A Case of Legionnaires' Disease Manifesting as Heat Exhaustion.

A 69-year-old male with a history of prior admissions of heat exhaustion presented with non-specific symptoms including fatigue, diarrhea, and dehydration. The workup revealed a positive legionella urine antigen. He was treated with levofloxacin with symptom resolution within 48 hours.

MULTIPLE RIB FRACTURES, PLEURAL EFFUSION AND RIGHT-SIDED DIAPHRAGMATIC HERNIATION OF THE COLON INTO THE CHEST ASSOCIATED WITH CHRONIC COUGH AFTER COVID-19.

Rib fractures are an infrequent consequence of severe cough. In some patients, undetected rib fractures can lead to life-threatening outcomes. The case of a 73-year-old man who presented with shortness of breath and a worsening dry cough from a SARS-CoV-2 infection for 4 weeks is described. In the emergency department, he was found to be hypoxic and hypotensive. Imaging studies revealed a large right pleural effusion, multiple rib fractures, and right-sided herniation of the colon into the chest. He was admitted to the cardiothoracic intensive care unit where he underwent a flexible bronchoscopy, right video-assisted thoracoscopic surgery, evacuation of a haemothorax, complete decortication, and repair of a diaphragmatic hernia. This case is an unusual presentation of an amalgamation of rare complications resulting from an unrelenting, poorly controlled SARS-CoV-2 infection cough that prompted rapid recognition and swift action. LEARNING POINTS: Physical examination and plain radiography frequently miss costal arch fractures if no bone pathology or history of trauma is present.Controlling cough is important, and decreases the chances of complications and rupture of organs.New-onset chest pain with a background of chronic cough makes cough-induced rib fracture a probable differential diagnosis. Pleural effusion in a patient presenting with cough and a rib fracture should make clinicians suspect haemothorax.

Ticagrelor use in patients after percutaneous coronary intervention: one year follow up in a community hospital.

BACKGROUND: Current guidelines from American College of Cardiology (ACC) recommend ticagrelor over clopidogrel in patients with acute coronary syndrome. We have observed many patients being switched from ticagrelor to clopidogrel after percutaneous coronary intervention (PCI) in our hospital. Our goal is to evaluate the use rate of ticagrelor and categorize the reasons for non-use. METHODS: We performed a retrospective data analysis of all patients who underwent PCI at Unity Hospital of Rochester, New York, from January 2019 to January 2020. A total of 330 patients underwent PCI for ACS over the year. After exclusions, 277 patients were enrolled in the analysis. RESULTS: Of the 277 patients, 179 (65%) completed one year of ticagrelor therapy, and 98 (35%) stopped ticagrelor and transitioned to clopidogrel. The most common reason for switching from ticagrelor was dyspnea (42 patients), followed by cost concerns (41 patients). CONCLUSION: At our community hospital, completion of one-year use of ticagrelor post-PCI occurred in 65% of patients. The most common reasons for discontinuation are dyspnea and medication cost.