Fishy story: paradoxical reaction associated with .

Paradoxical reactions occur when an infection has acute worsening in response to antibiotic therapy. Here, we describe a patient with chronic cutaneous ulcerative lymphangitis that acutely worsened following initiation of antibiotic therapy. The infection was caused by , a species which has not previously been associated with paradoxical reaction in immunocompetent persons.

Preventability of Hospital Deaths in Patients With Non-Ventilator Hospital-Acquired Pneumonia.

Background: Crude and adjusted mortality rates for patients with non-ventilator hospital-acquired pneumonia (NV-HAP) are among the highest of all healthcare-associated infections, leading to calls for greater prevention. Patients prone to NV-HAP, however, tend to be severely ill at baseline, making it unclear whether their high mortality rates are due to NV-HAP, their underlying conditions, or both.

Methods: Two infectious disease physicians conducted detailed medical record reviews on 150 randomly selected adults from 4 hospitals who died in-hospital following an NV-HAP event between April 2016 and May 2021.

Evaluation of the safety of inpatient empagliflozin in a real-world setting.

Background: Empagliflozin is a sodium glucose co-transporter 2 (SGLT2) inhibitor recommended by the American Diabetes Association for outpatient use. Support for its inpatient role is not well established due to possible safety concerns.

Methods: This was a retrospective study at an academic medical center between January 1, 2021, and December 31, 2021, evaluating the safety and efficacy of empagliflozin compared to other oral antihyperglycemic agents.

Improving Utilization of a Nursing-Initiated Supportive Medication Order Panel in the Inpatient Setting.

Background: Many medications are low-risk but must undergo the same ordering process as high-risk medications in the inpatient setting. Nurses identify the need for supportive medications and notify providers. An order panel and policy were developed to allow nurses to order low-risk, supportive medications.

Repair of complex ovine segmental mandibulectomy utilizing customized tissue engineered bony flaps.

Craniofacial defects require a treatment approach that provides both robust tissues to withstand the forces of mastication and high geometric fidelity that allows restoration of facial architecture. When the surrounding soft tissue is compromised either through lack of quantity (insufficient soft tissue to enclose a graft) or quality (insufficient vascularity or inducible cells), a vascularized construct is needed for reconstruction. Tissue engineering using customized 3D printed bioreactors enables the generation of mechanically robust, vascularized bony tissues of the desired geometry.

Fidaxomicin-Associated Hypersensitivity Reactions: Report of a Morbilliform Drug Eruption.

PurposeWe report a probable case of morbilliform drug eruption secondary to fidaxomicin in a patient with infection (CDI). A 62-year-old female presented to our institution's emergency department (ED) with symptoms consistent with infection. The patient was prescribed 2 weeks of oral vancomycin for CDI prior to presentation.

Rates and Outcomes of Periprosthetic Joint Infection in Persons Who Inject Drugs.

Background: The risk of periprosthetic joint infection (PJI) is higher in persons who inject drugs (PWID) after total joint arthroplasty (TJA), though reported rates vary widely. This study was designed to assess outcomes of TJA in PWID and to describe factors associated with improved PJI outcomes among PWID.

Methods: A retrospective matched cohort study was performed using a 1:4 match among those with and those without a history of injection drug use (IDU) undergoing TJA.

Implementation of Daily Pharmacy Student New Medication Education During Hospitalization to Improve Patient Satisfaction.

Studies have shown that patients would like to receive more medication education while hospitalized. Higher patient satisfaction has been correlated with lower mortality and fewer hospital readmissions. This was a quasi-experimental study.

A Case Series of Rifabutin Use in Staphylococcal Prosthetic Infections.

This case series describes seven patients who received rifabutin in place of rifampin combined with conventional antimicrobial therapy for treatment of hardware-associated staphylococcal infections. Infection recurrence, defined as need for unplanned surgical intervention within the evaluable follow up period after starting rifabutin, occurred in two patients. Two patients experienced possible treatment-associated adverse effects.

Antibiotic Prophylaxis for Total Joint Arthroplasty.

Total joint arthroplasty is an important therapeutic option for patients suffering from osteoarthritis and other degenerative joint diseases. However, joint replacements are susceptible to periprosthetic joint infection especially by staphylococci and other gram-positive organisms. Antibiotic prophylaxis, or systemic administration of antibiotics prior to primary arthroplasty, has been shown to reduce rates of surgical site infection and periprosthetic joint infection.

Antiplatelet therapy for Staphylococcus aureus bacteremia: Will it stick?

Staphylococcus aureus bacteremia (SAB) remains a clinically challenging infection despite extensive investigation. Repurposing medications approved for other indications is appealing as clinical safety profiles have already been established. Ticagrelor, a reversible adenosine diphosphate receptor antagonist that prevents platelet aggregation, is indicated for patients suffering from acute coronary syndrome (ACS).

Protocol for fungal infection following the induction of epithelial cell loss in larval zebrafish.

Epithelia provide the first line of defense against foreign pathogens, and disruption of tissue homeostasis frequently allows for opportunistic infections. Here we provide a protocol for induction of epithelial cell loss in zebrafish larvae, followed by infection with fungal pathogens. Details are provided for monitoring larval survival after infection, assessment of fungal burden, and prophylactic treatment with antifungal compounds.

Relation of apixaban bleeding rates to dose in patients with chronic kidney disease.

The objective of this study was to evaluate the safety and efficacy of apixaban 5 mg twice daily vs 2.5 mg twice daily for nonvalvular atrial fibrillation or venous thromboembolism in patients with chronic kidney disease stage 4 and 5, including those on hemodialysis. Data were collected retrospectively on patients with advanced chronic kidney disease and nonvalvular atrial fibrillation and/or venous thromboembolism who received apixaban while hospitalized at our institution between January 2013 and August 2018.

Evaluation of Anti-Xa Apixaban and Rivaroxaban Levels With Respect to Known Doses in Relation to Major Bleeding Events.

Background: Although not routinely recommended, anti-Xa level monitoring for apixaban or rivaroxaban may be useful in certain clinical scenarios. There are currently no laboratory standards, therapeutic ranges, or proven correlation between anti-Xa levels and clinical outcomes.

Objective: This study describes the utilization, application, and association of anti-Xa levels with clinical outcomes in patients receiving apixaban or rivaroxaban.

Ketamine in Refractory Cyclic Vomiting Syndrome: A Case Report and Review of Literature.

Purpose: To describe the use of ketamine in an adult patient in aborting a cyclic vomiting syndrome (CVS) episode.

Summary: A 40-year-old man with a history of CVS was admitted after several days of nausea and vomiting. He was given parenteral doses of lorazepam and ondansetron but was unable to remain emesis-free.

EGF-mediated suppression of cell extrusion during mucosal damage attenuates opportunistic fungal invasion.

Severe and often fatal opportunistic fungal infections arise frequently following mucosal damage caused by trauma or cytotoxic chemotherapy. Interaction of fungal pathogens with epithelial cells that comprise mucosae is a key early event associated with invasion, and, therefore, enhancing epithelial defense mechanisms may mitigate infection. Here, we establish a model of mold and yeast infection mediated by inducible epithelial cell loss in larval zebrafish.

Tornadic Shear Stress Induces a Transient, Calcineurin-Dependent Hypervirulent Phenotype in Mucorales Molds.

Trauma-related necrotizing myocutaneous mucormycosis (NMM) has a high morbidity and mortality in victims of combat-related injuries, geometeorological disasters, and severe burns. Inspired by the observation that several recent clusters of NMM have been associated with extreme mechanical forces (e.g.

Localized mandibular infection affects remote in vivo bioreactor bone generation.

Mandibular reconstruction requires functional and aesthetic repair and is further complicated by contamination from oral and skin flora. Antibiotic-releasing porous space maintainers have been developed for the local release of vancomycin and to promote soft tissue attachment. In this study, mandibular defects in six sheep were inoculated with 10 colony forming units of Staphylococcus aureus; three sheep were implanted with unloaded porous space maintainers and three sheep were implanted with vancomycin-loaded space maintainers within the defect site.

An Ovine Model of Bioreactor-Based Bone Generation.

The generation of vascularized mineralized tissues of complex geometry without the use of extrinsic growth factors or exogenous cells requires a large animal model to recapitulate the challenges seen in the clinic. The proposed versatile ovine model can be utilized to investigate the use of a customized bioreactor to generate mineralized tissue, matching the size and shape of a defect before transfer to and integration within another site. The protocol results in bioreactors that can be harvested for investigation of the effects of different biomaterials for the generation of bone or to generate tissues appropriate for repair of bony defects; this protocol focuses on reconstruction of the mandible but could be modified for orthopedic applications.

Role of Tissue Engineering in COVID-19 and Future Viral Outbreaks.

In light of the current novel coronavirus (COVID-19) pandemic, as well as other viral outbreaks in the 21st century, there is a dire need for new diagnostic and therapeutic strategies to combat infectious diseases worldwide. As a convergence science, tissue engineering has traditionally focused on the application of engineering principles to biological systems, collaboration across disciplines, and rapid translation of technologies from the benchtop to the bedside. Given these strengths, tissue engineers are particularly well suited to apply their skill set to the current crisis and viral outbreaks in general.

A Novel Phosphodiesterase 1 Inhibitor DSR-141562 Exhibits Efficacies in Animal Models for Positive, Negative, and Cognitive Symptoms Associated with Schizophrenia.

In our drug discovery program, we identified a novel orally available and brain-penetrant phosphodiesterase (PDE) 1 inhibitor, 3-methyl-7-(tetrahydro-2-pyran-4-yl)-2-{[-4-(trifluoromethyl)cyclohexyl]-methoxy}imidazo[5,1-][1,2,4]triazin-4(3)-one (DSR-141562). In the present study, we characterized the preclinical profile of DSR-141562. This compound has preferential selectivity for predominantly brain-expressed PDE1B over other PDE1 family members, and high selectivity for the PDE1 family over other PDE families and 65 other tested biologic targets.

Comparison of Levothyroxine Dosing in Patients with and without Heart Failure.

: Evidence has shown that low thyroid hormone levels may lead to worse prognosis including a higher mortality rate in patients with heart failure (HF). Thyroid replacement increases cardiac output and exercise performance without causing significant adverse events. The purpose of this study is to compare levothyroxine doses in patients with and without HF.

Evaluating Time to In-Hospital Venous Thromboembolism in Obese Patients.

Background: Currently, no consensus approach exists for optimal venous thromboembolism (VTE) prophylaxis in obese (BMI ≥30 kg/m) patients. Time to development of in-hospital VTE is not well studied.

Objective: This study evaluates time to in-hospital VTE in obese patients.