Memorial Regional Hospital

Objective: To present the case of a 17-year-old girl who was readmitted post-tonsillectomy due to dengue fever, hematemesis and late tonsillar bleeding three weeks after the surgery. Methods:Design: Case ReportSetting: Tertiary Government Training HospitalPatient: One Results: A previously healthy 17-year-old Filipino girl underwent uncomplicated elective tonsillectomy for chronic hypertrophic tonsillitis. Twenty days post-operatively, she developed fever, thrombocytopenia and massive hematemesis. Despite intensive care management for severe dengue fever with concurrent late post tonsillectomy bleeding, the patient died from hemorrhagic shock on post-operative day 21. Conclusion: This appears to be the first reported case of concurrent late post-tonsillectomy hemorrhage and dengue fever in a previously healthy adolescent girl. In dengue-endemic areas, post-tonsillectomy patients should be counseled about dengue prevention and advised to seek medical attention for persistent fever. Early recognition and management of this potentially fatal combination is crucial for improving patient outcomes.

This scoping review aims to comprehensively synthesize current research on the use of mobile applications in otology, identify research gaps, and assess the feasibility of mobilebased applications in this field. The aim is to support and direct future research studies on harnessing the potential of mobile technology in otology. Following the PRISMA-ScR guidelines, a literature profiling approach was adopted using the Google Scholar search engine from September 2022 to January 2023. Only articles published in English between 2012 and 2023 were included, resulting in a final sample size of 32 papers. The results revealed an increasing focus on the remote delivery of healthcare, with the majority of the articles originating from the United States and authored by medical doctors. Two main categories were identified within the 32 selected journals: audiology and smartphone otoscopy. A total of 124 mobile applications were identified in these journals, with 48 applications for hearing tests and 27 applications for smartphone otoscopes being the most commonly utilized. Mobile applications have the potential to serve as valuable tools in the field of otology, especially in the context of smartphone hearing tests and smartphone-enabled otoscopes. However, further research is needed to assess their effectiveness, accuracy, and appropriate usage.

Antipsychotics are the mainstay for the treatment of schizophrenia and other psychotic disorders; however, these agents are associated with an extensive side effect profile that may complicate treatment outcomes. We present the case of a 35-year-old woman with a history of schizoaffective disorder and five prior psychiatric hospitalizations.The patient first presented to the hospital for disorganized behavior, in addition to poor sleep, auditory hallucinations, and racing thoughts in the context of medication nonadherence. She received two loading doses of intra-muscular paliperidone with fair symptomatic improvement. After discharge, she was scheduled to receive a monthly dose of paliperidone, which she missed, resulting in decompensation, re-emergence of psychosis, and another hospitalization two months later. She was given the missed dose with no improvement and progressive deterioration, for which alternative agents were tried. She received olanzapine and was tried briefly on quetiapine and haloperidol as well, with no benefit, and she also developed abnormal perioral movements. She was reloaded with paliperidone, and her psychotic symptoms improved, although she developed akathisia and hyperprolactinemia. The patient returned to the hospital two days later after being discharged, due to disorganized behavior and multiple delusions. Clozapine was started and titrated to 100 mg qam and 200 mg qhs. While on clozapine, she developed profuse sialorrhea that was treated with sublingual atropine drops, and by the time of discharge psychotic symptoms had markedly improved, perioral movements diminished, and prolactin level trended down. The patient maintained stability for over a year after the last admission.Identifying antipsychotics to successfully treat refractory psychosis and managing their multiple potential side effects is challenging but can result in better quality of life for patients as well as improved treatment adherence. This case report is unique in the way it illustrates this point, while discussing different approaches to managing multiple side effects that can happen simultaneously.

Acute mesenteric ischemia (AMI) is associated with a high mortality and morbidity. There are limited studies on the presentation and management of elderly dementia patients with AMI. The following case of an 88-year-old female with dementia presenting with AMI highlights the challenges in the care of elderly dementia patients with AMI, the importance of identifying risk factors and hallmarks of acute mesenteric ischemia early in the clinical course, and suggests that aggressive workup with diagnostic laparoscopy is crucial to timely diagnosis and effective care.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Introduction/Objective. ?o ensure that all patients receive the best possible anesthetic care, it is essential to continuously evaluate our practices and strive for improvement. The objective of this study was to internally assess the anesthesia services provided during the peripartum period. Methods. The Anesthesiology Department of Leskovac General Hospital, Serbia (LGH) aimed to evaluate patient satisfaction with spinal anesthesia (SA) for Cesarean delivery (CD) using a questionnaire consisting of four open-ended questions. Following Institutional Review Board approval, an institutional-based survey was conducted from August 2021 to July 2022. During the study period, 624 (40.6%) of the total 1535 deliveries in LGH were CDs, with 311 (49.8%) of them performed under SA. Of the patients who underwent CD under SA, 87 agreed to anonymously complete the questionnaire. Results. Although patients had sufficient space to provide detailed responses, the majority of participants opted for brief answers, often limited to ?yes? or ?no?. Of the surveyed participants, 78% were informed about SA for CD before delivery, and 96.6% expressed satisfaction with the information provided during the preoperative anesthesiologist?s visit. Additionally, the majority of participants (94.3%) reported satisfaction with the postoperative analgesia they received. Conclusion. Our patients expressed high levels of satisfaction with the preoperative anesthesiologist?s visit and the SA provided for CD. However, there is a need to improve antenatal education for expectant mothers in the field of anesthesia. Conducting a new and more detailed survey would be necessary to further explore the influence of patient education and socio-economic status on patient satisfaction.