investigated. Samples from patients with chromoblastomycosis (n = 3), coccidioidomycosis (n = 2), histoplasmosis (n = 4), histoplasmosis or cryptococcosis with poor histological discriminability (n = 1), mucormycosis (n = 2), mycetoma (n = 3), rhinosporidiosis (n = 2), and invasive Entamoeba histolytica infections (n = 6) were analyzed by NGS (each one Illumina v3 run per sample). To discriminate contamination from putative infections in NGS analysis, mean and standard deviation of the number of specific sequence fragments (paired reads) were determined and compared in all samples examined for the pathogens in question. Results: For matches between NGS results and histological diagnoses, a percentage of species-specific reads greater than the 4th standard deviation above the mean value of all 23 assessed sample materials was required. Potentially etiologically relevant pathogens could be identified by NGS in 5 out of 17 samples of patients with invasive mycoses and in 1 out of 6 samples of patients with amebiasis. Conclusions: The use of NGS for hypothesis-free pathogen diagnosis from contamination-prone formalin- fixed, paraffin-embedded tissue requires further standardization. -
Pilot Study of a Nasal Airway Stent for the Treatment on Obstructive Sleep
Diso ep rde le rs S f & o T l h a e n r r a u p Hirata and Satoh, J Sleep Disord Ther 2015, 4:4 o y Journal of Sleep Disorders & Therapy J DOI: 10.4172/2167-0277.1000207 ISSN: 2167-0277 Research Article Open Access Pilot Study of a Nasal Airway Stent for the Treatment on Obstructive Sleep Apnea Yumi Hirata1* and Makoto Satoh2,3* 1Division of Sleep Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan 2International Institute for Integrative Sleep Medicine, University of Tsukuba, Japan 3Ibaraki Prefectural Center for Sleep Medicine and Sciences, Japan *Corresponding author: Makoto Satoh and Yumi Hirata, International Institute for Integrative Sleep Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan, Tel: +81 29 853 5643, fax: +81 29 853 5643; E-mail: [email protected], [email protected] Received date: May 26, 2015, Accepted date: Jun 27 2015, Published date: Jul 05, 2015 Copyright: © 2015 Hirata Y, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Study background: Obstructive sleep apnea (OSA) is a common disease characterized by repetitive upper airway obstruction during sleep. OSA is associated with an increased risk of cardiovascular morbidity. Continuous positive airway pressure (CPAP) has been established as a standard therapy for OSA, but it is not always tolerated by OSA patients. Objective: In a pilot study, we evaluated the therapeutic effects of the nasal airway stent (NAS), a new nasopharyngeal device placed in the nasopharynx, on OSA and snoring. -
Inhalation of “Borax”
Journal of Paediatrics and Neonatal Disorders Volume 4 | Issue 1 ISSN: 2456-5482 Case Report Open Access Inhalation of “Borax” and Risk of Severe Stridor Obaid O* Department of Pediatrics, MOH, Makkah, Saudi Arabia *Corresponding author: Obaid O, Department of Pediatrics, MOH, Makkah, Saudi Arabia, Tel: 00966500606352, E-mail: [email protected] Citation: Obaid O (2019) Inhalation of “Borax” and Risk of Severe Stridor. J Paedatr Neonatal Dis 4(1): 105 Received Date: March 21, 2019 Accepted Date: June 26, 2019 Published Date: June 28, 2019 Abstract Stridor in children is not uncommon reason to visit emergency department and usually due to croup but inhalation of toxic substance may cause severe stridor which is uncommon. Keywords: Stridor; Pediatric; Sodium Burate Case Report A 9 year old Saudi girl presented to emergency department accompanied by her grandmother with history of dry cough, shortness of breath and audible wheeze for more than12 hours. She has no history of fever, foreign body ingestion and chronic cough. No history of contact with sick person and no history of lip swelling or skin rash. Her vaccination status up to date. She was a Preterm 30 weeks, admitted to Neonatal intensive care for 2 months and discharge well. In emergency room she was ill looking with biphasic stridor, kept on oxygen 10 liter/min and given one dose IM epinephrine 0.3 mg and nebulizer Racemic epinephrine, connected to Cardiorespiratory monitor and 2 IV lines was inserted started on IV Fluids and given one dose of dexamethasone. Urgent consultation to ENT was done and they recommend bronchoscopy to rule out Foreign body ingestion. -
Management of Airway Obstruction and Stridor in Pediatric Patients
November 2017 Management of Airway Volume 14, Number 11 Obstruction and Stridor in Authors Ashley Marchese, MD Department of Pediatrics, Yale-New Haven Hospital, New Haven, CT Pediatric Patients Melissa L. Langhan, MD, MHS Associate Professor of Pediatrics and Emergency Medicine; Fellowship Director, Director of Education, Pediatric Emergency Abstract Medicine, Yale University School of Medicine, New Haven, CT Peer Reviewers Stridor is a result of turbulent air-flow through the trachea from Steven S. Bin, MD upper airway obstruction, and although in children it is often Associate Clinical Professor of Emergency Medicine and Pediatrics; Medical Director, Emergency Department, UCSF School of Medicine, due to croup, it can also be caused by noninfectious and/or con- Benioff Children’s Hospital, San Francisco, CA genital conditions as well as life-threatening etiologies. The his- Alexander Toledo, DO, PharmD, FAAEM, FAAP tory and physical examination guide initial management, which Chief, Section of Pediatric Emergency Medicine; Director, Pediatric Emergency Department, Arizona Children’s Center at Maricopa includes reduction of airway inflammation, treatment of bacterial Medical Center, Phoenix, AZ infection, and, less often, imaging, emergent airway stabilization, Prior to beginning this activity, see “Physician CME Information” or surgical management. This issue discusses the most common on the back page. as well as the life-threatening etiologies of acute and chronic stridor and its management in the emergency department. Editor-in-Chief -
The Nosebleed Feeling
February 2018 Academic Emergency Medicine Editor-in-Chief Pick of the Month The Nosebleed Feeling This month, I chose a paper about nosebleeds. (May I proffer from the outset, that I am avoiding the word “picked”). I admit that the problem of bleeding noses does not generate the enthusiasm of an ED thoracotomy, nor have the public health importance of opiate use. But what if I told you that your next patient is an unhappy bounce back epistaxis on Plavix? You are thinking “B-but, the other side has open beds!” Admit it. Nosebleeds are a pain for everyone. Especially the poor patient. That sentiment is why I picked--I mean, chose--the paper by Zahed et al, and why I also asked Michael Runyon to write a commentary about this paper (Topical tranexamic acid for epistaxis in patients on antiplatelet drugs: a new use for an old drug). The work by Zahed et al, may accomplish something that few papers do, and that is prompt an actual change in practice for a few folks. At the least, this paper should get your attention for a minute. Well, maybe it won’t get your attention. Maybe you’ve never experienced the nosebleed feeling. The nosebleed feeling is the dark sensation that creeps up inside you, as you witness the world’s worst parade. The world’s worst parade is led by the triage nurse, who strolls by first, holding paperwork in hand like a baton, glancing the rueful “you are screwed” glance your way. Marching onward to room 36, on your side of course, with the sorrowful procession in tow. -
Please Check All the Symptoms That Apply for the Past 3-6 Months. Patient Name
Review of Systems: Please check all the symptoms that apply for the past 3-6 months. Constitutional: Gastrointestinal: Dermatologic: o Loss of appetite o Blood in stool o Significant sun o Chills o Change in bowel habits exposure/sun burns o Fever o Difficulty swallowing o Change in moles o Weight gain o Abdominal pain o New skin lesions o Weight loss o Nausea o Night sweats o Vomiting Neurologic: Ophthalmologic: o Diarrhea o New headaches o Loss of vision o Constipation o Weakness on one side o Double vision o Gas and bloating o Seizures o Jaundice Ears, Nose & Throat: o Heartburn Psychological: o Nosebleed o Belching o Emotional abuse o Snoring o Stool incontinence o High stress level o Postnasal drip o Physical abuse o Hearing loss Urologic: o Sexual abuse o Voice changes o Difficulty urinating o Sleep disturbances o Blood in urine o Are you a worrier Cardiac: o Urinary urgency o Depression o Chest pain with activity o Painful urination o Do you feel anxious o Leg swelling o Frequent urination o Shortness of breath while o Recurrent urinary tract infections Endocrine: sleeping o Fatigue o Shortness of breath with Breast: o Heat intolerance activity o Breast lump o Racing heart o Chest pain o Nipple Discharge o Cold intolerance o Palpitations o Nipple inversion o Mammogram Allergy: Respiratory: o Sinus congestion o Chest pain with breathing Female Reproductive: o Stuffy nose o Shortness of breath o Sexually active o Itchy eyes o Cough o Regular periods LMP_________ o Runny nose o Wheezing o Irregular periods o Scratchy throat o Hot flashes o Decrease sex drive Hematologic\Lymphatic: Musculoskeletal: o Painful intercourse o Joint pain o Mood disturbances o Blood clots o Muscle pain o Excessive bleeding o Bone pain Male Reproductive: o Hepatitis exposure o Joint swelling o Difficulty with erection o HIV risk\exposure o Decrease sex drive o MRSA infections o Recent antibiotics o anemia o Swollen glands Patient name:___________________________________________________DOB:________________ Today’s date:____________________ . -
Information for the User FROVEX 2.5 Mg Film-Coated Tablets
Package leaflet: Information for the user If you have any doubt about taking other medicines with FROVEX 2.5 mg tablets, consult your doctor or pharmacist. FROVEX 2.5 mg film-coated tablets frovatriptan FROVEX with food and drink FROVEX 2.5 mg tablets can be taken with food or on an empty stomach, always with Read all of this leaflet carefully before you start taking this medicine because it an adequate amount of water. contains important information for you. - Keep this leaflet. You may need to read it again. Pregnancy and breast-feeding - If you have any further questions, ask your doctor or pharmacist. If you are pregnant or breast-feeding, think you may be pregnant or are planning to - This medicine has been prescribed for you only. Do not pass it on to others. It may have a baby, ask your doctor or pharmacist for advice before taking this medicine. harm them, even if their signs of illness are the same as yours. FROVEX 2.5 mg tablets should not be used during pregnancy or when breast feeding, - If you get any side effects, talk to your doctor or pharmacist. This includes any unless you are told so by your doctor. In any case, you should not breastfeed for 24 possible side effects not listed in this leaflet. See section 4. hours after taking FROVEX and during this time any breast milk expressed should be discarded. What is in this leaflet: 1. What FROVEX is and what it is used for Driving and using machines 2. What you need to know before you take FROVEX FROVEX 2.5 mg tablets and the migraine itself can cause drowsiness. -
Sporothrix Schenckii: ➢ Thermal Dimorphic
Subcutaneous mycoses ➢1-Mycetoma ➢2-Sporotrichosis ➢3-Chromoblastomycosis ➢4-Rhinosporidiosis ➢5- Lobomycosis ➢6- Entomophthoramycosis Sporotrichosis Rose gardener’s disease Chronic desease Agent Sporothrix schenckii: ➢ Thermal dimorphic ➢ In soil ➢ On decaying vegetation,plants,plant products (hay, straw, sphagnum moss), and a variety of animals (cats) ➢ less than 37° C (hyphal) ➢ 37° C (yeast) ➢ Sporothrix brasiliensis ➢ Sporothrix globosa Epidemiology ➢Worldwide ➢Tropical regions ➢Mexico ➢Brazile ➢France ➢USA Occupational disease: ➢Farmers ➢ ➢Workers ➢Gardeners ➢Florists Predisposing factors: ➢Trauma ➢Inhalation (very rarely) ➢HIV Clinical Syndromes 1-lymphocutaneous 2-Fixed cutaneous 3- Osteoarticular involvement 4-Pulmonary 5-Systemic Primary infection 1-Lymphocutaneous sporotrichosis 2-Fixed cutaneous sporotrichosis: Fixed cutaneous sporotrichosis verrucous-type sporotrichosis localized cutaneous type Paronychia sporotrichosis Osteoarticular involvement Pulmonary sporotrichosis: ➢Alcoholic ➢Pulmonary tuberculosis, diabetes mellitus and steroid ➢A productive cough ➢Low-grade fever ➢Weight loss Systemic sporotrichosis Transmission: ➢Dog bite ➢parrot bite ➢Insects bite ➢Cases of animal-to-human transmission Laboratory Diagnosis: 1-Collection of samples: ➢Drainage from skin lesions ➢Exudates ➢Pus ➢Blood ➢Pulmonary secretions ➢Tissue biopsy specimens 2-Direct examination ➢Gram ➢PAS ➢GMS ➢H & E ❖Yeast Cells ❖Asteroid body: Elongated Buds (“Cigar Body”) Wet Mount BHI Blood 37˚C Yeast with Elongated Daughter Cell Biopsy of subcutaneous tissue -
Boards' Fodder
boards’ fodder Medical Mycology By Adriana Schmidt, MD, and Natalie M. Curcio, MD, MPH. (Updated July 2015*) SUPERFICIAL ORGANISM CLINICAL HISTO/KOH TREATMENT MYCOSES* Pityriasis Malessezia furfur Hypo- or hyper-pigmented Spaghetti & meatballs: Antifungal shampoos and/or versicolor macules short hyphae + yeast PO therapy Tinea nigra Hortaea werneckii (formerly Brown-black non-scaly Branching septate hyphae Topical imidazoles or palmaris Phaeoannellomyces werneckii) macules + budding yeast allylamines Black piedra Piedraia hortae Hard firm black Dark hyphae around concretions acrospores Cut hair off, PO terbinafine, White piedra Trichosporon ovoides or inkin Soft loose white Blastoconidia, imidazoles, or triazoles (formely beigelii) concretions arthroconidia Fluorescent small Microsporum Canis KOH: spores on outside spore ectothrix: M. audouinii of the hair shaft; “Cats And Dogs M. distortum Wood’s lamp --> yellow Sometimes Fight T. schoenleinii fluorescence & Growl” M. ferrugineum+/- gypseum Large spore Trichophyton spp. (T. tonsurans in North America; T. violaceum in KOH: spores within hair Topical antifungals; PO endothrix Europe, Asia, parts of Africa). shaft antifungals for T. manuum, Tinea corporis T. rubrum > T. mentag. Majocchi’s granuloma: T. rubrum capitis, unguium T. pedis Moccasin: T. rubrum, E. floccosum. Interdigital/vesicular: T. mentag T. unguium Distal lateral, proximal and proximal white subungual: T. rubrum. White superficial: T. mentag. HIV: T. rubrum SUBQ MYCOSES** ORGANISM TRANSMISSION CLINICAL HISTO/KOH TREATMENT -
The Hematological Complications of Alcoholism
The Hematological Complications of Alcoholism HAROLD S. BALLARD, M.D. Alcohol has numerous adverse effects on the various types of blood cells and their functions. For example, heavy alcohol consumption can cause generalized suppression of blood cell production and the production of structurally abnormal blood cell precursors that cannot mature into functional cells. Alcoholics frequently have defective red blood cells that are destroyed prematurely, possibly resulting in anemia. Alcohol also interferes with the production and function of white blood cells, especially those that defend the body against invading bacteria. Consequently, alcoholics frequently suffer from bacterial infections. Finally, alcohol adversely affects the platelets and other components of the blood-clotting system. Heavy alcohol consumption thus may increase the drinker’s risk of suffering a stroke. KEY WORDS: adverse drug effect; AODE (alcohol and other drug effects); blood function; cell growth and differentiation; erythrocytes; leukocytes; platelets; plasma proteins; bone marrow; anemia; blood coagulation; thrombocytopenia; fibrinolysis; macrophage; monocyte; stroke; bacterial disease; literature review eople who abuse alcohol1 are at both direct and indirect. The direct in the number and function of WBC’s risk for numerous alcohol-related consequences of excessive alcohol increases the drinker’s risk of serious Pmedical complications, includ- consumption include toxic effects on infection, and impaired platelet produc- ing those affecting the blood (i.e., the the bone marrow; the blood cell pre- tion and function interfere with blood cursors; and the mature red blood blood cells as well as proteins present clotting, leading to symptoms ranging in the blood plasma) and the bone cells (RBC’s), white blood cells from a simple nosebleed to bleeding in marrow, where the blood cells are (WBC’s), and platelets. -
L121 Session: L193 It Is Just a Nosebleed Isn't
Session: L121 Session: L193 It Is Just a Nosebleed Isn’t It? Anesthetic Considerations for Unsuspected Pulmonary Hypertension Shu Ming Wang, M.D. University of California Irvine Medical Center, Orange, CA Disclosures: This presenter has no financial relationships with commercial interests Stem Case and Key Questions Content A 6 year-old girl presents for emergency examination under anesthesia and control of epistaxis. History of present illness: The patient has uncontrolled epistaxis. What are the common causes of epistaxis? Past medical history: The patient has no significant medical history. Mom states that the patient has frequent nosebleeds that are easily stopped, but not this time. Mom also adds that the patient does not eat much, and usually is not very active because she gets tired easily. Is it common behavior for a 6 year-old child? Patient’s mom states that they recently immigrated to the United States. She was seen by pediatrician in the clinic 2 months prior and referred for further evaluation by a heart specialist because of murmur. Does every child with heart murmur required cardiologist consultation and evaluation? If not, who should be referred? Who should not. The appointment is scheduled in two weeks. The rest of the medical history is unremarkable, except that the patient has missed school due of inability to clear persistent cold. What are the common reasons for a child hard to recover from URI? Pre-op holding: Patient is tearing and clinging to her mom. Blood streak over lower face, bloody tissues and bloodstained clothing noted in the OR holding. The anesthesiologist attempts to perform a physical examination, but the child traumatized by previous attempts is extremely uncooperative, and now there is more bleeding. -
Supraglottoplasty Home Care Instructions Hospital Stay Most Children Stay Overnight in the Hospital for at Least One Night
10914 Hefner Pointe Drive, Suite 200 Oklahoma City, OK 73120 Phone: 405.608.8833 Fax: 405.608.8818 Supraglottoplasty Home Care Instructions Hospital Stay Most children stay overnight in the hospital for at least one night. Bleeding There is typically very little to no bleeding associated with this procedure. Though very unlikely to happen, if your child were to spit or cough up blood you should contact your physician immediately. Diet After surgery your child will be able to eat the foods or formula that they usually do. It is important after surgery to encourage your child to drink fluids and remain hydrated. Daily fluid needs are listed below: • Age 0-2 years: 16 ounces per day • Age 2-4 years: 24 ounces per day • Age 4 and older: 32 ounces per day It is our experience that most children experience a significant improvement in eating after this procedure. However, we have found about that approximately 4% of otherwise healthy infants may experience a transient onset of coughing or choking with feeding after surgery. In our experience these symptoms resolve over 1-2 months after surgery. We have also found that infants who have other illnesses (such as syndromes, prematurity, heart trouble, or other congenital abnormalities) have a greater risk of experiencing swallowing difficulties after a supraglottoplasty (this number can be as high as 20%). In time the child usually will return to normal swallowing but there is a small risk of feeding difficulties. You will be given a prescription before you leave the hospital for an acid reducing (anti-reflux) medication that must be filled before you are discharged.