San Fernando General Hospital

This case report describes an elderly patient who experienced sudden death from fulminant pulmonary, gastrointestinal and nasal hemorrhage one day after receiving his second dose of the AstraZeneca ChAdox1nCoV-19 vaccine, during the SARS-CoV-2 pandemic. The patient was PCR negative for SARS-CoV-2, but had thrombocytopenia, erythroblastosis and markedly elevated D-Dimer levels. The clinical diagnoses considered included hypovolemic shock, Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT), PCR negative SARS-CoV-2 infection, Vaccine-Associated Enhanced Disease (VAED), Vaccine-induced Covid-19 mimicry Syndrome and Adenovirus induced thrombocytopenia and thrombosis. The autopsy findings revealed diffuse pulmonary hemorrhage, thrombosis of the microvascular system of the lungs, myocardium and kidneys, together with metastatic foamy cell prostate carcinoma to the lung and bone marrow. Disseminated Intravascular coagulation (DIC) secondary to advanced prostate cancer remained a significant differential diagnosis. This case report highlights the complexity of diagnosing (VITT) and the importance of considering other potential causes of thrombocytopenia and thrombosis, including the presence of solid tumors, particularly in elderly patients. The autopsy provided crucial insights into the patient’s condition.

Primary ovarian leiomyosarcoma is a rare clinical entity within the spectrum of gynecologic sarcomas. Accounting for less than 0.1% of all ovarian malignancies, ovarian leiomyosarcomas are highly aggressive mesenchymal tumours that arise from smooth muscle.This report describes the case of a 78-year-old postmenopausal woman who presented with non-specific lower abdominal discomfort, bloating and immobile palpable pelvic mass. Cross-sectional computed tomography demonstrated a large heterogenous adnexal mass with indeterminate features arising from the right ovary. The patient underwent primary cytoreductive surgery, including a total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings and infracolic omentectomy. Histopathology confirmed a stage IA right ovarian sarcoma favouring leiomyosarcoma morphology, with no evidence of uterine involvement or other primary source.Primary ovarian leiomyosarcomas tend to masquerade as epithelial neoplasms preoperatively. The aggressive clinical course, resistance to conventional chemotherapy and absence of established treatment protocols underscore the diagnostic challenges posed by primary ovarian leiomyosarcomas. This case highlights the importance of considering mesenchymal tumours in the differential diagnosis of atypical adnexal masses and underscores the need for formalized therapeutic guidelines for this rare tumour subtype.

Extracorporeal membrane oxygenation (ECMO) provides short-term cardiopulmonary support for patients with end-stage heart and lung failure and is increasingly used as a bridge to transplantation. Its expanding clinical role has prompted the need to clarify how patient selection, timing of initiation, and complication risks influence transplant eligibility and outcomes. This review aims to evaluate contemporary evidence on ECMO as a bridge to heart and lung transplantation by outlining selection criteria, analysing the timing of intervention, summarising survival and complication data, and identifying the limitations that prevent consistent clinical standardisation. For the selection of articles, a narrative review approach was used. Articles were screened from PubMed and Rayyan, restricted to English-language studies published within the past 15 years, using the search terms "ECMO", "heart failure", and "lung failure". Paediatric studies and non-English literature were excluded. Across the literature, patient selection is guided by absolute contraindications (e.g., chronic multiorgan dysfunction, unrecoverable primary cardiac disease) and relative contraindications such as advanced age. Early initiation of ECMO is consistently associated with improved survival. The venoarterial (VA)-ECMO and venovenous (VV)-ECMO provide critical cardiac and respiratory support with varying survival outcomes; however, the therapy is associated with substantial clinical risks, including renal failure, significant bleeding, systemic infection, and vascular complications such as stroke or limb ischaemia. Prolonged bridging due to donor shortages further complicates outcomes and limits comparability across centres. Thus, it reinforces that ECMO is a crucial bridge to heart and lung transplantation. However, its effectiveness depends on precise patient selection, early and standardised initiation strategies, and unified clinical guidelines. Improved standardisation and consistent reporting are essential to optimise outcomes and strengthen long-term post-transplant evidence.

Population aging is changing the workforce and the practice of occupational medicine. Older workers bring experience, judgment, and knowledge. But they may also have wider differences in physical reserve, sensory function, sleep tolerance, chronic disease, and recovery after illness or injury. This review examines the effects of these changes on work ability, fitness-for-work assessment, injury prevention, health surveillance, sickness absence, return to work, and workplace accommodation. We conducted a narrative review of PubMed-indexed, English-language human studies from database inception to June 2026. The search covered aging workers, occupational medicine, work ability, physical and cognitive capacity, chronic disease, work injury, shift work, workplace accommodation, return to work, and age management. We included 46 publications after screening for relevance. We grouped the evidence by theme. We did not perform a meta-analysis or formal risk-of-bias assessment. The evidence supports assessment based on function, job demands, hazards, and available controls rather than age alone. The strongest evidence supports broad principles. These include reducing the mismatch between worker capacity and job demands, improving ergonomic and fatigue controls, supporting chronic disease management, and using individual, time-limited accommodations. Other important issues include multimorbidity, polypharmacy, frailty, sarcopenia, burnout, ageism, organizational justice, and digital adaptation. But the intervention evidence is varied and limited by observational study designs, inconsistent definitions, and the healthy worker effect. Occupational medicine is moving from one-time medical clearance to long-term management of work ability. Occupational physicians should combine clinical findings with job analysis, prevention, rehabilitation, and organizational advice. Sustainable work needs age-inclusive design, fair access to training and accommodation, and regular review of risk controls.