Cryptococcal infection of the ventriculoperitoneal shunt in an immunocompetent patient

Patient: Male, 52 Final Diagnosis: Cryptococcal ventriculoperitoneal shunt infection Symptoms: Confusion • fever • Lethargy Medication: Amphotericin B • Flucytosine Clinical Procedure: Ventriculoperitoneal shunt removal Specialty: Infectious disease OBJECTIVE: Rare disease BACKGROUND: Ventriculoperitoneal shunting is an effective treatment for hydrocephalus. Ventriculoperitoneal shunt (VPS) infection is a common complication. Cryptococcus neoformans as an implicated organism is rare. In this report, we describe a patient with cryptococcal VPS infection. CASE REPORT: A 52-year-old male with normal pressure hydrocephalus, status post implantation of VPS one year prior to the presentation; who was admitted with a fever, lethargy and confusion for three days. He was treated empirically with intravenous cefepime and vancomycin for VPS infection. The CSF analysis from both the lumbar puncture and the VPS was significant for a low white blood count, low glucose and high protein. Other work-up including India ink and cryptococcal antigen was unrevealing. He remained febrile despite antibiotic treatment for 5 days. The CSF from the shunt was sent for analysis again and it demonstrated similar results from the prior study, but the culture was now positive for Cryptococcus neoformans. The patient was started on oral flucytosine and intravenous liposomal amphotericin B. The VPS was removed and an externalized ventricular catheter was placed. The patient showed rapid resolution of the symptoms. CONCLUSIONS: To date, there was a total of nine reported cases of cryptococcal VPS infection upon review of the literature. Our presenting case and the literature review highlight the difficulties in making an accurate diagnosis of cryptococcal shunt infection. There were case reports of false negative cryptococcal antigen tests with culture proven cryptococcal meningitis. The CSF culture from the shunt remains a mainstay for identifying cryptococcal shunt infection. Cryptococcal shunt infections are rare and early diagnosis and treatment is essential for patient management which involves shunt replacement with concomitant administration of intravenous antifungal medication. High clinical suspicion is crucial and shunt culture preferably from the valve is recommended

Youth and Digital Media: From Credibility to Information Quality

Building upon a process-and context-oriented information quality framework, this paper seeks to map and explore what we know about the ways in which young users of age 18 and under search for information online, how they evaluate information, and how their related practices of content creation, levels of new literacies, general digital media usage, and social patterns affect these activities. A review of selected literature at the intersection of digital media, youth, and information quality -- primarily works from library and information science, sociology, education, and selected ethnographic studies -- reveals patterns in youth's information-seeking behavior, but also highlights the importance of contextual and demographic factors both for search and evaluation. Looking at the phenomenon from an information-learning and educational perspective, the literature shows that youth develop competencies for personal goals that sometimes do not transfer to school, and are sometimes not appropriate for school. Thus far, educational initiatives to educate youth about search, evaluation, or creation have depended greatly on the local circumstances for their success or failure

Hemobilia from biliary angiodysplasia diagnosed with cholangioscopy

Biliary angiodysplasia is extremely rare. Our background search revealed only a few case reports in the English literature. We present a case of angiodysplasia of the proximal common bile duct in a patient with subacute upper gastrointestinal bleeding and symptomatic anemia. A standard esophagogastroduodenoscopy with subsequent dedicated duodenoscopy revealed blood-stained bile draining from the major ampulla orifice. A contrast-enhanced magnetic resonance cholangiopancreatography was unrevealing for any pancreaticobiliary pathology. The patient subsequently underwent an endoscopic retrograde cholangiopancreatography and SpyGlass® cholangioscopy, which demonstrated intermittent bleeding from angiodysplasia in the proximal common bile duct

On Remembrance

My works are inspired by autobiographical memories — especially those that are traumatic. However, the works rather discuss the nature of how memories are recalled, stored forgotten, remembered, manipulated, constructed, reconstructed, and destructed. Memory is a pseudo reality, that grounds on past events but is different from the objective truth. Memory is one’s own creation, which is formed by the body and mind through time, space, and experience. Then it is stored in the mind, within the infinite void of dimensional space. In my writing, I’ll explore John Sutton’s Philosophy and Memory Traces, Roland Barthe’s Camera Lucida, Cathy Caruth’s Unclaimed Experience, and art works by Alain Resnais, Doris Salcedo and Josiah McElheny

Asian American Representation on Social Media Platforms

YouTube is a popular social media platform where anyone can make an account and post any kind of content. When YouTube launched in 2005-06, it has since allowed minorities easier access to create stories in an industry that has a history of exclusion and whitewashing, specifically speaking about Asian Americans. Asian American content creators, such as Wong Fu Productions, Michelle Phan, Ryan Higa, and many others use YouTube as an outlet to adapt existing stereotypes into entertainment while resisting whitewashing in Hollywood. By analyzing their large influence online, we try to better understand who consists of their target audience, either it be Asian Americans or more broad. This will bring up the question: does this cause non-Asian American viewers to adapt their existing beliefs, or does this ultimately reenforce preconceived notions

Marsy\u27s Law: Florida\u27s Victim Classification Protections are Too Broad and Wrongfully Utilized by Florida Law Enforcement Agencies

While new trends in legislation may aim to reduce the use of excessive force by law enforcement, some Florida agencies interpreted their state’s Marsy’s Law to protect officers accused of using excessive force. This Comment examines the inappropriateness of Florida’s law enforcement agencies’ interpretation of Marsy’s Law, particularly in the context of the law’s original intentions. This Comment points to a potential solution to this problematic interpretation, advocating for an additional limiting clause that narrowly targets how law enforcement interpreted this statute in the context of excessive force reports

Towards a better future: How Engage Books creates books that make a difference

This report looks at the changing landscape of Engage Books as they switch their focus from publishing classic titles to publishing children’s books under the mandate ‘books that make a difference,’ and the tactics they are implementing to push boundaries within the children’s publishing industry. To provide context as to where Engage Books stands as an independent children’s publisher, the report gives a brief overview of the history of the acceptability of sensitive topics in children\u27s literature and the relationship between censorship and small presses. Engage Books has adopted the philosophy that it is easier to shape the minds of children than it is to change the minds of those who are already set in their ways, and thus, has begun introducing previously censored information and major world crises to children in an attempt to help the next generation become informed and engaged citizens who can help create a better society

Breakdowns in Mediated Conversations: How and Why Youth Exit Cross-cutting Political Talk on Social Media

Social media platforms are arguably reshaping how youth participate in politics today, but little is known about how youth navigate cross-cutting talk with different-minded others online. Based on in-depth interviews, this study examines the discursive strategies civic-minded youth employ to talk politics across lines of political difference on social media. Applying Hirschman (1970) to informal political talk, this study surfaces young people’s “voice” and “exit” strategies in cross-cutting political talk. Findings suggest that civic youth are well-versed in elements of rational deliberative discourse. However, youth appear to struggle when it comes to relational discourse that emphasizes reciprocity and relational listening. Youth tended to exit from political talk with different-minded others on social media. The low barriers for exit from cross-cutting talk on social media, combined with various psychosocial, dispositional factors, raise concerns about young people’s premature exits from democratic engagement on social media

Fitness Plug

My parents only allowed me to play videogames or watch television for a certain number of minutes or hours per day. By limiting screen time, they encouraged me to be active and find other things to do outside of television or videogames. The Fitness Plug aims to do both by converting time exercised to entertainment time; you can only watch television or play videogames for as long as you have exercised