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  • Leonard Bowers posted an update 10 months, 2 weeks ago

    Many healthcare resources have been and continue to be allocated to the management of patients with COVID-19. Therefore, the ongoing care of patients receiving oral anticoagulation with warfarin is likely to be compromised amid this unprecedented crisis. This article discusses a stepwise algorithm for the management of outpatient warfarin therapy. Alternative management strategies are presented and discussed, including alternative pharmacological therapy options and self-monitoring. Our algorithm aims to help clinicians safely optimize the treatment of patients requiring anticoagulation therapy in the context of the global response to the current pandemic.It is well known that Padua Medical School, Italy, played a fundamental role in shaping modern medicine. Its golden age lasted from the late XV to the late XVIII century, thanks in particular to its extraordinary anatomical school. One of the last fundamental achievements of the Padua Medical School was the founding of the anatomo-clinical method and organ pathology by Giovanni Battista Morgagni, Professor of Theoretical Medicine in Padua from 1711 and 1715 and of Anatomy from 1715 to his death. This method, which dramatically changed the course of medical diagnosis and therapy, was immediately developed by the so-called Anatomo-Clinical School of Paris. MEK inhibitor Figures such as Jean-Nicolas Corvisart and René Laennec improved this new approach in the clinical setting with the method of auscultation and the introduction of the stethoscope. However, organ pathology probably found its most important modern expression in the so-called Viennese School of Medicine, thanks to figures such as Karl von Rokitansky, Joseph Skoduring the different phases of Austrian domination in north Italy.Background Erythrasma is a superficial skin infection that presents with red-brown, flaky macules. It is caused by the Gram-positive bacteria Corynebacterium minutissimum. The purpose of our study is to investigate the prevalence and incidence of erythrasma in active sportsmen, i.e., athletes and football players, comparing the results with the incidence of the disease in the general population. Methods A total of 140 sportsmen, 110 male athletes and 30 football players, were examined by clinical examination, microscopic examination (Gram staining), and Wood’s lamp examination. Results Erythrasma was diagnosed in 39% (43) of the athletes and in 40% (12) of the football players studied. Inguinal folds were found to be most commonly affected. The disease was often localized to more than one area. This erythrasma study conducted in Bulgaria is the first in active athletes. The worldwide prevalence of erythrasma in the general population varies from 4 to 15%. Conclusion It was found that the incidence of erythrasma is high in men actively involved in sports. The results obtained are explained by the presence of many factors predisposing for the development of this disease in the athletes.Background Recently, improvised variants of sleeve gastrectomy SG were reported as alternative bariatric options in patients suffering from both morbid obesity and GERD, including mainly additional anterior or posterior fundoplication over a partially sleeved stomach. Methods We present the case of a 29-year-old male patient with a body mass index (BMI) of 46.2 kg/m2 underwent laparoscopic SG with concomitant posterior fundoplication Nissen-SG (N-SG). At postoperative day (POD) 4, he presented with epigastric pain, nausea, and 40 °C fever. The abdomen was tender with signs of peritonitis. Explorative laparotomy displayed a massive gastric leak with generalized peritonitis. Peritoneal lavage was performed. the patient was transferred to our department for the management of persistent SGL. Results Initial management comprised total parenteral nutrition and wide-spectrum intravenous antibiotics. Three weeks later, the patient underwent laparoscopic exploration. As shown in the video, at least two leaks were individualized, including one, anterior, catheterized by the pigtails, and the other one, posterior, impossible to reach endoscopically (Fig. 1). A residual abscess, located between the left crus, the pancreas, and the upper edge of the spleen, was evacuated. Eventually, Roux-en-Y gastro-jejunostomy was performed CONCLUSION The adjunction of a posterior fundoplication may have contributed to the multiple and complex occurrence of SGL. Having an ill-vascularized redundant fundus may have increased ischemia of the GE junction. Moreover, it is more difficult to perform endoscopic treatment in a plicated and sleeved stomach as well.Due to the profound effect of novel coronavirus disease 2019 (COVID-19) on healthcare systems, surgical programs across the country have paused surgical operations and have been utilizing virtual visits to help maintain public safety. For those who treat obesity, the importance of bariatric surgery has never been more clear. Emerging studies continue to identify obesity and several other obesity-related comorbid conditions as major risk factors for a more severe COVID-19 disease course. However, this also suggests that patients seeking bariatric surgery are inherently at risk of suffering severe complications if they were to contract COVID-19 in the perioperative period. The aim of this protocol is to utilize careful analysis of existing risk stratification for bariatric patients, novel COVID-19-related data, and consensus opinion from multiple academic bariatric centers within our organization to help guide the reanimation of our programs when appropriate and to use this template to prospectively study this risk-stratified population in real time. The core principles of this protocol can be applied to any surgical specialty.Concurrent surgical treatment of an intra-gastric stomach + morbid obesity is demonstrated. Video footage on diagnosis (gastroscopy and upper GI series) and surgical steps, as well as 2-year outcome (upper GI series), is presented. Although controversy exists regarding the best bariatric option when concomitantly repairing a giant para-esophageal hernia, in the light of recent reports and our own experience, sleeve gastrectomy may be the procedure of choice if reflux is no issue.