Emergency Physician-Performed Point-of-Care Ultrasound of a Renal Mass.

Emergency physicians (EPs) frequently integrate point-of-care ultrasound (POCUS) into the initial bedside evaluation of patients presenting to the emergency department with acute flank pain. A POCUS-first diagnostic approach can allow EPs to promptly assess for life-threatening pathologies of the aorta and gallbladder. POCUS is also a critical bedside tool to determine renal causes of acute flank pain, such as hydronephrosis in the setting of nephrolithiasis, subcapsular hematomas, renal abscesses, pyelonephritis, and renal masses.

Bedside Echocardiography Diagnosis of Tricuspid Valve Infective Endocarditis in the Emergency Department.

Infective endocarditis (IE) is a rare life-threatening entity that remains difficult to diagnose in the emergency department (ED). Focused cardiac ultrasound (FOCUS) with transthoracic echocardiography (TTE) is an indispensable bedside tool for the emergency physician (EP) to promptly diagnosis and expedite clinical management of IE. This report describes a case in which EP-performed FOCUS led to the early identification of right-sided tricuspid valve IE complicated with septic pulmonary emboli.

Point-of-Care Ultrasound Diagnosis of a Crohn's Disease-Related Intraabdominal Abscess in the Emergency Department.

The emergency department (ED) diagnosis of Crohn's disease (CD)-associated complications is typically established with abdominopelvic computed tomography imaging. Ultrasonography has been suggested as an effective alternative modality for diagnosing several CD complications, including intraabdominal abscesses. We report the identification of a CD-related intraabdominal abscess by emergency physician (EP)-performed point-of-care ultrasound (POCUS).

Bedside Ocular Ultrasound Diagnosis of a Traumatic Lens Dislocation.

Rapid identification of ophthalmologic emergencies can be challenging in the ED, and a missed or delayed diagnosis may have vision-threatening consequences. The application of ocular point-of-care ultrasound (POCUS) by the emergency physician (EP) can facilitate the timely recognition of a myriad of emergent eye conditions. This report describes a case in which EP-performed POCUS established the prompt diagnosis of a traumatic lens dislocation in a patient with chronic vision changes.

Point-of-care ultrasound diagnosis of a pyogenic liver abscess in the emergency department.

Pyogenic liver abscess (PLA) is a rarely encountered condition in the emergency department (ED) that necessitates a timely diagnosis by the emergency physician. An early ED diagnosis is challenging as the presenting symptoms of PLA are often variable and nonspecific. The rapid bedside diagnosis of PLA with point-of-care ultrasound (POCUS) performed by emergency physicians has not been investigated thoroughly.

Emergency physician-performed bedside ultrasound of pyomyositis.

Point-of-care ultrasound (POCUS) is an indispensable tool for emergency physicians in the rapid bedside diagnosis of skin and soft tissue infections. The utility of POCUS for the differentiation of cellulitis and subcutaneous abscess is well established; however, there is a paucity of studies highlighting POCUS as a first-line imaging approach for pyomyositis, an uncommon skeletal muscle infection and/or intramuscular abscess formation requiring emergent diagnosis. This report describes a case in which emergency physician-performed POCUS led to the early detection and timely management of pyomyositis in the emergency department.

Emergency Physician-Performed Bedside Ultrasound of Gastric Volvulus.

Gastric volvulus (GV) is a seldomly encountered life-threatening condition that necessitates rapid diagnosis in the emergency department (ED). The diagnosis of GV is traditionally established with cross-sectional imaging and/or endoscopy with surgical confirmation. The potential role of point-of-care ultrasound (POCUS) as a bedside tool to support the early identification of GV by emergency physicians (EPs) has not been thoroughly investigated.

Emergent Diagnosis of a Flail Mitral Leaflet With Bedside Echocardiography.

Flail mitral leaflet (FML) with associated acute pulmonary edema and acute decompensated heart failure is an emergent condition requiring prompt recognition by the emergency physician (EP). Focused cardiac ultrasound (FOCUS) and lung ultrasound (LUS) have a vital role in the evaluation of FML in the emergency department. This case report describes the identification of a FML with EP-performed bedside echocardiography.

Right Heart Thrombus in Transit Diagnosed With Focused Cardiac Ultrasound in the Emergency Department.

The diagnosis of a right heart thrombus (RHTh) in transit associated with pulmonary embolism (PE) is an uncommon phenomenon with a high mortality rate. Timely recognition of RHTh with focused cardiac ultrasound (FOCUS) in cases of suspected PE is necessary for critical decision making in the emergency department (ED). We present a case of RHTh with submassive PE in which the patient underwent successful catheter-directed thrombolysis.

Point-of-Care Ultrasound Diagnosis of Pneumoperitoneum in the Emergency Department.

Prompt and accurate diagnostic evaluation of the nontraumatic acute abdomen in the emergency department (ED) is crucial to lessen mortality burden. In patients with perforated viscus and pneumoperitoneum, point-of-care ultrasound (POCUS) can assist the emergency physician (EP) in the rapid bedside diagnosis. This report describes a case in which EP-performed POCUS led to the early detection and timely management of an atypical presentation of pneumoperitoneum.

Serial Point-of-care Echocardiography Performed by an Emergency Physician to Guide Thrombolytic Management of Massive Pulmonary Embolism.

Massive pulmonary embolism (PE) is a life-threatening condition with a high mortality burden. The rapid diagnosis of PE can be supported with focused cardiac ultrasound (FOCUS) by identifying signs of right ventricular dysfunction (RVD). This case report describes a patient with hemodynamically unstable massive PE who received systemic thrombolytic therapy.

A Cost-Effective, Rapidly Constructed Simulation Model for Ultrasound-Guided Pericardiocentesis Procedural Training.

Background: Emergent ultrasound-guided pericardiocentesis (USGP) is an uncommonly performed procedure by emergency physicians (EPs). USGP simulation models have previously been developed to increase procedural proficiency, but these models are limited for routine implementation secondary to high-cost, lengthy time to construct, and lack of durability. The objective of this study was to develop an USGP simulation model that is cost-effective, easily and rapidly constructed, and has procedure-specific fidelity.

Dual-Reporter Mycobacteriophages (Φ2DRMs) Reveal Preexisting Mycobacterium tuberculosis Persistent Cells in Human Sputum.

Unlabelled: Persisters are the minor subpopulation of bacterial cells that lack alleles conferring resistance to a specific bactericidal antibiotic but can survive otherwise lethal concentrations of that antibiotic. In infections with Mycobacterium tuberculosis, such persisters underlie the need for long-term antibiotic therapy and contribute to treatment failure in tuberculosis cases. Here, we demonstrate the value of dual-reporter mycobacteriophages (ΦDRMs) for characterizing M.

Serratia marcescens Cyclic AMP Receptor Protein Controls Transcription of EepR, a Novel Regulator of Antimicrobial Secondary Metabolites.

Unlabelled: Serratia marcescens generates secondary metabolites and secreted enzymes, and it causes hospital infections and community-acquired ocular infections. Previous studies identified cyclic AMP (cAMP) receptor protein (CRP) as an indirect inhibitor of antimicrobial secondary metabolites. Here, we identified a putative two-component regulator that suppressed crp mutant phenotypes.

The LysR Transcription Factor, HexS, Is Required for Glucose Inhibition of Prodigiosin Production by .

Generation of many useful microbe-derived secondary metabolites, including the red pigment prodigiosin of the bacterium , is inhibited by glucose. In a previous report, a genetic approach was used to determine that glucose dehydrogenase activity (GDH) is required for inhibiting prodigiosin production and transcription of the prodigiosin biosynthetic operon (). However, the transcription factor(s) that regulate this process were not characterized.

Bacterial cyclic AMP-phosphodiesterase activity coordinates biofilm formation.

Biofilm-related infections are a major contributor to human disease, and the capacity for surface attachment and biofilm formation are key attributes for the pathogenesis of microbes. Serratia marcescens type I fimbriae-dependent biofilms are coordinated by the adenylate cyclase, CyaA, and the cyclic 3',5'-adenosine monophosphate (cAMP)-cAMP receptor protein (CRP) complex. This study uses S.

A Serratia marcescens PigP homolog controls prodigiosin biosynthesis, swarming motility and hemolysis and is regulated by cAMP-CRP and HexS.

Swarming motility and hemolysis are virulence-associated determinants for a wide array of pathogenic bacteria. The broad host-range opportunistic pathogen Serratia marcescens produces serratamolide, a small cyclic amino-lipid, that promotes swarming motility and hemolysis. Serratamolide is negatively regulated by the transcription factors HexS and CRP.

Serratia marcescens quinoprotein glucose dehydrogenase activity mediates medium acidification and inhibition of prodigiosin production by glucose.

Serratia marcescens is a model organism for the study of secondary metabolites. The biologically active pigment prodigiosin (2-methyl-3-pentyl-6-methoxyprodiginine), like many other secondary metabolites, is inhibited by growth in glucose-rich medium. Whereas previous studies indicated that this inhibitory effect was pH dependent and did not require cyclic AMP (cAMP), there is no information on the genes involved in mediating this phenomenon.

Comparison of memory B cell, antibody-secreting cell, and plasma antibody responses in young children, older children, and adults with infection caused by Vibrio cholerae O1 El Tor Ogawa in Bangladesh.

Children bear a large component of the global burden of cholera. Despite this, little is known about immune responses to cholera in children, especially those under 5 years of age. Cholera vaccine studies have demonstrated lower long-term protective efficacy in young children than in older children and adults.

New vector tools with a hygromycin resistance marker for use with opportunistic pathogens.

The ability of many bacterial strains to tolerate antibiotics can limit the number of molecular tools available for research of these organisms. To help address this problem, we have modified a diverse set of vectors to include a broadly expressed hygromycin resistance (HmR) marker. Hygromycin B is an aminoglycoside antibiotic not used to treat infections in humans and has antimicrobial activity against a wide range of microorganisms.