The American journal of emergency medicine
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A meta-analysis of randomized controlled trials on evaluating the clinical efficacy of Xuebijing in treating patients with sepsis had been recently published in this journal, however, in our opinion, at least 6 questions or doubts existed about the content and methodology of the systematic review, thus, we write this letter to the journal to share these questions with the editor and readers with the hope of getting these questions solved and learning more about the true effects which Xuebijing should have on in treating patients with sepsis.
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Case Reports
Os subtibiale: Mimicking medial malleolar fracture a report of three cases and review of literature.
There are numerous sesamoids and accessory ossicles around the foot which can easily be misdiagnosed as fractures. Os subtibiale is a very rare normal variant of the medial malleolus which is usually diagnosed incidentally in routine ankle radiographs. In this report, we present a case series of 3 patients with os subtibiale who were admitted to the emergency department with ankle sprains and misdiagnosed as medial malleolar fractures. We would like to raise awareness to the very rare and usually asymptomatic os subtibiale as a diagnostic pitfall.
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Case Reports
Repeat acute abdomen and hemoperitoneum during the same pregnancy due to a ruptured ectopic treated by salpingostomy.
A leading cause of maternal mortality in the first trimester is hemorrhage due to a ruptured ectopic pregnancy. With the advent of tube salvage surgery, ectopic pregnancies can be removed while ensuring hemostasis and preserving the integrity of the fallopian tube. A major drawback of tube salvage surgery is the significant risk of persistent trophoblastic tissue being left behind. ⋯ Surgical intervention confirmed a ruptured ectopic pregnancy in the same site as previous, and salpingectomy was performed, after which the patient recovered without complications. The increased risk of persistent trophoblastic tissue associated with tube salvage surgery can lead to subsequent reoperation for tubal rupture. Patients undergoing these procedures should be closely monitored in the following weeks and undergo serial β-hCG testing in order to confirm successful removal of the ectopic.
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Case Reports
Spontaneous coronary artery dissection in a young woman with polycystic ovarian syndrome.
Polycystic ovarian syndrome (PCOS) affects 4% to 12% of women in reproductive age, representing a clinical condition that could predispose to cardiovascular diseases. We report a case of a 34-year-old woman with PCOS, presenting with chest pain, onset two days before, and ST segment-elevation myocardial infarction. ⋯ The patient was discharged in medical therapy after 5days. This is the first observation of spontaneous coronary artery dissection occurring in a PCOS patient.
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Hashimoto's Encephalopathy (HE) is a rare form of autoimmune encephalopathy associated with Hashimoto's thyroiditis in which patients experience cognitive impairment and various neurologic symptoms. We present a case of a young female that presented to the emergency department with urinary retention, and was ultimately diagnosed with HE. Examination was significant for direction-changing and vertical nystagmus (direction-changing nystagmus describes a phenomenon where the fast beat changes with the direction of gaze), hyperreflexia, clonus, and Babinski and Hoffman's reflexes (all upper motor neuron (UMN) signs). ⋯ To our knowledge, urinary retention in the presence of other UMN signs has not been reported in association with HE; nor has this patient's type of nystagmus. Emergency physicians should be aware of this condition and can play an important role by considering it when neurologic findings are not explained by infectious, toxic, metabolic, or structural etiologies. Although relatively rare, if detected and treated early HE can have a good prognosis.