Unique Footprint in the scl1.3 Locus Affects Adhesion and Biofilm Formation of the Invasive M3-Type Group A Streptococcus.

The streptococcal collagen-like proteins 1 and 2 (Scl1 and Scl2) are major surface adhesins that are ubiquitous among group A Streptococcus (GAS). Invasive M3-type strains, however, have evolved two unique conserved features in the scl1 locus: (i) an IS1548 element insertion in the scl1 promoter region and (ii) a nonsense mutation within the scl1 coding sequence. The scl1 transcript is drastically reduced in M3-type GAS, contrasting with a high transcription level of scl1 allele in invasive M1-type GAS.

Hematologic Disorders: Sickle Cell Disease.

Sickle cell disease, the most common inherited hemoglobinopathy in the United States, is a group of autosomal recessive red cell disorders resulting from hemoglobin S. Hemoglobin S forms rigid polymers when deoxygenated that give red blood cells their sickle crescent shape. Increased viscosity and cell adhesion result in vasoocclusion.

Hematologic Disorders: Bone Marrow Failure.

Pancytopenia with hypocellular bone marrow most often is caused by idiopathic aplastic anemia, but can be caused by inherited bone marrow failure syndromes, drugs, infections, nutritional deficiencies, and rheumatologic disease. Aplastic anemia (AA) can remain stable for years but can become severe or transform into a myelodysplastic syndrome, acute leukemia, or paroxysmal nocturnal hemoglobinuria. Corticosteroids and erythropoietin are ineffective for management of aplastic anemia; and granulocyte colony-stimulating factor is only indicated in severe infections that do not improve with antibiotics.

Hematologic Disorders: Blood Transfusion Products.

Until the 1980s, liberal blood transfusion criteria with limited evidence were used regardless of the patient's clinical condition. However, blood transfusion products are associated with several risks, such as infection, acute lung injury, circulatory overload, and hemolytic transfusion reactions. More restrictive transfusion criteria and patient monitoring can decrease the need for transfusions, as well as decrease morbidity and mortality rates and costs.

Hematologic Disorders: Anemia.

Anemia occurs in up to 25% of the US population. Normal hemoglobin levels vary by race, sex, and age. Classification of anemia by mean corpuscular volume guides the differential diagnosis and evaluation.

Chondrosarcoma of the tongue: a case report and a review of the literature.

Chondrosarcoma of the head and neck is uncommon and reported to constitute between 1% to 12% of all chondrosarcoma cases.1, 2, 3 Extraskeletal chondrosarcoma of the tongue is an extremely rare type of neoplasm with only three previously reported cases. The underlying origin of chondrosarcoma arising in the tongue is controversial.

Disseminated Cryptococcus with ocular cryptococcoma in a human immunodeficiency virus-negative patient.

A human immunodeficiency virus-negative 63-year-old male with autoimmune hemolytic anemia presented with decreased vision, photophobia and hearing loss. After initial testing seemed consistent with sarcoidosis, he was found to have disseminated Cryptococcus with a cryptococcoma of the left eye. Treatment with systemic anti-fungal therapy improved the patient's condition.

Perioperative uses of low-dose ketamine for pain management.

The purpose of this article is to explore the most current literature regarding perioperative pain management uses of low-dose ketamine. Research has demonstrated significant reductions in postoperative pain scores as well as opioid consumption with low-dose ketamine administration without side effects associated with its induction doses. The availability of S(+)-ketamine with double the analgesic potency of ketamine will create even more reason for its use.