Osteomyelitis due to Stenotrophomonas maltophilia treated with trimethoprim-sulfamethoxazole monotherapy.

Stenotrophomonas maltophilia is an opportunistic infection commonly encountered in various systems of the human body and has been noted to be a rare cause of osteomyelitis. This report examines a rare case of osteomyelitis of the foot caused by S. maltophilia from a poorly managed foot wound and highlights the successful treatment of this condition with trimethoprim-sulfamethoxazole monotherapy.

Facilitators of COVID-19 vaccine acceptance among Black and Hispanic individuals in New York: A qualitative study.

BACKGROUND: Black and Hispanic individuals experience poorer outcomes related to coronavirus disease (COVID-19), yet have alarmingly lower uptake of the COVID-19 vaccine compared to non-Hispanic White individuals. OBJECTIVE: To explore the perceptions of barriers and facilitators of COVID-19 vaccine acceptance among Black and Hispanic adults in the New York. METHODS: A qualitative study consisting of one-on-one semistructured interviews with Black and/ or Hispanic adults in New York state was conducted. Participants were recruited from local businesses, community-based social service agencies and Black and Hispanic churches and a college. All data were collected between February and March 2021. Transcripts were analyzed using qualitative thematic analysis. RESULTS: A total of 50 individuals (32 [64%] women; mean [SD] age, 42.04 [15.99] years) participated. The majority of participants identified as Black (n = 34, 68%), 9 (18%) identified as Hispanic, 3 (6%) as Black and Hispanic, and 4 (8%) as White and Hispanic. Twenty-two participants (44%) had high-school level education or less. Mistrust emerged as a central barrier to COVID-19 vaccine acceptance. Facilitators of effective COVID-19 vaccine messages include (1) key informants: like me, (2) personalized community outreach, (3) present the facts, and (4) communicate across multiple media platforms. CONCLUSIONS: This qualitative study found that among Black and Hispanic participants, receipt of reliable vaccine related information, social networks, seeing people like themselves receive the vaccination, and trusted doctors are key drivers of vaccine acceptance.

Clinical Presentation of Acute Pulmonary Embolism in Patients with Coronavirus Disease 2019 (COVID-19).

The clinical management of severely ill patients with COVID-19-related acute respiratory distress syndrome (ARDS) presents significant challenges. Many COVID-19 patients with ARDS also present with laboratory findings significant for derangement in coagulation function. In this report, we describe acute pulmonary embolism in three patients with COVID-19. We assessed the role of D-dimer assay and anticoagulation treatment in these patients. The aim of this case report is to increase awareness about the use of D-dimer in addition to patient's clinical status for making treatment decision in COVID-19 patients.

A case of Bacillus cereus bacteremia in a COVID-19 patient treated with steroids.

This report describes a case of Bacillus cereus bacteremia in a COVID-19 patient with prior inhalational steroid use and inpatient steroid treatment for COVID-19 pulmonary symptoms. The case herein is intended to illustrate an uncommon presentation of B. cereus bacteremia and highlight the increased likelihood for the occurrence of this bacteremia in patients with COVID-19 and concomitant steroid use.

Legionnaire's disease presenting with encephalitis, myoclonus, and seizures: Successful treatment with doxycycline.

Legionnaire's disease (LD) is a non-zoonotic atypical community acquired pneumonia (CAP) with several characteristic extra-pulmonary findings. Pending diagnostic test results, selected characteristic findings when considered together are the basis of clinical syndromic diagnosis and the basis of empiric antimicrobial therapy. Of the extra-pulmonary manifestation of LD, neurologic findings are among the most common, e.g., headache, mental confusion. In LD, encephalitis is rare as are myoclonus and seizures. This is a most interesting case of LD that presented with encephalitis, myoclonus and seizures. Pulmonary infiltrates developed early after admission. LD was suspected on the basis of otherwise unexplained characteristic findings, e.g., hypophosphatemia, elevated serum transaminases, microscopic hematuria, elevated ferritin, and empiric doxycycline therapy was started. The diagnosis of LD was further supported by prominent and persistent myoclonus and seizures, rare but characteristic neurologic findings in LD. On week 12 of hospitalization, he finally seroconverted with negative urinary antigen tests indicating his LD was due to a non-L. pneumophilia (serotype 01) strain. On doxycycline, he made a slow but complete recovery. We believe this is the first reported case of LD presenting with encephalitis, myoclonus, and seizures successfully treated with doxycycline.

A Rare Case of HHV-8 Associated Hemophagocytic Lymphohistiocytosis in a Stable HIV Patient.

BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a rare condition associated with viral infections including HIV. Cases have been reported mainly in advanced HIV/AIDS. This is a rare case that reports HLH associated with human herpes virus-8 (HHV-8) associated multicentric Castleman disease in a stable HIV patient. CASE PRESENTATION: A 70-year-old Asian male patient with history of stable HIV on medications with CD 4 cell count above 200 presented with cough and fever and was initially treated for pneumonia as an outpatient. Persisting symptoms prompted presentation to the hospital. The patient was found to have anemia which persisted despite repeated transfusion of packed red cells. A bone marrow biopsy to investigate anemia revealed hemophagocytosis. A CT scan revealed multiple enlarged lymph nodes and hepatosplenomegaly. An excisional lymph node biopsy revealed HHV-8 associated multicentric Castleman disease. The patient deteriorated despite initiation of treatment. CONCLUSION: HLH can occur at any stage of HIV, rapid diagnosis to identify possible underlying reactive infectious etiology and prompt initiation of treatment is crucial to survival.

Predictors of Disease-free Survival and Recurrence in Patients with Resected Bronchial Carcinoid Tumors.

BACKGROUND: Bronchial carcinoids are characterized by neuroendocrine differentiation and have distinct biological behavior, recurrence patterns, and prognosis compared with adenocarcinomas or squamous cell carcinomas. Because of their often indolent nature, it has been suggested that routine postoperative imaging surveillance may not be warranted in the majority of patients. This study aims to define the factors that predict disease-free survival (DFS) and recurrence after resection of these tumors, with the goal of identifying high-risk patients for whom image surveillance may be warranted. METHODS: We conducted a retrospective review of a prospective database to identify patients with completely resected bronchial carcinoid tumors. Surgical procedure, histology, pathological stage, follow-up, tumor recurrence, and survival were assessed. RESULTS: One hundred and forty-two patients were identified. Median age was 62 years and the majority was women (106). Surgical procedures included 20 wedge resections, 10 segmentectomies, 99 lobectomies, 3 bilobectomies, 2 pneumonectomies, 6 sleeve resections, and 2 bronchectomies. Pathologic stages included I (81%), II (10%), III (8%), and IV (1%). With a median follow-up of 31 months, there were seven recurrences. The 5- and 10-year overall survival rates were 92% and 75% and DFS rates were 88% and 72%, respectively. There were 34 patients with atypical carcinoids, and 6 (18%) developed recurrence, compared with 1 recurrence (1%) in the group of 108 patients with typical carcinoids (p = 0.0008). For atypical carcinoid tumors, the 5- and 10-year DFS rates were 72% and 32% versus 92% and 85% in typical carcinoid tumors (p = 0.001). Patients with more advanced tumor stage pT2-4 and pathologic N1/N2 nodal metastases had a significantly decreased 5- and 10-year DFS compared with those with early pT1 stage (p = 0.029) or those without nodal disease (p = 0.043). Multivariate Cox regression analyses showed advancing age (p = 0.001), atypical histology (p = 0.021), and advanced tumor stage (p = 0.047) were significant negative predictors for DFS. CONCLUSION: Long-term survival after resection of bronchial carcinoids is common, especially for patients with typical carcinoid tumors. DFS can be negatively influenced by atypical histology, advanced tumor, and nodal statuses. Efforts at postoperative image surveillance should target those patients with such high-risk factors.

A population-based analysis of robotic-assisted mitral valve repair.

BACKGROUND: Robotic-assisted mitral valve repair is becoming more frequently performed in cardiac surgery. However, little is known about its utilization and safety at a national level. METHODS: Patients undergoing mitral valve repair in the United States from 2008 to 2012 were identified in the National Inpatient Sample. Inhospital mortality, complications, length of stay, and cost for patients undergoing robotic-assisted mitral valve repair were compared with patients undergoing nonrobotic procedures. RESULTS: We identified 50,408 isolated mitral valve repair surgeries, of which 3,145 were done with robotic assistance. In a propensity score matched analysis of 631 pairs of patients, we found no difference between patients undergoing robotic-assisted and nonrobotic-assisted mitral valve repair with respect to inhospital mortality, complications, or composite outcomes in unadjusted or multivariable analyses. Robotic-assisted mitral valve repair surgery was associated with a shorter median length of stay (4 versus 6 days, p < 0.001), and there was no difference in median total costs between the two procedures. CONCLUSIONS: In our analysis of a large national database with its inherent limitations, robotic-assisted mitral valve repair was found to be safe, with an acceptable morbidity and mortality profile.

Perioperative Outcomes after Lung Resection in Obese Patients.

BACKGROUND: Obesity is a growing epidemic in the developed world. However, little is known about the impact of obesity on the perioperative morbidity and mortality after lung resection. PATIENTS AND METHODS: We analyzed the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2010 to determine whether obesity is a risk factor for perioperative morbidity and mortality after pulmonary resection. Demographic, clinical, intraoperative, and morbidity and mortality data were collected. Multivariable predictors of morbidity and mortality were determined using regression analysis. RESULTS: A total of 5,216 lung resections were identified (1,372 wedges, 3,713 lobectomies, and 131 pneumonectomies). The median age was 66 years and 2,587 (49.6%) were females. The body mass index (BMI, kg/m(2)) of the patients was as follows: 192 (3.7%) < 18.5; 1,727 (33.1%) 18.5 to 24.9; 1,754 (33.6%) 25 to 29.9; and 1,488 (28.5%) > 30. In-hospital mortality and all-cause morbidity was 2.4% (n = 127) and 14.5% (n = 757) for the entire cohort of patients, respectively. BMI was not found to be a predictor of increased mortality or morbidity, even in the morbidly obese (BMI > 35). Rather, age, approach (video-assisted thoracoscopic surgery vs. open), parameters assessing performance status, operative time, and preoperative radiation therapy were the predictors of morbidity and mortality. Conversely, being overweight (BMI 25-30) approached significance as a multivariate predictor for decreased pulmonary complications (odds ratio, 0.77 [0.592-1.004]; p = 0.054) consistent with the "obesity paradox" observed after nonbariatric general surgery. CONCLUSION: Our large national study shows that obesity does not negatively impact perioperative mortality and morbidity in patients undergoing lung resection. Surgical resections should not be denied to obese (BMI > 30) patients.

A rare case of fetal adenocarcinoma of the lung.

Fetal adenocarcinoma is a rare lung malignancy associated with improved outcomes compared to more common adenocarcinoma variants. We describe a case of a 31-year-old woman who presented with right-sided chest pain, and was subsequently diagnosed with an intermediate-grade stage IV fetal adenocarcinoma with chest wall invasion. She was treated with surgical resection and adjuvant radiation.

A propensity-matched analysis of wedge resection and stereotactic body radiotherapy for early stage lung cancer.

BACKGROUND: Patients who present with early stage non-small cell lung cancer and are poor candidates for lobar resection may be offered sublobar resection (commonly wedge) or stereotactic body radiotherapy (SBRT). However, comparing the relative effectiveness of these techniques is difficult because of differences in patient selection. We performed a propensity-matched analysis to compare the different treatment modalities. We compared the overall recurrence, overall survival, disease-free survival, and recurrence-free survival between treatment groups. METHODS: A prospectively collected database was reviewed for patients who underwent a wedge resection, a wedge plus brachytherapy, or SBRT for clinical stage IA non-small cell lung cancer from 2001 to 2012. Patients who underwent SBRT were further assessed to confirm operability. Univariate and Cox regression multivariate analysis were performed for predictors of a composite end point of recurrence and mortality. RESULTS: There were 164 patients identified, from which 99 were matched by age, sex, and histology. There were 61 women (62%) and 38 men (38%) with a median age of 73 years. Thirty-eight patients underwent a wedge resection only, 38 patients underwent a wedge with brachytherapy, and 23 patients had SBRT. Median follow-up was 35 months. Overall recurrence (local and distant) was significantly higher after SBRT (wedge, 9%; SBRT, 30%; p = 0.016). Although recurrence-free 3 -year survival was significantly better after wedge resection (88% versus 72%; p = 0.001), there was no difference between the two groups in disease-free 3-year survival (77% versus 59%; p = 0.066). Multivariate regression analysis identified male sex and SBRT as significant predictors for mortality and recurrence. CONCLUSIONS: Patients with clinical stage IA non-small cell lung cancer treated by SBRT appear to have higher overall disease recurrence than those treated by wedge resection. However, there was no significant difference in disease-free survival. A randomized trial is needed to define the role of SBRT in the potentially operable patient.