Value of Advance Care Directives for Patients With Serious Illness in the Era of COVID Pandemic: A Review of Challenges and Solutions.

Advance care directives (ACDs) are instructions regarding what types of medical treatments a patient desires and/or who they would like to designate as a healthcare surrogate to make important healthcare decisions when the patient is mentally incapacitated. At end-of-life, when faced with poor prognosis for a meaningful health-related quality of life, most patients indicate their preference to abstain from aggressive, life-sustaining treatments. Patients whose wishes are left unsaid often receive burdensome life sustain therapy by default, prolonging patient suffering. The CoVID pandemic has strained our healthcare resources and raised the need for prioritization of life-sustaining therapy. This highlights the urgency of ACDs more than ever. Despite ACDs' potential to provide patients with care that aligns with their values and preferences and reduce resource competition, there has been relatively little conversation regarding the overlap of ACDs and CoVID-19. There is low uptake among patients, lack of training for healthcare professionals, and inequitable adoption in vulnerable populations. However, solutions are forthcoming and may include electronic medical record completion, patient outreach efforts, healthcare worker programs to increase awareness of at-risk minority patients, and restructuring of incentives and reimbursement policies. This review carefully describes the above challenges and unique opportunities to address them in the CoVID-19 era. If solutions are leveraged appropriately, ACDs have the potential to address the described challenges and ethically resolve resource conflicts during the current crisis and beyond.

Cervical Spondylotic Myelopathy Presenting as Ischemic Stroke: A Case Report.

Cervical spondylotic myelopathy (CSM) is a condition seen in individuals greater than 50 years of age and is often asymptomatic. In patients who are symptomatic, the symptoms include cases where patients may present with paresis, neck stiffness, and gait abnormalities. We present a 63-year-old male who complained of a four-week-long "tingling and numbness" in his right upper and lower extremities. The sensation worsened over the next couple of days to the point where it affected his gait and led to a subsequent visit to the emergency room. Initial presentation prompted a stroke workup, but further investigation revealed findings suggestive of CSM. This case report highlights the symptomology of cervical spondylotic myelopathy in adults greater than 50 years of age and emphasizes the importance of recognizing the essential markers of this condition.

Bone marrow suppression: a side effect of ciprofloxacin therapy.

Ciprofloxacin is a commonly used antibiotic for gastrointestinal and genitourinary tract infections with a considerably good safety profile. However, occasionally it may cause life-threatening complications. Two case reports of bone marrow depression and 1 case of thrombocytopenia due to ciprofloxacin therapy have been reported in literature. We report a case of bone marrow depression due to ciprofloxacin therapy for urinary tract infection in an otherwise healthy woman.

A rare and unusual cause of PSA (prostate-specific antigen) elevation: sarcoidosis of the prostate.

Sarcoidosis and prostate cancer are 2 separate conditions that are more prevalent among the African American population. However, sarcoidosis of the prostate is a very rare clinical entity. Its association with prostate cancer is described in clinical case series. The use of PSA (prostate specific antigen) test for screening prostate cancer may be associated with false-positive results in this patient population. We report a patient who had an elevated PSA but had a biopsy proven to be sarcoidosis of the prostate gland.

Life-threatening hematoma associated with paracentesis: a case report.

Deep venous thrombosis prophylaxis is recommended in all high-risk hospitalized medical patients. We describe a unique complication of paracentesis in a patient receiving unfractionated heparin for deep venous thrombosis prophylaxis. Our patient developed a very large rectus sheath hematoma and hypotension gradually after paracentesis. Heparin should be used with caution for deep venous thrombosis prophylaxis in patients undergoing paracentesis.

Primary lymphedema tarda in an 88-year-old African-American male.

Primary lymphedema tarda is considered to be a congenital disease with delayed manifestations. We report a case of isolated lymphedema of the left upper extremity in an 88-year-old African-American male. The diagnosis of lymphedema was confirmed by lymphoscintigraphy, and appropriate diagnostic studies were done to rule out other known causes of lymphedema. Lymphoscintigraphic findings were consistent with idiopathic primary lymphedema. During the course of investigations, the patient was found to have adenocarcinoma in situ of the sigmoid colon with no evidence of metastatic spread. Based on the available data, we were unable to establish a causative relationship between colonic carcinoma and lymphedema in our patient. Therefore, this case can best be described as a case of Idiopathic primary lymphedema tarda. We emphasize the use of histopathologic examination in the diagnostic algorithm to rule out underlying malignant process only in patients with radionuclide findings suggestive of secondary lymphedema with no obvious etiology.