Autoimmune polyendocrine syndrome with atrial septal defect.

Atrial septal defect is frequently reported with genetic syndromes. But, to the best of our knowledge, it has not been reported with autoimmune polyendocrine syndrome. Here, the case of a 44-year-old-woman with concomitant involvement of the salivary gland, thyroid, intestines, and, possibly endocrine pancreas, diagnosed with autoimmune polyendocrine syndrome type II, is reported with accompanying atrial septal defect. Celiac disease, Hashimoto thyroiditis, and Sjögren syndrome were symptomatic and laboratory confirmed diagnosis; anti-glutamic acid decarboxylase antibody was positive but asymptomatic for type-1 diabetes. She was known to have sinus venosus type atrial septal defect diagnosed at 38 years old, when she had tiredness and chest pain.

Hospital-acquired pneumonia: challenges and options for diagnosis and treatment.

The management of hospital-acquired pneumonia (HAP) presents a major challenge for the clinician. The insensitivity of current diagnostic methods and the increasing prevalence of nosocomial pathogens with multiple antibiotic resistance complicate the issue. Use of mechanical ventilation and broad-spectrum antimicrobials in the intensive care setting predipose patients to acquire HAP more frequently with antimicrobial-resistant pathogens. Controversy exists regarding the patients in which invasive diagnostic testing is indicated; the timing of these procedures is another subject of debate. Proper empirical therapy is fundamental to a favourable outcome, and the selection of inappropriate agents to which pathogens are resistant contributes significantly to morbidity and mortality. In general, there is agreement on the requirement for a thorough knowledge of the local causative organisms and the pathogens' resistance profiles. A wide variety of antimicrobials can be used either as monotherapy or in combinations.