Hemophagocytic Lymphohistiocytosis Due to Ehrlichiosis: A Case Series.

Background: Hemophagocytic lymphohistiocytosis (HLH) is an immunologic syndrome characterized by excessive inflammation and tissue injury due to uncontrolled activation of the phagocytic system. The underlying mechanism is a lack of downregulation of activated macrophages and lymphocytes by natural killer and T cells. Unfortunately, the diagnosis is often delayed or missed due to the rarity of the disease, decreased awareness, and clinical picture variability.

Comparison of Cefazolin and Ceftriaxone Enterobacterales Susceptibilities for Inpatient Treatment of Urinary Tract Infections and Risk of Hospital-onset Clostridioides difficile Infection.

Purpose: Urinary tract infection (UTI) is the second most common indication for antibiotic therapy among inpatients in the United States. Ceftriaxone, a third-generation cephalosporin, is habitually chosen to treat inpatient UTIs due to familiarity, cost, and perceived safety. However, third-generation cephalosporins increase the risk of health care facility-onset Clostridioides difficile infection (HOCDI) more than any other antibiotic group, while no statistical risk exists for first-generation cephalosporins.

Written Communication, Visitation Policies, and Awareness of Medical Issues Among Intensive Care Unit Families.

Background: Open intensive care unit (ICU) visitation policies facilitate communication between clinicians and patients' families. Restrictive visitation policies (eg, during a pandemic) may reduce families' comprehension of information.

Objectives: To determine whether written communication increased awareness of medical issues among ICU families and whether the effect size depended on the visitation policies in place when participants were enrolled.

Saccharomyces boulardii prophylaxis for targeted antibiotics and infectious indications to reduce healthcare facility-onset Clostridioides difficile infection.

Background: Probiotic prophylaxis for Clostridioides difficile infection (CDI) is controversial stemming from deficits in strain and disease specificity considerations and concern for adverse effects. Here risk for healthcare facility-onset CDI (HO-CDI) dependent on concomitant antibiotic and infectious indication is assessed to identify opportunities for targeted prophylaxis.

Methods: Retrospective matched-cohort study from January 2016 through March 2019.

Incidence of Saccharomyces cerevisiae fungemia in hospitalised patients administered Saccharomyces boulardii probiotic.

Background: Bloodstream infection is an untoward effect of probiotic administration described by case reports and a cited reason to avoid using in the critically ill. The incidence rate of bloodstream infection in a population administered probiotics remains unknown.

Methods: A retrospective observational analysis of incident Saccharomyces cerevisiae fungemia in a population of hospitalised patients administered Saccharomyces boulardii for primary prevention of hospital-onset Clostridioides difficile infection.

A case of endogenous endophthalmitis after a mild dental infection.

Endophthalmitis is a rare but severe vision threatening disease that most often occurs in patients with a recent history of ophthalmic surgery or penetrating trauma to the eye. Often these patients have underlying risk factors or are immunosuppressed. We present a case of endogenous endophthalmitis in an otherwise healthy male after a tooth extraction.

Resection of an Asymptomatic Lymphangioma in a 76-Year-Old Male.

Lymphangiomas are benign congenital malformation comprised of the lymphatic system. They typically present in the head, neck, and axillary regions of children with <1% being described in the small bowel mesentery. We report a case of a 76-year-old man who presented with incidental large (9x6 cm) multiloculated cystic mass in the right upper quadrant (RUQ) on a CT scan performed for nephrolithiasis.

The Effect of Saccharomyces boulardii Primary Prevention on Risk of Hospital-onset Clostridioides difficile Infection in Hospitalized Patients Administered Antibiotics Frequently Associated With C. difficile Infection.

Background: Hospital-onset Clostridioides difficile infection (HO-CDI) is a costly problem leading to readmissions, morbidity, and mortality. We evaluated the effect of a single probiotic strain, Saccharomyces boulardii, at a standardized dose on the risk of HO-CDI within hospitalized patients administered antibiotics frequently associated with HO-CDI.

Methods: This retrospective cohort study merged hospital prescribing data with HO-CDI case data.

Evaluation of Noninvasive Thermometers in an Endoscopy Setting.

The measurement of body temperature is an important aspect of assessment prior to invasive procedures. The purpose of the study was to determine the level of agreement between temporal artery, noncontact infrared, and disposable oral electronic thermometers to a clinical reference device (nondisposable oral electronic thermometer) in outpatients prior to an endoscopic procedure. A descriptive, method-comparison study design was used to compare 3 noninvasive thermometers with a clinical reference device.

Inpatient Proton Pump Inhibitor Administration and Hospital-Acquired Clostridium difficile Infection: Evidence and Possible Mechanism.

The incidence of Clostridium difficile infection continues to increase globally. Particularly concerning are hospital-acquired cases that attribute significant morbidity, mortality, and expenditures to the health care system. Proton pump inhibitors, which are widely prescribed and generally considered to have minimal adverse effects, have recently come under scrutiny for positive associations with C.

The role of aldosterone antagonism agents in diabetic kidney disease.

Background: Diabetic kidney disease is a common consequence of the development of diabetes. In the United Kingdom 18-30% of chronic kidney disease cases and 44% of end-stage renal disease cases in the United States have been attributed to complications of diabetic kidney disease. Angiotensin blockade using angiotensin converting enzyme inhibitors or angiotensin receptor blockers is the standard for slowing the progression of diabetic kidney disease.

A bed management strategy for overcrowding in the emergency department.

In 2006, the Institute of Medicine cited growing visit volumes, hospital closures, financial pressures, and operational inefficiencies as the principal reasons for emergency department (ED) overcrowding and called for regulatory measures to resolve the problem. A Midwest medical center with 59,000 annual ED visits instituted a bed management strategy to decrease the need to board, or hold, admitted hospital patients in the ED awaiting transfer to an inpatient care unit. This strategy was successful in improving the hold time from an average of 216 minutes to 103 minutes, or by 52%.

Clinical competency, self-efficacy, and job satisfaction: perceptions of the staff nurse.

This descriptive study obtained survey data that explored the perception of staff nurses regarding their clinical competency, self-efficacy, and job satisfaction. The purpose of this study was to identify nursing professional development issues, data that can then be used to develop evidence-based educational programs.

Myelography as a stand-alone diagnostic procedure for degenerative spine disease in developing nations.

The use of "stand-alone" contrast myelography (i.e., without computed tomography) has a proven track record in developing nations where few patients have access to magnetic resonance imaging, whether on the basis of prohibitive cost or the absence of such a modality altogether.

The African experience: a proposal to address the lack of access to neurosurgery in rural sub-Saharan Africa.

Restricted access to neurosurgical care in rural sub-Saharan Africa remains an unaddressed and formidable challenge. Despite the implementation of a rigorous 5-year curriculum to train and certify indigenous neurosurgeons "in continent" as Fellows of the College of Surgeons in Neurosurgery for East, Central, and Southern Africa (FCS-ecsa-NS), provincial and rural hospitals are likely to see no change in this woeful status quo for the foreseeable future. Modifying that curriculum with a two-tiered training experience that includes fast-track certification of general surgeons to perform basic neurosurgical procedures in their own hospitals is a viable alternative to redress this problem in a timely fashion.