J Postgrad Med
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The World Health Organization added methicillin-resistant S aureus (MRSA) to the list of "priority pathogens," given its capacity to cause life-threatening infections. Clindamycin is a preferred treatment for non-complicated S aureus-induced skin and soft tissue infections. Its good tissue penetration and oral absorption make it suitable for outpatient therapy. However, the emergence of inducible and constitutive (MLS B ) resistance led to clinical challenges, primarily due to the potential oversight of inducible resistance in routine antimicrobial sensitivity testing. ⋯ To prevent clindamycin treatment failures, the D-test must be implemented to detect ICR in MRSA isolate. Neglecting simple and cost-effective tests may lead to inaccurate susceptibility reporting, jeopardizing treatment success.
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A 76-year-old male patient, who underwent a post-aortic valve replacement with a mechanical valve in 2006, was on oral anticoagulant therapy with warfarin, maintaining a stable therapeutic level of anticoagulation until 2022. He had a new diagnosis of ulcerative colitis in 2022, following which he was started on mesalamine. ⋯ The evaluation revealed severe depletion of vitamin K-dependent coagulation factors. In this report, we discuss the possible drug-drug interactions between mesalamine and vitamin K antagonists, which went unrecognized leading to life-threatening gastrointestinal bleeding.
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Prion diseases are rare, incurable, and rapidly progressive. Pathogenic misfolded proteins accumulate in the central nervous system causing fatal neurodegeneration. Fatal familial insomnia (FFI) is an even rarer, hereditary subset of prion disease. ⋯ His clinical course progressed rapidly, and death occurred several months after the initial hospital presentation. We discuss the pathophysiology and diagnosis of FFI and the emotional care required to treat this fatal disease. General practitioners should be aware of this rare diagnosis to improve patient management.