Legionella most commonly presents as pneumonia but can have disseminated involvement, presenting as extra-pulmonary disease involving gastrointestinal, neurological, cardiac, renal, and musculoskeletal systems, and skin and soft tissues. We present a case of a patient with pneumonia, rhabdomyolysis, renal failure, hypertriglyceridemia, pancreatitis, and cutaneous involvement. This case highlights the breath of involvement legionella can have, including the never previously documented manifestation of hypertriglyceridemia and severe rhabdomyolysis with the highest creatinine kinase recorded.

This review analyzes the implications of social engagement versus isolation to wellbeing and among individuals with Autism Spectrum Disorder (ASD), more specifically influences of social interventions, opportunities for involvement in social activities (i.e., skills training, vocational programs, sports, and community engagements), social media use, and mobile apps. All of which offer an opportunity for social interaction that may not be feasible under typical circumstances. It questions how these social influences affect the well-being and adjustment of individuals with ASD. It is important to consider how these forms of social engagement relate to the well-being of individuals with ASD, especially because of the increasing amount of literature that has suggested better outcomes for individuals with ASD who are presented with opportunities for social engagement. This review will be directed through the analysis of literature relative to improvements to well-being resulting from different areas of social engagement. Its goal is to bring awareness to and increase the amount of knowledge regarding the significance of social engagement, and how it is essential to overall well-being and social adjustment. This can be useful information for clinicians and counselors to consider in their work with individuals on the spectrum who may be seeking their help or support.

Pulmonary hypertension (PH) is characterized by a resting mean pulmonary artery pressure (PAP) of 20 mmHg or more and is a disease of multiple etiologies. Of the various types of PH, pulmonary arterial hypertension (PAH) is characterized by elevated resistance in the pulmonary arterial tree. It is a rare but deadly disease characterized by vascular remodeling of the distal pulmonary arteries. This paper focuses on PAH diagnosis and management including current and future treatment options. Over the last 15 years, our understanding of this progressive disease has expanded from the concept of vasoconstrictive/vasodilatory mismatch in the pulmonary arterioles to now a better appreciation of the role of genetic determinants, numerous cell signaling pathways, cell proliferation and apoptosis, fibrosis, thrombosis, and metabolic abnormalities. While knowledge of its pathophysiology has expanded, the majority of the treatments available today still modulate the same three vasodilatory pathways that have been targeted for over 30 years (endothelin, nitric oxide, and prostacyclin). While modifying these pathways may help improve symptoms and quality of life, none of these directly modify the underlying disease pathogenesis. However, there are now studies ongoing with new drugs that can prevent or reverse these underlying causes of PAH. This review discusses the evidence base for the current treatment algorithms for PAH, as well as discusses novel therapies in development.

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