Vitamin C Deficiency in a Food Insecure Patient: A Rare Case Report

Introduction: Scurvy is rarely seen in developed countries and is characterized by deficiency of vitamin C, which can lead to symptoms including wound impairment, bleeding manifestations, and loss of teeth. Case Description: We present a case of a 53-year-old male with a right knee hemarthrosis after a fall. The patient also noted progressively enlarging spontaneous hematomas, denying any recent trauma except for the fall to the knee. He denied family history of bleeding and clotting disorders and endorsed aspirin use in the setting of a prior stroke. He actively resided at a local shelter with limited means of transportation for routine medical care. Physical exam revealed large, firm hematomas on his bilateral lower extremities, poor dentition with spontaneous gum bleeding, and scattered petechiae on his back and feet. The patient’s diet consisted entirely of fast-food meals; he denied intake of fruits or vegetables for almost a full year. Nutritional deficiencies including ascorbic acid remained higher on the differential. Vitamin C levels returned \u3c 0.01 indicating severe deficiency (\u3c 0.02 is diagnostic). A bleeding disorder was ruled out based on other labs. He was treated with vitamin C, iron, thiamine, and folate supplementation. His hematomas improved significantly during the hospitalization. He was discharged on a multivitamin regimen and recommended outpatient physical therapy. Discussion: Scurvy is rare in the adult population of developed countries, and while easily treatable with an excellent prognosis, the consequences are deadly if missed. Clinicians should maintain a broad differential and consider social determinants of health in high-risk groups

Diagnostic and Therapeutic Challenge: A Case of Right Ventricular Thrombus

Right ventricular thrombus is a rare finding found in 4% of people diagnosed with pulmonary embolism. Although right ventricular thrombi are usually associated with atrial fibrillation, deep venous vein thrombi, or intracardiac procedures, isolated right ventricular thrombi are rare. Right ventricular thrombus has also been reported in patients with right ventricular infarction, as hypokinesis of the right ventricle causes blood stasis and promotes thrombosis as per Virchow’s triad. However, we present a case of isolated RV thrombus in a patient without evidence of deep vein thrombosis or right ventricular hypokinesis who presented with dyspnea on exertion

Accommodating practices during episodes of disillusionment with mobile IT

This study investigates how tablet users react when technology falls short of their expectations. We deploy a data/frame model to study this process and investigate resistance-related reactions and the deployment of accommodating practices at the individual level. Analyzing user blogs that provide narratives on user interaction with tablets, we identify triggers of episodes of disillusionment and illustrate five sensemaking paths that users follow, eventually leading to one of three practices: 1) users choose to defer tasks until the situation changes, or they abandon the platform altogether; 2) they develop workarounds at different levels of proficiency; or 3) they proceed by reframing their expectations of the platform. By revealing user decision-making process during episodes of disillusionment, the findings contribute to information systems post-adoption research. At a practical level, the findings inform IT artifact and application design by offering insights on how users process discrepancies between their expectations and actual use experience