According to the International Society of Aesthetic Plastic Surgery, surgical and nonsurgical aesthetic procedures increased in 2019 by 7.1% and 7.6%, respectively, compared with 2018. 1 Cosmetic medical tourism saw a concurrent increase during this time. Countries receiving the highest percentage of foreign patients were Thailand (33.2%), Mexico (22.5%), and Turkey (19.2%). 1 Many patients travel abroad due to reduced cost, cultural similarity between patient and providers, easy accessibility, and availability of procedures not performed in home country. 2,3 However, foreign regulations and safety standards for facilities, drugs, medical products, and devices may vary, and in some circumstances, be more lax than in the United States, increasing risk of postsurgical complications. 2 Additionally, patients who travel for procedures often lack follow-up with their surgeons, delaying timely detection of complications. 3 Common complications following cosmetic surgery performed abroad include wound infection, poor wound healing, wound dehiscence, and thromboembolic events. [2][3][4] Patients are also at risk of postsurgical infection associated with foreign pathogens. 2,4 This case highlights a patient presenting with serious surgical and medical complications post-lipoabdominoplasty performed in Latin America, emphasizing burdens on home healthcare system and importance of patient education. CASE REPORTA 48-year-old woman with no reported medical history underwent elective ventral hernia repair, liposuction, and abdominoplasty in Latin America. The patient reportedly had anaphylactic shock after receiving diclofenac postoperatively, and was transported via air to our hospital in San Antonio, Texas. On hospital day 2, the patient underwent emergent exploratory surgery due to tender abdomen, hemorrhagic bullae (Fig. 1), and ecchymosis (Fig. 2) found on examination, suggesting infection. In the OR, necrotizing soft tissue infection (NSTI) of the abdominal wall was observed; necrotic sections of abdominal wall were debrided with two areas of fascial debridement in right and left upper quadrants. Bowel perforation at the hepatic flexure was incidentally
The management of patients with elevated intracranial pressure (ICP) requires a systematic approach. After the failure of tier zero, tier one, and tier two therapies, all potential secondary causes of elevated ICP must be reviewed. Up to 28% of patients with blunt traumatic brain injury (TBI) develop cerebral sinus venous thrombosis (CSVT), among these, patients up to 55% have occlusive thrombi. A literature review revealed a dearth of specific treatment guidelines in this scenario. Here, we present one such case of refractory elevated ICP due to occlusive CSVT secondary to skull fractures. Initial CT venogram (CTV) on admission showed an occlusive CSVT; however, subsequent CTV on the post-trauma day (PTD) 4 and 6 showed non-occlusive thrombi only. The risks of worsening acute TBI-related hemorrhage with systemic anticoagulation versus the benefit of treating an occlusive CSVT are discussed here. In cases of occlusive CSVT with refractory elevated ICP and stable intracranial hemorrhage, the benefit of anticoagulation may outweigh the overall risks of hemorrhage expansion as prolonged uncontrolled ICP elevation is inevitably fatal. In this case, anticoagulation started on PTD 6, led to the resolution of ICP elevation and an excellent outcome for the patient, who was discharged to an acute rehab center, subsequently discharged home with no residual motor deficits, and was able to resume employment. Further prospective trials are necessary to develop guidelines for the management of occlusive CSVT in patients with severe TBI and to determine which patient populations are likely to benefit from early initiation of therapeutic anticoagulation.
Since penicillin was introduced in the world of medicine, this antibiotic saved millions from infectious diseases. However, in the past decades, antimicrobial resistance has developed into a widespread public health threat causing high morbidity and mortality rates. New Delhi Metallo β‐lactamase (NDM‐1) is associated with many resistant nosocomial infections by organisms such as Klebsiella pneumoniae. This organism has become resistant by producing NDM‐1 which hydrolyzes the beta‐lactam ring found in beta‐lactam antibiotics. It is important to find novel inhibitors against New Delhi Metallo β‐lactamase (NDM‐1). In order to find potential small molecule inhibitors against NDM‐1, a combination of wet lab and virtual screening procedures were performed. Virtual screening was done to identify high scoring compounds using GOLD. Different virtual libraries were screened along with positive and negative controls. In the wet lab, competent BL21(DE3) bacteria cells were transformed with an expression plasmid containing the CDS of NDM‐1 and then expressed using IPTG and ZnSO4 to improve soluble yield. In addition, three methods of purification were performed which included nickel affinity chromatography with 6xHIS tag, ion exchange and size exclusion Fast Protein Liquid Chromatography (FPLC). The protein samples were characterized using SDS‐PAGE gel. Furthermore, protein activity of the enzyme was analyzed in the presence of potential inhibitors using Nitrocefin as a substrate in spectrophotometric assays. Differential Scanning Fluorimetry (DSF) was performed to analyze the binding impact of several potential inhibitors on the melting temperature of NDM‐1. Out of the 12 compounds, only 1 showed modest shifts to the melting curve. Any novel compounds found to inhibit NDM‐1 activity may lead to effective new inhibitors to overcome antibiotic resistance.
Murine (endemic) typhus is a zoonotic disease spread by fleas carrying Rickettsia typhi bacteria. Typically, murine typhus presents with mild and nonspecific flu-like symptoms. However, it can manifest with severe systemic complications potentially leading to delayed treatment or unnecessary interventions. We present the case of a young woman from South Texas who presented to the emergency department after 10 days of fever, myalgia, headache, nausea, and right-sided abdominal pain. She was found to be febrile, severely hypotensive, suffering from acute liver injury with a predominantly cholestatic pattern, acute kidney injury, severe thrombocytopenia, and hyponatremia. She was initially managed with broad-spectrum antibiotics for undifferentiated septic shock, and doxycycline was added due to suspicion of a Rickettsial infection. Although radiographic findings showed some evidence of biliary involvement, they were not typical for common biliary diseases. However, due to her severe clinical presentation and findings suggesting possible acute cholangitis, she underwent an endoscopic ultrasound with endoscopic retrograde cholangiopancreatography, which revealed no evidence of acute obstructive biliary disease. Without strong evidence to explain her presentation, an extensive chronic liver disease workup was done, which was negative. The patient ultimately clinically improved with antibiotics alone. This case demonstrates an atypical presentation of murine typhus, presenting with septic shock and masquerading as acute cholangitis. With the rising incidence of murine typhus in endemic areas of the United States, this case reinforces the importance of being cognizant of the typical and atypical presentations of murine typhus, which may allow for early appropriate treatment and potentially avoid unnecessary interventions. Additionally, in this study, we conducted a literature review of murine typhus cases associated with acute biliary dysfunction.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.