Acute Saddle Embolus With Thrombus in Transit: A Case Report and Review of the Literature.

Pulmonary embolism is a life-threatening medical emergency associated with right ventricular failure. Rarely, it impacts the left ventricle to the point of compromising the left ventricular (LV) ejection fraction. We present a case of a 73-year-old African American male with a medical history pertinent for intravascular large B-cell lymphoma who developed an acute saddle embolus with a "clot-in-transit" and profound LV systolic dysfunction. Our report illustrates how an acute saddle embolus may be associated with LV systolic dysfunction via the "reverse Bernheim effect." Additionally, the report highlights the significance of a "clot-in-transit" and LV systolic dysfunction, as they both directly correlate with increased risk of mortality.

Reversible Nephropathy Associated with Jet Fuel Exposure.

Acute kidney injury (AKI) with progression to oliguric or anuric acute renal failure (ARF) is often related to use of well-known nephrotoxic agents including medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), angiotensin-converting enzyme inhibitors (ACEis)/angiotensin II receptor blockers (ARBs), and certain classes of antibiotics. Hyperosmolar IV contrast is also a well-known nephrotoxic agent. Severe sepsis with subsequent hypotension, marked hyperglycemia, and those with difficulty accessing water or with poor oral intake can also present with acute kidney injury related to kidney hypoperfusion, dehydration, and volume depletion. In this case report, we discover and discuss the possible effects of regular and daily occupational exposure of jet fuel (a mixture of hydrocarbons) on renal function. Jet fuel is an underdescribed and not well-known nephrotoxic agent; however, its direct toxicity on kidney function appears to be reversible with removal of exposure and aggressive fluid hydration.

Community-based assessment of human rights in a complex humanitarian emergency: the Emergency Assistance Teams-Burma and Cyclone Nargis.

INTRODUCTION: Cyclone Nargis hit Burma on May 2, 2008, killing over 138,000 and affecting at least 2.4 million people. The Burmese military junta, the State Peace and Development Council (SPDC), initially blocked international aid to storm victims, forcing community-based organizations such as the Emergency Assistance Teams-Burma (EAT) to fill the void, helping with cyclone relief and long-term reconstruction. Recognizing the need for independent monitoring of the human rights situation in cyclone-affected areas, particularly given censorship over storm relief coverage, EAT initiated such documentation efforts. METHODS: A human rights investigation was conducted to document selected human rights abuses that had initially been reported to volunteers providing relief services in cyclone affected areas. Using participatory research methods and qualitative, semi-structured interviews, EAT volunteers collected 103 testimonies from August 2008 to June 2009; 42 from relief workers and 61 from storm survivors. RESULTS: One year after the storm, basic necessities such as food, potable water, and shelter remained insufficient for many, a situation exacerbated by lack of support to help rebuild livelihoods and worsening household debt. This precluded many survivors from being able to access healthcare services, which were inadequate even before Cyclone Nargis. Aid efforts continued to be met with government restrictions and harassment, and relief workers continued to face threats and fear of arrest. Abuses, including land confiscation and misappropriation of aid, were reported during reconstruction, and tight government control over communication and information exchange continued. CONCLUSIONS: Basic needs of many cyclone survivors in the Irrawaddy Delta remained unmet over a year following Cyclone Nargis. Official impediments to delivery of aid to storm survivors continued, including human rights abrogations experienced by civilians during reconstruction efforts. Such issues remain unaddressed in official assessments conducted in partnership with the SPDC. Private, community-based relief organizations like EAT are well positioned and able to independently assess human rights conditions in response to complex humanitarian emergencies such as Cyclone Nargis; efforts of this nature must be encouraged, particularly in settings where human rights abuses have been documented and censorship is widespread.