The utility of bandemia in prognostication and prediction of mortality in sepsis.

Background: Bandemia, defined as a band count >10%, is indicative of underlying infection and is increasingly being used for early detection of sepsis. While an absolute band level has been linked to worse outcomes, its trend has not been extensively studied as a prognostic marker. In this study, we assessed patients admitted to the ICU with sepsis or septic shock and evaluated the correlation between bandemia trends and clinical trajectory among these patients. Methods: This study was a retrospective chart review. Band counts, serum lactate levels, and SOFA scores at 0 and 72 h after admission to the ICU were collected. Patients were risk stratified into groups depending on their SOFA trends, and corresponding band trends and serum lactate levels were compared. Results: 134 patients were included for analysis. There was a statistically significant decrease in bandemia trends for patients with a reduction in SOFA scores [median (IQR)-4.5 (-11, 0); p < 0.0001], and a statistically significant increase in bandemia trends for patients with worsening SOFA scores [median (IQR) 4 (0, 8); p = 0.0007]. Conclusion: Early trends of serum band levels in patients with sepsis or septic shock may help to predict a clinical trajectory and overall prognosis. More investigation is warranted as to whether incorporating bandemia trends, when used in conjunction with other known markers such as lactate levels, may help to guide bedside clinical decisions such as risk stratification, tailored therapies, and ultimately improve outcomes.

Hair-Dye-Related Accidental Poisoning and Death.

Para phenylenediamine (PPD) is a common component of hair dye as well as temporary tattoos and is a well-known cause of type 4 hypersensitivity reactions from topical exposure. While there have been several cases reported in the literature describing toxicities following ingestion, there are a paucity of reports of severe systemic disease following topical exposure. Cases of PPD ingestion have been reported to present with angioedema-like reactions, often progressing to rhabdomyolysis and renal failure. To our knowledge, there have only been two reported cases of severe reactions following topical exposure to PPD. We present a case of a 59-year-old man with topical exposure to hair dye who presented with an angioedema-like reaction shortly after topical exposure to PPD containing hair dye that rapidly progressed to rhabdomyolysis, renal failure, and eventually death.

Amyl Nitrite-Induced Hemolytic Anemia: Acute Therapy and Prevention.

Inhaled nitrites have been a substance of recreational use for centuries, primarily among men who have sex with men (MSM). However, there is a lack of awareness of the use of inhaled nitrites in this population and the possible complications and health disparities it carries. In this case report, we present a 62-year-old man with a past medical history of glucose-6 phosphate dehydrogenase (G6PD) deficiency presenting with severe hemolytic anemia and methemoglobinemia after recreational use of inhaled nitrites. The case was complicated with the presence of methemoglobinemia in a patient with G6PD deficiency. This report also aims to increase awareness of the use of nitrites in the MSM population. The use of nitrites is a predictor for high-risk sexual behavior and is associated with positive human immunodeficiency virus (HIV) status.

Emphysematous osteomyelitis of the clavicle: a pleural process?

Emphysematous osteomyelitis (EO) is a rare infection associated with intraosseous gas. EO is an often fatal disease with an estimated 34% mortality. We present a case of a 63-year-old man with sternoclavicular EO with pleural involvement and significant subcutaneous emphysema diagnosed by CT. Extension of intraosseous gas into the pleural cavity is an extremely interesting presentation that has not been previously reported. The patient underwent a multidisciplinary treatment approach with surgical debridement and an extended antibiotic course. Intraoperative cultures of the pectoralis muscle and bone biopsy grew pan-sensitive Escherichia coli Prompt recognition and treatment are paramount to avoid a potentially fatal outcome. A review of the literature of the previous 46 cases of EO is presented for associated risk factors, the role of surgical management and antibiotic therapy.

Riluzole attenuates the effects of chemoconvulsants acting on glutamatergic and GABAergic neurotransmission in the planarian Dugesia tigrina.

Planarians, the non-parasitic flatworms, display dose-dependent, distinct (C-like and corkscrew-like) hyperkinesias upon exposure to 0.001-10 mM aqueous solutions of glutamatergic agonists (L-glutamate and N-methyl-D-aspartate (NMDA)) and 0.001-5 mM concentrations of the glutamate decarboxylase (GAD) inhibitor (semicarbazide). In the planarian seizure-like activity (PSLA) experiments the three chemoconvulsants displayed the following order of potency (EC50): L-glutamate (0.6mM)>NMDA (1.4 mM)>semicarbazide (4.5mM). Planarian hyperkinesias behavior counting experiments also revealed that riluzole (0.001 to 1mM), an anti-convulsive agent, displayed no significant behavioral activity by itself, but attenuated hyperkinesias elicited by the three chemoconvulsants targeting either glutamatergic or GABAergic neurotransmission with the following order of potency (IC50): NMDA (44.7 µM)>semicarbazide (88.3 µM)>L-glutamate (160 µM). Further, (+)-MK-801, a specific NMDA antagonist, alleviated 3mM NMDA (47%) or 3mM L-glutamate (27%) induced planarian hyperkinesias. The results provide pharmacological evidence for the presence of glutamatergic receptor-like and semicarbazide sensitive functional GAD enzyme-like proteins in planaria in addition to demonstrating, for the first time, the anti-convulsive effects of riluzole in an invertebrate model. High performance liquid chromatography coupled with fluorescence detection (HPLC-F) analysis performed on planarian extracts post no drug treatment (control) or treatment with 3mM semicarbazide, combination of 3mM semicarbazide and 0.1 mM riluzole, or 0.1 mM riluzole revealed that 3 mM semicarbazide induced 35% decrease in the GABA levels and a combination of 3mM semicarbazide and 0.1 mM riluzole induced 42% decrease in glutamate levels with respect to the control group.