A Case Of Entamoeba Histolytica Infection Among Men Who Have Sex With Men.

Entamoeba histolytica is a parasite responsible for intestinal amebiasis and possible extraintestinal manifestations, such as liver abscesses. India, Africa, Mexico, and Central and South America have some of the highest rates of infection due to poor socioeconomic and environmental conditions. The infection has become more common in the United States due to an increase in emigration. There has been a rising incidence of sexual transmission of the infection, most commonly seen in men who have sex with men. Here, we present a case of a symptomatic extraintestinal E histolytica infection in a young Hispanic bisexual man.

A Comprehensive Analysis of the Impact of Acute Myocardial Infarction in Patients With Celiac Disease.

Background and Aims: We aimed to study the impact of acute myocardial infarction (AMI) in patients with celiac disease (CD). Methods: We used the National Inpatient Sample 2011-2018 to identify patients aged 18 years and older with a history of CD who presented with AMI using International Classification of Disease Nineth and Tenth Revision codes. Primary outcome of interest was mortality differences in AMI patients with and without CD. Secondary outcomes were in-hospital length of stay, hospital costs, and coronary revascularization. Results: A total of 2,287,840 weighted patients were included in this study with a principal diagnosis of AMI. Among this population, 183,027 weighted patients had a history of CD (0.08%), and 2,286,010 weighted patients had AMI without a history of CD (99.92%). Most AMI patients with and without CD were older (69.57 ± 13.21 vs 67.08 ± 13.87 years, respectively) and white (92.55% vs 75.39%, respectively). Patients with AMI and CD were more likely to be female than patients without CD (53.76% vs 38.47%; P < .05). In our study, we found that the difference in hospital charges (adjusted mean difference $2644.7) was lower among AMI and CD; however, length of stay was higher among patients with CD (adjusted mean difference 0.36 day) although they were not statistically significant (P > .05). Both cohorts had higher number of Medicare recipients and lower number of patients who self-pay. Our study also found that smoking was more prevalent among patients with CD, 12.14%, vs patients without CD, 2.51%. Moreover, patients with CD who developed AMI had a lower adjusted odds of mortality than those without CD (adjusted odds ratio [aOR] 0.41; P < .05). Patients with CD and AMI also had lower odds of coronary revascularization (aOR 0.80; P < .05). In addition, we found that adults with CD had a lower odds of developing AMI (aOR 0.78; P < .05). Conclusion: CD is a chronic disease leading to chronic inflammation and various nutrition-related problems which can lead to increased morbid conditions. However, we found lower odds of AMI among patients with CD, as well as lower mortality and comorbidities related to AMI, thus contradicting previous assumptions.

Stakeholder Engagement Significantly Decreased Colorectal Surgical Site Infections.

Background: Patients and care providers raised concerns about the increased incidence of colorectal surgical site infection (SSI) at a community hospital in Baltimore compared with peer institutions. Patients and Methods: A preliminary analysis was performed that identified several modifiable targets for interventions to reduce SSIs in this patient population. The intervention focused on wide engagement of all stakeholder groups across the spectrum of care including physicians, pharmacists, nurses, administrators, and patients. The engagement process involved hospital-wide educational sessions, adoption and implementation of the best clinical guidelines, and utilization of the electronic medical record system to reinforce compliance and ensure quality control. Data for SSIs in colorectal surgical procedures were collected prior to the intervention (January 1, 2017 to March 31, 2018) and after implementation (April 1, 2018 to October 31, 2018). Results: A total of 355 cases (229 pre-intervention group, 126 post-intervention group) met the inclusion criteria; the two groups were comparable with respect to all the key parameters except the procedure type and use of endoscopy. Multivariable logistic regression modeling was utilized to evaluate the effects of the stakeholder engagement intervention while adjusting for potential confounders. The incidence of colorectal SSIs was substantially lower after the intervention (2.78% vs. 8.73%, p = 0.02). This reduction was robust to adjustment for covariates in regression modeling (p = 0.04). Conclusions: Informed stakeholder engagement helped bring cohesion to the inherently fragmented elements of the care delivery model and was associated with decreased incidence of colorectal SSIs.