Stethoscope hygiene: A call to action. Recommendations to update the CDC guidelines.

Healthcare-acquired infections are a tremendous challenge to the US medical system. Stethoscopes touch many patients, but current guidance from the Centers for Disease Control and Prevention does not support disinfection between each patient. Stethoscopes are rarely disinfected between patients by healthcare providers.

Routine antiemetic prophylaxis with dexamethasone during COVID-19: Should oncologists reconsider?

The ongoing pandemic caused by severe acute respiratory syndrome (SARS) coronavirus type 2 (SARS-CoV-2, also known as COVID-19) has caused unprecedented strain on the global healthcare system, causing thousands of deaths worldwide. Patients with underlying conditions such as cancer are at substantial risk of acquiring and dying from this novel coronavirus. Numerous reports have shown that infection with SARS-CoV-2 causes depletion of B- and T-lymphocytes, including CD4 and CD8 T-cells, and is associated with severe illness and death and that patients with higher lymphocyte levels may have better outcomes.

Indomethacin and resveratrol as potential treatment adjuncts for SARS-CoV-2/COVID-19.

The ongoing pandemic caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2, also known as COVID-19) has led to unprecedented challenges for the global healthcare system. This novel coronavirus disease phenotype ranges from asymptomatic carriage to fulminant cytokine storm with respiratory failure, polyorgan dysfunction and death. Severe disease is characterised by exuberant inflammation resulting from high circulating cytokines such as interleukin-6 and tumour necrosis factor.

Diagnosis and management of hiccups in the patient with advanced cancer.

Benign, self-limited hiccups are more of a nuisance, but persistent and intractable hiccups lasting more than 48 hours and 1 month, respectively, are a source of significant morbidity in the patient with advanced malignancy.The hiccup reflex is complex, but stimulation of vagal afferents followed by activation of efferent phrenic and intercostal nerve pathways results in contraction of the diaphragm and intercostal muscles, respectively.The etiology of hiccups in the cancer and palliative care population may include chemotherapy, electrolyte derangements, esophagitis, and neoplastic involvement of the central nervous system (CNS), thorax, and abdominal cavity.

Hematologic abnormalities following renal transplantation.

Recipients of renal allografts are surviving longer and, consequently, may experience a variety of complications related not only to the transplanted kidney, but also to the hematopoietic system. Common hematologic complications in the renal transplant patient include abnormalities of one cell line, such as post-transplantation erythrocytosis or anemia, that are often treatable with simple measures. Conversely, pathologies involving the leukocyte and platelet population often exist in the context of pancytopenia, which may be a manifestation of systemic infection (e.

Refeeding syndrome: an important aspect of supportive oncology.

Refeeding syndrome (RFS) is an underappreciated, yet common and potentially dangerous, constellation of metabolic derangements that can occur upon reinstitution of any type of nutritional intervention. The typical patient who experiences RFS has been malnourished for days to weeks and develops hypophosphatemia and, occasionally, hypokalemia and hypomagnesemia when administered a carbohydrate load in the form of glucose-containing fluids, total parenteral nutrition (TPN), tube feedings, or an oral diet. The pathophysiology of RFS is complex but mainly results from an acute intracellular shift in electrolytes, increased phosphate demand during tissue anabolism, and formation of high-energy phosphate bonds.

Umbilical complications of malignancy.

Introduction: Cancer patients may manifest a variety of intraabdominal complications occurring during various phases of their illness; however, little in the literature exists regarding umbilical abnormalities in this population.

Discussion: Umbilical metastases (Sister Mary Joseph's sign) are the most common malignant complication involving the umbilicus and may be the presenting manifestation of visceral malignancy. Cancer patients may occasionally experience periumbilical ecchymosis (Cullen's sign), infection, hernia, or varices, each of which may require therapy.

Anemia following Roux-en-Y surgery for morbid obesity: a review.

Morbid obesity is a significant problem in the Western world. Recently, there has been an increase in the number of patients undergoing surgical weight loss procedures. Currently, the most widely performed procedure is the Roux-en-Y gastric bypass operation which combines restriction of food intake with malabsorption of calories and various nutrients, resulting in weight loss and nutritional deficiencies, respectively.

Electrocardiographic changes after shoulder arthroplasty.

Hyperkalemia is a commonly encountered electrolyte abnormality in the hospitalized patient population, and can be fatal if not recognized and treated in a timely matter. Although most cases of hyperkalemia in the acute care setting occur in the context of renal failure, certain drugs can cause an increase in serum potassium. One such drug is trimethoprim-suflamethoxazole, a broad spectrum antibiotic utilized for a variety of infections.

Cullen's sign associated with metastatic esophageal carcinoma.

Cullen's sign refers to the presence of periumbilical ecchymosis and is most often recognized as a manifestation of hemorrhagic pancreatitis. However, lesser-appreciated etiologies include ruptured ectopic pregnancy, leaking aortic aneurysm, and intraabdominal malignancy. We report the case of a patient with metastatic adenocarcinoma of the esophagus who developed Cullen's sign shortly before death.

Metastatic lung cancer presenting as lower gastrointestinal hemorrhage.

Lung cancer is the leading cause of cancer mortality in the developed world, and often presents with metastatic disease. Metastatic lung cancer rarely presents with gastrointestinal symptoms, but we report a case of an elderly male with metastatic lung carcinoma to the cecum who presented with melena. The patient required blood transfusions, but eventually died of septic shock.

Group C streptococcal sepsis complicating Fournier gangrene.

Fournier gangrene is a life-threatening necrotizing fasciitis of the perineal-scrotal area that occurs in diabetic males. Patients typically present with systemic toxicity and significant inflammatory changes in the scrotum and perineum. Most cases of Fournier gangrene are polymicrobic and require urgent surgical debridement and broad-spectrum antibiotic therapy.

Refeeding syndrome and hypophosphatemia.

Hypophosphatemia is a potentially life-threatening complication of reinstating nutrition in a malnourished patient. Refeeding syndrome is a term that refers to various metabolic abnormalities that may complicate carbohydrate administration in subnourished patient populations. Hypophosphatemia is the most well-known, and perhaps most significant, element of the refeeding syndrome and may result in sudden death, rhabdomyolysis, red cell dysfunction, and respiratory insufficiency.

Community-acquired pneumonia due to Pasteurella multocida.

Most cases of community-acquired pneumonia result from infection with predictable common pathogens. However, rare patients develop pneumonia from unusual bacterial species such as Pasteurella multocida, a Gram-negative oral commensal of most dogs and cats. The majority of P.

Leukemoid reactions complicating colitis due to Clostridium difficile.

Background: We sought to describe the characteristics of patients who had Clostridium difficile colitis complicated by leukemoid reactions (total leukocyte count greater than 35 x 10(9)/L) and to determine whether this complication is associated with higher morbidity or mortality than C difficile colitis without leukemoid reactions.

Methods: We performed a retrospective case series analysis of patients with a positive fecal assay for C difficile toxin and a peak leukocyte count greater than 35 x 10(9)/L during 1998 and 1999. Twenty cases that met these criteria were compared with 65 randomly selected control patients (patients with a positive C difficile toxin and a peak leukocyte count less than 35 x 10(9)/L).