COVID-19 infection and treatment-resistant cocaine-induced pyoderma gangrenosum: A case report

Introduction Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis of non-infectious etiology. Cocaine-induced PG (CIPG) is a documented clinical variant. Case presentation We report an exceptional case of cocaine-induced PG flare unresponsive to conventional treatment in the context of positive COVID status. A 41year-old male with past medical history of recent COVID infection, pyoderma gangrenosum and chronic cocaine abuse presented with acutely worsening multifocal ulcerations covering multiple limbs approximately 30% body surface area (BSA) one day after cocaine use. After hospitalization for ten days with no improvement in cutaneous symptoms, he was transferred to a burn center for disease control with biologics. Discussion The previous temporal relationship between disease outbreak and cocaine consumption and improvement after its discontinuation no longer remained in the setting of COVID positive status. This is the first case in literature of extensive and treatment-refractory PG in a COVID-positive patient with recent cocaine use. Conclusion This case highlights the importance of further investigation on the connection between COVID infection and PG and the need for establishing treatment guidelines for PG

Periprosthetic knee infection after benign tumor excision complicated by carbapenem resistant Enterobacteriaceae: A case report

Introduction Periprosthetic joint infection (PJI) is a major complication after total knee arthroscopy. Enterobacter is a rare cause of PJI. Case presentation We present a 65 year old Caucasian man who presented with acute right knee PJI with Carbapenem-resistant Enterobacteriaceae (CRE) two months after undergoing right knee intra-articular mass removal with endoprosthetic reconstruction. The periprosthetic joint infection (PJI) was treated with revision with 1-stage static spacer and IV meropenem. Discussion CRE is an uncommon cause of PJI, but when it does occur, it commonly infects patients who are immunosuppressed or have specific risk factors. For an immunocompetent patient with CRE PJI, we suggest further workup for other systemic disease. Conclusion This case demonstrates the importance of early diagnosis and treatment of CRE joint infections and the need for a multidisciplinary approach that includes aggressive surgical intervention and tailored antimicrobial therapy

Diagnosing a rare thoracic intramedullary spinal dermoid cyst using DWI with ADC mapping: Case report

Introduction Dermoid cysts are rare lesions generally associated with embryological errors that occur during neural tube closure. Intramedullary lesions are extremely rare, especially within the upper thoracic spinal cord. Case presentation We report a case of a 19-year-old male who had an intramedullary thoracic dermoid cyst presenting with progressive ataxia, lower limb weakness, and hyperreflexia. MRI demonstrated a 1.2 × 1.8-cm intramedullary thoracic dermoid cyst causing significant spinal cord compression, which was successfully removed via full resection. The patient had an uncomplicated postoperative course, with improvement in preoperative deficits. Discussion This is a unique case documenting a thoracic spinal cord intramedullary dermoid cyst not associated with trauma or congenital abnormality of the spinal cord. Conclusion We highlight the importance of future inclusion of diffusion-weighted magnetic resonance (MR) imaging (DWI) with apparent diffusion coefficient (ADC), an imaging modality that detects differences in cellularity of spinal cord lesions, for earlier diagnosis of dermoid cyst

CMS Sepsis Bundle Compliance Analysis at The Time of Patient Admission During The COVID-19 Pandemic in a Community Hospital in South Texas

Background: Sepsis remains an important cause of mortality in hospitals across the globe. The Centers for Medicare and Medicaid Services (CMS) have increased efforts to lower the mortality rate in sepsis patients via the CMS quality measure. The COVID-19 pandemic changed how we conduct healthcare and key elements of sepsis management might have been compromised, affecting the CMS sepsis bundle compliance rate. Our goals were to determine whether compliance rates were affected and to further analyze the mortality rates associated with sepsis management during the COVID-19 pandemic. Methods: A retrospective chart review was conducted to analyze the adherence to the CMS sepsis bundle and mortality rates in patients with sepsis. Results: The CMS sepsis bundle compliance rate was 38.62% during 2020 compared to before the pandemic \u3e70%. There was a mortality rate of 48.7% in patients treated optimally, defined as receiving the full sepsis bundle, compared to 58% in those treated sub-optimally, defined as not receiving the full sepsis bundle (p = 0.28). In patients who were optimally treated, the mortality rate in COVID-19 positive patients was 70.60% compared to 36.40% who were COVID-19 negative (p = 0.034). Conclusion: CMS sepsis bundle compliance rate is lower than previously recorded during the COVID-19 pandemic. The CMS sepsis protocol had no significant impact on mortality rates compared to patients who did not follow the CMS protocol. COVID-19 positive individuals had a significantly higher likelihood of mortality. Other studies have also found that sepsis protocols did not lead to decreased mortality rates. Perhaps the CMS sepsis bundle is not a reliable tool for best practice of treating patients with sepsis

Collar-button abscess as a complication of infected hematoma in the setting of uncontrolled type 2 diabetes

Introduction: Collar-button abscesses are deep space infections of the hand. Case presentation: We present a case of a 66-year-old man who developed an acute collar-button abscess of the hand after a concrete bench fell onto the dorsal aspect of his hand. The hand abscess was managed successfully with intravenous antibiotics and operative intervention. Discussion: While such infections comprise a small percentage of hand infections, insufficient or delayed treatment results in permanent hand disfiguration and dysfunction. This case highlights an uncommon dorsal-to-volar pattern of hand abscess extension. Conclusion: Knowledge of the anatomy of the hand is essential to diagnosis and appropriate surgical management

Medical Students Preventing Medical Errors: A Student-Led Approach to Patient Safety in Preclinical Curriculum

Introduction: Preventable medical errors are currently the third leading cause of death in the United States following heart disease and cancer (1). Early exposure to patient safety knowledge may lead to students to deliver safer care in their clerkship and residency years. This study was designed to assess the change in knowledge from earlier exposure and education during pre-clinical years and its impact on interest and knowledge about patient safety. Methods: For the past four years, a patient safety training has been conducted for interested first and second-year medical students and responses are assessed through a pre-test, immediate post-test, 3-month post-test, and 6-month post-test. The survey assesses student knowledge on various aspects of patient safety, identifying the correct course of action in different scenarios concerning patient safety. Results:The average percentage of correct answers on patient safety knowledge-based questions was 71.4% on the pre-test training and decreased to 68.4% in the 6-month post-test . The percent of students who considered themselves to be well-versed in different aspects of patient safety was 15.2% in the pre-test training and increased to 75% in the 6-month post-test. The percent of students that plan to incorporate patient safety techniques into their future practice was 97% in the pre-test training and 100% in the 6-month post-test. The percent of students who believed that patient safety can have a large impact on health outcomes was initially 97% in the pre-test training and 98.3% in the 6-month post-test. Conclusion:Improvement in patient safety knowledge amongst students immediately after training is promising. Although the percentage of correct answers decreased over time, students exhibited more knowledge on patient safety topics immediately after training than they had prior to any patient safety training. The lack of statistically significant findings can most likely be attributed to small sample size and will likely improve with further data collection.Continued training sessions will solidify knowledge about patient safety in preclinical years and potentially in clerkship years, and will allow for students to gain confidence in their knowledge of patient safety and medical errors

Artery tertiary lymphoid organs control aorta immunity and protect against atherosclerosis via vascular smooth muscle cell lymphotoxin β receptors

Tertiary lymphoid organs (TLOs) emerge during nonresolving peripheral inflammation, but their impact on disease progression remains unknown. We have found in aged Apoe−/− mice that artery TLOs (ATLOs) controlled highly territorialized aorta T cell responses. ATLOs promoted T cell recruitment, primed CD4+ T cells, generated CD4+, CD8+, T regulatory (Treg) effector and central memory cells, converted naive CD4+ T cells into induced Treg cells, and presented antigen by an unusual set of dendritic cells and B cells. Meanwhile, vascular smooth muscle cell lymphotoxin β receptors (VSMC-LTβRs) protected against atherosclerosis by maintaining structure, cellularity, and size of ATLOs though VSMC-LTβRs did not affect secondary lymphoid organs: Atherosclerosis was markedly exacerbated in Apoe−/−Ltbr−/− and to a similar extent in aged Apoe−/−Ltbrfl/flTagln-cre mice. These data support the conclusion that the immune system employs ATLOs to organize aorta T cell homeostasis during aging and that VSMC-LTβRs participate in atherosclerosis protection via ATLOs

A web-based app to provide personalized recommendations for COVID-19

Peer Reviewe

March 1955

Presidents Report - Frank P. Dunlap (page 1) The Student Purdue Serves - Dr. N. M. Parkhurst (2) A Student Reports - Bill Roach (4) Corrective Management of Shrubs - H. W. Gilbert (5) Nutrient Absorption by Plants - J. R. Watson Jr. (7) Disease Development is Slow - Dr. Wm. Klomparens (10) Poa Annua Control with Arsenic Materials - W. H. Daniel (11) Labor Relations - Cincinnati Country Club - John McCoy (14) Labor Policies at my Course - Ernest Schneider (15) Labor Policies at my Course - Don Strand (16) Nitrogen Use and Why - Robert M. Williams (17) Fertilizing Greens and Why - Don Likes(18) Nitrogen Use and Why - Lawrence Huber (20) Report on Experimental Green - Taylor Boyd (21) Experiences with Fairway Improvements - Ray Davis (23) Fairway Improvement Program - Bert Rost (24) Experiences on Merion Bluegrass - Carl Habenicht (24) Merion Bluegrass Experiences - P. E. Drachman (25) Zoysia for Lawns and Nurseries - P. E. Drachman (27) Preparation for Mortorized Carts - James W. Brandt (28) Preparing for Motorized Carts - Carl Bretzlaff (29) Merion Bluegrass Experiences - Ben O. Warren (31) Pennlu Distribution - W. H. Daniel(32) Zoysia for Midwest Lawns - W. H. Daniel (34) Crabgrass Prevention and Control - W. H. Daniel (36) Plant Carbohydrates Must Balance Nitrogen - M. R. Teel (39) Put Yourself in His Place - Fred Grau (40) Nitrogen Use and Why Wm. E. Lyons (45) The Management of Bentgrass Fairways - O. J. Noer (49) Fairway Improvement Program O. W. Young (52) Experiences with Zoysia - Ferank Dinelli (53

SyncMesh: Improving Data Locality for Function-as-a-Service in Meshed Edge Networks

The increasing use of Internet of Things devices coincides with more communication and data movement in networks, which can exceed existing network capabilities. These devices often process sensor or user information, where data privacy and latency are a major concern. Therefore, traditional approaches like cloud computing do not fit well, yet new architectures such as edge computing address this gap. In addition, the Function-as-a-Service (FaaS) paradigm gains in prevalence as a workload execution platform, however the decoupling of storage results in further challenges for highly distributed edge environments. To address this, we propose SyncMesh, a system to manage, query, and transform data in a scalable and stateless manner by leveraging the capabilities of Function-as-a-Service and at the same time enabling data locality. Furthermore, we provide a prototypical implementation and evaluate it against established centralized and decentralized systems in regard to traffic usage and request times. The preliminary results indicate that SyncMesh is able to exonerate the network layer and accelerate the transmission of data to clients, while simultaneously improving local data processing