Primary Mpox and Secondary Syphilis in an HIV Patient: A Community Hospital Experience.

Mpox was an emerging outbreak in California in 2022, primarily in major metropolitan areas, as part of the global mpox outbreak declared by World Health Organization in July 2022. Community hospitals outside of major metropolitan areas have seen fewer cases to date, so they may be less equipped to diagnose and treat patients with mpox. They may have limited public health resources commensurate with the area's population density. Mpox may also be superimposed on ongoing local outbreaks of other sexually transmitted infections. We present a case of a person with HIV who contracted mpox and also developed secondary syphilis. Early detection can be beneficial for prompt treatment, decreased burden of disease for the individual, and prevention of further spread of the infection.

A Fatal Case of Penile Calciphylaxis.

Calciphylaxis is a rare and serious complication of chronic renal failure characterized by vascular calcium overload. It has a high mortality rate. Penile calciphylaxis is an extremely rare condition of penile necrosis due to calciphylaxis of the penile arterioles. Presented here is a severe case of systemic calciphylaxis initially presented as penile necrosis treated with sodium thiosulfate and amputation.

A Case and Review of Ophthalmomyiasis Caused by Oestrus ovis in the Central Valley of California, United States.

Ophthalmomyiasis externa is the infestation of external ocular structures most commonly by Oestrus ovis, sheep nasal bot fly, which have a pupal stage in soil. Farmers and shepherds are commonly affected but rarely in urban areas. This is the first case of Oestrus ovis ophthalmomyiasis externa in California since Catalina Island 1986. No livestock exposure was noted. Manure fertilizer sourced from grazing fields of natural hosts was used on a local urban sports field and is the suspected source.

Radial Arterial Lines Have a Higher Failure Rate than Femoral.

INTRODUCTION: Arterial lines are important for monitoring critically ill patients. They are placed most commonly in either femoral or radial sites, though there is little evidence to guide site preference. METHODS: This is an ambispective, observational, cohort study to determine variance in failure rates between femoral and radial arterial lines. This study took place from 2012 to 2016 and included all arterial lines placed in adult patients at a single institution. Causes of line failure were defined as inaccuracy, blockage, site issue, or accidental removal. The primary outcome was line failure by location. Secondary outcomes included time to failure and cause of failure. RESULTS: We evaluated 272 arterial lines over both arms of the study. Fifty-eight lines eventually failed (21.32%). Femoral lines failed less often in both retrospective (5.36% vs 30.71%) and prospective (5.41% vs. 25.64%) arms. The absolute risk reduction of line failure in the femoral site was 20.2% (95% confidence interval [3.7 - 36.2%]). Failures occurred sooner in radial sites compared to femoral. Infection was not a significant cause of removal in our femoral cohort. CONCLUSION: Femoral arterial lines fail much less often then radial arterial lines. If placed preferentially in the femoral artery, one line failure would be prevented for every fourth line.

Adaptation of Predictive Models to PDA Hand-Held Devices.

Prediction models using multiple logistic regression are appearing with increasing frequency in the medical literature. Problems associated with these models include the complexity of computations when applied in their pure form, and lack of availability at the bedside. Personal digital assistant (PDA) hand-held devices equipped with spreadsheet software offer the clinician a readily available and easily applied means of applying predictive models at the bedside. The purposes of this article are to briefly review regression as a means of creating predictive models and to describe a method of choosing and adapting logistic regression models to emergency department (ED) clinical practice.

Rapid oral loading of carbamazepine in the emergency department.

STUDY OBJECTIVE: This study evaluates the safety and efficacy of rapid oral loading of carbamazepine in the emergency department (ED). METHODS: Adult patients receiving maintenance carbamazepine who presented with negligible levels received an oral load of carbamazepine suspension, with a dose of 8 mg/kg. RESULTS: Forty-two oral loads among 36 patients were studied. Mean subject age was 36 years; 61% of the sample were male patients. The actual load administered ranged from 7.9 to 8.6 mg/kg. The mean 3-hour carbamazepine level (therapeutic 4 to 12 microg/mL) was 6.5 microg/mL (SD 2.0 microg/mL). Three patients had subtherapeutic levels after loading (successful loading rate 93%). Adverse effects occurred in 58% of patients, most commonly drowsiness (26%) and nausea (23%). Other adverse effects included dizziness, nystagmus, abdominal pain, vomiting, ataxia, and double vision. Two patients were treated for vomiting. All other adverse effects were mild and self-limited. CONCLUSION: Rapid oral loading of carbamazepine in the ED in this cohort, although effective, was associated with a high rate of adverse effects. Given a sample size of 36, 95% confidence intervals suggest that the rate of serious adverse effects may be as high as 9.7% and that the rate of successful loading may be as low as 76.9%.

Reentrant supraventricular tachycardia in a pediatric trauma patient masquerading as a cardiac contusion.

Establishing the etiology of tachycardia in a trauma patient is often difficult. Pediatric trauma patients present an even tougher challenge. Cardiac contusion should be suspected when other more common traumatic injuries that produce hypoxia and blood loss are excluded. The diagnosis of cardiac contusion is notoriously difficult to make largely due to the controversy over the definition of the disease, and the lack of a true gold standard confirmatory test. Atrioventricular nodal reentrant tachycardia (AVNRT) is a common form of supraventricular tachycardia (SVT) that can also present a diagnostic challenge to emergency physicians. While electrophysiologic studies are the gold standard for confirming the diagnosis, there are certain aspects of the history, electrocardiogram (ECG), and responses to cardiac maneuvers that strongly suggest the diagnosis. We present the case of a pediatric trauma patient that presented with new onset AVNRT masquerading as cardiac contusion.

Fatal pulmonary embolism in a 10-year old with nephrotic syndrome.

We present a case report of a 10-year-old male with nephrotic syndrome who presented with a complaint of shortness of breath. The patient had been recently hospitalized for an exacerbation of nephrotic syndrome and had received steroid and diuretic therapy. Initial vital signs showed tachycardia and mild tachypnea. After being observed for more than four hours without deterioration he was discharged home for close follow up. The patient returned 4 hours later with worsening symptoms and went into cardiac arrest in the ED. Autopsy revealed bilateral large pulmonary emboli. Pulmonary embolism is a known complication of nephrotic syndrome. Hyperviscosity occurs due to a variety of mechanisms. Nearly all reported incidents are associated with the use of steroids and diuretics. It is essential to maintain a heightened suspicion of pulmonary embolism (PE) when children with nephrotic syndrome present with pulmonary complaints, particularly when they have been treated with steroids and diuretics.