Mycoplasma hominis necrotising pneumonia in an immunocompetent adult male.

Mycoplasma hominis, a common coloniser of the urogenital tract, is a rare cause of respiratory infections in an immunocompetent patient. M. hominis lacks a cell wall and can be difficult to identify with standard culture methods posing difficulties in diagnosis and treatment. We describe a case of M. hominis pneumonia in an immunocompetent man in his early 40s without any risk factors presenting with a cavitary lesion who developed empyema and necrotising pneumonia requiring surgical debridement. Identification of M. hominis and subsequent modification of antibiotic therapy led to favourable outcome. M. hominis should be considered in the differential diagnosis of patients with treatment resistant pneumonia especially in patients with trauma, intracranial injury, lung transplant or if immunocompromised. While M. Hominis is naturally resistant to all antibiotics that target cell wall synthesis, we recommend levofloxacin or other fluoroquinolone to most effectively treat with doxycycline as a potential alternative.

Factors Predictive of Performance on USMLE Step 1: Do Commercial Study Aids Improve Scores?

BACKGROUND: The United States Medical Licensing Examination (USMLE) Step 1 was the most cited factor in granting medical student applicants' residency interviews in a 2016 NRMP survey. Medical students utilize numerous commercial resources to achieve the highest score possible. This study sought to examine preparatory resources and their association with USMLE Step 1 performance. METHODS: In 2016 and 2017, 170 medical students from a public, Midwestern medical school completed a voluntary survey after completing USMLE Step 1. The survey asked about study aids, anticipated performance, test preparation time, and practice exam performance. Actual scores and academic performance (overall percent for years 1 and 2 of medical school) were matched to survey responses. Data was analyzed using descriptive and inferential statistical analyses. RESULTS: USMLE Step 1 performance was associated with academic performance (r = 0.719, p < 0.01). Post hoc tests indicated a positive difference with the UWorld Qbank and exam performance (F 4,134 = 10.29, p < 0.05). Amount of days dedicated to test preparation was negatively correlated with performance in the 2017 student cohort (r = - 0.304, p < 0.01). The use of other commercially available products and the number of practice tests completed were not correlated with performance. DISCUSSION: Cumulative pre-clinical grades had the strongest association with performance on the USMLE Step 1. Completing UWorld Qbank at least once was positively related with Step 1 scores. However, the use of other study aids, completing multiple practice exams, and delaying exam dates were not statistically significant. This study indicates performance in the pre-clinical curriculum and increased usage of UWorld are strongly associated with USMLE Step 1 performance.

Role of microRNAs in Alcohol-Induced Multi-Organ Injury.

Alcohol consumption and its abuse is a major health problem resulting in significant healthcare cost in the United States. Chronic alcoholism results in damage to most of the vital organs in the human body. Among the alcohol-induced injuries, alcoholic liver disease is one of the most prevalent in the United States. Remarkably, ethanol alters expression of a wide variety of microRNAs that can regulate alcohol-induced complications or dysfunctions. In this review, we will discuss the role of microRNAs in alcoholic pancreatitis, alcohol-induced liver damage, intestinal epithelial barrier dysfunction, and brain damage including altered hippocampus structure and function, and neuronal loss, alcoholic cardiomyopathy, and muscle damage. Further, we have reviewed the role of altered microRNAs in the circulation, teratogenic effects of alcohol, and during maternal or paternal alcohol consumption.