Sutter Santa Rosa Regional Hospital

The trapdoor fracture is a subtype of orbital fracture and is considered a rare condition that occurs primarily in children and adolescents. The treatment consists of surgery to access and remove the trapped tissue in the floor of the orbit that prevents the movement of the eyes on the affected side. The aim of this article is to present a case of a trapdoor fracture in a 4-year-old child who suffered a domestic accident and underwent surgery under general anesthesia to release the muscles trapped in the orbital floor. The postoperative outcome was considered excellent, with complete recovery of visual and aesthetic functions, without the need for reconstruction of the fractured region with any type of fixation material.

Collagenous sprue (CS) is a rare autoimmune gastrointestinal disorder characterized by specific histologic changes in the small intestine. It often presents with more severe symptoms and a worse prognosis compared to celiac disease, including significant malabsorption, weight loss, and nutrient deficiencies. Despite treatment with a gluten-free diet, symptom improvement is limited, with only a small fraction of patients responding positively. This case report highlights the diagnostic challenges and clinical features of CS in a 74-year-old woman, whose symptoms resolved following cessation of olmesartan. The case emphasizes the importance of recognizing medication-induced forms of the disease and outlines the need for targeted management strategies to improve patient outcomes.

BackgroundRemdesivir, a nucleotide analogue prodrug that inhibits viral RNA polymerases, has shown in vitro activity against SARS-CoV-2.MethodsWe provided remdesivir on a compassionate-use basis to patients hospitalized with Covid-19, the illness caused by infection with SARS-CoV-2. Patients were those with confirmed SARS-CoV-2 infection who had an oxygen saturation of 94% or less while they were breathing ambient air or who were receiving oxygen support. Patients received a 10-day course of remdesivir, consisting of 200 mg administered intravenously on day 1, followed by 100 mg daily for the remaining 9 days of treatment. This report is based on data from patients who received remdesivir during the period from January 25, 2020, through March 7, 2020, and have clinical data for at least 1 subsequent day.ResultsOf the 61 patients who received at least one dose of remdesivir, data from 8 could not be analyzed (including 7 patients with no post-treatment data and 1 with a dosing error). Of the 53 patients whose data were analyzed, 22 were in the United States, 22 in Europe or Canada, and 9 in Japan. At baseline, 30 patients (57%) were receiving mechanical ventilation and 4 (8%) were receiving extracorporeal membrane oxygenation. During a median follow-up of 18 days, 36 patients (68%) had an improvement in oxygen-support class, including 17 of 30 patients (57%) receiving mechanical ventilation who were extubated. A total of 25 patients (47%) were discharged, and 7 patients (13%) died; mortality was 18% (6 of 34) among patients receiving invasive ventilation and 5% (1 of 19) among those not receiving invasive ventilation.ConclusionsIn this cohort of patients hospitalized for severe Covid-19 who were treated with compassionate-use remdesivir, clinical improvement was observed in 36 of 53 patients (68%). Measurement of efficacy will require ongoing randomized, placebo-controlled trials of remdesivir therapy. (Funded by Gilead Sciences.)

There is a paucity of prevalence data for genital angiokeratomas in adults. The objective of this article is to determine prevalence of genital angiokeratomas in adults as a function of sex, age, and race/ethnicity. A cross-sectional study was conducted over 11 months during 2013 and 2014 using a convenience sample of adult men and women consenting to genital examination during melanoma screening and surveillance by a senior dermatologist in an outpatient clinic. The analysis was conducted from April through December 2016. Of 213 white/European American adults examined (127 men and 86 women), genital angiokeratomas were detected in 30.0% (64/213). Presence of at least one genital angiokeratoma was significantly associated with male sex (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.3-4.5; P < .001) and age older than 50 years (OR, 3.4; 95% CI, 1.7-6.7; P = .008). Genital angiokeratomas are relatively common in adults of white/European American origin and important to recognize because of their benign nature and occasional confusion with other tumors.