Black Urine and Methemoglobinemia in the Setting of Sepsis Due to Clostridium Perfringens.

Clostridium Perfringens is an anaerobic gram-positive bacillus able to produce different types of toxins and can cause septicemia. The mechanism is through translocation from a previously colonized gastrointestinal or genital tract. Massive intravascular hemolysis induced by this bacterium is a rare presentation reported in only 7% to 15% of cases of Clostridium Perfringens bacteremia with a mortality rate reaching 90%.We present the case of a middle-aged man with metastatic melanoma having black-colored urine as the first sign of massive hemolysis along with mild methemoglobinemia. Despite timely management, the patient progressed into septic shock with severe hypoxia and passed away. Postmortem, blood cultures grew clostridium perfringens. Black-colored urine and blood samples, sepsis-induced mild methemoglobinemia and acute massive hemolysis should raise concern for Clostridium Perfringens sepsis in the appropriate clinical settings.

Impact of Ramadan on emergency department visits and on medical emergencies.

BACKGROUND: Fasting during Ramadan is important to Muslims. This study describes changes in emergency department (ED) visits and in frequencies of emergency conditions and impact on clinical outcomes during Ramadan in a tertiary care center in Beirut, Lebanon. PATIENTS AND METHODS: Patients presenting to ED during Ramadan 1 month before and 1 month after Ramadan over a 3-year period with specific conditions (acute coronary syndrome, stroke, seizure, diabetes, renal colic, headache or hypertension) were included. Clinical and sociodemographic characteristics, ED volume, diagnoses, and outcomes were examined during two periods (Ramadan vs. non-Ramadan). Multiple logistic regressions were performed to identify the impact of Ramadan on ED bounce-back and mortality at ED discharge. RESULTS: A total of 3536 patients were included. The daily average ED volume was higher during non-Ramadan months (145.65±22.14) compared with Ramadan (128.85±14.52). The average ED length of stay was higher during Ramadan (5.42±14.86 vs. 3.96±4.29 h; P=0.006). Frequencies and admission rates for the selected diseases were comparable during the two periods, except for patients with acute coronary syndrome or stroke who had lower admission rates during Ramadan.ED bounce-back rates and mortality at ED discharge were higher during Ramadan (odds=1.34, 95% confidence interval: 1.03-1.74 and odds ratio=2.88, 95% confidence interval: 1.01-8.27, respectively). CONCLUSION: EDs might experience a decrease in volumes, higher length of stay, and potentially worse outcomes during Ramadan. Changes in the frequencies of ED visits related to common conditions are not expected. Prospective studies documenting fasting status would clarify further the impact of Ramadan.