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An uncommon gastrointestinal bleeding in a patient with portal vein thrombosis: a case report and literature review

Published on: 5th May, 2023

Portal vein thrombosis (PVT) is a rare condition that may congest bowel venous drainage and cause mesenteric ischemia. In acute settings, gastrointestinal bleeding (GIB) is rare, and acute abdominal pain is the most common clinical presentation. A 24-year-old man who presented with acute abdominal pain and a single episode of hematemesis is reported. Workups revealed evidence of thrombosis in the portal vein, but upper endoscopy was incapable to detect the source of the bleeding. We discuss the possible scenarios for the GIB in this case and review similar reports in the literature.
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Refractory priapism associated with anti-psychotics. Report of a case for risperidone

Published on: 8th May, 2023

Priapism is a prolonged erection, usually painful, that occurs in the absence of sexual desire or stimulation, is not relieved by masturbation or intercourse and is the consequence of a mismatch in the regulatory mechanisms that initiate penile erection and those that allow its detumescence. One of the main causes of low-flow priapism is the use of drugs with an α-adrenergic antagonist effect, among which antipsychotic drugs stand out. Our objective is to present a clinical case and review the literature on the use of antipsychotics in medicine, psychiatry and other specialties and their relationship with the dose of the psychoactive drug in the onset of priapism. We present a 23-year-old male patient, single, with a significant history of mild Autism, for which he has received regular treatment with 6 mg daily of risperidone. He started experiencing priapism spontaneously for the last 4 days until a family member took him to the Emergency Room – intense, persistent and painful penile erection. Given the failure of the initial medical treatment for priapism, it was decided to perform multiple distal cavernous-cancellous shunts with improvement after 72 hours and discharge of the patient. We understand that there is a high affinity of antipsychotics for the α 1-adrenergic receptor, risperidone has an α 1 antagonist capacity. In fact, the third cause of priapism cases induced by atypical antipsychotics is secondary to risperidone, including recent cases associated with its parenteral depot presentation RisperdalConsta®.
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Haemodynamic, Biochemical and Respiratory Implications of total Bronchoalveolar Lavage in Pulmonary Alveolar Proteinosis

Published on: 17th June, 2023

Introduction: Total bronchoalveolar lavage (BAL) continues to be the treatment of choice for alveolar proteinosis (AP), facilitating the removal of lipoprotein material. The purpose of this article is to evaluate the impact of haemodynamic, biochemical, and respiratory parameters, as well as the complications and evolution of patients undergoing this procedure. Methods: Retrospective, observational, and descriptive study of BAL. The technique was performed in the Intensive Care Unit. Blood gases, blood pressure, central venous pressure, body temperature, and fluid balance were analyzed. Results: Including eight patients, thirty-eight BAL were performed from 2008 to 2021. The mean instillation of saline at each session was 13.464 ± 4.002 ml per lung. No significant changes were observed before and after BAL in heart rate and blood pressure. Mean central venous pressure increased by 2.59 cm H20. The pO2 initial was 126 mmHg with a final mean of 69.7 mmHg, with statistical significance. The pCO2, HCO3 and pH parameters remained stable. Complications were observed during fifteen of the thirty-eight BAL (nine with arterial hypotension, three with glottic oedema, one acute pulmonary oedema, one pneumothorax, and one cardiorespiratory arrest). In terms of evolution, one case had a clinical-radiological resolution, one case of exits, one required lung transplantation, and the remaining five remained stable. Conclusion: This study demonstrates that the procedure, is well tolerated haemodynamically and that the biochemical alterations to which the patient is subjected are not compromised. With few complications and good results in delaying the progression of AP.
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Electronic Health Record in the ICU: An Essential Need in the Modern Era

Published on: 27th July, 2023

One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). Despite incentives that provide reimbursements to hospitals and healthcare providers for adopting EHR technology, there is a large number of barriers that preclude its implementation. EHR has a great impact on a variety of healthcare outcomes, mainly favoring its use. Consequently, the development of effective implementation strategies is essential in modern healthcare society.
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latrogenic Pneumothorax Caused by Thoracic Puncture Secondary to Anti-aging Medicine

Published on: 27th July, 2023

Introduction: Pneumothorax is defined as air in the pleural cavity, the iatrogenic cause happens after invasive procedures as thoracic needle aspiration, central line placement, pacemaker placement, etc. Nevertheless, it is possible to be found in non-medical procedures, such as alternative medicine, more specifically acupuncture. There are medications used against aging that FDA has warned to be used only in its first objective, an example is procaine hydrochloride.Case: A 63 y/o female, Mexico City resident, with anxiety, came to a follow-up appointment for an aging cohort, where CT, PFT, and laboratories are made for pulmonary healthy subjects to investigate normal lung aging and how other environmental factors can affect the lungs; at physical examination, we did not find any pleuropulmonary syndrome, but in the CT a left Iatrogenic pneumothorax was found; we re-asked for antecedents and she described that 15 days before the date she had 2 punctures in the middle clavicular line to apply procaine hydrochloride as an anti-aging treatment.Discussion: There is diverse evidence of adverse effects associated with acupuncture, and even if pneumothorax has a small percentage of incidence, in some cases it can be severe and can even cause fatalities.Conclusion: The pneumothorax in this case was iatrogenic due to the thoracic puncture for an anti-aging treatment, with a total resolution with conservative treatment, however we as health professionals have the responsibility to inform our patients that initiatives of administration ways can cause important complications.
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Bipolar and Goldenhar: A Case Report of Bipolar Disorder with Psychotic Features in a Man with Goldenhar Syndrome

Published on: 24th August, 2023

Background: Goldenhar syndrome is a congenital condition primarily affecting eye, ear, and spine development. In some cases, it can also impact the heart, lungs, kidneys, and central nervous system. The exact cause of Goldenhar syndrome is not fully understood, and its incidence is estimated to range from 1 in 3500 to 1 in 5600 live births. While intellectual disability is associated with the condition, no established link exists between Goldenhar syndrome and psychiatric disorders.Case presentation: In the presented case, a patient with Goldenhar syndrome has been diagnosed with an episode of mania with psychotic features in the context of bipolar disorder. The patient had no history of prior mental disorders and had an independent life.Discussion: There are few case reports of Goldenhar syndrome patients with mental disorders. In all instances, including our own case, patients exhibited psychotic features during psychiatric examinations.Conclusion: Based on the studies cited and our own research, it is recommended to further investigate the potential association between this syndrome and psychiatric disorders.The following sections provide details on the examination, medical history, and treatment of this patient.
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