Streptococcus alactolyticus, a member of the Streptococcus bovis/Streptoccus equinus complex, is primarily hosted in the gastrointestinal tract of animals and rarely of humans, with only scarce reports relating to human disease. We herein present a case of subacute infective endocarditis (IE) caused by S. alactolyticus in a 64-year old male with pre-existing mitral prolapse. Despite a 10-month history of low-grade fever and weight loss, the diagnosis of IE was triggered by left quadrant abdominal pain which revealed splenic infarcts on computed tomography. A definitive diagnosis of IE was subsequently established by four consecutive blood cultures positive for S.alactolyticus plus demonstration of a vegetation on the mitral valve by trans-esophageal ultrasound. Further workup revealed multiple embolic phenomena including brain and spine. A dental abscess was identified as the most probable origin of the bacteraemia, while colonoscopy revealed no evidence of cancer. The patient recovered uneventfully with antibiotic treatment and underwent successful cardiac surgery post-discharge. Although rare, IE caused by S. alactolyticus may be severe and of obscure origin; oral cavity should not be overlooked as a possible origin. Attention should be given in patients with preexisting risk factors.

Nocardia spp. is a genus of Gram-positive bacteria which can cause cutaneous, pleuropulmonary, or disseminated disease. The latter two forms are encountered in immunocompromised patients, with prolonged usage of corticosteroids being a well-recognized risk factor. However, endogenous Cushing’s syndrome is less frequently associated with nocardiosis. We report on a 40-year-old woman who presented for further workup of abnormal findings in the chest computed tomography (three lung nodules, one of which being cavitary). She underwent trans-thoracic fine-needle lung aspiration of the cavitary nodule, which led to the diagnosis of lung nocardiosis. Moreover, the identification of cushingoid features from the history and clinical examination initiated further investigation with hormonal laboratory assessment and bilateral inferior petrosal sinus sampling which established the diagnosis of pituitary adrenocorticotropic hormone (ACTH) hypersecretion (Cushing’s disease). We conclude that pulmonary nocardiosis can be an opportunistic infection as well as a presenting manifestation of Cushing's disease.

Background The present study aimed to assess the efficacy of applying active learning and integrated methodologies in the undergraduate Pathology medical education curriculum. Another goal was to acquire student feedback and explore the students’ motivation and perceptions on Pathology education. Methods Our study involved two parts: (1) a quasi-experimental part, involving medical students enrolled in our Pathology course. An optional educational intervention was offered until the end of the semester, in parallel with the already established curriculum. The intervention involved integrated case-based seminars and group-based presentations of Pathology cases. We used a multivariate regression model in order to better assess the educational effectiveness of our method; and (2) a questionnaire-based cross-sectional survey was held at the end of the semester. The set of questions for the intervention group mainly involved feedback about our educational method, while the questions for the control group involved questions about Pathology education in general. Results 348 Students completed the study. The performance of the intervention group was significantly improved at post-test. From the questionnaire, we found that intervention participants gave positive feedback, while their main reason for participation was because they already valued the Pathology professor’s teaching style. As for non-participants, even though most of them were interested in an integrated/experiential approach, more than half chose not to participate because of lack of time in general or in order to study for the final exams. Conclusions Active learning and integrated methodologies seem to be of value in undergraduate Pathology teaching. However, regardless of the instructional approach, shifting the emphasis from purely summative achievement to formative, learning-centered development is essential. A successful educator must therefore not only employ innovative methods but also encourage intrinsic motivation and a deeper, more reflective approach to learning.

Human immunodeficiency virus (HIV) has troubled humankind for many years. The rate of new HIV cases is decreasing steadily, mostly because of safer sexual practices and scientific advances in medicine. However, the number of HIV-related trials has significantly increased, as the search for a definite cure for HIV is still fruitless. Our current treatment options involve antiretroviral therapy (ART) with various drug combinations that lower the patients’ viral load in order for the immune system to reconstitute itself. This way, adherent patients achieve a life expectancy similar to the general population. Besides the established treatment protocols, the focus has currently shifted towards secondary pharmaceutical regimen programs that enhance a patient’s immune system and response to opportunistic infections. Vitamins C and D are easily obtainable even in the developing world and are known to improve an individual’s daily life, with vitamin D enhancing the human immune response and vitamin C having an assisting role in both the immune response and as an important antioxidant. Recently, many studies assessing the effect of these vitamins on the progression of HIV have been performed. We aimed to collect and review these studies in order to determine the necessity of the supplementation of these vitamins in HIV-infected patients, which might complement the existing ART. To this day, the scientific community is conflicted, and more studies must be conducted before a definite conclusion about these vitamins’ effects on HIV patients can be reached.