Postgraduate medicine
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Postgraduate medicine · Jan 2025
Surgical intervention for patients with fibrinopurulent pleural empyema and acute respiratory failure: a case report.
Fibrinopurulent thorax is a rare condition that can lead to respiratory failure. Fibroblastic decortication surgery has been shown to be an effective treatment for chronic empyema in previous studies. However, there is limited evidence supporting surgical intervention for fibrinopurulent thorax in cases of respiratory failure. ⋯ This case demonstrates the efficacy of surgical treatment for fibrinopurulent thorax with respiratory failure, a scenario not previously documented in literature. Successful treatments for pneumonia and chronic empyema in the context of respiratory failure have provided both inspiration and validation for this approach. The findings of this case highlight the potential of surgical intervention as a new treatment option for clinical practice. However, as this is a single case report, further research is necessary to validate the efficacy and safety of this treatment method.
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Postgraduate medicine · Jan 2025
Must we remain blind to the need for clinical ethics support services in Africa? Eyes on Nigeria.
Hospitals and healthcare workers in Africa, and Nigeria specifically, are increasingly being confronted by complex situations, in which decision-making becomes more troublesome in the presence of conflicting goals, values, and preferences among the respective stakeholders. Given that all healthcare decision-making requires ethical considerations, and there is a noted absence or paucity of documentation of institutionalized mechanisms for addressing any associated concern or dilemma in Nigeria, it is thus unclear how most hospitals, healthcare workers, and the public handle the ethical dimensions of patients' care and hospital practice, while also generating possibilities for improvement in care quality. ⋯ Based on the identified bioethics manpower capacity and societal utilization of the existing telecommunication infrastructure in Nigeria, we propose the establishment of a homegrown and socially responsive pilot initiative in which, on-site hospital ethics support services, as well as a web/portal-based or online component will be accessible to all interested healthcare professionals/students, patients, bioethicists, and members of the public. Though the evidence for the effectiveness and impact of CESS and related services on the quality and outcome of care has remained relatively weak and there is no single existing CESS model that has been comprehensively proven to be beneficial to healthcare practice in all settings, we argue that the establishment of formal and homegrown CESS should be of top priority in Nigeria, and Africa generally.
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Postgraduate medicine · Jan 2025
Skin ecchymosis in migraine patients: a retrospective and exploratory study.
Migraine is a recurrent headache disorder characterized by moderate to severe, throbbing pain, typically unilateral. It can be classified as migraine with or without aura, depending on the presence or absence of visual or sensory disturbances known as auras, respectively. ⋯ Intermittent skin ecchymosis may be a differentiating factor between migraine and tension-type headache and a specific marker of migraine to be considered as a criterion for its diagnosis.
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Postgraduate medicine · Jan 2025
Case ReportsDelayed diagnosis of adult onset Still's disease in 2 cases: diagnostic dilemma in positive antinuclear antibody and tuberculosis endemic areas.
Adult-onset Still's disease (AoSD) is a rare systemic autoinflammatory disorder of unknown etiology that affects young adults. Here, we report two cases of delayed AoSD diagnosis, which was initially diagnosed as tuberculous arthritis and systemic lupus erythematosus (SLE) before referral. ⋯ After further evaluation, the clinical and laboratory features were found to be appropriate for the diagnosis of AoSD. Both patients had anemia, fever, arthritis, and high ferritin levels and were treated with high-dose methylprednisolone followed by methotrexate; clinical improvement was observed, and the ferritin levels reduced.
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Postgraduate medicine · Jan 2025
In-hospital and delayed mortality in patients with upper gastrointestinal bleeding on antithrombotic treatment: effects of withdrawal and resuming.
Antithrombotic drugs pose a dual challenge to acute upper gastrointestinal bleeding, with associated risks of bleeding complications and thromboembolic events upon withdrawal. We aimed to determine the impact of antithrombotic medications on in-hospital and delayed outcomes and whether suspension and resumption influenced delayed mortality. ⋯ Patients with upper gastrointestinal bleeding treated with antithrombotic drugs had lower in-hospital mortality despite increased comorbidities and older age. Conversely, delayed 6-month mortality was higher. Shorter antithrombotic suspension durations increased in-hospital mortality, whereas suspension for > 7 days increased delayed mortality.