Skeletal Fluorosis.

ABSTRACT: A 27-year-old man with polysubstance abuse including methamphetamine, fentanyl, and 1.5 years of electronics compressed gas duster inhalation presented following an assault. Radiologic imaging performed for suspected fractures revealed periosteal reaction, cortical thickening with increased bone density, and ligament and tendon ossification, which were not present on imaging obtained 3 years before presentation. A bone scan was subsequently performed revealing a metabolic superscan with cortical irregularity. Further investigation revealed skeletal fluorosis from electronics compressed gas duster inhalation. Skeletal fluorosis may be considered when these osseous findings are encountered.

FDG PET/CT in Mixed Langerhans Cell Histiocytosis and Erdheim-Chester Disease.

ABSTRACT: The histiocytoses arise from hematopoietic bone marrow stem cells or monocytes. They range from limited to disseminated disease. We report a 31-year-old woman with multisystem Langerhans cell histiocytosis (LCH). The recognition that pericardial disease was rare in LCH prompted review of the initial limited biopsies, which helped establish a second diagnosis of Erdheim-Chester disease. The increasing recognition of mixed histiocytoses requires searching for Erdheim-Chester disease when a patient is diagnosed with LCH and vice versa. FDG PET/CT can help establish the diagnosis or suggest mixed disease based on the organs involved.

Real-world impact of vaccination on coronavirus disease 2019 (COVID-19) incidence in healthcare personnel at an academic medical center.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) vaccination effectiveness in healthcare personnel (HCP) has been established. However, questions remain regarding its performance in high-risk healthcare occupations and work locations. We describe the effect of a COVID-19 HCP vaccination campaign on SARS-CoV-2 infection by timing of vaccination, job type, and work location. METHODS: We conducted a retrospective review of COVID-19 vaccination acceptance, incidence of postvaccination COVID-19, hospitalization, and mortality among 16,156 faculty, students, and staff at a large academic medical center. Data were collected 8 weeks prior to the start of phase 1a vaccination of frontline employees and ended 11 weeks after campaign onset. RESULTS: The COVID-19 incidence rate among HCP at our institution decreased from 3.2% during the 8 weeks prior to the start of vaccinations to 0.38% by 4 weeks after campaign initiation. COVID-19 risk was reduced among individuals who received a single vaccination (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.40-0.68; P < .0001) and was further reduced with 2 doses of vaccine (HR, 0.17; 95% CI, 0.09-0.32; P < .0001). By 2 weeks after the second dose, the observed case positivity rate was 0.04%. Among phase 1a HCP, we observed a lower risk of COVID-19 among physicians and a trend toward higher risk for respiratory therapists independent of vaccination status. Rates of infection were similar in a subgroup of nurses when examined by work location. CONCLUSIONS: Our findings show the real-world effectiveness of COVID-19 vaccination in HCP. Despite these encouraging results, unvaccinated HCP remain at an elevated risk of infection, highlighting the need for targeted outreach to combat vaccine hesitancy.