INTRODUCTION: Wünderlich syndrome (WS) is a rare presentation of hypovolemic hemorrhagic shock. It is a fatal disease described as a syndrome of spontaneous non-traumatic subcapsular and retroperitoneal hemorrhage. The etiology of WS is varied, with renal causes including malignancy being the most common, followed by renal vasculature abnormalities, vasculitis, cystic rupture, pyelonephritis, and idiopathic. The appropriate treatment depends on the accuracy of diagnosis and precise determination of its cause. To our knowledge, this is the first case report of WS due to acute pyelonephritis in a patient with congenital solitary kidney and Jehovah's Witness religious beliefs which impacted his care.
Background: Seasonal influenza is a respiratory illness caused by the influenza virus. During the 2017-2018 flu season, the Centers for Disease Control and Prevention noted approximately 959,000 hospitalizations and 79,400 deaths from influenza. We sought to evaluate the educational quality of informational videos pertaining to seasonal influenza on the popular social media forum, YouTube. Methods: Using the keywords "seasonal influenza," all videos from 28 January to 5 February 2017 were included and analyzed for characteristics, source, and content. The source was further classified as healthcare provider, alternativemedicine provider, the patient and/or their parents, company, media, or professional society. Videos about other categories of influenza (e.g. swine or Spanish) or in foreign languages were excluded. A total of 10 blinded reviewers scored each video independently. Results: Overall, 300 videos were analyzed, with a median of 341.50 views, 1.00 likes, 0 dislikes, and 0 comments. Based on the average scores of videos by source, there was statistically significant difference in the average score among videos by video source (p < 0.01). Healthcare provider videos had the highest mean scores whereas alternative medicine provider videos had the lowest. Conclusions: Although the aforementioned video sources scored higher than others, these videos did not fulfill our criteria as far as educating patients thoroughly. Our data also suggest alternative medicine and patient source videos were misleading for patients. Clinical implications: Although videos by healthcare providers were a better source of information, videos on seasonal influenza were shown to be poor sources of valid healthcare information. This study reiterates the need for higher-quality educational videos on seasonal influenza by the medical community.
We describe the case of a 62-year-old female who presented with gradually progressing abdominal distension and dyspnea. Computed tomography (CT) chest and abdomen revealed large bilateral pleural effusions with large ascites, a mid-abdominal mass, and peritoneal carcinomatosis. Pleural and peritoneal tap revealed chylous fluid, and the biopsy findings from abdominal mass were consistent with follicular lymphoma. We then discuss a review of the literature and diagnoses for bilateral chylothorax and chylous ascites.
Knowledge Attitude PracticesTaenia solium a b s t r a c t Background: Taenia solium cysticercosis is one of the commonest, but potentially eradicable,
Serious complications from bronchoalveolar lavage (BAL) are uncommon but have been reported. The most common complications of BAL include transient hypoxemia, post-BAL fever, bronchospasm, increased pulmonary infiltrate and rarely pneumothorax. We present a case of a ruptured lung abscess leading to necrotizing pneumonia, a rare but serious complication of BAL. 60-year-old male with history of polysubstance, tobacco and chronic alcohol abuse, hypertension, diabetes, liver cirrhosis and chronic right middle lobe lesion requiring hospitalization and prolonged antibiotics few months ago presented to the hospital with two days of hemoptysis and right-sided chest pain. A computed tomography angiography (CTA) chest ruled out a pulmonary embolism but showed worsening right middle (RML) and upper lobe (RUL) cavitary lesions. Bronchoscopy and BAL with 90cc of normal saline revealed blood oozing from the RML with mucosal thickening and cultures grew Klebsiella pneumoniae. Few hours after the procedure, the patient had worsening respiratory symptoms, a Chest x-ray showed a total right lung white out. Subsequently, CTA chest revealed hydropneumothorax and increased pleural effusion. Chest tube was inserted and later he underwent a right thoracoscopic decortication with wedge resection. The patient was started on 4 weeks of IV antibiotic with cefazolin and metronidazole, he was discharged soon after. Guidelines for approaching to cavitary lesions diagnosis are lacking. Bronchoalveolar lavage is commonly performed as the first line of investigation for most of pulmonary diseases with abnormal imaging findings. Though BAL is overall considered a safe procedure, rarely a severe complication may arise. Although most complications are related to extent of lavaged lung area, volume and tempreture of instilled fluid, it is difficult to determine the risk factors that predispose to the rupturing of cavitary disease from BAL due to its rarity. Our patient had an extended period with untreated cavitary disease. The chronicity of the cavitary disease may be one risk factor as spontaneous cavitary rupture has been associated with delayed diagnosis and treatment. Performing BAL with lesser volume of instilled fluid and applying gentle negative pressure to aspirate fluid might decrease the complications although there are no significant data supporting this.
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