Death following bilateral complete Achilles tendon rupture in a patient on fluoroquinolone therapy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Risk of tendon rupture, especially of the Achilles tendon, is one of the many potential side-effects of fluoroquinolone therapy. Achilles tendon rupture may be painful, debilitating or, as seen in our patient, devastating. While fluoroquinolone-induced tendon rupture typically accompanies other comorbidities (for example renal impairment) or concurrent steroid therapy, our case represents a medical 'first' in that there were no such comorbidities and no steroid therapy. Furthermore, our case is remarkable in that tendon rupture was bilateral, complete, and resulted in a devastating outcome.</p> <p>Case presentation</p> <p>A healthy 91-year-old Caucasian man was placed on fluoroquinolone (levofloxacin) therapy for a presumed bacterial pneumonitis. Subsequently, he developed bilateral heel pain, edema, and ecchymoses leading to a diagnosis of bilateral complete Achilles tendon rupture. This drug's side-effect was directly responsible for his subsequent physical and psychologic decline and unfortunate death.</p> <p>Conclusion</p> <p>Fluoroquinolones are a powerful and potent tool in the fight against bacterial infection. As a class, they are employed by primary care physicians as well as by subspecialty physicians in all areas of medical practice. However, as this case illustrates, the use of these drugs is not without risk. Attention must be paid to potential side-effects when prescribing any medication, and close follow-up with patients is a medical necessity to evaluate for these adverse reactions, especially with fluoroquinolones.</p

Impoundment Drawdown and Artificial Nest Structures as Management Strategies for Snowy Plovers

This paper presents preliminary work on two potential management techniques that might enhance populations of Snowy Plovers (Charadrius alexandrines). Large tracts of suitable plover nesting habitat are being degraded by vegetation encroachment at Great Sale Lake, Utah. Therefore, we used impoundment drawdown to create shorebird nesting habitat by eliminating unwanted vegetation at a diked wetland. Twenty-two pairs of Snowy Plovers, four pairs of American Avocets (Recurvirosta Americana), and one pair of Long-billed Curlew (Numenius americanus) nested in a 12-ha drawdown impoundment. Also, some apparently suitable nesting macrohabitants (sparsely vegetation salt flats) were not used by breeding plovers. We thought increasing the availability of potential nest-site microhabitants in these suitable macrohabitants might increase their use. We placed 1-m2 gravel pads on selected barren salt flats at Great Salt Lake, and Snowy Plovers readily used these artificial substrates; 50% of 32 small-grained structures were used for building scrapes and three structures had clutches initiated on them. These strategies represent potential management techniques that should be field tested by land managers to determine their effectiveness to enhance Snowy Plover populations

Rethinking Resident Perceptions of Tourism in British Columbia, Canada

This joint academic/practitioner report segments British Columbia, Canada residents to provide destination managers with new ways to better understand resident perceptions of tourism. The data collection was conducted in April and May of 2022 and had a total of 2,265 valid responses. It was also a practical objective to conduct this research in a manner that is repeatable in jurisdictions beyond British Columbia. This report has confirmed five distinct categories of residents’ perceptions toward tourism, including socio-cultural, economic, environmental, job/career, and Indigenous impacts. In addition to the categories of impacts, a cluster analysis has revealed six clusters of residents based on the five categories: Tourism Ambassadors, Tourism Supporters, Socio-cultural and Tourism Economic Supporters, Neutrals, Concerns about Careers and Environment, and Tourism Adversaries. Managerial implications and opportunities for future destination management and governance are discussed

Factors Affecting the Immune System of the Ornate Box Turtle (\u3ci\u3eTerrapene ornata\u3c/i\u3e)

While many studies have detailed the complex intricacies of the endothermic immune system, relatively little is known about the immune system of ectotherms--specifically, reptiles. In an attempt to gain more knowledge about the factors affecting reptilian immune function, ornate box turtles (Terrapene ornata) were subjected to chronic stress in the form of high ambient temperatures in a semi-natural environment. It was hypothesized that chronic stress would lead to elevated levels of corticosterone in the blood, which would, in turn, suppress immune activity. It was found that body temperature and body mass in particular were significantly affected by chronic heat stress. Among turtles subjected to chronic heat stress, white blood cell to red blood cell ratios decreased and numbers of natural antibodies decreased--all of which suggests lowered immune activity. This decrease in immune activity correlated with increases in body temperature as well as body mass. Changes in corticosterone levels within and between both treatment groups were insignificant. Taken together, these results suggest that turtles subjected to chronic heat stress experienced improved health due to increased body mass, increased body temperature, and decreased immune function. This study reinforces the complexity of the stress response, and it highlights its far-reaching effects not only on immune function, but also on the body as a whole

Apollo experience report guidance and control systems: Primary guidance, navigation, and control system development

The primary guidance, navigation, and control systems for both the lunar module and the command module are described. Development of the Apollo primary guidance systems is traced from adaptation of the Polaris Mark II system through evolution from Block I to Block II configurations; the discussion includes design concepts used, test and qualification programs performed, and major problems encountered. The major subsystems (inertial, computer, and optical) are covered. Separate sections on the inertial components (gyroscopes and accelerometers) are presented because these components represent a major contribution to the success of the primary guidance, navigation, and control system

Magnetism, X-rays, and Accretion Rates in WD 1145+017 and other Polluted White Dwarf Systems

This paper reports circular spectropolarimetry and X-ray observations of several polluted white dwarfs including WD 1145+017, with the aim to constrain the behavior of disk material and instantaneous accretion rates in these evolved planetary systems. Two stars with previously observed Zeeman splitting, WD 0322-019 and WD 2105-820, are detected above 5 sigma and > 1 kG, while WD 1145+017, WD 1929+011, and WD 2326+049 yield (null) detections below this minimum level of confidence. For these latter three stars, high-resolution spectra and atmospheric modeling are used to obtain limits on magnetic field strengths via the absence of Zeeman splitting, finding B* < 20 kG based on data with resolving power R near 40 000. An analytical framework is presented for bulk Earth composition material falling onto the magnetic polar regions of white dwarfs, where X-rays and cyclotron radiation may contribute to accretion luminosity. This analysis is applied to X-ray data for WD 1145+017, WD 1729+371, and WD 2326+049, and the upper bound count rates are modeled with spectra for a range of plasma kT = 1 - 10 keV in both the magnetic and non-magnetic accretion regimes. The results for all three stars are consistent with a typical dusty white dwarf in a steady-state at 1e8 - 1e9 g/s. In particular, the non-magnetic limits for WD 1145+017 are found to be well below previous estimates of up to 1e12 g/s, and likely below 1e10 g/s, thus suggesting the star-disk system may be average in its evolutionary state, and only special in viewing geometry.Comment: 14 pages, 7 figures, 3 tables; accepted to MNRA