Metastatic disease to the thyroid is not an unusual finding at autopsies, but it is rare to be found in clinical situations. We present the first case of adenocarcinoma of the proximal esophagus presenting as a thyroid mass in a young healthy patient without any previous history of malignancy. This case highlights the importance of thorough work-up when addressing a thyroid mass. A high index of suspicion should be maintained in order to be able to detect unusual etiologies of thyroid conditions, especially when histopathology is not characteristic for primary thyroidal malignancies.

We did not identify any significant association between MIC creep and vancomycin failure or between higher vancomycin MICs and agr group II. However, a higher mortality was seen in agr group II than agr group I.

The management of infective endocarditis (IE) is very challenging in patients with blood cultures negative for a microorganism. Unfortunately, this situation is not uncommon, occurring in up to 30% of cases of IE. Precise microbiological diagnosis, however, is critical to optimize the antibiotic regimen, and thus, nonYculture-based molecular techniques are playing a growing role in the care of these patients. We present a patient with culture-negative IE due to Haemophilus parainfluenzae, with the pathogen identified only via molecular techniques.(Infect Dis Clin Pract 2010;18: 120Y123)

Objective: COVID-19 has placed an immense pressure on the healthcare systems across the world regarding development of protocols and initiatives to mitigate the spread. Clinicians are coping with enormous challenges to their professional commitment and the need to support them has risen more than ever during these unprecedented times. Design: We describe a support initiative implemented by Spectrum Health, a quaternary center in West Michigan to support providers across the community. COVID-19 Provider resource support tool helped clinicians across multiple other systems in the region with real time information about COVID-19. Method: A COVID-19 provider resource workgroup was created with 18 physicians who volunteered to receive calls and emails from providers across the region over 8 weeks. The group aimed to be the real-time COVID-19 resource while clinicians are facing the pandemic in an ever-changing environment. Conclusion: Providers have not faltered to embrace new responsibilities, implementing protocols and coaching their colleagues in response to COVID-19. Support initiatives like these while essential to maintain psychosocial health of the clinicians also reveals the true strength of professionalism amidst the pandemic.