The Utilization of Low Dose Naltrexone for Chronic Pain.

Naltrexone is a mu-opioid receptor antagonist with a long half-life compared with naloxone. Both of these drugs, along with others, were developed with the intention of reversing the effects of opioid abuse or toxicity. Evidence has also shown that naltrexone has a benefit in preventing relapse by reducing opioid cravings and reducing symptoms of opioid withdrawal. The benefits of this drug were not only shown with opioid abuse. In 1984 this drug was also approved for alcohol abuse. Naltrexone has been proven to decrease alcohol relapse by decreasing the craving. Apart from these approved indications for the use of naltrexone, with time, it has been seen that this drug has a benefit in treating chronic pain. A number of studies have shown the benefits of this drug with inflammatory bowel disease, fibromyalgia, multiple sclerosis, diabetic neuropathy, and complex regional pain syndrome, among others. More studies are needed to approve this medication for specific chronic pain conditions.

What If We Don't? A Retrospective Review of Standard Precautions for MRSA.

BACKGROUND: There are conflicting data in the literature about the need for contact isolation for active methicillin-resistant Staphylococcus aureus (MRSA) infections. METHODS: In this retrospective review, we compared the MRSA bloodstream standardized infection ratio for 1 year while contact precautions were in place for MRSA infections and for 1 year after routine contact precautions for MRSA were no longer in place. RESULTS: There was no change in the MRSA bloodstream standardized infection ratio between the two time periods. DISCUSSION: With cessation of contact precautions for MRSA infections, there was no change in bloodstream MRSA standardized infection ratios across a large health system. While standardized infection ratios would not detect asymptomatic horizontal transmission of a pathogen, it is reassuring that bloodstream infections - a known complication of MRSA colonization status - did not rise with cessation of contact precautions.

Fatal Case of Burkholderia gladioli Pneumonia in a Patient With COVID-19.

Background: Burkholderia gladioli (B gladioli) is a rare, gram-negative rod that was initially regarded as a plant pathogen. However, B gladioli has been reported as the primary pathogen causing pneumonia in organ transplant recipients and in patients with cystic fibrosis. We report a case of bacterial pneumonia caused by B gladioli in a patient hospitalized for coronavirus disease 2019 (COVID-19). Case Report: A 68-year-old male was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia. He was treated with dexamethasone and convalescent plasma, resulting in improvement in the hypoxemia. However, during the latter part of his inpatient stay, the patient developed pneumonia caused by B gladioli. The isolate of B gladioli was sensitive to meropenem, levofloxacin, and trimethoprim/sulfamethoxazole and intermediate to ceftazidime. He was treated with meropenem and levofloxacin. Despite treatment, the patient developed acute respiratory distress syndrome with multiorgan failure, suffered cardiac arrest, and died. Conclusion: To the best of our knowledge, this case is the first report of B gladioli coinfection in a patient hospitalized for COVID-19 and provides insight into the possible detrimental outcome of B gladioli and COVID-19 coinfection.

Unusual Freshwater-Related Infections Caused by Haematospirillum jordaniae.

Freshwater-related infections can be caused by a broad range of pathogens, potentially leading to skin and soft tissue, pulmonary, gastrointestinal, or even systemic diseases. Haematospirillum jordaniae (H. jordaniae),a gram-negative, aerobic organism previously regarded solely as an environmental microbe, has been classified as a pathogen capable of causing human infection in the United States. There has been only one other case reported in the literature of H. jordaniae infection, and little is known about the pathogenesis.The presentation and progression of clinical symptoms in our cases indicate freshwater cutaneous injury as the most likely route of H. jordaniae infection. We present two cases of H. jordaniae infection in elderly males. Both patients had freshwater exposure and skin injury resulting in sepsis, cellulitis at the site of injury, and bacteremia. Additionally, one patient presented with an acute deep venous thrombosis. The diagnosis of H. jordaniae was confirmed using Sanger sequencing 16s ribosomal RNA data. Antimicrobial therapy included piperacillin-tazobactam, ceftazidime, and levofloxacin. Both patients recovered successfully. While clinical cases and literature involving the newly classified human pathogen H. jordaniae are still rare, it is crucial to recognize the potential emergence of environmental organisms, previously believed to be harmless, as human pathogens. In cases of bacteremia and cellulitis with recent freshwater exposure and injury, H. jordaniae infection should be considered as part of the differential diagnosis.

Diffuse Large B-cell Lymphoma Presenting as a Primary Pleural Mass: A Case Report and Literature Review.

Primary pleural lymphoma is a rare type of lymphoma that accounts for only ​​0.3% of all non-Hodgkin's lymphomas. The rarity and nonspecific clinical presentation of primary pleural lymphomas pose a diagnostic challenge for clinicians. We present an atypical case of primary pleural lymphoma in an elderly patient without any associated pleuro-pulmonary disease, immunosuppression, or history of lymphoma. To our knowledge, this is one of the first described cases of a primary pleural lymphoma with such a presentation.

Assessment of NAD+metabolism in human cell cultures, erythrocytes, cerebrospinal fluid and primate skeletal muscle.

The reduction-oxidation state of NAD+/NADH is critical for cellular health with NAD+ and its metabolites playing critical roles in aging and pathologies. Given the inherent autooxidation of reduced dinucleotides (i.e. NADH/NADPH), and the well-established differential stability, the accurate measurement of NAD+ and its metabolites is technically challenging. Moreover, sample processing, normalization and measurement strategies can profoundly alter results. Here we developed a rapid and sensitive liquid chromatography mass spectrometry-based method to quantify the NAD+ metabolome with careful consideration of these intrinsic chemical instabilities. Utilizing this method we assess NAD+ metabolite stabilities and determine the presence and concentrations of NAD+ metabolites in clinically relevant human samples including cerebrospinal fluid, erythrocytes, and primate skeletal muscle.