The American journal of emergency medicine
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Case Reports
HIV-positive patient with herpes zoster: a manifestation of the immune reconstitution inflammatory syndrome.
Herpes zoster is a common illness that can lead to serious morbidity. There is now evidence that HIV-infected patients who have been treated with antiretroviral therapy are at greater risk of developing herpes zoster not when they are severely immunocompromised but, paradoxically, when their immune system is recovering. This is a manifestation of the immune reconstitution inflammatory syndrome. ⋯ Emergency department physicians should be aware that HIV-infected patients treated with HAART may have clinical deterioration despite immune system strengthening. This immune reconstitution inflammatory syndrome can present with infectious, autoimmune, or oncological manifestations. Our case patient, an HIV-positive man with immune system recovery after treatment with HAART, presented with an infectious manifestation, herpes zoster.
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Case Reports
Myocardial infarction secondary to contrast agent. Contrast effect or type II Kounis syndrome?
The diagnostic administration of contrast agents has been increased recently in various fields, including coronary angiography, but reports of coronary artery spasm caused by contrast agents are rare. However, myocardial infarction following administration of nonionic contrast agents has not been reported, as far as we are aware. Herein, we described a case of acute anterior myocardial infarction induced by the contrast agent iopromide (Ultravist). We also discussed the possible reasons for this situation.
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Case Reports
Life-threatening anaphylactoid shock caused by recombinant tissue plasminogen activator.
Recombinant tissue plasminogen activator (rt-PA) is currently the only approved agent for treating acute ischemic stroke. However, rt-PA may cause fatal symptomatic intracranial hemorrhage and other adverse effects like bleeding complications and allergic reactions. ⋯ This report is about a patient with a history of ACE inhibitor intake who experienced life-threatening anaphylactoid shock during rt-PA administration. The relationship between rt-PA and ACE inhibitor was also discussed.
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We sought to describe the use of radiographic studies in pediatric major trauma patients and determine the extent to which a selective, clinically guided use of imaging contributes to delayed diagnosis of injury (DDI). ⋯ Patients with DDI had similar initial plain x-ray evaluations to patients without DDI, despite DDI patients being more severely injured. Delayed diagnosis of injury was not attributable to inadequate CT use. Most DDIs were orthopedic, highlighting the importance of a tertiary survey and a low threshold for skeletal radiographs.
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The study aimed to estimate the prevalence of need for dental care among patients in the ED and assess associated characteristics. ⋯ Of the patients presenting to the ED, 40.6% were in some need of dental care. This need was not associated with insurance or socioeconomic status as shown in previous studies. Age, ethnicity, and no routine oral care in the last 3 years were all associated with early/urgent need for oral health care.