Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) are a relatively new class of medications used for the management of type II diabetes mellitus targeting the kidneys. Within the last decade, several warnings have been issued regarding the development of severe genitourinary infections, including necrotizing fasciitis, or Fournier's gangrene, in those with pre-existing type II diabetes and concomitant use of this drug class.Objective: The purpose of this review is to highlight and discuss the factors contributing to the development of Fournier's gangrene, its pathogenesis, and a review of existing literature describing patient outcomes, treatment, and future directions regarding early detection of this complication.Methods: Articles and studies addressing effective treatment adherence and key factors contributing to Fournier's gangrene with SGLT2 inhibitors were identified by effective keyword searches in PubMed Central, Google Scholar, and Cochrane, as well as the references found within these articles.Results: Using the keywords provided, 55 case reports, review articles, and meta-analysis reports written within the last 20 years were utilized as the source of the data presented in this systematic review article.

Cavitary lesions of the lungs are a very frequent picture found in clinical practices resulting from a wide range of pathological processes with variable duration of formation depending on infectious pathogens. Common organisms causing cavitary lesions are Staphylococcus aureus , Klebsiella pneumoniae , Streptococcus pneumoniae , Haemophilus influenzae , typical and atypical Mycobacterium , and Aspergillus . Herein, we are presenting a case that developed cavitary lesions in both lungs colonizing Acinetobacter , a rare causative agent, within less than two months of a positive coronavirus disease 2019 (COVID-19) infection.

Colorectal carcinoma has increasingly been reported to be associated with gut microbial dysbiosis. Bacteroides , Fusobacterium , Faecalibacterium , Blautia , etc., are gut microbes commonly associated with colorectal carcinoma. Gut microbial dysregulation secondary to infectious, inflammatory, toxin exposure or change in dietary habits coupled with the disruption of the inner mucosal layer overlying the luminal epithelium is hypothesized as the inciting events leading to microbial invasion and subsequent tumorigenesis. Although the precise mechanism is unclear, disruption of normal host responses like inflammation, apoptosis, cellular proliferation, free radical injury, production of oncogenic toxins, etc., is postulated to play a role. We report a case of Veillonella bacteremia in a patient with metastatic colorectal carcinoma without a preceding history of periodontal disease. The patient was managed with ampicillin-sulbactam, which was followed by subsequent negative blood cultures. This case report signifies the association of gut microbiota like Veillonella with colorectal carcinoma and the importance of subsequent screening for colorectal cancer following Veillonella bacteremia .

Acute pyelonephritis (APN) is considered a rare cause of acute kidney injury (AKI), especially when no anatomical abnormalities or predisposing factors are identified. Additionally, non-obstructive pyelonephritis is a very infrequent cause of rapidly progressive acute kidney injury. Herein, we present a rare case of a 55year-old female patient who was diagnosed with acute non-obstructive pyelonephritis leading to AKI eventually requiring hemodialysis. The patient eventually recovered with the administration of intravenous antibiotics with a significant recovery of renal function.

Nonalcoholic fatty liver disease is increasing with the rise in obesity and metabolic risk factors like diabetes mellitus. Type 2 diabetics are highly prone to deranged liver function test. Increase in serum aminotransferases level is an indicator of hepatocellular injury. The aim of this study is to correlate serum aminotransferases level with anthropometric measurements, diabetic retinopathy and types of treatment received in diabetics. A total of 236 patients (142 females) of age more than 40 years with type 2 diabetes attending Nepal Medical College and Teaching Hospital between February 2016 and January 2017 were included in this cross-sectional observational study. Blood samples were sent for fasting blood sugar, HbA1c and serum aminotransferases tests. Body mass index and waist hip ratio were measured as per standard protocol. Fundoscopy was done in all patients. Pearson and independent t-test were applied to see the correlation between the variables. The mean HbA1c was 8.01± 2.08. In the sub group analysis, serum aminotransferases level was significantly high in patients with poor glycemic control, higher body mass index and waist hip ratio (p value < 0.001). Patients with diabetic retinopathy also had higher serum aminotransferases level (p value < 0.001). Pearson correlation between HbA1c with serum alanine aminotransferases level was significant (r=0.76, n=5, p value < 0.001).