Aspergilloma in a patient with no previous history of chronic lung disease

Patients with aspergilloma should undergo surgical treatment, because there is a risk of sudden life threatening hemoptysis and because there is no effective alternate medical therapy. We report a case of aspergilloma in a 47 year old man with no past history of tuberculosis presented with the complaint of hemoptysis for two weeks. It was diagnosed radiologically and treated with left upper lobectomy. Post operative course was complicated by cardiorhythmic disorder

Creutzfeldt-jakob disease: a case report presenting to the emergency department

Creutzfeldt-Jakob disease is lethal and most common spongiform encephalopathy worldwide and is rarely encountered in the Emergency department. For the benefit of patients and healthcare workers, rapid consideration of this condition needs to be sought in the setting of rapid neurological decline and myoclonic jerky movements. We present a case of a 54-year old male with behavioral changes, jerky body movements, cognitive dysfunction and left sided weakness developing over the course of few months and presented to our Emergency Department for the evaluation for stroke. Due to the non-specific nature of psychiatric and neurologic complaints, the initial diagnosis remained unclear. Magnetic Resonance Imaging of Brain demonstrated global atrophy with periventricular and subcortical T2 hyperintensities. Electroencephalogram showed continuous generalized periodic sharp wave activity with triphasic configuration. Investigations were highly supportive of probable Creutzfeldt-Jakob disease. Brain biopsy was planned but was not an acceptable option for suffering family. Our report showcased the symptoms, investigations, diagnostic challenges and raising concerns regarding this condition. It is advantageous for the emergency physician to be aware of clinical presentation of this rare condition. The prognosis for this disease is very poor and there is currently no cure

Optimising ventilator use during the COVID-19 pandemic

Hypoxemia is the most common cause for hospitalization in COVID-19 patients. Acute hypoxemic respiratory failure or acute respiratory distress syndrome (ARDS) is the most common complication in COVID-19 patients. Close monitoring of respiratory decompensation is essential. Supplemental oxygen, high flow nasal canula, non-invasive ventilation and endotracheal intubation are the most commonly suggested methods to improve oxygenation. Early intubation with pre-oxygenation, modified rapid sequence intubation and intubation using a video laryngoscope has been advised as a strategy including lung protective ventilation, prone position ventilation, adequate sedation and extracorporeal membrane oxygenation. Strict personal precautions and challenges related to airway management has been currently studied. The authors summarize here the issues of mechanical ventilation and some strategies to resolve them

Streptococcal pharyngitis: Delving deeper than the throat

Acute rhabdomyolysis and elevated transaminases during streptococcal pharyngitis are rare presentations. The proposed pathophysiological mechanisms include direct bacterial invasion and toxin generation. Physicians should be aware of the association between these infections and the above-mentioned complications to facilitate optimal treatment of these patients. We present the case of a 18-years-old gentleman with β-haemolytic streptococcal pharyngitis complicated by rhabdomyolysis and elevated liver function tests. Such high levels of creatine phosphokinase of 111856 IU/L and elevated liver function tests with aspartate aminotransferase (AST) of 1862 U/L and alanine aminotransferase (ALT) of 1003 U/L in streptococcal pharyngitis is rare to find in the literature. He was treated with aggressive intravenous hydration, antibiotics and hemodialysis. Key Words: Rhabdomyolysis, β-haemolytic Streptococci, Creatine phosphokinase, Liver function tests