Bullying Victimization Type and Feeling Unsafe in Middle School.

Given their significance to school violence, this study quantifies the association between bullying victimization and perceptions of safety separately for victimization where the type is not specified versus victimization that is physical in nature. Generalized liner mixed modeling was employed with 5,138 sixth- to eighth-grade students in 24 schools who self-reported on their bullying victimization and perceptions of school safety on an anonymous survey in fall 2015. Results indicate a multiplicative interaction exists with regard to the odds of feeling unsafe at school among those who were bullied at all (odds ratio [ OR] = 3.1) compared to those who were bullied physically ( OR = 9.12). For school nurses who work with students with a variety of concerns and health issues, this research indicates that the use of bullying victimization as an outcome, proxy and/or predictor, requires inquiry into the type of bullying experienced to aid in the care and support received.

Phlegmonous gastritis and group A streptococcal toxic shock syndrome in a patient following functional endoscopic sinus surgery.

BACKGROUND: Phlegmonous gastritis is a rare and often fatal condition that can affect healthy individuals in 50% of cases. The condition has been described in accounts dating back to the pre-antibiotic era, during which time mortality was nearly 100%. Over the past century, case reports average about one per year. The etiology remains unclear, although Streptococcus species is isolated frequently. The optimum treatment has not been delineated clearly but likely involves a combination of antibiotics with or without surgical resection. METHODS: A case report was presented and the pertinent literature was reviewed. CASE REPORT: A 45-year-old man with a history of recent paranasal sinus surgery presented with acute abdominal pain and criteria consistent with toxic shock syndrome. Computed tomography scan showed diffuse thickening of the gastric wall and free intraperitoneal fluid. Exploratory laparotomy revealed a thickened stomach wall with outer fibrinous exudate and murky peritoneal fluid, which grew Streptococcus pyogenes. Intraoperative esophagogastroduodenoscopy revealed thickened gastric folds with a "cobblestone" appearance and no evidence of perforation. He was treated with antibiotics intravenously and sustained a difficult intensive care unit course complicated by ventilator-dependent respiratory failure, renal failure, and coagulopathy, but survived without major disability. CONCLUSIONS: This is an unusual case presentation of a rare but potentially lethal condition, whose optimal treatment is unclear. Phlegmonous gastritis should be considered when isolated gastric wall thickening is encountered in the clinical setting of toxic shock syndrome.