Complex Management of Septic Joint and Cutaneous Nocardiosis in an Immunocompromised Patient: A Case Report.

Nocardia, an opportunistic, gram-positive, catalase-positive, rod-shaped bacterium found in soil and water, is known to cause infections in humans, predominantly among immunocompromised individuals, through inhalation or direct inoculation. This report details a rare case of a septic joint caused by Nocardia brasiliensis, which subsequently led to cutaneous involvement, in a patient with multiple underlying health issues. The management of this case was complicated by the patient's extensive medical history, including diabetes, chronic urinary tract infections, and recent surgical procedures, which necessitated a nuanced approach to antibiotic therapy. The treatment regimen underwent several adjustments in response to concurrent infections in other organs and the emergence of multidrug-resistant organisms. Despite an expanded arsenal of therapeutic options for Nocardia infections, treating such infections remains challenging due to potential adverse outcomes, particularly in immunocompromised patients prone to infection relapse. This case underscores the complexities involved in diagnosing and managing Nocardia infections and highlights the importance of tailored antibiotic therapy in achieving favorable outcomes while minimizing the risk of relapse.

A Case of Asymptomatic Massive Inguinoscrotal Bladder in Acute Renal Failure.

Inguinal hernia is a common condition that typically affects males in the age group of 50-70 years. While often asymptomatic or mildly symptomatic, complications such as urinary bladder herniation and obstructive uropathy can occur if left untreated. We present a unique case of a 60-year-old man with a body mass index of 37 kg/m2 with a 20-year history of untreated bilateral inguinal hernias. His condition progressed to a complicated right inguinoscrotal hernia involving the bladder, leading to obstructive uropathy, acute renal failure, and pulmonary edema. Diagnostic imaging revealed hydronephrosis and obstruction of the distal right ureter, necessitating several procedures, including diuretic therapy, a nephrostogram, a nephrostomy, and ultimately hemodialysis due to persistent renal failure. Surgical management was achieved through an emergent robotic-assisted repair of the right inguinal hernia using resorbable mesh while repairing the left hernia was delayed to mitigate potential risks. This case illustrates the severe complications that can arise from a longstanding untreated inguinal hernia, highlighting the importance of routine monitoring and early intervention. It also emphasizes the diagnostic role of different imaging modalities and immediate pharmacological and surgical intervention in managing such complications. Despite the commonality of inguinal hernia, a lack of timely treatment can lead to life-threatening conditions, necessitating a comprehensive approach to management to improve patient outcomes.

Exercise, cancer and cardiovascular disease: what should clinicians advise?

Cardiovascular disease is one of the leading causes of morbidity and mortality in persons with cancer. The elevated risk is thought to derive from the combination of cardiovascular risk factors and direct cardiotoxicity from cancer therapies. Exercise may be a potential strategy to counteract these toxicities and maintain cardiovascular reserve. In this article, we review the evidence for the potential cardioprotective effects of exercise training in cancer patients before, during, and following treatment. We also propose a patient-tailored approach for the development of targeted prescriptions based on individual exercise capacity and cardiovascular reserve.