We present the case of a 42-year-old male cirrhotic chronic alcoholic who was admitted during the height of the COVID pandemic with a large right pleural effusion. Thorough investigation revealed a large right-sided distal esophageal rupture near the gastroesophageal junction and he was diagnosed with Mallory Weiss tear converted to Boerhaave’s syndrome. He successfully underwent endoscopic placement of a covered esophageal stent, but had a protracted recovery with presumed empyema continuing to require chest tube drainage. He eventually required surgical intervention with a right thoracotomy, decortication, and wash out. Our case provides an excellent example of the risk of distraction during a global pandemic secondary to nonspecific symptomatology being attributed to COVID-19 and significant critical care requirements leading to a significant delay in diagnosis of an esophageal rupture. However, our patient is also uniquely impressive when compared to similarly published cases of Mallory Weiss conversion to Boerhaave’s Syndrome given his survival with excellent clinical outcome leading to discharge home on oral diet despite his increased risk of morbidity based on his prolonged critical illness disease course.
We discuss a case of a 58 year old male who presented for left upper extremity steal syndrome including ischemic monomelic neuropathy (IMN) 1.5 months after arteriovenous fistula creation. He presented after three surgical attempts to salvage his fistula with rest pain, complete loss of function with contracture of the 4th and 5th digits, and loss of sensation in the ulnar distribution for more than three weeks. At our institution, he underwent surgical ligation of the distal fistula and creation of a new fistula proximally, resulting in complete resolution of his vascular steal symptoms almost immediately despite the chronicity prior to surgical presentation. Our patient provides a unique perspective regarding dialysis access salvage versus patient quality of life. The patients’ functional status and pain levels should take precedence over salvage of an arteriovenous access site, and early ligation of the access should be completed prior to chronic IMN development. However, if a patient presents late along the IMN course, we recommend strong consideration of access ligation in order to attempt to regain the full neurovascular function of the extremity as we experienced in our patient.
Background The media play a critical role in informing the public about the pandemic. International travel is a highly contested subject in the media during the COVID-19 pandemic at both the international and national levels. We examined Canadian media reporting on international travel restrictions during the pandemic, how these restrictions aligned with the IHR (2005), and how the narrative around international travel evolved for the pandemic.MethodsWe analysed Canada’s top three national newspapers by circulation, namely – The Globe and Mail, The National Post and The Toronto Star, published between Jan 1, 2020 - May 31, 2020. Our search yielded a total of 378 articles across the three newspapers. Upon removing duplicates and screening the remaining articles, we included a total of 62 articles for the analysis. We conducted a qualitative media content analysis by using the inductive coding approach.ResultsThree major themes were identified within the articles. These included: 1) The role of scientific and expert evidence in implementing travel restrictions; 2) Federal legislation, regulations and enforcement of international travel measures; and 3) Compliance with WHO guidelines in travel restriction policy- and decision-making. The federal government relied on scientific evidence for implementing international travel restrictions. The federal government fully exercised its powers under the Quarantine Act to enforce travel regulations and comply with the IHR (2005). The government embraced rules-based international order by following WHO recommendations on international travel, contributing to delaying border closure and travel restrictions until mid-March.Conclusion The media focussed significantly on international travel related issues during the early phase of pandemic. The dominant media narrative remained the need for earlier travel restrictions against international travel.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.