The Rare Case of Streptococcus Pyogenes Pneumonia and Its Sequelae

Introduction Group A Streptococcus (GAS) or Streptococcus pyogenes is an aerobic gram-positive coccus that causes a multitude of infections that range in severity. GAS most commonly infects the soft tissues, which results in infections such as cellulitis, erysipelas, necrotizing fasciitis and myositis. These deep soft tissue infections are also the most common source of GAS bacteremia. Other common infections caused by GAS include pharyngitis, rheumatic fever and glomerulonephritis.1 The lower respiratory tract is an uncommon site for GAS infection and it is the least common source of GAS bacteremia; however, in adults with GAS pneumonia, the incidence of bacteremia is 80 percent.2 Patients with a severe GAS infection can develop streptococcal toxic shock syndrome, which consists of GAS bacteremia in conjunction with shock and organ failure. Here we present a case of severe GAS pneumonia complicated by toxic shock syndrome and purpura fulminans, a rare complication of disseminated GAS infection. Case Presentation A 57-year-old male with a history of gastric adenocarcinoma status post partial gastrectomy presented with a two-day history of shortness of breath and chest tightness. He denied any associated fevers, cough, sputum production, pharyngitis, diarrhea or dysuria. In the emergency room, he was afebrile (although he had been taking acetaminophenoxycodone tablets every 4 to 6 hours for his chest pain) with a heart rate of 123 bpm, blood pressure 78/49 mmHg, respiratory rate 21-27 bpm, and pulse oximetry of 94% on a non-rebreather. Physical exam revealed right upper lobe rales, as well as egophony and sinus tachycardia. There was no evidence of pharyngeal erythema, exudates, or ulcers. Pertinent lab work on admission included a creatinine of 2.3 mg/dL and a lactate of 9.0 mmol/L. Computed tomography (CT) of his chest was consistent with pneumonia in the right upper lobe with patchy areas of consolidation in the right middle and lower lobes. The patient received ceftriaxone, azithromycin and five liters of normal saline. He was admitted to the medical intensive care unit (MICU) for severe sepsis secondary to communityacquired pneumonia

A 55-Year-Old Man With Rapid Onset Rectosigmoid Mass and Hepatic Metastases with an AFP of \u3e 3 Million ng/mL

Case A 55-year-old male with a past medical history of ulcerative colitis diagnosed in 1999, Barrett’s esophagus, hyperlipidemia, and diabetes mellitus presented with a 2-week duration of daily constant abdominal pain. He described the pain as a sharp, epigastric pain not worsened with food intake or bowel movements. He was unable to tolerate any oral intake for a week prior to admission secondary to increased epigastric pain. He stated an increase in bowel movements to 1 per day that was softer and less formed than usual. He also stated he had a near syncopal episode on the day of admission and reported dizziness. The patient denied any bright red blood per rectum or having dark stools. He states he also had some fevers, chills, and a sore throat for 3 days duration. He had tried some Pepto Bismol without any improvement

Improving the Patient Colonoscopy Prep Experience

AIM: To improve patient prep compliance, prep quality, and an overall better experience by designing a prep specific website that will address the most common prep questions and concerns Once launched, the website address will be placed on printed colonoscopy prep instructions and stated on the after hours GI clinic voicemail as an additional patient resourcehttps://jdc.jefferson.edu/patientsafetyposters/1049/thumbnail.jp

A Case Report of Multiple Aseptic Facial and Spinal Abscesses in a 45-Year-Old with Inflammatory Bowel Disease

INTRODUCTION Sterile abscess syndrome is a rarely described entity that is often associated with auto-inflammatory disorders. Although clinically similar to septic abscesses, sterile abscesses are known to be unaffected by antibiotic regimens and instead highly sensitive to steroids. The association of sterile abscesses with inflammatory bowel disease has been well-described. The majority of sterile abscess syndromes described in the literature are intraabdominal abscesses related to a primary gastrointestinal inflammatory disease. We describe a unique case of extra-abdominal sterile abscess syndrome associated with inflammatory bowel disease presenting as facial and paraspinal lesions

Professionalism and moral injury in a capitalist healthcare system

Professionalism cautions against profit while capitalism exists for profit. This case is a structural analysis of capitalism in a clinical setting that reveals physicians to be simultaneously wage laborers and professionals. Capitalism generates profit. Professionalism views profit as a conflict of interest that erodes trust in the doctor-patient relationship. Managing these conflicting values causes moral injury for physicians, which is a driver of physician burnout

SGLT2 Inhibitors in Patients with Diabetes and Cardiovascular Disease

Problem Definition: Multiple studies (e.g. EMPA-REG, CANVAS) demonstrate that SGLT2 Inhibitors (Inh) improve cardiac outcomes in patients with Type II Diabetes (DM2) with comorbid Cardiovascular Disease (CVD) including Heart Failure and Coronary Artery Disease. SGLT2 Inhibitors are considered standard of care for patients with DM2 and CVD. Based on literature published in European Journal of Preventative Cardiology and JACC HF, our prediction is that physicians at Thomas Jefferson University Hospital Ambulatory Practices (TJUH) under-utilize SGLT2 Inh for patients with co-morbid CVD and DM2. Aims for Improvement: Within the Jefferson Healthcare System, we sought to determine: Future Interventions The percentage of patients with an indication for an SGLT2 Inhibitor who were actually being prescribed this. How often providers within the Jefferson system were prescribing these medications, and what the barriers to prescribing are. With this information, we hoped to increase the percentage of (qualifying) patients who are on these medications as part of standard of care by 20% within one year of intervention

Dextromethorphan-quinidine is helpful for pseudobulbar affect disorder in stroke patients

An informed consent article using Hammond FM, Alexander DN, Cutler AJ, et al. PRISM II: an open-label study to assess effectiveness of dextromethorphan/quinidine for pseudobulbar affect in patients with dementia, stroke or traumatic brain injury. BMC Neurology. 2016;16:89. https://doi.org/10.1186/s12883-016-0609-0 for a patient with pseudobulbar affect following strok

Simulated rescue airway use by laypersons with scripted telephonic instruction.

BACKGROUND: The King LT-D is a supraglottic airway with the potential for use by trained first responders in settings where access to advanced life support interventions by a physician or Emergency Medical Services may be delayed. OBJECTIVES: To determine the success rate of novice users in the telephone-directed placement of the King LT-D airway during a simulated respiratory arrest in order to establish the feasibility of conducting further study into use of the device by first responders after minimal training. METHODS: We conducted a prospective study using 30 undergraduate students without medical training and a high-fidelity simulator. Subjects were instructed using a telephone-directed protocol to assess the airway, place the King LT-D and ventilate the simulator. Subjects were assessed on the successful placement of the King LT-D, time to placement, and perceived ease of use of the device. A Likert scale was used to identify the participant\u27s perceptions. Subjects with CPR/AED certification were compared to those without such training. Data were analyzed using descriptive statistics and a t-test. RESULTS: The King airway was successfully placed in 80% (95% CI: 65; 95) of attempts. Success rate did not differ with prior CPR training. The median time to successful placement was 1min 50s (95% CI: 1min 6s; 2min 39s). The participants perceived the King LT-D to be easy to place in 90% (27/30) of cases. CONCLUSION: The King LT-D is simple enough to use, that it can be successfully placed by novice users with minimal telephonic instruction. This suggests that further studies could be conducted to determine the effect of King LT-D use on quality of airway management in scenarios depicting management of cardiac arrest by first responders in areas with delayed access to ALS interventions

Simultaneous Forward-Backward Prony Estimation

Power system dynamic stability can be evaluated through the analysis of transient oscillations that occur following significant system events. One of the earliest methods for this type of study is Prony analysis, which estimates the system's electromechanical modes. While previous studies have highlighted advantages of performing Prony analysis on data in the forward and backward directions, the proposed method does so simultaneously. As a result, signal poles corresponding to electromechanical modes can be distinguished from spurious poles more reliably. The method also produces a single mode estimate, where independent application in the forward and backward directions would produce two estimates for each mode. The method is validated using simulated and measured power system data

Characterization of the pscC (Type III secretion) gene of Pseudomonas aeruginosa (PA01) and assessment of immunogenicity of pscC protein in rats

Proteins associated with the bacterial membrane can be recruited for application as antigens for the development of vaccines. This preliminary study was directed towards evaluating the antigenic properties of the Pseudomonas aeruginosa (PA01) pscC protein which is a component of the Type III secretion system. Gene specific primers were designed to isolate the pscC gene which was isolated, ligated onto the multiple cloning site of vector pGS21(a), cloned and expressed in Escherichia coli (BL21). The molecular weight of the expressed pscC protein was determined by SDS-PAGE (10% sodium dodecyl sulphate-polyacrylamide gel electrophoresis) and was found to be around 57 KDa and purified by the size exclusion chromatography. Finally, the purified pscC protein was injected subcutaneously into adult Sprague Dawley rats with a range of concentrations (50, 100 and 150 microgram per rat) respectively. Recombinant pscC antigen induced a specific humoral immune response against the antigen, which was validated by Enzyme-linked immunosorbent assay (ELISA). The results concluded that anti-pscC antibody was elicited in the animal model