Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023380 (lethargy)
 5,697 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Background: While ventriculoperitoneal shunt (VPS) is the most commonly performed surgical procedure for treating hydrocephalus, complications following shunt placement are associated with a high mortality rate. Preoperative medical optimization and surgery are the primary means of correcting shunt migration. We present the case of an 11-week-old patient who underwent emergent surgical intervention for transrectal VPS migration and associated infection. Case Report: An 11-week-old female presented with VPS tubing protruding from her rectum. The patient had a history of grade III intraventricular hemorrhage complicated by hydrocephalus status post VPS placement at age 3 weeks. Shunt tap demonstrated gross infection, and she was started prophylactically on broad-spectrum antibiotics. She was taken emergently to the operating room (OR) for VPS externalization and exploratory minilaparotomy. VPS tubing was removed, and the patient was transferred to the pediatric intensive care unit for postoperative management. Cultures confirmed methicillin-resistant Staphylococcus aureus, and the patient was treated according to infectious disease recommendations. On postoperative day (POD) 5, the patient had a full component VPS replacement. On POD 23, computed tomography scan of the head obtained for lethargy demonstrated a new midline shift, and she was returned to the OR for another VPS replacement. A small abscess was discovered and drained; postoperative cerebrospinal fluid laboratory values normalized after drainage. Once the infectious process cleared, the VPS was internalized on POD 33, and the patient was discharged home on POD 35. Conclusion: Few case reports detail the appropriate anesthetic considerations for cases of VPS migration. This report describes shunt migration pathophysiology and patient assessment with a focus on anesthetic preparation and management for this rare complication.
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PMID:Perioperative Management for Rectal Migration of a Ventriculoperitoneal Shunt. 3261 85

Coronavirus disease 2019 (COVID-19) emerged from the West District of Southern China Seafood Wholesale Market in late December 2019 and has been declared a global pandemic by the World Health Organization (WHO). Infection with severe acute respiratory syndrome coronavirus (SARS-CoV-2) presents with upper respiratory symptoms like cough, fever, and lethargy. At the same time, in later stages, critical COVID-19 patients develop acute respiratory distress syndrome (ARDS), venous thromboembolism (VTE), and multiple organ failure from cytokine storm and coagulation hyperactivity. Primary manifestations of thrombotic events include deep vein thrombosis (DVT), disseminated intravascular coagulation (DIC) and pulmonary embolism (PE). Initial coagulopathy in COVID-19 patients presents with elevated fibrin degradation products, especially D-dimers. In contrast, late presentations show evidence of prolonged prothrombin time (PT) and activated partial thromboplastin (aPTT), increased platelets, and fibrinogen levels. Diagnosis and monitoring of disease progression are done by regular screening of laboratory parameters, including D-dimer and fibrinogen. Management of coagulopathy in COVID-19 patients is like that of critically ill patients, including thromboprophylaxis. Coagulopathy is a poor prognostic factor, and optimum strategies should be developed for early diagnosis, prevention, and prompt treatment of VTE in COVID-19 patients. Thrombosis prophylaxis with low molecular weight heparin (LMWH) has shown beneficial results in preventing coagulopathy a reducing risk of mortality due to thrombotic events. We will discuss VTE in COVID-19 patients highlighting the role of D-dimer, fibrinogen, and interleukin-6 (IL-6).
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PMID:D-Dimer, Fibrinogen, and IL-6 in COVID-19 Patients with Suspected Venous Thromboembolism: A Narrative Review. 3322 33


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