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We report the case of a woman from the Bronx, New York, who presented to the emergency department (ED) in June 2020 with a febrile respiratory illness resembling coronavirus disease 2019 (COVID-19) but was ultimately diagnosed with Legionnaires' disease (LD). New York City (NYC) rapidly became an epicenter of the global COVID-19 pandemic in 2020. In the years since the pandemic started, variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have recurred in multiple waves and remain an important cause of viral respiratory illness. The bacteria Legionella pneumophila is often under-recognized as a cause of community-acquired pneumonia, yet it recurs each year in clusters, outbreaks, or as sporadic infections. Pneumonia caused by SARS-CoV-2 and Legionella can present similarly and may not be readily distinguished in the absence of diagnostic testing., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Patel et al.)

Malaria is a global health concern with high morbidity and mortality. It is often attributed to the Plasmodium (P.) falciparum species, particularly in sub-Saharan Africa, and it normally has an incubation period of seven to 14 days. Dormant disease secondary to P. vivax and P. ovale is well-reported, yet only a handful of cases report dormant malaria secondary to P. falciparum . Even though malaria is significantly less common in the United States in comparison to other parts of the world, it is still a growing concern given international travel from endemic regions and a growing immunocompromised population. Here, we present a case of Plasmodium falciparum malaria in a patient with systemic lupus erythematosus (SLE) with neuromyelitis optica spectrum disorder (NMOSD) and renal transplant without travel to sub-Saharan Africa in 10 years., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Valle et al.)

Background: Peer observation of teaching (POT) is a well-documented faculty development tool, but published research focuses mostly on programs in which participating physicians had protected time in their schedule in which to complete observations. Most programs nationally depend on hospitalists who have minimal, if any, protected time in their schedule and thus in order to complete these observations, will need to figure out a way to schedule these into their regular working day . Objective: We determined whether a POT program, focused on hospitalists with minimal non-clinical time, scheduled around clinical responsibilities, could be feasible and acceptable., Methods: Seven hospitalists participated in a POT pilot program from January 2019 to June 2019. Each hospitalist completed three 30-minute observations during this interval. At the completion of the pilot, the hospitalists were surveyed on their experience and results were assessed via open-ended narrative questions, which underwent thematic analysis., Results: Twenty of the 21 scheduled observations (95%) were completed. Of the completed observations, 100% were completed while the observer was assigned to concomitant clinical duties. The survey response rate was 100%. From free-text responses, the following themes emerged: (1) Acceptable time commitment with minor inconvenience, (2) learning through observing and reflecting for personal growth, and (3) stress-free peer observations., Conclusions: This study demonstrates the successful development and implementation of a POT program that served as a faculty development initiative focused primarily on hospitalists with minimal protected time., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Shaines et al.)

Exertional rhabdomyolysis is more common in sickle trait due to a predisposition to dehydration and inability to concentrate the urine. Spinning, an indoor cycling workout, has been associated with exertional rhabdomyolysis in recent reports. A consequence of rhabdomyolysis is acute kidney injury, which may be expected to be more common in patients with sickle trait. We report a case of spinning induced rhabdomyolysis in a woman with sickle trait that did not result in renal injury. "Spin rhabdo" is thought to be more severe than other causes of exertional rhabdomyolysis and is associated with higher creatine kinase levels than other causes of exertional rhabdomyolysis. Therefore, individuals with known sickle trait should visit their physician prior to participation in spin classes for the first time. We might also consider voluntary screening for sickle trait in at risk populations prior to enrolling in spin classes given that many patients are unaware of their sickle trait status., Competing Interests: No competing interests were disclosed.

Exertional rhabdomyolysis is more common in sickle trait due to a predisposition to dehydration and inability to concentrate the urine. Spinning, an indoor cycling workout, has been associated with exertional rhabdomyolysis in recent reports. A consequence of rhabdomyolysis is acute kidney injury, which may be expected to be more common in patients with sickle trait. We report a case of spinning induced rhabdomyolysis in a woman with sickle trait that did not result in renal injury. "Spin rhabdo" is thought to be more severe than other causes of exertional rhabdomyolysis and is associated with higher creatine kinase levels than other causes of exertional rhabdomyolysis. Therefore, individuals with known sickle trait should consider visiting their physician prior to participation in spin classes for the first time. We might also consider voluntary screening for sickle trait in at risk populations prior to enrolling in spin classes given that many patients are unaware of their sickle trait status., Competing Interests: No competing interests were disclosed.

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEs/ARBs) have proven benefit for patients with myocardial infarction and heart failure; their use is a core measure of hospital quality for the Centers for Medicare and Medicaid Services. The authors' urban medical center has lower-than-average performance on this measure. The authors used published best practices to design and implement a comprehensive strategy to improve ACE/ARB performance with existing decision support and human resources. Chart reminders were targeted to providers of patients eligible for ACEs/ARBs but not receiving them. ACE/ARB performance increased 8.5% in postintervention patients compared with historical controls. The increase was 20.7% among patients not on ACEs/ARBs on admission (P =.03). Chronic kidney disease (CKD) was inversely associated with the effectiveness of the intervention. A comprehensive strategy can be effective in narrowing the performance gap even for populations with a high prevalence of CKD. However, future work is needed to improve performance among patients whose ACEs/ARBs are withheld during hospitalization.