Imaging Utilization Patterns and Injury Characteristics Associated with Electric Standing Scooters in a Major Urban Area.

BACKGROUND: The recent proliferation of electric standing scooters in major urban areas of the United States has been accompanied by injuries of varying severity and nature, representing a growing public health concern. OBJECTIVE: Our aim was to characterize imaging utilization patterns for injuries associated with electric scooter (e-scooter) use, including their initial emergency department (ED) management. METHODS: We conducted a retrospective review of the electronic medical record for all patients presenting to affiliated EDs for e-scooter-related injuries between July 2018 and April 2020. Demographics, date and time of presentation, imaging study type, resultant injury, and procedural details were recorded. RESULTS: Ninety-seven patients were included; mean age was 27.6 years. Of these, 55 patients (57%) had injuries identified on imaging and 40% of all imaging studies were positive. Most identified injuries (61%) were musculoskeletal, with a small number of neurological (2%) and genitourinary (1%) injuries. The highest prevalence of presentations occurred in August; most patients (72%) presented between 3 pm and 1 am and granular peaks were between 12 am and 1 am and 5 pm and 6 pm. CONCLUSIONS: Patients presenting with e-scooter injuries have a high likelihood of injury to the radial head, nasal bone, and malleoli. Emergency physicians should be especially vigilant for injuries in these areas at presentation. Visceral injuries are uncommon but may be severe enough to warrant surgery.

Chlorthalidone-Induced Fixed-Drug Eruption: Unmasking an Uncommon Reaction to a Common Diuretic.

Fixed-drug eruptions (FDEs) are dermatological reactions characterized by specific skin lesions triggered by certain medications. Our case reports commonly used medications that can cause drug-induced skin reactions. Chlorthalidone, a widely used diuretic, had not been prominently linked to FDEs. Here, we present the case of a 45-year-old African-American male who developed classic FDE skin lesions following the initiation of chlorthalidone therapy. This case underscores the imperative for further investigation and heightened awareness among healthcare professionals regarding chlorthalidone-associated FDEs. Findings suggest that such reactions might be more prevalent than previously acknowledged, underscoring the significance of prompt diagnosis and effective management of drug-induced skin responses. Notably, the patient's lesions showed complete resolution upon discontinuing the diuretic, reinforcing the causal relationship. This case is an essential reminder of the importance of vigilance in monitoring patients for adverse drug reactions, even in unlikely medications, such as chlorthalidone.​​​​​​.

A near-miss diagnosis of necrotizing breast fasciitis complicated by atrial fibrillation secondary to septic focus: a case report and brief review of literature.

Necrotizing fasciitis of the breast is a rare, life-threatening entity characterized by a rapidly aggressive infection of the soft tissue. There are few literature reports on necrotizing fasciitis at the level of the breast tissue as the most common locations are within the abdominal wall or extremities, but this entity can lead to sepsis and systemic multiorgan failure if not adequately managed. Here, we report a case that highlights the course of a 68-year-old African American female with a past medical history of hypertension, hyperlipidemia, and poorly controlled diabetes mellitus, who presented with the complaint of a painful right breast abscess with intermittent, purulent drainage. An initial point-of-care ultrasound displayed an area of induration of the right breast as well as soft tissue edema with no identifiable fluid collection. A subsequent CT abdomen and pelvis was obtained given new onset abdominal pain, which demonstrated incidental findings of inflammatory changes and subcutaneous emphysema along with colonic diverticulosis. Surgical intervention was immediately sought for which she underwent debridement and exploration of the right breast with findings that were consistent with necrotizing transformation. The patient was sent back to the OR for an additional surgical debridement the next day. Of note, the patient had post-op atrial fibrillation with rapid ventricular response and had to be admitted to the ICU for conversion to sinus rhythm. She returned to sinus rhythm and was transferred back to medicine before application of a negative pressure wound dressing on discharge. The patient was transitioned from Enoxaparin to Apixaban for anticoagulation control in the setting of atrial fibrillation before being discharged to a Skilled Nursing Facility with long-term antibiotics. This case highlights the difficulty and significance in establishing a prompt diagnosis for necrotizing fasciitis.

Transient Kluver-Bucy Syndrome as a Manifestation of Post-temporal Lobe Seizure: A Rare Case Entity.

Following epileptic seizures, patients can subsequently experience a post-ictal state characterized by disorienting symptoms, such as confusion, drowsiness, hypertension, headache, and nausea, rather than neurobehavioral sequelae. We report the case of a 64-year-old male with unilateral left temporal lobe injury, who presented with post-ictal transient Kluver-Bucy Syndrome symptomatology following a complex partial seizure. Brain magnetic resonance imaging revealed encephalomalacia of the left temporo-parieto-occipital region from a previous infarct, and his symptoms resolved following the administration of antiepileptic medications. Therefore, transient Kluver-Bucy Syndrome can follow unilateral temporal lobe injury and should be suspected in patients who fit the clinical criteria, even in the absence of classic bilateral temporal lobe damage on imaging.

Clear Cell Carcinoma of the Endometrium in a Patient Presenting with Postmenopausal Bleeding but Negative Endometrial Biopsy.

Endometrial carcinoma is the most common gynecological malignancy in the USA with approximately 66,570 cases and 12,940 deaths in 2020. Clear cell carcinoma (CCC) of the endometrium is an estrogen-independent type II endometrial cancer which accounts for <5% of endometrial cancer. When diagnosed roughly, 45% of patients have extrauterine metastases. Current American College of Obstetrics and Gynecology guidelines recommend transvaginal ultrasound for postmenopausal bleeding and a biopsy for those with endometrial thickness >5 mm. However, we present a case of a postmenopausal woman with a history of fibroid where endometrial biopsy has failed to make diagnosis twice. Hence, further testing should be performed in patients with unexplained postmenopausal bleeding including vaginal hysterectomy with lymph node dissection.

Autism Spectrum Disorder and Chiari 1 Malformation Co-occurring in a Child.

Very few studies have shown associations between autism spectrum disorder, attention deficit hyperactivity disorder and Chiari 1 malformation. Here, we report an 10-year-old male that presented after having seizures with a history of Chiari 1 malformation, autism spectrum disorder and ADHD with moderate mental retardation and speech delay. This case highlights the fact that autism spectrum disorder as biologically based neurodevelopmental disorder with altered brain growth may be associated with Chiari 1 malformation and ADHD.