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The article describes a case of a rare iatrogenic subcutaneous emphysema associated with dental extraction in a 40-year-old man presented to the hospital following an episode of central chest pain.

A 26-year-old female presented with a 3-month history of dry cough, unintentional weight loss, night sweats and fatigue. Her background history was significant for ulcerative colitis, managed with Adalimumab for almost 2 years. Clinical examination was unremarkable, apart from some mild pallor. Abnormal chest x-ray findings prompted a computerised tomography (CT) thorax which demonstrated multifocal peri-bronchial consolidation. The differential diagnosis was multifocal organising pneumonia and tuberculosis (TB). Extensive investigations, including invasive bronchial imaging and biopsy, ultimately ruled out TB. This paper reports a case of Adalimumab-induced organising pneumonia and discusses its clinical implications.

Importance: The end of the COVID-19 public health emergency (PHE) provides an opportunity to fully describe pandemic-associated racial and ethnic mortality disparities. Age-specific excess mortality differences have important downstream implications, especially in minoritized race and ethnicity populations., Objectives: To characterize overall and age-specific all-cause excess mortality by race and ethnicity during the COVID-19 PHE and assess whether measured differences reflected changes from prepandemic disparities., Design, Setting, and Participants: This cross-sectional study analyzed data of all US residents and decedents during the COVID-19 PHE, aggregated by observed race and ethnicity (at time of death) and age. Statistical analysis was performed from March 2020 to May 2023., Exposures: COVID-19 PHE period (March 2020 to May 2023)., Main Outcomes and Measures: All-cause excess mortality (incident rates, observed-to-expected ratios) and all-cause mortality relative risks before and during the PHE., Results: For the COVID-19 PHE period, data for 10 643 433 death certificates were available; mean (SD) decedent age was 72.7 (17.9) years; 944 318 (8.9%) were Hispanic; 78 973 (0.7%) were non-Hispanic American Indian or Alaska Native; 288 680 (2.7%) were non-Hispanic Asian, 1 374 228 (12.9%) were non-Hispanic Black or African American, 52 905 (0.5%) were non-Hispanic more than 1 race, 15 135 (0.1%) were non-Hispanic Native Hawaiian or Other Pacific Islander, and 7 877 996 (74.1%) were non-Hispanic White. More than 1.38 million all-cause excess deaths (observed-to-expected ratio, 1.15 [95% CI, 1.12-1.18]) occurred, corresponding to approximately 23 million years of potential life lost (YPLL) during the pandemic. For the total population (all ages), the racial and ethnic groups with the highest observed-to-expected all-cause mortality ratios were the American Indian or Alaska Native (1.34 [95% CI, 1.31-1.37]) and Hispanic (1.31 [95% CI, 1.27-1.34]) populations. However, higher ratios were observed in the US population aged 25 to 64 years (1.20 [95% CI, 1.18-1.22]), greatest among the American Indian or Alaska Native (1.45 [95% CI, 1.42-1.48]), Hispanic (1.40 [95% CI, 1.38-1.42]), and Native Hawaiian or Other Pacific Islander (1.39 [95% CI, 1.34-1.44]) groups. In the total population aged younger than 25 years, the Black population accounted for 51.1% of excess mortality, despite representing 13.8% of the population. Had the rate of excess mortality observed among the White population been observed among the total population, more than 252 000 (18.3%) fewer excess deaths and more than 5.2 million (22.3%) fewer YPLL would have occurred., Conclusions and Relevance: In this cross-sectional study of the US population during the COVID-19 PHE, excess mortality occurred in all racial and ethnic groups, with disparities affecting several minoritized populations. The greatest relative increases occurred in populations aged 25 to 64 years. Documented differences deviated from prepandemic disparities.

In an attempt to reduce the number of inappropriate clotting screens being performed in our Trust, an electronic prompt was introduced to our haematology requesting system. Over the six month period after introduction of this prompt the number of clotting screen requests reduced by 7001, representing a 21% reduction when compared to the same 6 month period one year earlier. This represented a cost saving of over £98,000 without any increase in adverse incidents being reported related to bleeding complications.

Duplex scanning is utilised by many departments in the investigation of suspected DVT. NICE Guideline CG144 recommended repeat scanning for patients in whom the initial Wells score was 'likely' in the presence of a raised D-Dimer, following a normal first scan. Following implementation of this recommendation in our department there was a dramatic rise in the number of repeat scans being undertaken, all of which were negative for DVT. Introduction of an electronic message to the report, placing the onus back on the referring clinician to arrange repeat scan if deemed appropriate resulted in a fall in the number of scans being undertaken without impacting on patient outcome.

Background and Objectives: This study investigated a novel, high-power, 532 nm frequency-doubled Nd:YAG, KTP laser with contact cooling for the treatment of spider veins of the lower extremities., Study: Twenty female subjects with Fitzpatrick skin types I-III, were treated to 79 sites using the 532 nm wavelength of a dual-wavelength 532/1,064 nm laser (Excel V, Cutera, Brisbane, CA) with a 5 mm-diameter spot, fluences ranging from 13 to 15 J/cm(2) , and a pulse-duration of 40 milliseconds. Two treatments were performed 12 weeks apart. Photographs were taken at baseline and 12 weeks following the final treatment. Improvement was assessed by two independent physicians reviewing photographs in a blinded fashion using a 5-point improvement scale., Results: All subjects demonstrated improvement resulting in a median improvement of 2.5 (one-sample Wilcoxon signed rank test, 95% CI: 1.9-2.9, P = 0.000). The reviewers were highly consistent (kappa of 0.85), and highly accurate (kappa of 0.85) in identification of "after photograph" and they were highly consistent in grading improvement. Subjects and the treating physician reported "significant" to "very significant" (∼51 to 100%) improvement in 75% and 69% of subjects, respectively. Post-inflammatory hyper-pigmentation was seen in 2% of sites (1/64). No serious adverse effects reported. All subjects tolerated the treatments well (mean pain score of 2.9/10)., Conclusion: Treatment of spider veins of the leg with a novel 532 nm KTP laser was found to be safe and effective, with minimal discomfort and adverse effects in Fitzpatrick skin types I-III., (© 2013 Wiley Periodicals, Inc.)