A Case of Methicillin-Sensitive Staphylococcus aureus (MSSA) Prostate Abscess, Osteomyelitis, and Myositis Associated with MSSA Bacteremia in a 60-Year-Old Patient Presenting with Back Pain.

BACKGROUND Staphylococcus aureus (SA) is a rare cause of prostatic abscess. Risk factors include genito-urinary instrumentalization and immunocompromised states. Because of the lack of guidelines on the diagnosis, management, and follow-up of SA prostate abscess, the diagnosis can sometimes be challenging. Our patient was a 60-year-old man who initially presented with lower back pain and was diagnosed with a methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia, prostate abscess, osteomyelitis, and myositis. CASE REPORT A 60-year-old man presented with lower back pain. He had a past medical history of incompletely treated MSSA cervical osteomyelitis with epidural abscess, alcohol use disorder, intravenous drug use (IVDU), and poorly controlled diabetes mellitus (DM). He was afebrile and hemodynamically stable. Laboratory test results revealed leukocytosis and an elevated C reactive protein (CRP). Lumbar spine magnetic resonance imaging (MRI) showed vertebral osteomyelitis and right psoas myositis. Blood cultures isolated MSSA. The patient was treated with vancomycin and piperacillin-tazobactam. On day 5, our patient reported having fever, chills, flank pain, and dysuria. Computed tomography (CT) revealed a 4.0×4.9 cm prostatic abscess. CT-guided percutaneous abscess drainage was performed, and fluid culture revealed MSSA. Both antibiotics were discontinued and cefazolin was started following sensitivities. Post-drainage pelvic ultrasound (US) showed resolution of the abscess. CONCLUSIONS This case highlights the importance of a rapid diagnosis of SA prostate abscess in patients with documented risk factors and characteristic symptoms. Timely management with antibiotics and drainage as indicated are imperative to avoid further complications from the underlying bacteremia, including sepsis and metastatic infections.

Calcitonin Gene-Related Peptide Antagonists as a Savior in Episodic and Chronic Migraine: A Review.

Headaches due to migraine are the second leading cause of disability in the world. Migraine can be classified as episodic migraine (EM) and chronic migraine (CM). The course of the disease starts from an aura followed by 4-72 hours of bouts of throbbing, mostly unilateral headache associated with nausea, photo/phonophobia with/without neurological deficit. The pathophysiology of migraine remains debatable and many drugs are used to help control migraine attacks with little or no benefit. However, patient compliance remains a reason for over and underdosing of these medications. The calcitonin gene-related peptide (CGRP), a vasoactive peptide is known to contribute to the disease course. Much work is done on antagonizing the receptor or the molecule itself. For this purpose, genetically engineered monoclonal antibodies are being utilized for long-term reduction in morbidity and prevention of migraine headaches. The four to name are: galcanezumab, fremanezumab, eptinezumab, and erenumab. The purpose of this review is to shed light on the use of these monoclonal antibodies, completed and recruiting trials, and the role of these medications in the prevention of not only EM and CM but also in medication overuse headaches.

Diabetes Mellitus in Children and Its Effect on Caregivers' Mental Health.

Introduction Caring for a child with diabetes often has a negative effect on the mental health of caregivers and other family members. The goal of this study was to determine the effect of caring for children with diabetes on the mental health of caregivers. Materials and methods This case-control study was conducted in the National Institute of Child Health from October to November 2017 to compare the mental health effects associated with caring for children with diabetes as against caring for children without diabetes. The case group consisted of the caregivers of 60 children with diabetes, and the control group consisted of the caregivers of 60 children without diabetes. A validated questionnaire with two scales was used. Frequencies, percentages, confidence intervals, and p-values were reported for the categorical variables. The variables were analyzed using Patient Health Questionnaire 9 (PHQ-9) and Generalized Anxiety Disorder 7 (GAD-7) scales to determine associations. Results In the case group, most caregivers were mothers, 60% had consanguineous marriages, 21.7% were employed, and 21.7% were suffering from a long-term illness. Of those reporting a disease, 13.3% reported a change in their disease. Most caregivers (71.7%) received family support, and 78.3% of caregivers had social support. Most caregivers in the case group had mild depression, and 35% had mild anxiety. In the control group, most caregivers were mothers, 5% were employed, and 35% had disease(s). Of those reporting a disease, 15% reported a change in their health. Most of the caregivers in the control group (93.3%) had family support, and 85% had social support. Most (62%) were found to have mild depression, and more than half had no anxiety. Most children in the control group were under five years old, and most children in the case group were over 10 years old. Nearly half of the children in the case group had a positive family history of thalassemia, and 68.3% of them have insulin administered once daily. Strong variables that affect caregiver mental health were caregiver age, health changes, and consanguinity. Conclusion The caregivers of children with diabetes have a higher incidence of anxiety compared with the caregivers of children without diabetes; depression was similar for both groups. Health care providers should be aware of the differences in parenting stress related to caring for children with long-term illnesses and should consider ways to help improve the well-being of these caregivers.