Major depressive disorder (MDD) is a significant psychiatric condition, with many affected individuals not gaining remission from conventional treatments, leading to classification as treatment-resistant depression (TRD). This study aimed to investigate the potential of intravenous (IV) ketamine, particularly the S-enantiomer esketamine in nasal spray form, for treating patients with TRD and associated comorbidities. We report three cases of patients with diverse psychiatric and medical backgrounds whom all reported significant symptomatic relief from depressive episodes and suicidal ideation (SI) following esketamine administration. Additionally, esketamine seemed to proffer benefits beyond the primary depressive symptoms, positively impacting other comorbid conditions, such as agitation, self-injurious behavior (SIB), and chronic pain. The goal of this paper is to highlight that while esketamine's primary utility is in addressing TRD, its therapeutic potential may extend to a variety of associated conditions. However, it is crucial to underscore the heterogeneity of MDD, emphasizing the necessity for individualized therapeutic approaches and further research into esketamine's broader applications.Full article

Practice guidelines recommend fixed combinations of calcipotriol, a topical vitamin D analogue, and betamethasone dipropionate, a high potency corticosteroid, as first line topical treatment for mild to moderate plaque psoriasis of the body and scalp. A new foaming lotion for treatment of Psoriasis was developed and patented by the Spanish Ministry of Industry, Trade and Tourism (Invention patent reference number 202030824). The foaming lotion is composed of clobetasol, papaverine hydrochloride, spironolactone, milk-peptide-complex and propylene glycol. Three cases with moderate Psoriasis aged 34, 36 and 66 years old were treated with our new foaming lotion for 7-8 days. The three patients reported important improvement in the itching sensations and remission of the scaled lesions. Before and after application of the new foaming lotion, Psoriasis Area Severity Index (PASI) scores improved in the first patient from 24.3 to 1.8, in the second patient from 26.1 to 1.8, and in the third patient from 27 to 1.8. Our results show the short-term effectiveness of the new foaming lotion in treating moderate and extensive Psoriasis. Long follow-up is needed to evaluate the remission period of Psoriasis and possible side effects of the new topical treatment.Full article

Anaphylaxis can be associated with hemodynamic shock, which requires the early initiation of adrenaline as part of its management. Cardiogenic pulmonary edema is a frequent entity in emergency services with increased mortality in patients with acute coronary syndrome. The case report presents the case of a 55-year-old male patient who entered the emergency department with a non-ST-segment elevation myocardial infarction (NSTEMI) associated to pulmonary edema and anaphylaxis. During his stay in the emergency room, he had an anaphylactic reaction to dipyrone (metamizole) used for pain control. The patient presented signs of acute pulmonary edema, a hypertensive urgency after the use of adrenaline for the management of anaphylaxis.  There was doubt as to whether the dyspnea was of anaphylactic or cardiogenic origin, so an emergency ultrasound was performed, which suggested a bilateral pattern B.  This allowed timely management of ventilatory failure with systemic nitrates, diuretics, and oxygen therapy, which controlled blood pressure and resolved ventilatory failure. Subsequently, he was transferred to an institution with a hemodynamic service for the management of NSTEMI. We highlight the utility of emergency ultrasonography for immediate decision-making and the low prevalence of anaphylactic reaction in a patient with NSTEMI leading to acute pulmonary edema.Full article

Background: Pseudomonas aeruginosa (P. aeruginosa) is one of the most common pathogens in hospital-acquired pneumonia (HAP) including ventilator-associated pneumonia (VAP). Recently, ceftolozane/tazobactam (CTLZ/TAZ) has been used to treat pneumonia due to P. aeruginosa. Case series: Two cases of P. aeruginosa pneumonia treated by CTLZ/TAZ that had been initially treated by piperacillin/tazobactam (PIPC/TAZ) are presented. (Case 1): A 76-year-old man who underwent esophagectomy developed severe pneumonia caused by P. aeruginosa infection and received oxygen by high-flow nasal canula. PIPC/TAZ was started, and he improved 10 days later. PIPC/TAZ was switched to sulbactam/ampicillin, but on day 14, his respiratory condition worsened, and septic shock developed. P. aeruginosa was isolated from his blood, and CTLZ/TAZ was started because the isolated P. aeruginosa showed resistance to PIPC/TAZ. Although he recovered on Day 28, and CTLZ/TAZ was switched to levofloxacin, his condition worsened again, and P. aeruginosa resistant to CTLZ/TAZ was isolated from his blood on day 32. Finally, he died of septicemia and renal failure. (Case 2) A 51-year-old woman who underwent surgery for a brain tumor developed VAP due to P. aeruginosa and was treated by PIPC/TAZ. Her pneumonia improved, but pneumothorax developed, and she was therefore switched to CTLZ/TAZ on day 7. Her pneumonia improved smoothly without bacteremia 10 days later. Conclusions: These data and cases suggest that CTLZ/TAZ was effective for severe P. aeruginosa pneumonia although the isolated P. aeruginosa was resistant to PIPC/TAZ. However, the duration of CTLZ/TAZ administration may need to be considered for pneumonia cases with bacteremia due to P. aeruginosa.Full article

Acupuncture is an alternative medicine, actually it has had a greater acceptance in our continent being use for multiple therapeutic purposes. Although it is a minimally invasive procedure it is not exempt from complications, most common minor complications such as infections or local pain have been described, as well as less frequently but potentially fatal complications such as subarachnoid hemorrhage and tension pneumothorax. We report a case of pneumothorax secondary to acupuncture in a patient who was treated for carpal tunnel syndrome.Full article

Hyphaema is the presence of blood in the anterior chamber (AC) of the eye and is commonly caused by a blunt ocular trauma. In this case report, we discuss a case of a 29-years-old African man presented to the emergency department with severe right ocular pain and blurry vision following a blunt injury. This is a teaching case report aimed to discuss the management options, potential complications and visual prognosis of this particular case.Full article

Giant cell arteritis (GCA) with ocular involvement is an emergency condition, and treatment with glucocorticoids should be provided immediately upon clinical suspicion of GCA to prevent potential blindness. In this case report, we discuss a case of a 70-years-old Caucasian male presented to the emergency department with one day sudden onset of double vision. This is a teaching case report aimed to discuss the management options, potential complications and visual prognosis of this particular case.Full article

To report a case of a major branch retinal vein occlusion (BRVO) in the superotemporal region with superior macular involvement and a review of its natural history. This is a retrospective case presentation of a 49-year-old African Caribbean female patient presented to Accident and Emergency with unilateral persistent acute history of reduced central vision of left eye for 10 days with no other associated symptoms. Treatment options included using scatter (pan-retinal) laser photocoagulation followed by intravitreal injections as the area of non-perfusion is >5-disc area. It is warranted to understand the risk factors associated with BRVO and to develop appropriate treatment and follow-up plans.Full article

May-Thurner Syndrome, left iliac vein compression by the right iliac artery, is a congenital permissive lesion that requires an additional insult prior to the onset of symptoms. We present a case of a 31-year-old gravida 1 para 0 at 28.6 weeks who presented to the emergency room with a 2-month history of progressive lower left leg swelling since 21.2 weeks’ gestation. The patient endorsed incidence of domestic violence at 17 weeks’ gestation. The patient had a twin sister who was also pregnant and had not experienced these symptoms. Physical exam revealed 3+ pitting edema in the left lower extremity from ankle to groin. There was left calf tenderness with negative Homan’s sign bilaterally. Overall finding on magnetic resonance angiography revealed severe compression of the upper left common iliac vein and lower inferior vena cava by gravid uterus. Conservative management and anticoagulation is instrumental in preventing veno-thromboembolic events in pregnancies complicated by MTS.Full article

Although rarely, echinococcosis might present cardiac involvement, with cysts growing inside myocardial structures of arising adjacent to heart. A careful differential diagnosis with other mass formations and rare cardiac tumours is necessary, whenever there is a clinical and radiological suspicion. Imaging studies and serology will establish diagnosis. A multidisciplinary approach is warranted in all cases, with surgical intervention being unavoidable in most settings. Patients generally present with chest pain and dyspnoea. Cases need a close follow up of their postoperative course, while being treated appropriately with albendazole (or mebendazole) for prevention of recurrences.Full article