Intermittent left bundle branch block (LBBB) is an unusual phenomenon, with very few cases documented in the literature. It is often considered a reflection of underlying conditions known to increase the risk of cardiovascular morbidity and death, including coronary artery disease (CAD), cardiomyopathy, hypertensive heart disease, and aortic valve disease. In rare instances, coronary vasospasm is the sole underlying condition. It is typically diagnosed by ECG and managed according to the underlying cause. We describe a case of intermittent LBBB presenting with chest pain. The ECG showed dynamic changes with transient/intermittent LBBB. An angiogram was performed, revealing significant coronary lesions. The patient was eventually managed conservatively and discharged on dual antiplatelet therapy for a duration of one year with a one-month clinic follow-up where his condition improved. Intermittent LBBB represents a transient disturbance in the intraventricular conduction system, where diseased conduction occurs secondary to an underlying cause, but normal conduction eventually restores. This results in complexes where LBBB appears alongside normally conducted beats in a single ECG tracing. There is limited knowledge about the prognosis of patients with intermittent LBBB; therefore, patients with LBBB should undergo careful evaluation due to the known association with serious cardiac pathologies, particularly cardiac ischemia. It is important to consider the potential adverse effects on ventricular function.
Thyroid storm is a rare and a life-threatening condition, and serious complications could happen if not diagnosed and managed early. The typical clinical manifestations of hyperthyroidism are exaggerated in thyroid storm, particularly marked pyrexia and tachycardia, and altered mental status as agitation, delirium, or coma. Many precipitating factors contribute to the presentation of thyroid storm, and new recent factors like Epstein-Barr virus (EBV) could play a significant role. Serious and rare complications from the thyroid storm can increase the risk of mortality and morbidity up to 30% as fulminant hepatic failure, which is reported only a handful of times in the literature. Also, congestive heart failure can be part of the multiorgan dysfunction from the presentation, if associated with the thyroid storm. In this report, we present a case of thyroid storm precipitated by EBV and causing fast atrial fibrillation complicated by congestive heart failure and fulminant hepatic failure for 46-year-old Bangladeshi male not known to have any medical illness. He presented to the emergency department with 10-day history of an on and off subjective fever, associated with generalized abdominal pain and vomiting. He developed palpitation at the day of presentation. He was managed, stabilized, intubated, and shifted to the ICU as the patient started to be apneic after the conscious sedation for the cardioversion. During the admission anti-EBV viral capsid antigen IgM antibody was positive. The patient was discharged after five days in ICU and 14 days of overall hospital stay. Although the complication of thyroid storm as fulminant hepatic failure and congestive heart failure are rare, they should be considered in cases with thyroid storm. The pre-existing of EBV as a precipitating factor should always be considered, and more studies in these regards need to be done.
Calciphylaxis is a rare but highly fatal vascular calcification disorder with a predilection for patients with end stage renal disease (ESRD). The pathogenesis of calciphylaxis is unknown, however, several risk factors have been identified such as hypercalcemia, hyperphosphatemia, hyperparathyroidism, low serum albumin, and history of warfarin therapy. This article presents a case of calciphylaxis induced by warfarin in a COVID-19 patient.
Splenic injuries are one of the most common injuries following blunt abdominal trauma. It occurs in 32% of blunt abdominal trauma, with motor vehicle accidents being the most common cause. The patient may present with generalized abdominal pain or left upper quadrant pain associated with left shoulder pain. Hemodynamic instability is one of the most reliable signs of splenic injuries. A focused assessment with sonography for trauma (FAST) scan is the initial imaging used to assess for solid organ injury in the abdomen, followed by computed tomography (CT) scans. Evidence of free fluid in the abdomen in the FAST scan indicates a solid organ injury. However, the absence of the before-mentioned finding does not rule out the presence of solid organ injury. Hereby a case of a 13-year-old Saudi male with left-sided abdominal pain after falling from a motorbike. A set of the investigation was done with insignificant results. However, FAST revealed a heterogenous appearance in the spleen. Thus, the patient subsequently underwent abdominal CT scans. The patient was managed conservatively and then discharged against medical advice (DAMA). Previously documented cases have mentioned the presence of free fluid in the abdomen in FAST scan in a stable patient leading to undergoing a CT scan and further managing trauma victim patients, which was absent in the present case.
Background: Urinary tract infection (UTI) is a major public health issue that affects millions of people each year, and a common reason for hospital admission and Emergency Department (ED) visits. ED is a common yet crucial setting for antibiotic prescription. Unfortunately, antibiotic therapies that are unnecessarily prescribed continue to contribute to the global issue of bacterial resistance. Our study aims to determine the prevalence and reasons for inappropriate antibiotic use for UTI in the ED, to highlight the most commonly prescribed antibiotic, and to define the most sensitive antibiotic and most common pathogen based on urine cultures. Methods: A retrospective cohort review conducted at King Fahad University Hospital in Al Khobar, eastern province of Saudi Arabia. Data was collected during the duration of 2017 – 2022 from electrical medical records for all patients who had a urinalysis and urine culture in the ED and were managed as outpatients. Antibiotic prescription was considered Inappropriate if: Asymptomatic patient, Negative urinalysis, Negative or contaminated urine culture or Prescribed antibiotic did not demonstrate sensitivity to the tested bacteria. R-Jamovi software (version 2.3, 2022) was used for analysis. Results: The total sample included 2531 patients. 70.4 % (n= 1781) were females. The most common age group was adults (from 15- 63 years old. Dysuria was the most reported symptom, representing 28.3 % (n = 606). Only ~ 21% of the prescribed antibiotics were appropriate (P< 0.001). The most common reason for inappropriateness was that the tested antibiotic was not sensitive to growth. Ciprofloxacin was the most commonly prescribed antibiotic, representing 34.8%. E. coli was the most common pathogen causing UTI, representing 37.5%. Gentamicin was the most sensitive antibiotic among the urine culture results, representing 90% (P
Introduction:
In the last decade, electronic cigarettes have emerged and spread over the world. Different generations were developed varying in designs and features
Objectives:
We examined the level of awareness, knowledge and perception of electronic cigarettes and its use among adults’ residents of eastern province aging 18 and above. We also examined the reasons behind electronic cigarettes use and whether adults who were only using e-cigarette were at risk of smoking conventional tobacco. and whether it did or did not help them quit smoking
Procedure/method:
A cross-sectional survey was conducted, and data obtained through an online questionnaire targeting age group of 18 and above of eastern province residents. Questionnaire comprised questions such as demographic question including nationality, sex, age, academic degree, occupation and income. Next questions were testing knowledge and awareness regarding e-cigarette, safety of e-cigarette, e-cigarette usage and any side effects perceived after e-cigarette use. Last questions were whether vaping had led subjects to conventional cigarette use and whether. vaping had helped them to quit smoking or not
Results:
A 1080 adult in the eastern province of Saudi Arabia have participated. The prevalence of vaping among participants was 33.6% (28.3% male and 5.3% female). The highest age group of vaping was between 18-24 years accounting for 18.5%. The highest group of smokers were high school diploma carriers (18.8%). 53.8% of participants thought that E-cigs was not safer than nicotine patches or nicotine gum. 34.3% of participants thought that E-cigs were safer than regular cigarettes and tobacco products, whereas 46.6% of them thought that they are not safer. 46% of participants believed that E-cigs contained dangerous chemicals while 18.4% thought the opposite. Regarding subsequent use of traditional tobacco after E-cigs smoking, 11.6% of participants reported that they had been pushed into using traditional tobacco. 26.8% of participants reported that they quitted tobacco products after E-cigs use, whilst 16.8% reported lesser usage of tobacco products after E-cigs use. Yet 17.9% kept using traditional tobacco products in the same quantities after E-cigs use
Conclusion:
Vaping is increasingly used among adult and a significant amount of people unaware of its risks. Even though it may help some people to quit traditional smoking its risks has been established and awareness should be raised.
Scabies is a common contagious ectoparasitosis. The association of scabies and leukocytoclastic vasculitis (LCV) is unclear, and only a few cases of scabies-related LCV have been documented. Here, we report a case of scabies complicated by LCV in an 86-year-old woman diagnosed with scabies and treated accordingly. The patient presented to our hospital with a one-day history of fever, increased rash, and itchiness. Histologic examination of a purpuric lesion revealed signs of LCV. Although histologic examination did not identify the scabies mite in the purpuric lesion, the LCV was likely a post-scabetic presentation following infestation based on other case reports, despite this being a rare occurrence.
Moyamoya disease (MMD) is a rare cerebrovascular occlusion condition characterized by progressive stenosis in the terminal portion of the internal carotid arteries on both sides. The measured incidence of MMD is 0.086 per 100,000 people. MMD has variable neurological manifestations, however, seizure is a significant manifestation of MMD with few reported studies. The combination of sickle cell disease (SCD) and MMD confers a much higher risk of ischemic stroke. In this paper, we describe a 32-year-old female with a known case of SCD taking tramadol for a vaso-occlusive crisis, who was presented to the emergency department by a family member due to a low level of consciousness. Despite ongoing management, the patient developed multiple seizure attacks and intubation was performed. A computed tomography (CT) brain angiogram was performed, and the diagnosis of MMD was made. The patient was shifted to the intensive care unit (ICU) and in spite of the ongoing management in the ICU, the patient died. In this case, we highlight the importance of considering MMD as a differential diagnosis when dealing with an SCD patient who developed refractory status epilepticus.
Perforated viscus is a fatal condition associated with a high mortality rate that necessitating immediate management. In gastric cancer, perforation is a relatively late rare presentation. In this study, we report a case of a 40-year-old male who presented with perforated gastric cancer. In the emergency department (ED), the provisional diagnosis was septic peritonitis and shock. However, upon exploratory laparotomy, pyloric tumor was detected metastasizing to the duodenum, liver, and porta hepatis.
Background. Gamma-Butyrolactone (GBL), a chemical in many solvents that is metabolized into Gam-ma-Hydroxybutyrate (GHB) which acts as a precursor to Gamma-AminoButyric Acid (GABA) in the Central Nervous System, which is known for its calming effect leading to unconsciousness and coma making it popular in the drug-abusing scene, such cases reported in the country are limited, leading to weak understanding of a patients' presentation. Case report. A 21-years-old male patient presented by ambulance to the Emergency department (ED) of Tertiary hospital in Saudi Arabia after being found un-conscious due to GBL and methamphetamine ingestion which was obtained from Gel-removers. Patient was unconscious with bilateral pinpoint pupils, sinus bradycardia, and bradypnea. Initial intervention with atropine and naloxone IV improved the heart rate without respiratory rate or mental state improve-ment. agitation and confusion were noted, thus midazolam was administered and brain CT was done to rule out intracranial pathologies which was negative. Another naloxone dose was administered after an hour due to the development of snoring and posterior displacement of the tongue with no improvement, intubation was done and maintenance sedation started. After 1.5 hours the patient woke-up agitated and Sedation was discontinued, he was hemodynamically stable and gradually gained full consciousness. It was revealed that the patient had been abusing a GBL-containing substance and methamphetamine, which accounted for the clinical presentation and progression of symptoms. Conclusion. Due to the rise of GBL/GHB intoxication cases, further literature must be established and more cases should be report-ed to raise the awareness regarding this substance.
