A 63-year-old woman with a history of hyperlipidemia presented to our hospital with a swollen right hand. The patient noted that she had closed her hand in a car door one week earlier, causing minor trauma to the right third metacarpophalangeal joint. Shortly after injuring her hand, she'd sought care at an outpatient facility, where she was given a diagnosis of cellulitis and a prescription for an oral antibiotic. The swelling, however, worsened, prompting her visit to our hospital.
Acromegaly affects men and women equally. 1 Impaired glucose tolerance and diabetes mellitus (DM) are common in patients with acromegaly, with a prevalence of 36% and 30%, respectively. 2 Diabetic ketoacidosis (DKA) is a rare complication of acromegaly with only a few cases reported in the English medical literature. 3-15 Factors that promote ketoacidosis in acromegalic patients include infection, surgical procedures, cessation of octreotide therapy, and excessive ingestion of sugar-containing soft drinks. 7
Introduction Cultured yogurts and probiotics are a $28 billion worldwide industry and are relatively cheap and readily available to consumers in supermarkets, pharmacies, and hospitals. They come in a variety of different forms, including commercial yogurts and capsules, and are well known in the baking and brewing industries. Many health care providers recommend cultured yogurts/probiotics for patients with altered bowel flora to restore the functional integrity of the bowel. There have been multiple adult randomized controlled trials of marginal quality that have shown the ability of these agents to prevent diarrhea associated with antibiotic usage and have been proposed to be used in conditions such as Crohn’s disease and other inflammatory bowel conditions. Despite harboring live bacteria and/or fungi, cultured yogurts and probiotics are an uncommon cause of infection in humans and generally have been deemed effective and safe. They are considered the “good bacteria” by many and, by definition, should be beneficial to the ingesting host. However, with an increase in the population at risk for chronic and debilitating diseases with exposure to significant risk factors, such as the use of immunosuppressive drugs and broad spectrum antibiotics, parenteral nutrition, and use of central venous catheters, the number of reported cases of infections due to these agents over the last century is clearly on the rise.
Introduction Atrial fibrillation (AF) may result in thromboembolism often from a thrombus in the left atrium or atrial appendage accounting for nearly 15% of all strokes in the US, with an annual incidence of stroke of up to 6% or higher in some patients. Atrial fibrillation ablation, if successful over the long-term, may reduce the risk of future stroke. New anticoagulants, such as dabigatran, rivaroxaban, and apixaban, have been shown to be superior to warfarin to reduce the risk of stroke in non-valvular atrial fibrillation (NVAF), but no solid data are available to show if they are appropriate to utilize as an alternative to warfarin in patients undergoing catheter ablation procedures. Our case illustrated that such therapy may not be efficient.
