A 36-Year-Old Male With Left-Sided Neck Pain and Progressive Dyspnea.

CASE PRESENTATION: A 36-year-old male with no significant medical history presented to the ED with progressive left-sided neck and facial pain for the last 7 days. The patient also reported subjective fevers, chills, difficulty opening his mouth, and anorexia for the last 1 week. He denied cough, chest pain or tightness, shortness of breath, skin rashes, dysphagia, or odynophagia. He reported use of two to three 59.15 mL beers daily for the last 20 years. There was no recent travel or sick contact exposure. He did not report any TB exposure, IV drug use, or recent sexual encounters.

Do You Bleed? A 1-Year FOBT Case-Series Study.

GOALS: The goal of this study is to investigate fecal occult blood test's (FOBT) usage in cases of suspected gastrointestinal bleeding and how it may affect hospitalization length and inpatient endoscopy procedures. BACKGROUND: FOBT is an approved modality used in colorectal cancer screening but is often used inappropriately for the investigation of suspected gastrointestinal bleeding (GIB) in the hospital setting. The efficiency of FOBT when used for this purpose is questionable. STUDY: This study was performed at a 766-bed tertiary academic medical center. All FOBT performed during a 12-month period were identified and 678 cases were analyzed. The results of FOBT were collected along with information regarding patients' hemoglobin levels, rectal examination frequency, performance of endoscopy, length of hospital stay, and presence/absence of gastrointestinal lesions. RESULTS: There were no findings on endoscopy in 13.5% of cases with positive FOBT, demonstrating weak test sensitivity. Low percentage (14.6%) of patients having negative FOBT results underwent endoscopy, even with negative FOBT results, whereas less than 50% of positive FOBT patients were offered procedural evaluation, demonstrating the inefficiency of FOBT in guiding management. Patients with positive FOBT had longer hospitalization periods. Even in the absence of GIB symptoms, critically anemic patients would still undergo endoscopy for GIB investigation even without FOBT being performed. CONCLUSIONS: FOBT is inappropriately used in the hospital setting for GIB investigation. This study shows the inefficiency of FOBT to guide management and the high frequency of positive inpatient FOBT tests leading to unnecessary endoscopic investigation, longer hospitalizations, and delays in care. FOBT should be limited to the outpatient setting and be avoided while investigating GIB, anemia, etc. in the hospital.

PDGF-BB Promotes Type I IFN-Dependent Vascular Alterations and Monocyte Recruitment in a Model of Dermal Fibrosis.

Systemic sclerosis (SSc) is a chronic autoimmune disorder that can result in extensive tissue damage in the skin and, in advanced cases, internal organs. Vasculopathy, aberrant immune activation, and tissue fibrosis are three hallmarks of the disease that have been identified, with vasculopathy and aberrant immunity being amongst the earliest events. However, a mechanistic link between these processes has not been established. Here, we have identified a novel role of platelet derived growth factor-BB (PDGF-BB)/PDGFRß activation in combination with dermal injury induced by bleomycin as a driver of early, aberrant expression of interferon stimulatory genes (ISGs) and inflammatory monocyte infiltration. Activation of PDGFRß in combination with bleomycin-induced dermal injury resulted in increased dermal thickness, vascular density, monocyte/macrophage infiltration, and exacerbation of tissue injury. Many of these features were dependent on IFNAR-signaling, and an increase in the number of interferon-beta (IFN-ß) producing monocytes cells was found in the skin lesions. Taken together, these results identify a novel link between PDGFRß activation, and Type I IFN-driven vascular maintenance and monocyte/macrophage cell recruitment, and provide a potential explanation linking key features of SSc that were previously thought to be unrelated.