E-Cigarette and Vaping Induced Lung Injury

E-cigarette and Vaping induced lung injury (EVALI) is a current public issue that has been present within the last year. First cases of this were noted starting in the state of Wisconsin and spread throughout the United States with cases totaling greater than 1,000. Patients present with respiratory symptoms including shortness of breath and cough. This disease process is a diagnosis of exclusion and unfortunately, there is no particular diagnostic test that is available. Treatment involves aggressive supportive care with exogenous oxygen therapy and strict fluid balance management; steroids have also been reported to have minimal efficacy. In this case, we observe a 39-year-old man without significant medical history who presents after vaping a week ago with shortness of breath and hypoxemia. He requires aggressive intervention in the intensive care unit, but would eventually progress to the point of being discharged home

Emphysematous Pyelonephritis

Emphysematous pyelonephritis is one of the most dangerous complications in patients with uncontrolled diabetes. In this necrotizing disease process, microbes such as Escherichia coli or Klebsiella pneumoniae produce gas that accumulates within the renal capsule causing compression of the internal anatomy. In a diabetic patient, emphysematous pyelonephritis can be exacerbated secondary to the diabetic complication of diminished proprioception. Without surgical intervention, emphysematous pyelonephritis can progress into systemic infection and sepsis, much like this case study. Abdominal pain, fever, nausea, vomiting are all the hallmark exam findings that a healthcare provider may observe in a patient that presents with this disease state. For an accurate diagnosis, computed tomography is the gold standard for emphysematous pyelonephritis. In this case, the patient would present with a several day history of left lower quadrant abdominal pain with nausea and vomiting. Due to access to care for financial reasons, the patient, in this case, was unaware of her diabetes diagnosis and was unable to be treated prior to her presentation. The patient subsequently undergoes a radical nephrectomy and would recover from sepsis in the surgical trauma intensive care unit postoperatively

A new species of Apatolestes from California (Diptera: Tabanidae)

Volume: 52Start Page: 311End Page: 31

Benjamin Franklin and his enemies

In this engaging study of the much-loved statesman and polymath, Robert Middlekauff uncovers a little-known aspect of Benjamin Franklin's personality - his passionate anger. He reveals a fully human Franklin who led a remarkable life but nonetheless had his share of hostile relationships - political adversaries like the Penns, John Adams, and Arthur Lee - and great disappointments - the most significant being his son, William, who sided with the British. Utilizing an abundance of archival sources, Middlekauff weaves episodes in Franklin's emotional life into key moments in colonial and Revolutionary history. The result is a highly readable narrative that illuminates how historical passions can torment even the most rational and benevolent of men

A history of colonial America /

Published in 1942 under title: The foundations of American civilization: a history of colonial America.Bibliography: p. 637-677