Blastomycosis Complicated by Adult Respiratory Distress Syndrome in an Immunocompetent Adult: A Case Report and Literature Review.

Blastomycosis is an endemic mycotic infection caused by inhalation of thermally dimorphic fungi from the genus Blastomyces. Blastomyces dermatitidis is the species most related to human infection in the USA and North America. Adult respiratory distress syndrome (ARDS) is a rare complication of blastomycosis and is associated with high mortality. Due to its rarity, evidence-based guidelines for diagnosing and treating ARDS associated with blastomycosis are scarce. In this case presentation, a 22-year-old male with a history of chronic cannabis use presented with severe respiratory symptoms, initially treated as community-acquired pneumonia. Despite antibiotic treatment, his condition deteriorated, necessitating intubation and resulting in the development of ARDS. A delayed diagnosis of pulmonary blastomycosis was confirmed through polymerase chain reaction testing. Treatment with amphotericin B and corticosteroids proved successful in addressing the fungal infection, leading to the recovery of the patient from his severe clinical condition. This case highlights the challenges associated with diagnosing and treating blastomycosis, particularly when complicated by ARDS, emphasizing the importance of considering fungal infections in the differential diagnosis of non-responsive pulmonary infections. Additionally, it suggests the potential utility of corticosteroids in severe cases and emphasizes the crucial role of early diagnosis and a combination of diagnostic modalities for the timely management of this rare and potentially life-threatening condition.

The relationship between disordered eating behaviors and injury rates in adolescent athletes.

OBJECTIVE: To explore the relationship between disordered eating (DE) and significant sport injury in adolescent athletes. METHOD: Responses to one item of the Disordered Eating Screen for Athletes and the Eating Attitudes Test (EAT-26) items, administered to n = 308 adolescent athletes, were analyzed with data on injury. Nonparametric statistics and multiple regression analysis were used to examine differences in DE rates amongst known injured adolescent athletes. RESULTS: The EAT-26 scores of injured females, median score of 9, were significantly higher than all other groupings with H(3) = 17.26 p < .001, η2  = .047. Using regression analyses, injury significantly predicted a rise in EAT-26 score by five points in females, p = .01, R2  = .052. DISCUSSION: This evidence suggests a relationship between adolescent female sport injury and DE, but no relationship between adolescent male sport injury and DE. These results demonstrate a need to screen for DE in athletes. Given a positive screen, athletes should be educated on the risks associated with relative energy deficiency and potentially referred to a practitioner with knowledge of the associated complications.

Initial validation of a screening tool for disordered eating in adolescent athletes.

BACKGROUND: Disordered eating (DE) is a growing problem among all athletes, particularly adolescents. To help prevent the progression of DE to a clinical eating disorder (ED), a brief screening tool could offer an efficient method for early identification of DE in athletes and facilitate treatment. The aim of this study is to validate a screening tool for DE that will identify male and female adolescent athletes of all sports and levels of competition who are at risk for DE. The Disordered Eating Screen for Athletes (DESA-6) consists of only 6 items and was designed for use in both male and female athlete populations. METHODS: Validation involved two phases: Phase I consisted of screening high school athletes using the Eating Attitudes Test (EAT-26) and the DESA-6; and Phase II included inviting all high school athletes categorized as "at risk" after screening, plus age- and self-reported gender- matched athletes categorized as not "at risk", to complete the same surveys a second time along with clinical interview. Validity and regression analyses were used to compare the DESA-6 to the EAT-26 and EDE 17.0D. RESULTS: When comparing to clinical interview, the DESA-6 had a total sensitivity of 92% and specificity of 85.96%, respectively. Upon comparison of concurrent validity, Phase II DESA-6 had a strong significant positive correlation for both males and females when compared to Phase II EDE 17.0D. CONCLUSIONS: A brief, easy to administer screening tool for recognizing DE that can be used by physicians, psychologists, athletic trainers, registered dietitians, and other sport/healthcare staff is of utmost importance for early intervention, which can lead to improved treatment outcomes. The DESA-6 is a promising tool for risk assessment of DE in athletes.

Diagnosing and Managing Sacroiliac Joint Pain.

ABSTRACT: Sacroiliac joint pain commonly occurs because of anatomic disruption within the joint. Sacroiliac joint pain and sacroiliac joint mimics create a broad differential, adding difficulty to diagnosis. Clinically, this disruption presents with a mobility limitation relative to baseline and sharp pain inferolateral to the posterior superior iliac spine. While attempting to rule out other causes of low back pain, provocation tests such as FABRE, distraction, thigh thrust, sacral compression, Gaenslen's, and sacral thrust can be a useful diagnostic tool for the diagnosis of sacroiliac joint pain. Although recently, the provocation tests' validity has been challenged. Currently, the most accurate way to assess sacroiliac joint pain is with image-guided injections of local anesthetic. Pain reduction after the injection indicates the pain originating from the sacroiliac joint. Once confirmed, it is recommended to use a patient-centered approach that focuses on pain control, followed by restoration of function through noninvasive measures such as therapeutic exercise, manual medicine, sacroiliac joint belts, and orthotics. If these noninvasive procedures have not provided adequate treatment, then more invasive procedures should be considered.

Prevalence of disordered eating in athletes categorized by emphasis on leanness and activity type - a systematic review.

BACKGROUND: Disordered Eating (DE) shows a strong association with athletics and can lead to several negative mental and physical health effects. Traditionally, sports have been grouped based upon whether or not the sport emphasizes leanness as a competing factor. Due to sociocultural factors, risk for DE may also be associated with the sport type. The aim of this review is to critically analyze the available research and data in this field to consider the relationship between DE and sport type to see which factors influence prevalence among athletes. METHOD: A systematic review was completed using keywords specific to DE and sport types. Articles were either excluded due to lack of specification of athlete type or failure to use a standardized screening tool or interview for data collection. RESULTS: 6 out of 7 studies found a significant increase in DE rates among lean sport types. When classifying by sport type reports were less consistent, but show non-lean sports also have increased rates of DE. CONCLUSION: There are variations in prevalence of DE behaviors depending on athlete type. It is important to identify the risk for DE early in athletes so emphasis can be placed on treatment options to nullify progression to an eating disorder, lower negative impacts on an athlete's performance, and prevent other negative health effects. Using sport groups is important to clinical practice as well as research, as certain sports may have a higher risk for development of DE.