Enoxaparin‐induced bullous hemorrhagic dermatosis at a distant location from the injection site

Heparin‐induced bullous hemorrhagic dermatosis is a benign and self‐limited condition. However, it might cause significant patient frustration. Clinicians should be aware of this rare adverse reaction.     

Rebound of platelet count in a patient with type 2 calreticulin-mutant essential thrombocythemia in the postpartum period: A case report

Introduction:Essential thrombocythemia (ET) is an uncommon myeloproliferative neoplasm. It is more common in females; 20% of them are below 40 years old. The optimal management of ET during pregnancy and postpartum periods is still not well established.Patient concern:We report a case of a young lady with type 2 calreticulin-mutant ET who developed a marked rebound in her platelet count (reaching 2030 × 10³/μL) 2 weeks after premature delivery of her baby (24^th week of gestation). She was on Pegylated Interferon alfa 2-a during pregnancy (her platelet was around 500 × 10³/μL during the second trimester), but she had stopped it on her own from the 20^th week of gestation.Diagnosis:Postpartum rebound of platelet count due to medication non-compliance.Intervention and outcome:We resumed her regular Pegylated Interferon, and subsequently, her platelet count reduced dramatically within 4 weeks to an acceptable level (684 × 10³ /μL).Conclusion:The guideline is still not well-established regarding the optimal approach for postpartum rebound of platelet count in patients with ET. It is still unclear if the platelet count will fall spontaneously without intervention after the rebound phase. Further research is required to establish the optimal management of ET during the postpartum phase. This case emphasizes the importance of platelet count follow-up during the postpartum period and outlines our management approach in such cases.     

Time trends in <Emphasis Type="Italic">Staphylococcus aureus</Emphasis> bacteremia, 1988–2010, in a tertiary center with high methicillin resistance rates

Introduction

Changes in the epidemiology of Staphylococcus aureus bacteremia (SAB) have been described in recent decades. Decreased mortality has been reported over time, mostly from countries with low methicillin resistance rates. We aimed to describe time trends in SAB in a tertiary center with high methicillin resistance rates.

Methods

We retrospectively analyzed 1692 patients with SAB, and compared between three time periods: 1988–1994 (342 patients), 1998–2004 (597 patients) and 2005–2010 (753 patients).

Results

In our cohort, 30 days mortality increased significantly with time, reaching 42.9 % during 2005–2010. The latter period was characterized by higher rates of older patients (35.1 % aged 80 years and older), with lower functional capacity (46.5 % bedridden) and higher rates of comorbidities (33.6 % renal disease, 24.8 % heart failure, 19.0 % dementia). These patients were more likely to be ventilated (18.7 %) and carry a urinary catheter at presentation (46.6 %); present with septic shock (15.9 %) and have pneumonia (20.5 %) or endocarditis (7.2 %) as source. Similar characteristics were found among patients younger than 50 years and with independent functional status. No significant increase in methicillin resistant Staph aureus (MRSA) rates or inappropriate empirical therapy was demonstrated during 2005–2010.

Conclusions

In our cohort, increased mortality in recent years in patients with SAB can be explained by baseline condition of patients. MRSA or inappropriate empiric therapy did not explain the increase in mortality. The patients afflicted with SAB changed over time. Epidemiology and outcomes of SAB vary with time and according to geographical location. External validity of studies should be taken into consideration.

     

Culture collections, the new herbaria for fungal pathogens

This paper discusses the importance of culture collections in plant pathology and reviews the methods currently available to store cultures. The preservation and maintenance of plant pathogenic fungi in a viable yet stable state for long periods has always been important, because isolates of these fungi can serve as standards for identification of quarantine taxa. Such isolates are also important for testing disease resistance and for plant breeding programs. The increasing use of molecular sequences analysis in the systematics of plant pathogenic fungi has meant that maintaining fungi in culture collections has become essential. Herein we discuss trends in the identification of plant and post-harvest pathogens, using Aspergillus, Colletotrichum, Phyllosticta and Mycosphaerella and its anamorphs as examples. Herbarium specimens, although still a requirement of the Botanical Code when describing new species are, perhaps, less important in providing useful information when defining a pathogenic species. Many pathogen groups consist of complexes of species and morphology alone can no longer distinguish among species. However, ex-type living cultures are essential for identification and future species comparisons that incorporate the use of molecular techniques. As such, ex-type cultures of any new species of pathogen, or when new diseases are reported or studies involving pathogenic strains are published, cultures of the taxa studied should be deposited in widely available culture collections, preferably in at least three members of World Federation for Culture Collections. Methods for the storage of fungal cultures such as water preservation, freezing, mineral oil overlay, freeze drying and lyophilization are reviewed in this paper. The main objective of culture preservation is to maintain the vigor and genetic characteristics of a pure culture. Therefore, safe long-term preservation methods are required to ensure fungal survival and retention of any valuable characteristics. To minimize the risk of any morphological, physiological, or genetic changes, several different preservation conditions should be used whenever possible. The present review also describes a complete preservation methodology that can be used for plant pathogenic fungi.     

Qatari Women Living With Cardiovascular Diseases—Challenges and Opportunities to Engage in Healthy Lifestyles

In Qatar, cardiovascular diseases are the leading causes of morbidity and mortality. Cardiovascular diseases can be prevented and controlled by modifying lifestyle risk behaviors. In this qualitative study, we investigate ways to increase participation in physical activity, and to promote a healthy diet, and nonsmoking behavior in Qatari women. Individual in-depth interviews were conducted with 50 Arabic women. Participation in physical activity, observing a healthy diet, and abstinence from smoking are desirable lifestyle practices among Qatari women. Social support networks, cultural values, religion, changing sociodemographic and economic conditions, heart disease, and a harsh climate affect the ability of these women to pursue a healthy lifestyle.     

Study of Predictive Value of Pediatric Risk of Mortality (PRISM) Score in Children with End Stage Liver Disease and Fulminant Hepatic Failure

Objective  

To evaluate the use of the PRISM score as a predictor of outcome in patients with end stage liver disease (ESLD) and fulminant hepatic failure (FHF).     

Thrombocytopenia secondary to iron deficiency anemia responding to iron therapy

A broad spectrum of diseases can cause anemia and thrombocytopenia. Some of these diseases are a hematological emergency; others are benign diseases, so early and accurate diagnosis is crucial in managing such patients. Usually, IDA is associated with thrombocytosis or normal platelets; however, in rare cases, IDA can be associated with thrombocytopenia; even though, thrombocytopenia that occurs with IDA responds to iron therapy. Iron therapy rarely causes transient thrombocytopenia per se. We are reporting an African female patient who is found to have thrombocytopenia secondary to iron deficiency anemia (IDA), and she responded to iron replacement therapy initially with a transient drop in platelets, followed by a rapid rise in platelets till platelets reached the normal level.