Extreme Thrombocytosis Resulting from Minimally Invasive Foot Surgery with Forefoot Necrosis: A Rare Case Report
Cuervas-Mons Manuel, Alvarez Baena Lucia, Garcia Ruano Angela and Arnal Burro Javier
Article Type: Case Report | First Published: September 19, 2019
Essential thrombocythemia is a chronic myeloproliferative syndrome characterised by excessive proliferation of platelets and megakaryocytes, with a relatively favourable course. We present a case of extreme thrombocytosis resulting from minimally invasive foot surgery with forefoot necrosis. A 72-year-old female patient presented with hallux valgus and metatarsalgia. A platelet count of 560,000/ µL was detected as an unexpected finding. Minimally invasive surgery was performed, and in the first post-surgical week, skin lesions appeared on the forefoot. Three weeks later, the patient presented...
Investigating the Validity of Soft Tissue Signs on Lateral Ankle X-Ray to Aid Diagnosis of Achilles Tendon Rupture in the Emergency Department
Lowri Bowen, Rhodri Evans, Owen Bodger, Joshua Howard and Anne-Marie Hutchison
Article Type: Review Article | First Published: September 14, 2019
We retrospectively identified two groups of patients; Group A consisted of patients with an Achilles tendon rupture and Group B included patients with a clinically intact Achilles tendon but with a lateral ankle ligament sprain. Three clinicians independently reviewed all patients’ x-rays for each of the radiological features under investigation to determine whether a rupture was present or not. Inter-rater and Intra-rater reliability were calculated using the Kappa coefficient (Kc.) To determine the predicted value of the signs sensitivity, specificity, positive predicted values and negativ...
More Than Just 1200 Foot Care Nurses in America are Needed for 30.3 Million People Who Have Diabetes
Jacqueline E Sharpe, PhD, RN, CHES
Article Type: Commentary | First Published: September 23, 2019
There is an outstanding group of registered nurses who specialized in the care of wounds and working with DFUs. Since there are only about 1200 of them in the US and 30.3 million people who have diabetes, these nurses need some help and that help can come from the community. Looking at the increasing number of people with diabetes and their need to know preventive care information, there is no time better than this for community organizing and community building for health and wellness. One does not have to be a registered nurse in teaching a person how to keep their feet clean-some people do ...
Is it Time to Review the Role of Continuous Glucose Monitoring Systems in Diabetes Management?
Le Minh Quang, MSc, MD
Article Type: Review Article | First Published: September 19, 2019
Hemoglobin A1C (HbA1c) and self-monitoring of blood glucose (SMBG) are widely used as standardized measurements in diabetes management. HbA1c is a measure of the mean blood glucose level over a period of 8-12 weeks. This index is easy to measure, relatively inexpensive and internationally standardized. HbA1c helps to predict the complications, particularly microvascular complications in patients with diabetes. However, because HbA1c represents only an average measure of glucose levels, it does not provide glycemic variability (GV), glucose excursions or hypoglycemia. Hypoglycemia and GV ultima...
Psychogenic Voice Disorders Literature Review, Personal Experiences with Opera Singers and Case Report of Psychogenic Dysphonia in Opera Singer
Pedro Claros, Agata Karlikowska, Astrid Claros-Pujol, Andres Claros and Carmen Pujol
Article Type: Review Article | First Published: September 15, 2019
The point of this article is to make a diagnosis of psychological voice disorders easier by reviewing germane to the subject literature. Current view on terminology, classification, clinical manifestation and underlying psychological background of this rare condition is given. Secondly our aim is to asses prevalence ratio of psychological voice disorders in a group of 1520 professional opera singers-people with the most challenging voice effort among professional voice users. Our findings contradict common belief of high occurrence rate of this disorder among opera singers. Characteristics of ...
TCM Combined Chemoradiotherapy in the Treatment of LimitedStage Small Cell Lung Cancer: Current Status and Perspectives
Shulin He, Rui Liu, Qiujun Guo, Huamin Wei, Yanjiu Bao, Xinyao Xu, Shuntai Chen, Honggang Zheng and Baojin Hu
Article Type: Review Article | First Published: September 21, 2019
About 13% of lung cancer cases are of the small cell subtype, but this variant is highly aggressive, and approximately 40% of patients with small cell lung cancer will have limited-stage disease, which is potentially curable with the combination of chemotherapy and radiation therapy. The standard therapy for limited-stage small cell lung cancer is concurrent chemoradiotherapy, and the 5-year survival rate observed in clinical trials is approximately 25%. For patients who obtain a near complete or complete response, prophylactic cranial irradiation (PCI) reduces the incidence of brain metastase...
The Resected Tumour Volume of the Specimen as a Marker of the Quality of the Transurethral Resection in T1 Urinary Bladder Cancer
Staffan Jahnson and Hans Olsson
Article Type: Original Article | First Published: September 18, 2019
This prospectively performed population-based study included all patients in the Southeast Healthcare Region in Sweden with T1 UBC registered in the period 1992-2001, inclusive. RV, RTV and important clinic-pathological variables were studied. All patients had T1 tumours including detrusor muscle at the histopathological examination. Median values for RV and RTV were cut-off points for dichotomisation and 3 cm was the cut-off point for tumour size measured at TUR. Recurrence and progression were analysed using Kaplan-Meier curves with Log-rank test and Cox Proportional Hazards analysis....
Isoproterenol and Lidocaine for Recurrent Torsades de Pointes in a 32-Year-Old Pregnant Woman
Breyanna Reachi, PharmD, Jenna Negrelli, PharmD, Abby Hickman, PharmD, MBA, BCCCP, Sarah Beesley, MD and Jeffrey Osborn, MD
Article Type: Case Report | First Published: September 19, 2019
A 15-week pregnant 32-year-old female was admitted to an outside hospital for alcohol withdrawal and developed multiple episodes of ventricular tachycardia (VT) and TdP resulting in her prompt transfer to our hospital for escalation of care. On arrival she was awake, alert, and hemodynamically stable but quickly began experiencing recurrent episodes of TdP that developed into pulseless VT despite defibrillation, magnesium and calcium administration, and chest compressions. We initiated lidocaine and isoproterenol infusions, after which the patient stabilized. Isoproterenol and lidocaine were s...
Comparison of Normal Skin and Thermal and Chemical Burn Wounds using Vibrational Optical Coherence Tomography
Frederick H Silver, Nikita Kelkar and Ruchit Shah
Article Type: Research Article | First Published: September 16, 2019
The search for methods to evaluate the extent and severity of skin lesions, such as burns and other skin disorders, has been a subject of extentive research. While suction testing, elastography and other tests can be done noninvasively on intact skin, these tests cannot be done on burns and open wounds due to the possible injury that may occur. In addition, they fail to yield comparable results obtained using destructive tests such as uniaxial tensile testing. We have developed a technique to combine optical coherence tomography (OCT) with vibrational analysis (VOCT) to non-invasively and non-...
Systemic Atherosclerosis Treated by Hybrid Surgical and Systemic Percutaneous Endovascular Management
Walid Hassan, MD, MACP, FACC, FSCAI, Amr Aljareh, MD, Mariam Hassan, Khaldoun Al Saadi, MD and Sahar Sharaf Eldin, MD
Article Type: Case Report | First Published: September 23, 2019
Atherosclerotic disease in one arterial site, raise the probability of having other sites affected by about 50% within the vascular axis. Hence once vascular pathology found in one site i.e. coronary artery disease (CAD), other sites i.e. Cerebral and peripheral circulation must be assessed thoroughly, especially in patients with multiple risk factors. Percutaneous intervention (PCI) is a conservative reasonable solution for high risk and inoperable cases; sometimes it supersedes the choice surgery especially with the new era of drug eluting stents (DES) and combined Anti-Ischemic medications....