In this global health case study, we describe a case of nicotine addiction due to chronic use of electronic cigarettes (e-cigarette) and discuss the beliefs on safety and awareness of their side effects. Many people believe that smoking an e-cigarette (vaping) does not have any side effects, especially among teenagers and young adults. Teenagers using an e-cigarette at a young age are twice as likely to try cigarettes later in their life because of nicotine dependency or other social factors. More recent studies have shown long-term systemic side effects of vaping regardless of traditional cigarette smoking history. This report was done for further assessing their risk and to clear out misconceptions of this large-scale condition.
DesCripTionA 19-year-old male patient presented to the emergency room with dyspnoea and severe retrosternal chest pain. The patient's medical history is significant for cerebral palsy with spastic tetraplegia. He layed in a semirecumbent position as pain was severe on lying down. The pain radiated to the back, neck and shoulder. Pain was associated with gastro-oesophageal reflux disease and dysuria. On examination, he was breathless, and lungs were clear to auscultation. On auscultating over the heart, pericardial rub was heard. Abdomen was tender on palpation and he did not defecate for 2 days. He had a history of recurrent pneumonia that needed frequent hospital admissions and currently receiving treatment as the last episode was 1 month ago.ECG showed widespread concave ST elevation and PR depression with reverse changes in aVR of ST depression and PR elevation with sinus tachycardia suggesting early stage of pericarditis. Sputum culture was negative. Chest X-ray was done (figure 1) and revealed an area of previous pneumonia in the right lung and enlarged left border of heart, which was not definitive of pericarditis because of the rotational effect of his scoliosis, but raised the need for further investigation into the presumptive diagnosis of pericarditis. C reactive protein was elevated on laboratory investigation. Transthoracic echo was not significant besides that all other findings met the criteria for the diagnosis of pericarditis, that is, at least two from (1) characteristic chest pain, (2) pericardial rub, (3) ECG changes (widespread ST elevation and/or PR depression) and (4) new pericardial effusion. While examining the X-ray further, the most remarkable finding was the presence of large intestine loops between the liver and diaphragm, which was previously undiagnosed.
A novel coronavirus was identified at the end of 2019, causing a pneumonia epidemic in China, which later rapidly spread to cause a global pandemic. However, most people who contracted the COVID-19 had mild to moderate symptoms. A fair percentage developed ARDS, Septic shock, and multi-organ failure. Given the necessity of immunization in combating this disease, COVID-19 vaccines were widely deployed, giving rise to multiple reported cases of post-vaccination autoimmune flareups and new onset of autoimmune phenomena. We present a case of an 81-year-old female who was diagnosed with erosive arthritis post COVID-19 vaccination.
Coronavirus disease 2019 (COVID-19) has caused significant morbidity and mortality in a vast majority of the patient population, especially those with malignancies. Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults and is often an indolent disease. High white blood cell counts greater than 120 k/cumm in chronic lymphocytic leukemia may be implicated in cases of COVID-19. Hyperleukocytosis leads to falsely elevated potassium levels due to cell fragility. Pseudohyperkalemia occurs when elevated potassium is present due to potassium movement out of cells during or after a blood sample is drawn. Pseudohyperkalemia may be suspected when elevated potassium is present in asymptomatic patients with no corresponding electrocardiogram findings. The authors present a case of hyperleukocytosis and pseudohyperkalemia in a patient whose COVID-19 infection unmasked CLL.
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