Clostridium septicum is a Gram-positive, anaerobic, spore-forming bacillus found in the intestine. It is linked to colon cancer and immunosuppression. Infection with C septicum may vary in manifestation and is associated with more than 60% mortality rate. In this article, we present a case of incidental isolation of C septicum in a patient who presented with fever and later on colonoscopy was found to have colon carcinoma. Bacteremia may be the unexpected initial presentation of undiagnosed colon carcinoma.

IntroductionChronic obstructive pulmonary disease (COPD) has a significant disease burden and is among the leading causes of hospital readmissions, adding a significant burden on healthcare resources. The association between 30-day readmission in a COPD patient undergoing bronchoscopy and a wide range of modifiable potential risk factors, after adjusting for sociodemographic and clinical factors, has been assessed, and comparison has been made with COPD patients not undergoing bronchoscopy. MethodsWe conducted a comprehensive analysis of the 2016 Nationwide Readmission Database (NRD) of 30-day all-cause readmission among COPD patients undergoing bronchoscopy. A Cox's proportional hazards model was used to obtain independent relative risks of readmission following bronchoscopy in COPD patients as compared to patients not undergoing bronchoscopy. Our primary outcome was the 30-day all-cause readmission rate in both groups. Other secondary outcomes of interest were the 10 most common reasons for readmission, resource utilization, independent predictors of readmission, and relative proportion of comorbidities between the index admission (IA) and the readmission in both groups. ResultsThe overall rate of readmission following bronchoscopy in COPD patients as compared to patients not undergoing bronchoscopy was 17.32% and 15.87%, respectively. The final multivariate model in the bronchoscopy group showed that the variables found to be an independent predictor of readmission were: pulmonary hypertension (hazard ratio [HR] 2.35; 95% confidence interval [CI] 1.26-4.25; P < .01), adrenal insufficiency (HR 4.47;; P = .01) and discharge to rehab status. Independent predictor variables of admission in Group B were gender (women < men; HR 0.91; 95% CI 0.88-0.93; P < .01), and type of insurance (Medicaid > Medicare > private insurance).For all patients undergoing bronchoscopy, the mean length of stay (LOS) for IA was 11.91 ± Open Access Original Article

Hemodialysis machines are equipped with a blood leak detector/alarm to prevent loss of blood following rupture of semipermeable membrane; the blood leak alarms could also be triggered by sensor malfunction or presence of air bubbles in the system. Hydroxocobalamin is a Food and Drug Administration–approved rapid-acting antidote to cyanide poisoning that converts cyanide to nontoxic cyanocobalamin. Side effects are reddish discoloration of skin and body fluids, urticarial rash, and rarely anaphylaxis. In this article, a case of false blood leak alarm following treatment of cyanide poisoning with hydroxocobalamin is reported, wherein the blood leak detector in dialysis machines prevented the patient from undergoing hemodialysis by repeatedly activating blood leak alarms. Continuous renal replacement therapy was used to overcome this problem. As the use of hydroxocobalamin increases, health care professionals should be educated about its potential to interfere with hemodialysis.

Background:Significant improvement has been noted in the outcome of patients with advanced hematologic malignancies with the advances in hematopoietic cell transplantation (HCT) techniques. However, it has been observed that patients receiving HCT have increased risk of cardiovascular disease (CVD) over time with increased risk of cardiovascular mortality. Materials and Methods:This was a retrospective observational analysis. We queried the National Inpatient Sample database from 1998 to 2012 for patients aged ≥18 years who had received HCTin the past and were admitted for non-ST-elevation acute coronary syndrome (NSTE-ACS) or ST-elevation myocardial infarction (STEMI). We performed univariate logistic regression followed by multivariate logistic regression analysis to study various demographic factors and comorbiditiesand temporal trends of ACS in these patients. Results:A total of 150,072 patients with prior history of HCT were identified, out of which 952 hospitalizations were for ACS.47.16% of these patients underwent Percutaneous CoronaryIntervention.Mean age for ACS patients was 56.98 years and 71.75% patients were male. The demographic factors found to significantly affect the incidence of ACS were increasing Age (OR 1.02, p=0.01) and Insurance(Medicare as reference)[Medicaid(OR 0.3, p=0.04), private(OR 1.66, p=0.01). Charlson Comorbidity Index (CCI) had significant correlation with incidence of ACS (CCI=1 as reference) [CCI=2(OR 0.12, p=0.00), CCI³3(OR 0.60, p=0.01)]. The Medical comorbidities found to significantly affect the outcome were Congestive Heart Failure (OR 1.53, p=0.04), COPD(OR 0.54, p=0.02), smoking(OR 2.96, p=0.00), underlying CAD (OR 39.65, p=0.00) and Pulmonary Hypertension (OR 4.01, p=0.00). A trend analysis for Incidence of ACS in patients with History of HCT showed overall decline in ACS incidence which was found to be statistically significant. (Trend p-Value 0.003). Conclusion:Our study identifiedvarious factors affecting incidence of ACS in HCT patients. We also discoveredan overall downward trend in incidence of ACSin HCT patients.Further studies need to be conducted to confirm these findings. Disclosures Rajeeve: ASH-HONORS Grant: Research Funding.

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