Purple urine bag syndrome, or PUBS, is a manifestation of a complicated urinary tract infection. Organisms such as Escherichia coli (E. coli) and Enterococcus can reside in urinary catheters and exhibit the purple color detected in this phenomenon. Risk factors described for this syndrome include the use of plastic urinary catheterization, the malfunctioning of the catheter, and long-term institutionalization. This disorder could be the earliest presentation of a urinary catheter flaw and requires immediate intervention and revision. In our case, a male resident of nursing home presented with urosepsis and appropriate antibiotics were initiated. Computed tomography (CT) urogram was done and showed left kidney hydronephrosis and bilateral staghorn calculi. To address the source of infection, a nephroureteral drain was placed in both kidneys. A few days after the initiation of treatment and urological intervention, urine on the left side became purple. The urologist re-evaluated the nephroureteral drainage tubes and replaced them. The purple color in the urine resolved later. In our case, PUBS was the earliest sign of urinary drainage malfunctioning and required early intervention and treatment.

Long-term treatment with or addiction to methadone and other opiates can lead to serious complications such as opioid-induced constipation (OIC). Here we report a case where a longterm opioid user presents in the ER in respiratory distress. Radiographic findings concerning pneumoperitoneum and cooperation with specialists lead to a diagnosis of stercoral colitis with possible micro-perforations. Through fecal disimpaction and counseling on chronic opioid use, the patient initially improved, but consecutively had a fatal outcome.

The issue of glycemic control in critically ill patients has yet to be settled. Large studies exploring strict protocols were equivocal, as better outcomes were seen in surgical patients, while potential harm loomed over medical patients. Subsets within these groups and degrees of glycemic control, yielded conflicting findings, further complicating the overall picture. The effects of episodic glycemic variation remain unclear in those most critically ill of patients-those with severe sepsis and septic shock. METHODS: This is a multi-center retrospective chart review study of patients admitted for severe sepsis and septic shock to the critical care unit of Raritan Bay Medical Center, Perth Amboy and Raritan Bay Medical Center, Old Bridge from January 2016 to August 2017. We extracted data on hypoglycemia, (single blood sugar reading below 70), and hyperglycemia, (two consecutive blood sugar readings greater than 200). Primary outcomes were mortality and length of ICU and hospital stay. Possible confounders, such as diabetes, steroids, and sepsis category (severe sepsis or septic shock), were also measured.