Case Report of E-cigarette Associated Lung Injury in a Health Female

This is a case of a woman presenting with four days of diarrhea and dyspenea found to have E-cigarette or vaping-associated lung injury (EVALI

Got Sugar? Pharmacist Intervention to Improve A1c

AIM: Within 6 months, we aim to decrease by 10% the number of our diabetic patients with an A1c \u3e8 through Clinical Pharmacist referrals.https://jdc.jefferson.edu/patientsafetyposters/1033/thumbnail.jp

Clinical Image: Halo Sign

CASE PRESENTATION A 68-year-old man with no significant past medical history was transferred to our hospital for evaluation of newly diagnosed acute leukemia. His bone marrow biopsy showed acute undifferentiated leukemia. He was initiated on standard induction chemotherapy with cytarabine and idarubicin. His hospital course was complicated by neutropenic fever secondary to Fusobacterium bacteremia. He was started on antibiotic therapy with intravenous cefepime and oral metronidazole. Intravenous vancomycin was added in the setting of recurrent intermittent fevers. On hospital day 20, he developed minimal hemoptysis, pleuritic chest pain, and recurrent fevers. A CT scan of the chest showed a right upper lobe band-like opacity. Due to concern for possible invasive aspergillosis, he was started on oral voriconazole. Serum galactomannan was negative. Given the patient’s thrombocytopenia, tissue diagnosis was deferred. Repeat CT of the chest two weeks later showed an interval increase in the right upper lobe spiculated mass with surrounding ground glass “halo” (Figure 1). A presumptive diagnosis of pulmonary aspergillosis was made in the setting of prolonged neutropenia, classic symptomatology, and rapid growth of the mass suggestive of an infectious process, as well as the halo sign on CT. He was discharged on voriconazole with plans for repeat imaging in several weeks and possible tissue diagnosis at that time

Clinical Images: Sigmoid Volvulus

Case Presentation: A 72-year-old male with a history of Parkinson\u27s disease, Type 2 diabetes, hypertension, hyperlipidemia, and cerebral vascular accident presented to the emergency room for 10 minutes of unresponsiveness at his nursing home. A workup for the unresponsiveness was unrevealing. His hospital course was complicated by constipation, a condition that resulted in multiple hospitalizations in the prior 6 months. Abdominal exam was notable for mild distension, and an initial x-ray demonstrated an ileus. The severity of his distention acutely worsened two days after it was initially noted, and was associated with borborygmi and high-pitched bowel sounds. A repeat x-ray was consistent with a sigmoid volvulus. The patient underwent endoscopic colonic decompression with resolution of the volvulus, but due to recurrence, ultimately required a sigmoidectomy

Evaluation of Asthma Control in Patients with and without Sinonasal Polyps following Treatment with Biologic Agents

Background: The effects of biologics on severe asthmatics with chronic rhinosinusitis with sinonasal polyposis (CRSwNP) have not been well established. This study evaluates overall control of asthma in patients with and without sinonasal polyps following initiation of biologics therapy. Methods: Retrospective review of patients with asthma treated with a biologic agent (benralizumab, omalizumab, dupilumab, mepolizumab) and CRSwNP. Charts were assessed for ACT scores at time of biologic enrollment and at 4-7 months. Results: 82 patients met inclusion criteria; 42 (52.5%) patients with asthma and 40 (47.5%) with concurrent sinonasal polyps. The average ACT score for the non-polyp cohort was 13.16 + 4.12 at baseline, and 16.45 + 4.79 at long term follow-up; 15.85 + 3.13 and 20.19 + 1.68 in patients with polyps at both time points respectively. Patients with polyps had better control of their asthma at baseline (p=0.001), however both cohorts had overall poor baseline asthma control (ACT\u3c19). Patients with polyps continued to have significantly better overall control of their asthma at long term follow up (p\u3c0.001) and, on average, were able to achieve sustained asthma control (mean ACT = 20.19), after initiation of biologic therapy. Conclusions: Patients with and without sinonasal polyps who begin biologic therapy are shown to have significant improvements in their ACT score at follow-up. In addition, patients with polyps are shown to have significantly better control of their asthma while on biologics than patients with no polyps. Comorbid CRSwNP may predict response to biologic therapy in those with severe asthma (SA)