Accounting for air cleaner utilization and performance to improve interpretation of patient outcomes in real-world indoor air cleaner intervention trials.

There is an increasing number of randomized clinical trials intended to assess the effectiveness of indoor air cleaners for improving participant outcomes in real-world settings. In this communication, we synthesize the current state of registered air cleaner intervention trials and call attention to the critical importance of conducting measurements to characterize the performance and utilization of air cleaners in such trials to improve interpretation of exposure measurements and patient outcomes. We draw upon the existing literature and preliminary findings from our ongoing one-year, randomized, single-blind, placebo-controlled case-control trial of stand-alone air filtration in the homes of U.

Fournier's Gangrene and Sodium-Glucose Cotransporter 2 Inhibitor Use: A Report of Two Cases.

Necrotizing fasciitis is a serious infection that requires prompt surgical excision and broad spectrum antibiotics. Fournier's gangrene (FG) is a type of necrotizing fasciitis that specifically affects the perineal, scrotal, and genital region. FG is a known adverse outcome of the class of medications known as sodium-glucose cotransporter 2 (SGLT2) inhibitors.

Nasal Cannula Dislodgement During Sleep in Veterans Receiving Long-term Oxygen Therapy for Hypoxemic Chronic Respiratory Failure.

Background: Chronic obstructive pulmonary disease (COPD) is highly prevalent in male veterans. Long-term oxygen therapy (LTOT) can effectively reduce all-cause mortality in these patients, but the effects of nasal cannula dislodgement (NCD) during sleep have not been well studied.

Methods: This study sought to determine whether veterans receiving LTOT for hypoxemic chronic respiratory failure (CRF) due to COPD reported NCD while they slept and, if so, its impact on hospitalizations for COPD exacerbations.

A man with diarrhea.

Respiratory syncytial virus (RSV) primarily affects infants and children and can manifest as upper airway dysfunction. Patients at the highest risk of increased morbidity and mortality from RSV include those who are immunosuppressed and the elderly. Patients with RSV hepatitis most commonly present with fever, abdominal pain, nausea, and vomiting; however, patients may present with jaundice and coagulopathies in a severe infection.

Take It Easy! Serotonin Syndrome Precipitated by the Rapid Titration of Sertraline and Trazodone in the Setting of Risperidone Use.

Serotonin syndrome is a potentially life-threatening condition caused by a toxic excess of serotonin leading to overstimulation of the nervous system. Because it is a diagnosis of exclusion, it can be underrecognized, making the true incidence unknown. The classic triad of serotonin syndrome includes neuromuscular excitation, autonomic instability and altered mental status.

Alpha-1 Antitrypsin Phenotyping: An Unmet Educational Need of Healthcare Providers.

Background: Diagnosing alpha-1 antitrypsin deficiency (A1ATD) involves two-step laboratory testing, determination of serum alpha-1 antitrypsin (A1AT) level and phenotyping if A1AT < 100 mg/dL. Whether these guidelines are effectuated in clinical practice is uncertain. To begin to address this issue, we determined whether A1AT phenotyping is performed in patients with serum A1AT 57 - 99 mg/dL at our institution.

Hyperprolactinemia-induced acute ischemic stroke.

Strokes are the fifth leading cause of death in the United States with almost 800,000 patients seeking emergency care each year-most of whom are seen for ischemic strokes. Acute ischemic strokes (AIS) can be caused by emboli in diseases such as atrial fibrillation as well as thrombus formation in the form of platelet deposition in patients with atherosclerotic disease. Platelet activation by immunomodulators including thromboxane A2 (TXA2), serotonin, and thrombin have been extensively delineated; however, the activation by hormones such as prolactin has only recently been revealed.

Battlefield Acupuncture vs Ketorolac for Treating Pain in the Emergency Department.

Background: Many patients arrive in the emergency department (ED) with acute pain. Battlefield acupuncture (BFA) uses small, semipermanent acupuncture needles in 5 set points anatomically located on each ear to reduce pain in a few minutes. Pain relief can last months, depending on the pathology of the pain.

Priapism Associated With the Addition of Hydroxyzine to Risperidone: A Case Report.

Hydroxyzine hydrochloride is a piperazine derivative antihistamine that is used in the treatment of anxiety. Its tendency to cause somnolence makes it an attractive option for patients with anxiety-induced insomnia. Despite its antihistamine activity, hydroxyzine is noted to have alpha-adrenergic antagonism activity.

Spontaneous tumor lysis syndrome in the setting of Candida albicans Fungemia.

Tumor Lysis Syndrome (TLS) is a metabolic emergency seen in patients who receive cytotoxic chemotherapy and can result in significant morbidity and mortality, especially in those patients with high tumor burden. Spontaneous tumor lysis syndrome (STLS) occurs in patients without preceding chemotherapy but may occur in the setting of glucocorticoid administration. We present a case of a 75-year-old male with a history of myelodysplastic syndrome who presented with shortness of breath and developed acute renal failure due to tumor lysis syndrome, likely triggered by candidemia.

Hydroxyzine-induced priapism.

Priapism is a severe urologic condition requiring emergency management. Ischemic priapism is the most common subtype which is characterized by a long-lasting, painful, and rigid erection which can be caused by medications with alpha-adrenergic properties such as hydroxyzine. Typically, medication-induced priapism is reported at therapeutic doses and few case reports exist implicating medication overdose as the cause.

Management of Rodenticide Poisoning Associated with Synthetic Cannabinoids.

Synthetic cannabinoids may be adulterated with potent vitamin K antagonists, which should be considered if a patient presents with unexplained coagulopathy, widespread bleeding, and a history of synthetic cannabinoid use.

Fixed dose 4-factor prothrombin complex concentrate for bleeding caused by long acting anticoagulant rodenticides.

Acute, unintentional drug-related poisonings lead to an estimated 418,313 ED visits in 2014, according to the latest statistics from the Center for Disease Control and Prevention. While most of these were opiate-related poisonings, anticoagulant rodenticides were the most common cause of rodenticide-related poisoning in the United States. Many clinical syndromes and treatment algorithms have been described for patients with anticoagulant rodenticide poisoning.