Rhizobium radiobacter-Induced Peritonitis: A Case Report and Literature Analysis.

Rhizobium radiobacter (R. radiobacter) is a gram-negative bacterium, primarily a soil contaminant and rarely pathogenic to humans. Only a few cases of peritonitis secondary to R. radiobacter have been reported worldwide. A 66-year-old male with end-stage renal disease who was on peritoneal dialysis (PD) developed R. radiobacter-induced peritonitis. We have treated the infection successfully with intraperitoneal antibiotics and managed to keep his PD catheter intact without interruption in PD treatment. More prolonged antibiotic therapy and frequent clinical follow-up is required to treat this infection. Better clinician awareness is needed to prevent this rare infection.

Intravenous Drug Use-Associated Infective Endocarditis in Pregnant Patients at a Hospital in West Virginia.

Introduction Due to high levels of intravenous drug use (IVDU) in West Virginia (WV), there are increasing numbers of hospitalizations for infective endocarditis (IE). More specifically, pregnant patients with IE are a uniquely challenging population, with complex management and a clinical course that further affects the health of the fetus, with high morbidity and mortality. Timely recognition and awareness of the most common bacterial causes will provide hospitals and clinicians with valuable information to manage future patients. Methods This retrospective study analyzed the clinical course of pregnant patients admitted with IE and IVDU history presenting at Cabell Huntington Hospital from 2013 to 2018. Inclusion criteria were women between 16 and 45 years of age confirmed to be pregnant by urine pregnancy test and ultrasonography with at least eight weeks gestation, with a first-time diagnosis of endocarditis and an identified history of IVDU. We excluded charts with pre-existing risk factors including a history of valvular disease, rheumatic heart disease, surgical valve repair or mechanical valve replacement, or a diagnosis of coagulopathies. The resulting charts were evaluated for isolated organisms, reported clinical course, and complications of the pregnancy. Results A total of 10 patients were identified, with methicillin-susceptible and methicillin-resistant Staphylococcus aureus, Serratia marcescens, Haemophilus parainfluenza, and Enterococcus faecalis species. Complications included loss of fetus (30%), septic embolization (40%), hemorrhagic stroke (10%), and transfer to outside facilities for cardiothoracic surgical intervention (40%). Discussion IE in pregnancy, while rare, has serious complications. In the context of the IVDU epidemic, it has an increasing impact on WV hospitals. A better understanding of the clinical course may allow for early diagnosis and guide the development of rational empiric therapies. More effective management of IE in pregnant patients can reduce complications and potentially improve maternal and fetal morbidity or mortality.

Nocturia is an Independent Predictor of Abdominal Aortic Calcification in Women: Results from the National Health and Nutrition Examination Survey.

Nocturia is generally considered a urological condition, but may be an indicator of cardiovascular disease, as prior studies have found associations with cardiovascular risk factors as well as clinical and subclinical markers of coronary artery disease. This study aimed to explore potential associations between nocturia and abdominal aortic calcification (AAC). We analyzed 2013-2014 National Health and Nutrition Examination Survey dual energy x-ray absorptiometry-derived AAC data and concurrent interview data on kidney conditions from respondents aged 40-80 years. AAC was defined as a score ≥ 1 on the 24-point semi-quantitative AAC scale. Nocturia was defined as an average of ≥ 2 voids per night. Three incremental multivariate logistic regression models controlling for (1) age, (2) sex, race, and BMI, and (3) hypertension, diabetes mellitus, and smoking history were used to determine whether nocturia predicted AAC. These models were and modified to exclude age and/or sex to perform age- and/or sex-specific sub-analyses, respectively. Complete data were available from 2,945 participants (29.1% AAC, 31.4% nocturia). On univariate analysis, the association between nocturia and AAC was significant in women (OR 1.77 [95% CI 1.37-2.29], p < 0.001), but not in men (1.14 [0.74-1.76], p = 0.531). Multivariate analysis showed nocturia was an independent predictor of AAC in women in Models I-II (ORs 1.49-1.58, p ≤ 0.032) but not Model III (1.37 [0.90-2.09], p = 0.133). Stratification by age revealed a strong univariate association among women aged 50-59 (3.88 [1.97-7.61], p < 0.001), which persisted across all multivariate models (ORs 4.05-4.41, p ≤ 0.001). The presence of nocturia is an important clue of AAC in women, especially those middle-aged.

Prevalence and control rates of hypertension in the USA: 2017-2018.

BACKGROUND: Recent review of hypertension guidelines requires fresh updates of prevalence and control rates. Though retrospective analysis provided burden estimates, control rates were grossly misleading. We set out to update the prevalence and control rates of hypertension in the USA using contemporary NHANES data. METHODS: Persons with mean systolic blood pressure (mSBP) ≥130 mmHg or mean diastolic blood pressure (mDBP) ≥80 mmHg or self-reported current use of antihypertensive medications were classified as hypertensives. Hypertensives on medications with mSBP <130 mmHg and mDBP <80 mmHg were classified as having well-controlled hypertension. Subgroup comparisons of hypertension prevalence were computed using Chi-square test. Predictors of hypertension and well-controlled BP were assessed using multivariable logistic regressions. Two tailed p-values <0.05 were considered statistically significant. RESULTS: The prevalence of hypertension in the USA in 2017-2018 was 49.64% (95% CI 46.67-52.61) corresponding to 115(95% CI 104-128) million persons. NH Blacks: 58.53% (95% CI 55.39-61.60); Men: 54.46% (95% CI 51.01-57.87); older persons and obese individuals: 61.03% (95% CI 57.31-64.63) as well as persons with diabetes and CKD, comparatively. The overall rate of well-controlled hypertension was 39.64% (95% CI 36.20-42.81). Persons with at least a college degree: OR 2.20(95% CI 1.02-5.04, p=0.049) and persons with incomes ≥3 times the poverty threshold; OR 1.88(95% CI 1.1.8-2.99, p=0.011) had higher rates of well-controlled hypertension when compared to lowest categories. CONCLUSION: One in every two persons ≥20 years in the USA has hypertension with only 39.64% on medications having well-controlled hypertension. Significant discrepancies exist in the burden and control rates in different subpopulation categories. Targeted interventions could help improve the prevalence and hypertension control rates in the USA.