The American journal of emergency medicine
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Clinicians use the Modified Centor Score (MCS) to estimate the risk of group A streptococcal (GAS) pharyngitis in children with sore throat. The Infectious Diseases Society of America (IDSA) recommends neither testing nor treating patients with specific viral symptoms. The goal of this study is to measure the impact of those symptoms on the yield of GAS testing predicted by the MCS. ⋯ The presence of viral symptoms specified by the IDSA alters the predicted yield of testing by traditional MCS. Clinicians may consider adjusting interpretation of a patient's MCS based on the presence of viral symptoms, but viral symptoms may not always fully obviate the need for GAS testing.
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Case Reports
Inhaler intoxications developed during autopsy of the corpse due to cyanide intake: Case series.
The primary cause of cyanide intake is suicidal attempts, most of which result in death. People who interfere with suspicion of cyanide intoxication may also be exposed to cyanide poisoning. ⋯ Meanwhile, a 36-year-old patient who had come into contact with the patient at night also presented to the ED. Some of the precautionary measures to be taken against inhalation of cyanide may be wearing appropriate masks as well as suitable clothes and keeping the surroundings below 28 °C when exposed to cyanide.
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Case Reports
A change of heart: Transformation of the electrocardiogram in a patient with apical hypertrophic cardiomyopathy.
An asymptomatic 83-year-old man with a history of hypertension, prior stroke with no residual deficits, and bilateral carotid artery stenosis, presented for evaluation prior to cataract surgery. His transthoracic echocardiogram was typical for apical hypertrophic cardiomyopathy (AHCM), and his electrocardiograms (ECG) showed large precordial R-waves and inverted T-waves, previously associated with AHCM, while his ECG 7 years earlier was normal. Mechanistic explanations for the developed ECG abnormalities, and their importance for the detection and monitoring of patients with AHCM are provided.
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Capnocytophaga canimorsus, commonly transmitted by dog bites, can cause severe sepsis, and the mortality rate is very high. We experienced a case of hemophagocytic lymphohistiocytosis (HLH) complicated by severe sepsis caused by C. canimorsus. A 58-year-old man with no remarkable medical history was admitted to another hospital with fever and mild consciousness disorder developed 3 days after being bitten by his dog. ⋯ Once antibiotic and steroid therapy was started, the patient's infection and cytopenia improved. Unfortunately, the patient's fingers and toes required amputation, but his life was saved, and he was discharged from hospital. Because HLH may be hidden in such cases, it may be necessary to measure serum ferritin and perform bone marrow aspiration if hyperferritinemia is suspected.