A Difficult-To-Diagnose Case of American Tegumentary Leishmaniasis.

This case report presents a difficult-to-diagnose case of American tegumentary leishmaniasis (ATL) caused by Leishmania (Viannia) guyanensis in a 24-year-old Hispanic male with a travel history to the Panama jungle, an endemic region for tropical infectious diseases. The patient initially presented with persistent skin lesions that progressed to abscesses with ulceration. Despite negative initial diagnostic tests, including microbiological investigations and histopathological examination, a comprehensive diagnostic workup and subsequent polymerase chain reaction (PCR) confirmed the presence of Leishmania parasites. This case underscores the need to consider tropical infectious diseases despite initial negative tests. Accurate species identification is vital for proper drug treatment, with miltefosine as an emerging option. Early, precise diagnosis and tailored management are essential for successful treatment. This report emphasizes the significance of conducting a comprehensive diagnostic workup, including PCR, in individuals with a history of travel to endemic regions, to accurately diagnose and effectively manage complex infectious diseases.

Loculated pericardial hematoma compressing the right atrium post mechanical aortic valve replacement and the role of point-of-care echocardiography: a case report.

BACKGROUND: Bleeding in the postoperative period after cardiac surgery is relatively frequent, especially in patients with early anticoagulant therapy, as in the case of mechanical valve replacement. Diffuse hemopericardium is relatively easy to diagnose; however, loculated pericardial hematomas leading to hemodynamic collapse are relatively rare and their diagnosis is more challenging. CASE PRESENTATION: This report is of a 75-year-old Asian woman who presented dyspnea, confusion and hemodynamic collapse related to loculated pericardial hematoma compressing the right atrium 3 days after mechanical aortic valve replacement. Urgent transthoracic echocardiogram performed as point-of-care approach showed right atrial compression, the aortic valve prosthesis had normal function. Surgical removal of the hematoma resulted in complete recovery. CONCLUSION: Loculated pericardial hematoma might lead to hemodynamic collapse. Close monitoring of hemodynamic parameters is essential, also point-of-care echocardiography is essential for early recognition and prompt management in patients with critical hemodynamic condition.

A randomized clinical trial comparing the effect of maternal intravenous hydration and placebo on the amniotic fluid index in oligohydramnios.

OBJECTIVE: To compare the treatment of acute intravenous hydration with placebo in term pregnant women manifesting oligohydramnios. METHODS: All patients with oligohydramnios who met the inclusion criteria were offered participation in this randomized, double-blind, placebo-controlled study. After ruling out rupture of membranes and maternal and fetal complications, we recruited 44 women with third trimester singleton pregnancies having an amniotic fluid index (AFI) of less than 6. Patients were randomized into treatment or control groups. Patients in the treatment group received a continuous intravenous infusion of (1/2) normal saline (NS) at a rate of 1000 mL/h for two hours. Patients in the placebo group received an intravenous infusion of (1/2) NS at 10 mL/h for two hours. The AFI was re-assessed by the same sonographer one hour after the hydration was completed. Both the patient and the examiner were blinded to the study groups. RESULTS: Maternal age, parity, gestational age, and birth weight were not significantly different between the two groups. The AFI increased significantly in both treatment (3.8 +/- 1.2 vs. 5.3 +/- 2.5, p < 0.05) and placebo (4 +/- 1.3 vs. 5.5 +/- 2.4, p < 0.05) groups. Moreover, the changes in AFI did not significantly differ between the treatment and the placebo groups (1.2 +/- 2.1 vs. 1.5 +/- 2.1, respectively; p > 0.05). CONCLUSIONS: There are statistically significant short-term increases in the AFI in patients with oligohydramnios whether the patients are treated with intravenous fluids or not. The short-term increase in AFI may reflect physiologic diurnal variations in the amniotic fluid.

Clinical and sonographic estimation of fetal weight performed during labor by residents.

OBJECTIVE: This study was undertaken to assess the accuracy of both clinical and sonographic estimations of the fetal weight (EFW) performed during the active phase of labor by residents. METHODS: The study protocol consisted of achieving clinical, followed by sonographic EFW by the admitting resident during the active phase of labor. Patients who had an EFW (clinical or sonographic) within the last 2 weeks were excluded from the study. In addition, the effect of the following variables on the accuracy of the EFW were examined: maternal age, maternal weight and body mass index, parity, the Bishop score before obtaining the EFW, gestational age, birth weight, and the postgraduate year of the examiner. The Pearson correlation, chi2 test, and Student t test were the statistical analyses used. We also calculated the sensitivity, specificity, and positive and negative predictive values for clinical and sonographic EFW for detecting macrosomia (birth weight > or = 4000 g). RESULTS: A total of 192 patients participated in this study. The coefficient of correlation between the clinical and sonographic EFW and the actual birth weight was 0.59 (P < .0001) and 0.65 (P < .0001), respectively. Clinical EFW was correct (within +/-10%) in 72% of the cases and the sonographic EFW was correct (within +/-10%) in 74% of the cases. However, the sensitivity of predicting birth weight of 4 kg or more was only 50% for both clinical and sonographic EFW, with 95% and 97% specificity, respectively. None of the clinical variables that were tested were significantly associated with the accuracy of the EFW. CONCLUSION: Both clinical and sonographic EFW performed during the active phase of labor by residents correlate with the actual birth weight but have poor sensitivity in detecting macrosomic fetuses. Sonographic EFWs offer no advantage over clinical EFWs.