Past and Present of Point-of-Care Ultrasound (PoCUS): A Narrative Review.

This article aims to conduct a literature review to gain insight into point-of-care ultrasound (PoCUS). PoCUS is a rapid, accurate, non-invasive, and radiation-free imaging modality that can be used in stable and unstable patients. PoCUS can be performed parallel to physical examination, resuscitation, and stabilization; repeated exams in critical patients are essential for improving sensitivity. The review highlights how PoCUS, which was initially used to detect free intraperitoneal fluid in trauma patients, has developed into a life-saving diagnostic tool that could be utilized by treating physicians during various stages of diagnosis, resuscitation, operation, and postoperative critical care when managing sick patients. The review also notes the barriers to the widespread uptake of PoCUS in general internal medicine and the recent commercial availability of "pocket" or handheld probes that have made PoCUS more readily available. This review concludes that adopting a focused binary decision-making approach can maximize PoCUS's value in many clinical settings, including emergency departments, intensive care units, and operation theatres. Overall, the review emphasizes the importance of awareness of common indications, limitations, and strengths of this evolving and promising technology to determine its future trajectory: Providing comprehensive PoCUS training within internal medicine curriculums and supporting trainers to do so.

Detrimental Pneumoperitoneum and Bowel Necrosis Secondary to Dilatation and Curettage: Necessitating the Importance of Healthcare Awareness.

We have read about numerous cases depicting life-threatening fatalities due to the lack of awareness and accessibility to health care facilities. A 23-year-old pregnant woman in a village in India underwent a dilation and curettage procedure for spontaneous abortion by an uncertified medical practitioner. Eventually, she presented to the emergency room with ER and an initial abdominal X-ray was consistent with the finding of free air under the diaphragm/pneumoperitoneum and air-fluid levels. Here we present a case of bowel perforation secondary to being strangulated within the uterine cavity.

Leukocytoclastic Vasculitis: Depiction of the Diagnostic Dilemma.

Vasculitis is classified based on the size of the blood vessels involved. Sub-group Leukocytoclastic vasculitis (LCV) refers to small blood vessel inflammation, which involves cutaneous capillaries and venules. To date, there have been myriad primary and secondary probable causes of LCV. Here, we present a case of an 86-year-old male who presented with non-blanchable purpura involving the ankles, knees, and palms. The patient had idiopathic pulmonary fibrosis (IPF), for which he had been on long-term oxygen therapy and chronic corticosteroids. He was recently started on Bactrim DS (trimethoprim-sulfamethoxazole double strength) for prophylaxis of pneumocystis pneumonia. After a meticulous workup, including a skin biopsy, the causative agent of the LCV was established to be Bactrim DS, and the event was likely triggered by superimposed acute stress of sepsis secondary to UTI and bacteremia. There were several diagnostic dilemmas due to the ongoing chronic medical conditions; however, the occurrence of LCV while being on chronic corticosteroids was concerning as it should have prevented such an untoward occurrence. Eventually, the presentation subsided past an increase in the dose of corticosteroids and discontinuation of Bactrim DS. This raises concern regarding either the dose-dependent immunosuppressive effects of corticosteroids or deficits in our current understanding of the mechanism of action. Additionally, it necessitates further exploration into the causes of LCV and a thorough understanding of its pathogenesis.

Antipsychotics as a probable cause of Leukocytoclastic Vasculitis: A Systematic Review

Abstract: Leukocytoclastic vasculitis (LCV) is a skin condition that is a result of unregulated immune activation. The exact causes have to date not been established. The studied causes tend to have a higher probability of causing LCV. This raises concerns about a deep-seated causal relationship and the tendency of an individual for the development of LCV. Antipsychotics are a class of drug mainly used for psychiatric disorders including schizophrenia, schizophreniform disorder, or even depressive disorder with psychotic features. These drugs target the dopamine receptors in the central nervous system to exert their effects. They are classified as typical or the older antipsychotics and atypical or the newer antipsychotics. Prevalent in the current literature are the reported cases of LCV with antipsychotic medications. We carried out a systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) protocol to find out previously reported cases on LCV due to antipsychotic medication administration from inception till current date. Our study aims to check and in turn, discuss the causal relationship of antipsychotics with LCV.