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Background Approximately 90% of Americans have access to the internet with the majority of people searching online for medical information pertaining to their health, or the health of loved ones. The public relies immensely on online health information to make decisions related to their healthcare. The American Medical Association (AMA) and the National Institute of Health (NIH) recommend that publicly available health-related information be written at the level of the sixth-seventh grade. Materials and methods Patient education materials available to the public on the Annals.org , a website sponsored by the American College of Physicians, were collected. All 89 patient education articles were downloaded from the website and analyzed for their ease of readability. The articles were analyzed utilizing a readability software generating five quantitative readability scores: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG). All scores, with the exception of FRE, generate a grade level that correlates with the required school-grade level to ensure adequate readability of the information. Results Eighty-nine articles were analyzed generating an average score as follows: FRE 62.8, FKGL 7.0, GFI 8.6, CLI 9.6 and SMOG 9.8. Overall, 87.6% of the articles were written at a level higher than the 7th-grade level, which is recommended by the AMA and NIH. Conclusion In an era of increased reliance on the internet for medical information pertaining to patients’ health, materials written at a higher grade than recommended has the potential to negatively impact patients’ well-being, in addition to tremendous ramifications on the healthcare system. Potentially redrafting, these articles can prove beneficial to patients who rely on these resources for making healthcare-related decisions.

Various causative organisms and predisposing factors were implicated in the pathogenic process behind prosthetic valve endocarditis. Lactobacillus paracasei , a classic constituent of probiotics, rarely causes infections in humans and was reported only in few case reports. The use of probiotics was hypothesized to be a risk factor for these infections; however, no causative relationship could be drawn. We describe a 75-year-old woman with history of Birt-Hogg-Dube syndrome and bioprosthetic aortic valve replacement who presented with worsening dyspnea was found to have Lactobacillus paracasei bacteremia and evidence of bacterial vegetations noted on transesophageal echocardiography (TEE) along with evidence of severe aortic insufficiency. Based on antibiotics sensitivity profile, she was treated with penicillin and gentamycin, which resulted in bacterial clearance on repeat blood cultures, and the patient was transferred to a different facility to undergo replacement of the prosthetic aortic valve. Although Lactobacillus paracasei is rarely involved in human infections, it should be suspected in patients with underlying structural heart/valvular disease, recent antibiotic exposure or recent probiotic use who are presenting with evidence of infective endocarditis. Combination antibiotics including beta lactams, aminoglycosides and clindamycin are suggested treatment of choice for this organism.

Cardiac arrhythmias were reported in cases of West Nile Virus (WNV) encephalitis; however, the underlying pathophysiology remains incompletely understood. We present a 67-year-old male with altered mental status, later diagnosed with WNV encephalitis. Hospital course was complicated by progressive sinus bradycardia and corrected QT (QTc) prolongation. These findings persisted despite the absence of classical causes and resolved only after improvement of the underlying encephalitis. After excluding classical causes, autonomic dysfunction is one of the proposed mechanisms behind cardiac arrhythmias in WNV encephalitis. Resolution of arrhythmias is expected after the improvement of underlying encephalitis and should be taken into consideration before proceeding for pacemaker placement or other cardiac intervention. Furthermore, this case highlights the importance of continuous cardiac monitoring in WNV encephalitis patients.