Shoulder Injury Related to Vaccine Administration: A Rare Reaction.

Awareness of shoulder injury related to vaccine administration and a high index of suspicion are necessary to evaluate patients with shoulder concerns postvaccination.

The Asthma-COPD Overlap Syndrome.

Asthma-COPD overlap syndrome (ACOS) has a higher disease burden than either condition alone. Patients with ACOS have frequent exacerbations, poor quality of life, a more rapid decline in lung function, and high mortality.

Plasma resistin levels in asthmatics as a marker of disease state.

BACKGROUND: Resistin is a protein produced by adipocytes and circulating macrophages that has been found to be associated with inflammatory states. OBJECTIVE: To determine the levels of resistin in relation to asthma disease state and severity, we investigated a cohort of adult patients with asthma. METHODS: A cohort of moderate to severe persistent asthma patients and control patients were recruited and underwent fasting labs to evaluate levels of serum glucose, C-reactive protein (CRP), and resistin. RESULTS: No significant differences were found between the control and asthma group with respect to serum CRP at 0.78 +/- 0.60 mg/dL and 0.48 +/- 0.60 mg/dL, (p < 0.36) or glucose at 92.2 +/- 11.9 mg/dL and 89.5 +/- 7.2 mg/dL, (p < 0.084), respectively (mean +/- SD). However, plasma resistin levels were found to be significantly elevated in asthma patients, 186 ng/mL (95%CI 169-202) compared with control patients 121 ng/mL (95%CI 90.4-151), (p < 0.005). CONCLUSIONS: Patients with asthma were found to have higher levels of resistin, and resistin levels were increased with disease severity in the asthma cohort.

Randomized placebo controlled assessment of airway inflammation due to racemic albuterol and levalbuterol via exhaled nitric oxide testing.

STUDY OBJECTIVES: The S-stereoisomer found in racemic albuterol may have associated proinflammatory properties. We tested the hypothesis that airway inflammation as assessed by exhaled nitric oxide is no different in patients with COPD when using racemic albuterol relative to levalbuterol or placebo. MEASUREMENTS: Twelve mild to moderate COPD patients were assigned to five days each of nebulized racemic albuterol, levalbuterol, and saline placebo. Before and after each course of treatment, airway inflammation was assessed via exhaled nitric oxide breath testing. Secondary functional outcomes that were measured included spirometry, a functional assessment utilizing a six-minute walk, and symptoms score using the University of California, San Diego Shortness of Breath Questionnaire. RESULTS: There was no statistically significant difference in pre and post FeNO levels within and between treatment groups (p = 0.121). There were also no significant differences within or between treatment groups for the secondary outcome measurements of FEV1 (p = 0.913), functional assessment utilizing a six-minute walk (p = 0.838) and the symptom scores using Shortness of Breath Questionnaire (p = 0.500). CONCLUSION: We found no difference in mild to moderate COPD patients treated with racemic albuterol, levalbuterol or placebo for measurement of exhaled nitric oxide or the secondary outcomes that were measured.

Intraoperative anaphylaxis to bacitracin during pacemaker change and laser lead extraction.

BACKGROUND: Bacitracin is widely used in operating rooms to soak implants, irrigate compound fractures, and apply to surgical incisions. However, bacitracin is a known sensitizer and causes not only allergic contact dermatitis but also anaphylaxis. OBJECTIVE: To describe a 72-year-old woman with anaphylaxis after irrigation and packing of an infected pacemaker pocket with a bacitracin solution. METHODS: Skin prick testing to bacitracin and latex; serum tryptase, serum histamine, serum IgE to latex, and serial cardiac enzyme measurements; blood cultures, transthoracic echocardiograms, and venograms were performed to characterize the reaction. RESULTS: Six hours after the anaphylactic event, the patient had an elevated serum tryptase level of 49 ng/mL (reference range, 2-10 ng/mL), which normalized the next morning. She had immediate-type skin prick test reactions to full-strength bacitracin ointment (500 U/g) and bacitracin solution (150 U/mL). Serum IgE level to latex was undetectable, and results of skin testing to latex were negative. CONCLUSIONS: To our knowledge, this is the first case report of anaphylaxis to bacitracin during pacemaker surgery. This case illustrates that intraoperative anaphylaxis to bacitracin can be life-threatening.