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Dive into the research topics where Richard Duncalf is active.

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Featured researches published by Richard Duncalf.


American Journal of Case Reports | 2014

Opioid overdose with gluteal compartment syndrome and acute peripheral neuropathy

Muhammad Adrish; Richard Duncalf; Gilda Diaz-Fuentes; Sindhaghatta Venkatram

Patient: Male, 42 Final Diagnosis: Gluteal compartment syndrome • acute peripheral nauropathy Symptoms: — Medication: — Clinical Procedure: — Specialty: Critical Care Medicine Objective: Management of emergency care Background: Heroin addiction is common, with an estimated 3.7 million Americans reporting to have used it at some point in their lives. Complications of opiate overdose include infection, rhabdomyolysis, respiratory depression and central or peripheral nervous system neurological complications. Conclusions: We present a 42-year-old male admitted after heroin use with heroin-related peripheral nervous system complication preceded by an acute gluteal compartment syndrome and severe rhabdomyolysis. Case Report: Early diagnosis and surgical intervention of the compartment syndrome can lead to full recovery while any delay in management can be devastating and can lead to permanent disability. The presence of peripheral nervous system injuries may portend a poor prognosis and can also lead to long term disability. Careful neurological evaluation for signs and symptoms of peripheral nervous system injuries is of paramount importance, as these may be absent at presentation in patients with opioid overdose. There is a potential risk of delaying a necessary treatment like fasciotomy in these patients by falsely attributing clinical symptoms to a preexisting neuropathy. Early EMG and nerve conduction studies should be considered when the etiology of underlying neurological weakness is unclear.


Medicine | 2016

A Case Report of Cannabis Induced Hemoptysis.

Hafiz Rizwan Talib Hashmi; Richard Duncalf; Misbahuddin Khaja

AbstractAs the principal route of marijuana use is by inhalation, potential harmful consequences on pulmonary structure and function can be anticipated. Here, we present a case of hemoptysis attributed to smoking cannabis in a 38-year-old man. The patient experienced an episode of hemoptysis and shortness of breath immediately after smoking marijuana. Chest radiograph and computed tomography (CT) scans of the chest showed bilateral diffuse ground-glass opacities. A fiber optic bronchoscopy confirmed bilateral diffuse bleeding from respiratory tract. Additional evaluation of hemoptysis indicated no infection or immunological responses. Urine toxicology was positive for cannabis.Chronic marijuana smoking causes visible and microscopic injury to the larger airways responsible for symptoms or chronic bronchitis. We review the beneficial and deleterious effects of marijuana and describe a case of significant hemoptysis attributed to smoking marijuana. In addition to other respiratory complications of marijuana use, physicians should educate their patients about this potentially lethal effect of marijuana smoking in the form of hemoptysis.


Case reports in oncological medicine | 2014

An Innocent Appearing Subcutaneous Nodule Diagnoses a Small Cell Lung Cancer in a Never-Smoker Female

Nupur Sinha; Masooma Niazi; Gilda Diaz-Fuentes; Richard Duncalf

Lung cancer among never-smokers is recognized as the 7th most common cause of cancer death globally. Adenocarcinoma is the most commonly reported histology. Small cell lung cancer (SCLC) has the strongest association with smoking and is rarely reported in never-smokers. Although lung cancer in never-smokers is more common in women, the overall incidence of SCLC in female never-smokers still remains low. Soft tissue metastases from any cancer are rare with an overall prevalence of 1.8%. Soft tissue metastases from lung primary are uncommon, mostly from adenocarcinoma, and portend a poor prognosis. Cutaneous metastases from SCLC are exceptionally rare with reported incidence of 0.3% to 0.8%. We believe ours is the first reported case of SCLC presenting as subcutaneous nodule, in a never-smoker, otherwise asymptomatic female. The diagnosis of SCLC was made incidentally by the excisional biopsy of the subcutaneous nodule. Subsequent CT chest and PET scan revealed a hypermetabolic right lower lobe spiculated lung mass with adrenal and liver involvement. Platinum and etoposide chemotherapy with prophylactic cranial irradiation was initiated for advanced SCLC, and she required further irinotecan and taxol for subsequent pancreatic and adrenal metastases. With continued deterioration, she died approximately 36 months from diagnosis, while under hospice care.


Medicine | 2016

Failing phrenics: an obscure cause of exertional dyspnea: Case report and literature review.

Arsalan Rafiq; Mohsin Ijaz; Hassan Tariq; Trupti Vakde; Richard Duncalf

Introduction:Idiopathic phrenic nerve palsy is a rare cause of exertional dyspnea. We present a case of a patient presenting with worsening dyspnea of an unknown etiology found to be related to bilateral phrenic nerve palsy. Discussion:Forty-two-year-old man presented to our emergency department with exertional dyspnea, orthopnea, and a left lower lobe consolidation treated initially as bronchitis by his primary physician as an outpatient, then subsequently as pneumonia at another institution, with no improvement in symptomatology. After admission to our hospital, CT chest demonstrated only supradiaphragmatic atelectatic changes. Echocardiography was normal. Bronchoscopy was contemplated however the patient could not lie flat. A fluoroscopic sniff test demonstrated diaphragmatic dysfunction and pulmonary function tests revealed restrictive pulmonary disease with evidence of neuromuscular etiology. Nerve conduction studies confirmed bilateral phrenic neuropathy. He was referred to a specialized neuromuscular disease center where subsequent workup did not demonstrate any specific etiology. A sleep study confirmed sleep disordered breathing suggestive of diaphragmatic paralysis and he was discharged on bi-level positive pressure ventilation. Conclusion:This is a unique case of exertional dyspnea and orthopnea from diaphragmatic paresis caused by bilateral phrenic nerve palsy where the initial workup for pulmonary and cardiovascular etiologies was essentially unremarkable. Shortness of breath and orthopnea caused by phrenic neuropathy is a rare condition, yet has a variety of etiologies. Our case suggests a template to the diagnostic approach, management, and follow up of bilateral phrenic nerve palsy.


Case reports in critical care | 2016

Beta Lactamase Producing Clostridium perfringens Bacteremia in an Elderly Man with Acute Pancreatitis

Rashmi Mishra; Nupur Sinha; Richard Duncalf

Clostridium perfringens bacteremia is associated with adverse outcomes. Known risk factors include chronic kidney disease, malignancy, diabetes mellitus, and gastrointestinal disease. We present a 74-year-old man admitted with confusion, vomiting, and abdominal pain. Exam revealed tachycardia, hypotension, lethargy, distended abdomen, and cold extremities. He required intubation and aggressive resuscitation for septic shock. Laboratory data showed leukocytosis, metabolic acidosis, acute kidney injury, and elevated lipase. CT scan of abdomen revealed acute pancreatitis and small bowel ileus. He was started on vancomycin and piperacillin-tazobactam. Initial blood cultures were positive for C. perfringens on day five. Metronidazole and clindamycin were added to the regimen. Repeat CT (day 7) revealed pancreatic necrosis. The patient developed profound circulatory shock requiring multiple vasopressors, renal failure requiring dialysis, and bacteremia with vancomycin-resistant enterococci. Hemodynamic instability precluded surgical intervention and he succumbed to multiorgan failure. Interestingly, our isolate was beta lactamase producing. We review the epidemiology, risk factors, presentation, and management of C. perfringens bacteremia. This case indicates a need for high clinical suspicion for clostridial sepsis and that extended spectrum beta lactam antibiotic coverage may be inadequate and should be supplemented with use of clindamycin or metronidazole if culture is positive, until sensitivities are known.


Medicine | 2016

Failing phrenics: an obscure cause of exertional dyspnea

Arsalan Rafiq; Mohsin Ijaz; Hassan Tariq; Trupti Vakde; Richard Duncalf


Archive | 2014

Rapidly reversible multiorgan failure after ingestion of "Molly" (pure 3,4- methylenedioxymethamphetamine):

Trupti Vakde; Manuel Diaz; Kalpana Uday; Richard Duncalf


Chest | 2013

Have You Heard About Molly

Trupti Vakde; Manuel Diaz; Kalpana Uday; Richard Duncalf


american thoracic society international conference | 2011

Utility Of Routine Daily Blood Work In A Medical Intensive Care Unit; An Observational Study

Sindhaghatta Venkatram; Vijai Daniel; Muhammad Anwer; Richard Duncalf; Gilda Diaz Fuentes


Chest | 2011

Outcome of Patients With Out of Hospital Cardiac Arrest Admitted to the Intensive Care Unit in an Inner City Hospital

Anmol Kharbanda; Sindhaghatta Venkatram; Richard Duncalf; Muhammad Adrish; Gilda Diaz-Fuentes

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Gilda Diaz-Fuentes

Bronx-Lebanon Hospital Center

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Trupti Vakde

Bronx-Lebanon Hospital Center

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Arsalan Rafiq

Bronx-Lebanon Hospital Center

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Hassan Tariq

Bronx-Lebanon Hospital Center

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Kalpana Uday

Bronx-Lebanon Hospital Center

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Mohsin Ijaz

Bronx-Lebanon Hospital Center

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Muhammad Adrish

Albert Einstein College of Medicine

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Nupur Sinha

Bronx-Lebanon Hospital Center

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Manuel Diaz

Universidad Autónoma de Nuevo León

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