Rejected

Thyroiditis is a general term for inflammation of the thyroid gland. The most common forms of thyroiditis encountered by family physicians include Hashimoto, postpartum, and subacute. Most forms of thyroiditis result in a triphasic disease pattern of thyroid dysfunction. Patients will have an initial phase of hyperthyroidism (thyrotoxicosis) attributed to the release of preformed thyroid hormone from damaged thyroid cells. This is followed by hypothyroidism, when the thyroid stores are depleted, and then eventual restoration of normal thyroid function. Some patients may develop permanent hypothyroidism. Hashimoto thyroiditis is an autoimmune disorder that presents with or without signs or symptoms of hypothyroidism, often with a painless goiter, and is associated with elevated thyroid peroxidase antibodies. Patients with Hashimoto thyroiditis and overt hypothyroidism are generally treated with lifelong thyroid hormone therapy. Postpartum thyroiditis occurs within one year of delivery, miscarriage, or medical abortion. Subacute thyroiditis is a self-limited inflammatory disease characterized by anterior neck pain. Treatment of subacute thyroiditis should focus on symptoms. In the hyperthyroid phase, beta blockers can treat adrenergic symptoms. In the hypothyroid phase, treatment is generally not necessary but may be used in patients with signs and symptoms of hypothyroidism or permanent hypothyroidism. Nonsteroidal anti-inflammatory drugs and corticosteroids are indicated for the treatment of thyroid pain. Certain drugs may induce thyroiditis, such as amiodarone, immune checkpoint inhibitors, interleukin-2, interferon-alfa, lithium, and tyrosine kinase inhibitors. In all cases of thyroiditis, surveillance and clinical follow-up are recommended to monitor for changes in thyroid function.

We report a case of sclerokeratouveitis with an unfavorable response to treatment. To the best of our knowledge, there are no previous reports of this fungus invading the sclera. A 68-year-old diabetic farmer male patient presented with a 3-week history of pain and redness and a decrease in visual acuity occurring 5 days before admittance in the right eye. Examination revealed severe mixed hyperemia and a scleral calcified plaque with a surrounding area of ischemia and lysis. The cornea showed diffuse infiltrates, stromal edema, and hypopyon. Initial scrapings were negative, and empiric antibiotics were started. After a fungus was reported, topical and systemic antifungals were initiated, but there was no clinical response. The eye was enucleated. A slow-growing fungus , resistant to voriconazole, was isolated. Fungal etiology must be kept in mind when dealing with infectious scleritis. Despite treatment, the outcome of this case was unfavorable due to the slow-growing nature of the fungus and this strain's resistance to voriconazole.

The incidence of myocarditis in patients with coronavirus disease 2019 (COVID-19) remains unknown; however, increasing evidence links COVID-19 to cardiovascular complications such as arrhythmias, heart failure, cardiogenic shock, fulminant myocarditis, and cardiac death. We present a case of suspected COVID-19-induced myopericarditis and discuss the diagnostic implications, pathophysiology, and management. A 72-year-old female was admitted to the hospital with acute on chronic respiratory failure in the setting of COVID-19. The next day, she developed pressure-like retrosternal chest pain. Laboratory findings revealed elevated cardiac enzymes and inflammatory markers consistent with myocardial injury. Electrocardiogram revealed diffuse ST segment elevations without reciprocal changes, concerning for myopericarditis. Transthoracic echocardiography showed new findings of severely reduced left ventricular (LV) systolic function, with an estimated ejection fraction (EF) of 20%. Her hospital course was further complicated by cardiogenic shock that required treatment in the intensive care unit with vasopressors and inotropes. During the next few days, she had almost full recovery of her LV function, with EF improving to 50%. However, her clinical status deteriorated, likely the result of a bowel obstruction. She was transitioned to comfort care at the request of her family, and she died shortly after. This case highlights diagnostic and therapeutic challenges that physicians may encounter when managing acute cardiac injury in the setting of COVID-19. The multiple mechanisms of COVID-19-related myocardial injury may influence the approach to diagnosis and treatment.

Trigeminal neuralgia (TGN) is often caused by a neurovascular conflict at the root entry zone of the fifth nerve. Dural arteriovenous fistula (DAVF) accounts for 3%-4% cases of TGN. We report a posttraumatic head injury patient, presenting with gait ataxia and right facial pain. Radiographic evidence with magnetic resonance imaging and digital subtraction angiography was suggestive of DAVF. Surgical clipping and obliteration of fistula alleviated the TGN.

Spinal anesthesia is a safe, reliable, and inexpensive technique with the advantage of providing surgical anesthesia and prolonged postoperative pain relief, and it also blunts autonomic, somatic, and endocrine responses to surgical stimulus.

Due to the recent increase in the successful pregnancies after renal transplant, the number of renal transplant recipients having vaginal or cesarean delivery possibly associated with high maternal, fetal and/or neonatal risk requiring team approach increased. We aimed to evaluate antenatal follow-up, perinatal outcomes, and anesthesia management in pregnancies with renal transplantation and to compare them with the current literature.

We identified the need to modernize frostbite management in our northern centre and implemented a treatment protocol in 2015. Our aim was to describe the clinical course of patients presenting to the hospital since the implementation of the protocol.

is an emerging coagulase-negative regarded as a formidable pathogen capable of causing significant infections at various body sites including bone and joints. We report the case of a Caucasian elderly male with recurrent lumbar osteomyelitis due to . He had a history of chronic low back pain. Besides chronic kidney failure and need for hemodialysis, he had no other history of immunosuppression. He did not have fever or leukocytosis; however, the erythrocyte sedimentation rate was elevated, and repeated blood cultures from the periphery and the hemodialysis access (tunneled catheter) were continuously positive for . The diagnosis was made by bone biopsy and culture. The bacteremia cleared after removing of the dialysis catheter. The patient received 8 weeks of antibiotic therapy for the osteomyelitis.

To explore the impact of the New York State Prescription Drug Monitoring Program (IStop) on the self-reported management of patients with chronic pain by primary care providers.

Gallbladder adenomyomatosis (GA) is a benign alteration of the gallbladder wall. There are three types involved: segmental, fundal, and diffuse pattern; the last type is very rare. Ultrasound is the imaging method of choice for diagnosing that shows Rokitansky-Aschoff sinuses with cholesterol deposition creating comet-tail artifacts. Asymptomatic GA does not require surgery in case there are no malignant lesions defined by imaging diagnosis. We present the rare case of a 51-year-old man who was admitted to hospital due to abdominal pain concomitant with inflammatory syndrome. Imaging and histological findings were appropriate to diagnose diffuse GA and complication of cholecystitis.