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Soler-Luna C, Reynoso-Saldana D, Burgos MI, Gutierrez CH. Unexpected Ground-Glass Opacities on Abdominopelvic CT of a Patient With a Negative SARS-CoV-2 Antigen Test Result and No Respiratory Symptoms Upon Admission. Cureus 2020; 12:e11044. [PMID: 33101790 PMCID: PMC7575311 DOI: 10.7759/cureus.11044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 01/08/2023] Open
Abstract
One of the biggest challenges during the coronavirus disease 2019 (COVID-19) pandemic continues to be the detection of asymptomatic and presymptomatic persons infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Persons infected with SARS-CoV-2 who do not have symptoms of COVID-19 may transmit the virus to others and may have subclinical lung abnormalities. Some hospitals use SARS-CoV-2 antigen tests for pre-admission screening testing because they are relatively inexpensive, have a rapid turnaround time, and can be performed at the point of care; however, antigen tests are generally less sensitive than nucleic acid amplification tests with reverse transcription polymerase chain reaction (RT-PCR) assay. Moreover, as the local COVID-19 prevalence increases, the negative predictive value of antigen tests may decrease, meaning that the probability of having false-negative results may increase. We present a case of a patient who, prior to admission for a surgical procedure, had a negative antigen test result for SARS-CoV-2, had no respiratory symptoms, and had no suspected or known exposure to SARS-CoV-2; however, she tested positive for SARS-CoV-2 RNA after admission. The only factor that led the healthcare team to suspect SARS-CoV-2 infection was an unexpected finding of bilateral ground-glass opacities on an abdominopelvic computed tomography (CT), which was performed to assess the extent of a perianal abscess the patient presented. This case highlights the importance of using highly sensitive SARS-CoV-2 tests for pre-admission screening testing in the hospital setting.
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Affiliation(s)
- Carol Soler-Luna
- Internal Medicine, University of Texas Rio Grande Valley School of Medicine/Doctors Hospital at Renaissance, Edinburg, USA
| | - Domingo Reynoso-Saldana
- Internal Medicine, University of Texas Rio Grande Valley School of Medicine/Doctors Hospital at Renaissance, Edinburg, USA
| | - Monica I Burgos
- Anesthesiology, Universidad Autonoma de Guadalajara, Guadalajara, MEX
| | - Cesar H Gutierrez
- Internal Medicine, University of Texas Rio Grande Valley School of Medicine/Doctors Hospital at Renaissance, Edinburg, USA
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Abstract
We present three cases where an inflamed incarcerated appendix was in a femoral, inguinal, and an umbilical hernia. All three patients underwent an appendectomy laparoscopically. The hernias in two of the patients (femoral and inguinal) were left unrepaired as the primary goal was to relieve the patients' symptoms and achieve source control. The hernia was repaired primarily in the patient with an umbilical hernia intraoperatively. At three months follow-up, none of the patients had a clinically visible hernia.
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Affiliation(s)
- Anupam K Gupta
- Minimally Invasive Surgery, University of Miami Hospital, Miami, USA
| | - Oscar A Vazquez
- Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Miami, USA
| | - Monica I Burgos
- Anesthesiology/Internal Medicine, Universidad Autonoma de Guadalajara, Guadalajara, MEX
| | - Jose Yeguez
- Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Miami, USA
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Abstract
At our center, over 200 patients undergo minimally invasive repairs of inguinal hernias every year using a laparoscope and a robotic-assisted technique. In three patients who underwent a minimally invasive procedure for uncomplicated indirect inguinal hernia, the postoperative course was complicated with bleeding and required an exploratory laparotomy. Post-procedure, the patients developed tachycardia and hypotension with a drop in hemoglobin, for which the patients required surgical re-exploration in an emergent fashion. The factors leading to bleeding were analyzed and are reported herein to increase awareness and prevent the occurrence of these complications during inguinal hernia surgery.
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Affiliation(s)
- Anupam K Gupta
- Minimally Invasive Surgery, University of Miami Hospital, Miami, USA
| | - Monica I Burgos
- Internal Medicine, Universidad Autonoma de Guadalajara, Guadalajara, MEX
| | | | - Miguel Lopez-Viego
- Surgery, Bethesda Hospital East, Boca Raton, USA.,Surgery, Bethesda Hospital, Boynton Beach, USA
| | - Matthew M Ramseyer
- Trauma and Critical Care Surgery, Florida State University Collage of Medicine, Palm Beach, USA
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Gupta AK, Burgos MI, Lopez-Viego M, Hus N. Gluteal Compartment Syndrome After Prolonged Immobilization in Drug Abusers. Cureus 2020; 12:e9847. [PMID: 32953354 PMCID: PMC7497769 DOI: 10.7759/cureus.9847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background There has been an increasing incidence of drug abuse patients presenting with rhabdomyolysis after prolonged immobilization. Our study was to assess etiology and management challenges with patients presenting with gluteal compartment syndrome after drug abuse. Methodology We did a retrospective analysis of five patients who presented with gluteal compartment syndrome secondary to drug abuse over one year. Results We had a 100% association with rhabdomyolysis and acute renal injury necessitating hemodialysis. There was a frequent association with the involvement of additional compartments like thigh and leg. Conclusion Patients with drug overdose can present with unusual compartment syndrome involvement like the gluteal compartment. Compartment syndrome is a surgical emergency and needs multidisciplinary involvement.
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Affiliation(s)
- Anupam K Gupta
- Minimally Invasive Surgery, University of Miami Hospital, Miami, USA
| | - Monica I Burgos
- Internal Medicine, Universidad Autonoma de Guadalajara, Guadalajara, MEX
| | | | - Nir Hus
- Surgery, Delray Medical Center, Delray Beach, USA.,Surgery, Florida Atlantic University, Boca Raton, USA
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Gupta AK, Burgos MI, Azar F, Rueda M, Hus N. Vascular Shunt for Small Vessel Trauma in a Polytrauma Patient. Cureus 2020; 12:e9150. [PMID: 32789087 PMCID: PMC7417326 DOI: 10.7759/cureus.9150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A 15-year-old male patient presented with multiple gunshot injuries. The patient underwent emergency lifesaving exploratory laparotomy and subsequently needed repair of his left upper limb ulnar artery injury. A shunt helped restore blood flow to the hand in a setting of damage control surgery in an exsanguinating patient with an ulnar artery injury having a massive disruption. After resuscitation, the patient underwent definitive repair of the artery using a vein interposition graft.
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Affiliation(s)
- Anupam K Gupta
- Minimally Invasive Surgery, University of Miami Hospital, Miami, USA
| | - Monica I Burgos
- Internal Medicine, Universidad Autonoma de Guadalajara, Guadalajara, MEX
| | - Faris Azar
- Surgery, St. Mary's Medical Center, West Palm Beach, USA
| | - Mario Rueda
- Trauma and Acute Care Surgery, St. Mary's Hospital, Boca Raton, USA
| | - Nir Hus
- Surgery, Delray Medical Center, Delray Beach, USA.,Surgery, Florida Atlantic University, Boca Raton, USA
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Gupta AK, Burgos MI, Lopez-Viego M. Delayed Presentation of Foot Compartment Syndrome. Cureus 2020; 12:e8628. [PMID: 32685297 PMCID: PMC7364411 DOI: 10.7759/cureus.8628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 30-year-old male after consuming alcohol and drugs lost consciousness and passed out in his bathroom. After 10 hours, he was found immobilized stuporous on his bathroom floor and brought by emergency service to the emergency room. He was found to have compartment syndrome of the right lower limb and underwent emergency fasciotomy of three compartments of the thigh and four compartments of the leg. The postoperative course was complicated by acute kidney injury necessitating hemodialysis. On postoperative day three from the index fasciotomy patient was found to develop foot compartment syndrome despite not having foot compartment involved in the initial presentation. In opioid abuse, patients' additional compartments can get involved during the disease process, and it is essential to identify them with regular physical examination and use of biomarkers.
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Affiliation(s)
- Anupam K Gupta
- Minimally Invasive Surgery, University of Miami Hospital, Miami, USA
| | - Monica I Burgos
- Internal Medicine, Universidad Autonoma de Guadalajara, Guadalajara, MEX
| | - Miguel Lopez-Viego
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA.,Surgery, Bethesda Hospital, Boynton Beach, USA
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Capelli TK, Gupta AK, Burgos MI, Hus N. Isolated Injury to Prepuce After Motor Vehicle Collision. Cureus 2020; 12:e8451. [PMID: 32637288 PMCID: PMC7331917 DOI: 10.7759/cureus.8451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A four-year-old male restrained passenger in the rear seat was in a motor vehicle collision. He had pain and swelling in the tip of the penis with the inability to micturate. The patient on evaluation had an isolated injury of the prepuce. The patient underwent an evaluation to rule out underlying penile/urethra and associated injury of kidney and bladder. The patient had an isolated injury to prepuce, causing urinary retention for which he underwent circumcision.
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Affiliation(s)
| | - Anupam K Gupta
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Monica I Burgos
- Internal Medicine, Universidad Autonoma de Guadalajara, Guadalajara, MEX
| | - Nir Hus
- Surgery, Delray Medical Center, Delray Beach, USA.,Surgery, Florida Atlantic University, Boca Raton, USA
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Gupta AK, Vazquez OA, Burgos MI, Buicko J, Lopez-Viego M. Fulminant Ischemic Pancolitis: A Severe Variant of Ischemic Colitis. Cureus 2020; 12:e7720. [PMID: 32431998 PMCID: PMC7233966 DOI: 10.7759/cureus.7720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present the case of a 75-year-old female with abdominal pain and a sudden change in mental status. She progressed rapidly with manifestations of acidosis without episodes of bloody bowel movements or diarrhea. The patient underwent emergent exploratory laparotomy, and a diagnosis of fulminant ischemic pancolitis was made with visual confirmation of infarcted colon from cecum to proximal rectum leading to subtotal colectomy and ileostomy. Postoperatively, the patient showed improved acidosis and mental status; unfortunately, over the subsequent days, the patient declined and was transferred to hospice and palliative care.
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Affiliation(s)
- Anupam K Gupta
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Oscar A Vazquez
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Monica I Burgos
- Internal Medicine, Universidad Autonoma de Guadalajara, Guadalajara, MEX
| | - Jessica Buicko
- Endocrine Surgery, Bethesda Hospital East/Florida Atlantic University, Boynton Beach, USA
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