As healthcare professionals continue to combat the coronavirus disease 2019(COVID-19)infection worldwide,there is an increasing interest in the role of imaging and the relevance of various modalities.Since imaging not...As healthcare professionals continue to combat the coronavirus disease 2019(COVID-19)infection worldwide,there is an increasing interest in the role of imaging and the relevance of various modalities.Since imaging not only helps assess the disease at the time of diagnosis but also aids evaluation of response to management,it is critical to examine the role of different modalities currently in use,such as baseline X-rays and computed tomography scans carefully.In this article,we will draw attention to the critical findings for the radiologist.Further,we will look at point of care ultrasound,an increasingly a popular tool in diagnostic medicine,as a component of COVID-19 management.展开更多
BACKGROUND Kratom is a psychoactive substance that is isolated from the plant Mitragyna speciosa.The leaves can be chewed fresh or dried,smoked,or infused similar to herbal teas.The plant leaves have been used by nati...BACKGROUND Kratom is a psychoactive substance that is isolated from the plant Mitragyna speciosa.The leaves can be chewed fresh or dried,smoked,or infused similar to herbal teas.The plant leaves have been used by natives of Southeast Asia for centuries.The substance has been used for its stimulant activity at low doses,and as an opium substitute at higher doses due to a morphine like effect.CASE SUMMARY A 37-year-old female with a history of depression and obesity(body mass index:32)presented to emergency room with a week-long history of nausea,decreased appetite,fatigue,and two days of jaundice.On admission bilirubin was markedly elevated.Her condition was thought to be due to consumption of Kratom 2 wk before onset of symptoms.Liver biopsy showed changes mimicking primary biliary cholangitis.Patient’s symptoms and jaundice improved quickly.CONCLUSION The use of Kratom has been on the rise in recent years across the United States and Europe.Several case reports have associated adverse health impact of Kratom-containing products including death due to its ability to alter levels of consciousness.Only a few case reports have highlighted the hepatotoxic effects of Kratom.Even fewer reports exist describing the detailed histopathological changes.展开更多
Hyperglycemia is commonly associated with adverse outcomes especially in patients requiring intensive care unit stay.Data from the corona virus disease 2019(COVID-19)pandemic indicates that individuals with diabetes a...Hyperglycemia is commonly associated with adverse outcomes especially in patients requiring intensive care unit stay.Data from the corona virus disease 2019(COVID-19)pandemic indicates that individuals with diabetes appear to be at similar risk for COVID-19 infection to those without diabetes but are more likely to experience increased morbidity and mortality.The proposed hypothesis for hyperglycemia in COVID-19 include insulin resistance,critical illness hyperglycemia(stress-induced hyperglycemia)secondary to high levels of hormones like cortisol and catecholamines that counteract insulin action,acute cytokine storm and pancreatic cell dysfunction.Diabetic patients are more likely to have severe hyperglycemic complications including diabetic ketoacidosis and hyperosmolar hyperglycemic state.Management of hyperglycemia in COVID-19 is often complicated by use of steroids,prolonged total parenteral or enteral nutrition,frequent acute hyperglycemic events,and restrictions with fluid management due to acute respiratory distress syndrome.While managing hyperglycemia special attention should be paid to mode of insulin delivery,frequency of glucose monitoring based on patient and caregiver safety thereby minimizing exposure and conserving personal protective equipment.In this article we describe the pathophysiology of hyperglycemia,challenges encountered in managing hyperglycemia,and review some potential solutions to address them.展开更多
As we continue to fight against the current coronavirus disease-2019(COVID-19)pandemic,healthcare professionals across the globe are trying to answer questions surrounding how to best help patients with the up-to-date...As we continue to fight against the current coronavirus disease-2019(COVID-19)pandemic,healthcare professionals across the globe are trying to answer questions surrounding how to best help patients with the up-to-date available science while awaiting the development of new therapies and mass vaccination.Since early in the pandemic,studies indicated a heightened risk of venous thromboembolism(VTE)in COVID-19 infected patients.There have been differing expert opinions about how to assess pretest probability of VTE in this patient population.This has been partly due to the high prevalence of respiratory failure in this patient population and the use of D-dimer as a prognostic test which is also frequently elevated in patients with COVID-19 in absence of VTE.Some experts have argued for an approach similar to usual care with testing if clinical suspicion is high enough.Some have argued for more routine screening at different points of care.Others have even suggested empiric therapeutic anticoagulation in moderate to severely ill COVID-19 patients.In the following article,we review and summarize the most current literature in hopes of assisting clinicians in decision making and guidance for when to be concerned for VTE in COVID-19 patients.We also discuss research gaps and share pathways currently being used within our institution.展开更多
文摘As healthcare professionals continue to combat the coronavirus disease 2019(COVID-19)infection worldwide,there is an increasing interest in the role of imaging and the relevance of various modalities.Since imaging not only helps assess the disease at the time of diagnosis but also aids evaluation of response to management,it is critical to examine the role of different modalities currently in use,such as baseline X-rays and computed tomography scans carefully.In this article,we will draw attention to the critical findings for the radiologist.Further,we will look at point of care ultrasound,an increasingly a popular tool in diagnostic medicine,as a component of COVID-19 management.
文摘BACKGROUND Kratom is a psychoactive substance that is isolated from the plant Mitragyna speciosa.The leaves can be chewed fresh or dried,smoked,or infused similar to herbal teas.The plant leaves have been used by natives of Southeast Asia for centuries.The substance has been used for its stimulant activity at low doses,and as an opium substitute at higher doses due to a morphine like effect.CASE SUMMARY A 37-year-old female with a history of depression and obesity(body mass index:32)presented to emergency room with a week-long history of nausea,decreased appetite,fatigue,and two days of jaundice.On admission bilirubin was markedly elevated.Her condition was thought to be due to consumption of Kratom 2 wk before onset of symptoms.Liver biopsy showed changes mimicking primary biliary cholangitis.Patient’s symptoms and jaundice improved quickly.CONCLUSION The use of Kratom has been on the rise in recent years across the United States and Europe.Several case reports have associated adverse health impact of Kratom-containing products including death due to its ability to alter levels of consciousness.Only a few case reports have highlighted the hepatotoxic effects of Kratom.Even fewer reports exist describing the detailed histopathological changes.
文摘Hyperglycemia is commonly associated with adverse outcomes especially in patients requiring intensive care unit stay.Data from the corona virus disease 2019(COVID-19)pandemic indicates that individuals with diabetes appear to be at similar risk for COVID-19 infection to those without diabetes but are more likely to experience increased morbidity and mortality.The proposed hypothesis for hyperglycemia in COVID-19 include insulin resistance,critical illness hyperglycemia(stress-induced hyperglycemia)secondary to high levels of hormones like cortisol and catecholamines that counteract insulin action,acute cytokine storm and pancreatic cell dysfunction.Diabetic patients are more likely to have severe hyperglycemic complications including diabetic ketoacidosis and hyperosmolar hyperglycemic state.Management of hyperglycemia in COVID-19 is often complicated by use of steroids,prolonged total parenteral or enteral nutrition,frequent acute hyperglycemic events,and restrictions with fluid management due to acute respiratory distress syndrome.While managing hyperglycemia special attention should be paid to mode of insulin delivery,frequency of glucose monitoring based on patient and caregiver safety thereby minimizing exposure and conserving personal protective equipment.In this article we describe the pathophysiology of hyperglycemia,challenges encountered in managing hyperglycemia,and review some potential solutions to address them.
文摘As we continue to fight against the current coronavirus disease-2019(COVID-19)pandemic,healthcare professionals across the globe are trying to answer questions surrounding how to best help patients with the up-to-date available science while awaiting the development of new therapies and mass vaccination.Since early in the pandemic,studies indicated a heightened risk of venous thromboembolism(VTE)in COVID-19 infected patients.There have been differing expert opinions about how to assess pretest probability of VTE in this patient population.This has been partly due to the high prevalence of respiratory failure in this patient population and the use of D-dimer as a prognostic test which is also frequently elevated in patients with COVID-19 in absence of VTE.Some experts have argued for an approach similar to usual care with testing if clinical suspicion is high enough.Some have argued for more routine screening at different points of care.Others have even suggested empiric therapeutic anticoagulation in moderate to severely ill COVID-19 patients.In the following article,we review and summarize the most current literature in hopes of assisting clinicians in decision making and guidance for when to be concerned for VTE in COVID-19 patients.We also discuss research gaps and share pathways currently being used within our institution.
