Τρίτη 6 Απριλίου 2021

Symptomatic Emergency Department Patients Should Undergo Empirical Therapy for Gonorrhea/Chlamydia Regardless of Testing

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Neisseria gonorrhoeae and Chlamydia trachomatis are the 2 most commonly diagnosed and reported sexually transmitted infections in the United States.1 Among men, these infections cause urethritis and epididymitis. Among women, they cause cervicitis and urethritis, although most infected patients are asymptomatic.2 Antibiotics readily cure urethritis, cervicitis, and pelvic inflammatory disease, and early treatment of these infections prevents transmission and complications. All emergency department (ED) patients with presentations consistent with N gonorrhoeae or C trachomatis should undergo empirical therapy rather than test-based treatment.
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Bridging Oceans and Thrombolysis

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Zi W, Qiu Z, Li F, et al. Effect of endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke: the DEVT randomized clinical trial. JAMA. 2021;325:234-243.
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Young Man with Odynophagia

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A 30-year-old man presented to the emergency department with throat pain and oral intolerance of fluids for several hours. Earlier that day, an outpatient operation was aborted after multiple unsuccessful intubation attempts in the operating room. The patient had unremarkable vital signs, noting only odynophagia. Computed tomography (CT) of the neck and an esophagram with water-soluble contrast were acquired.
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Highlighting the Concepts of Local Exhaust Ventilation in Negative-Pressure Rooms

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We think the letter by Braude and Femling1 pointed out that negative-pressure rooms are not absolutely safe for health care professionals. The authors briefly mention that negative pressure and air exchanges will not make the room much safer owing to aerosolized particles that are generated continuously.
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Elderly Man With Chest Pressure

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A 78-year-old man was rushed to the emergency department (ED) from an outpatient computed tomography (CT) imaging suite with complaints of chest pressure. He was noted to have a pulse of 62 beats/min and blood pressure of 197/101 mm Hg, and was breathing 20 times a minute with an oxygen saturation of 100% with 15 L of oxygen through a nonrebreather mask. While he was undergoing CT imaging, an abnormality was discovered within the right ventricle (Figure 1).
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Man With Seizure

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A 42-year-old male patient presented to the emergency department (ED) because of syncope and headache. The physical examination result was normal. Blood pressure was 90/60 mm Hg, and other vital signs were in normal limits. He had tonic-clonic seizures in the ED, which ended spontaneously. Point-of-care ultrasonography was performed to assess the patient's volume status, and internal jugular veins were also examined (Figure 1, Video). Computed tomography (CT) imaging was obtained to exclude other differential diagnoses (Figure 2).
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A Woman with Out-of-hospital Cardiac Arrest

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A 55-year-old woman with Parkinson's disease presented to the emergency department with out-of-hospital cardiac arrest at home. The paramedics arrived 7 minutes after the cardiac arrest, and cardiopulmonary resuscitation (CPR) was initiated. Initial rhythm was asystole. She was transported to the hospital by ambulance 29 minutes after the cardiac arrest and received a single dose of epinephrine in transit. After intubation, transesophageal echocardiography was performed while the chest compression point was at the internipple line (Figure 1 and Video E1, available online at http://www.annemergmed.com).
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Man With Syncope

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A 74-year-old man with hypertension presented to the emergency department after a syncopal episode. His pulse rate was 55 beats/min and other vital signs were normal. Physical examination result was normal. His ECG was initially interpreted as having a 2-second sinus pause (Figure). Cardiac troponin and electrolyte levels were normal. The emergency physician performed point-of-care ultrasonography to assess the relationship between atrial and ventricular contractions (Video).
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Man With Fever and Groin Mass

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A 54-year-old man with a history of hypertension, hyperuricemia, and dyslipidemia presented to the emergency department (ED) with fever and a mass in the left side of the groin since 3 days earlier. One month before presenting to the ED, he received a diagnosis of a urinary tract infection and was treated with oral antibiotics. On arrival in the ED, he was well oriented and had a temperature of 38.1°C and 100.58 °F. Physical examination revealed a firm, tender, longitudinal mass over the left side of the groin (Figure 1).
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High prevalence of methotrexate use in patients with Epstein–Barr virus-positive mucocutaneous ulcer may cause confounding bias

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Modern Pathology, Published online: 23 March 2021; doi:10.1038/s41379-021-00798-7

High prevalence of methotrexate use in patients with Epstein–Barr virus-positive mucocutaneous ulcer may cause confounding bias
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Inflammatory rhabdomyoblastic tumor with progression to high-grade rhabdomyosarcoma

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Modern Pathology, Published online: 23 March 2021; doi:10.1038/s41379-021-00791-0

Inflammatory rhabdomyoblastic tumor with progression to high-grade rhabdomyosarcoma
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Toward a unifying entity that encompasses most, but perhaps not all, inflammatory leiomyosarcomas and histiocyte-rich rhabdomyoblastic tumors

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Modern Pathology, Published online: 24 March 2021; doi:10.1038/s41379-021-00797-8

Toward a unifying entity that encompasses most, but perhaps not all, inflammatory leiomyosarcomas and histiocyte-rich rhabdomyoblastic tumors
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PDGFB RNA in situ hybridization for the diagnosis of dermatofibrosarcoma protuberans

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Modern Pathology, Published online: 24 March 2021; doi:10.1038/s41379-021-00800-2

PDGFB RNA in situ hybridization for the diagnosis of dermatofibrosarcoma protuberans
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