Application of Aspiration-Assisted Percutaneous Venous Removal of Right Atrial Thrombus in a Critically Ill Patient: A Case Study and Clinical Management Overview

We herein present a complex case of a 50-year-old female with catheter-related atrial thrombus (CRAT). This patient with end-stage renal disease on hemodialysis presented with angioedema leading to respiratory failure. She was subsequently intubated, and the pre-procedural course was complicated by a cardio-respiratory arrest, and anoxic brain injury. The patient’s hemodialysis catheter placement in the superior vena cava (SVC) potentially correlated with the development of the right atrial thrombus. The patient was treated percutaneously as she presented with complex morbidities. The mass was successfully removed via aspiration-assisted percutaneous right heart bypass, a procedure that utilizes a vacuum system to remove thrombi. Post-procedure, the patient remained stable and continued supervised care.

The Impact of COVID-19 Pandemic on Dermatological Conditions: A Novel, Comprehensive Review

Background: The earliest cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, in December 2019. Since the declaration as a pandemic on 11 March 2020, further dermatological conditions continue to be documented. We herein present a novel literature review of dermatological manifestations associated with the Coronavirus Disease 2019 (COVID-19) pandemic. To date, this literature review is the first broad-spectrum examination that analyzes a range of dermatological manifestations related to the COVID-19 pandemic: infection, vaccinations, personal protective equipment (PPE), and psychosocial factors. Methods: A detailed literature search was conducted using key terms for cutaneous manifestations associated with the scope of this review. The search retrieved 2199 articles. Results: The COVID-19 pandemic has triggered a significant range of dermatologic sequela. Etiologies of lesions continue to be investigated. Proposed mechanisms include inflammatory response to spike protein, vitamin D deficiency, ACE2 receptor activation, androgen levels, and increased psychological stress. One prominent mechanism describes viral spike protein invasion into the dermis by binding to the angiotensin-converting enzyme 2 (ACE-2) receptors in keratinocytes, with a secondary immunological response. Conclusions: Dermatologists play an integral role in the proper diagnosis and treatment of COVID-related lesions. Early treatment regimens and timely prophylaxis have been shown to safely reduce infection-related dermatological sequelae. Additional investigations and data collection can reduce disease burden and improve overall prognosis.

Advocacy for Change: An Osteopathic Review of Traumatic Brain Injury Among Combat Veterans

As a "signature injury" of the Iraq and Afghanistan wars, traumatic brain injury (TBI) remains a major health concern among military service members. Traumatic brain injury is associated with a wide range of symptoms which may be cognitive, emotional, psychological, biochemical, and social in nature. Mild TBI (mTBI) ranks as the most common traumatic brain injury among veterans. Due to the absence of specific symptoms, mTBI diagnosis may be challenging in acute settings. Repetitive traumatic brain injury during combat deployments can lead to devastating chronic neurodegenerative diseases and other major life disruptions. Many cases of TBI remain undetected in veterans and may lead to long-term adverse comorbidities such as post-traumatic stress disorder (PTSD), suicide, alcohol disorders, psychiatric diagnoses, and service-related somatic dysfunctions. Veterans with TBI are almost twice as likely to die from suicide in comparison to veterans without a history of TBI. Veterans diagnosed with TBI experience significant comorbid conditions and thus advocacy for improved care is justified and necessary. Given the complexity and variation in the symptomatology of TBI, a personalized, multimodal approach is warranted in the evaluation and treatment of veterans with TBI and other associated conditions. As such, this review provides a broad overview of treatment options, with an emphasis on advocacy and osteopathic integration in the standard of care for veterans.

Aggressive Cutaneous Squamous Cell Carcinomas Following Treatment for Graft-versus-Host Disease: A Case Report and Review of Risk Factors

A 19-year-old female with a history of pre-B cell acute lymphocytic leukemia (ALL) presented with two aggressive cutaneous squamous cell carcinomas (C-SCC) in the right hand. The patient was diagnosed with pre-B cell ALL at four years of age. She underwent chemotherapy with initial remission. However, recurrence of the pre-B cell ALL required an unrelated allogeneic cord hematopoietic stem cell transplant (alloHSCT). Post-transplant, the patient developed Graft-Versus-Host Disease (GVHD), which was treated with immunosuppressant therapy for six years until resolution. Fourteen years following the transplant, the patient developed a morbilliform drug eruption secondary to clindamycin. She consequently received prednisone treatment. During the treatment period, the patient developed a new ulcerated and tender nodule on the dorsal aspect of her right hand. Further histopathological biopsy confirmed the diagnosis of C-SCC, which required excision. Ten months following the excision, the patient developed an additional C-SCC nodule on the same right hand, separated by 2.6 cm from the prior C-SCC. She was referred for a ray resection procedure. This case illustrates a patient with multiple risk factors that may have contributed to the continued development of C-SCC. Such risk factors include: a prolonged course of immunosuppressant medications and voriconazole treatment. Additional research is needed to investigate the etiologies and risks of C-SCC development in patients who require a transplant and long-duration immunosuppressive therapy.