Limited data exist regarding the amount of opioids patients need after cesarean delivery, or what factors are predictive of an individual patient's opioid needs. This study further supports the growing literature demonstrating that providers frequently over-prescribe opioids following cesarean delivery. It uniquely adds associations of patient-specific factors and outpatient opioid needs.This study further supports the growing literature demonstrating that providers frequently over-prescribe opioids following cesarean delivery. It uniquely adds associations of patient-specific factors and outpatient opioid needs.We report two cases of malaria diagnosed in Rhode Island. First, a 21-year-old female who presented with 5 days of fevers, chills, headache, and myalgias after returning from a trip to Liberia, found to have uncomplicated malaria due to P. ovale which was treated successfully with atovaquone/proguanil and primaquine. Second, a chronically ill 55-year-old male presented with 3 days of headache followed by altered mental status, fever, and new-onset seizures after a recent visit to Sierra Leone, found to have P. falciparum malaria requiring ICU admission and IV artesunate treatment. The diagnosis and management of malaria in the United States (US), as well as its rare association with subdural hemorrhage are subsequently reviewed.Presentations of angioedema range from mild edema to immediate life-threatening airway involvement. Management is typically straightforward and dependent on the degree of presentation. In our case, a 61-year-old female presented with angioedema requiring immediate intubation. Before admission to the intensive care unit, a screening ECG was obtained that revealed ST segment elevations which redirected our patient to the cardiac catherization lab. Our patient was ultimately diagnosed with a stress-induced cardiomyopathy after initially presenting with ACE-inhibitor induced angioedema.Rabies is an acute encephalitis that is caused by rabies virus (RABV) infection, which belongs to the Rhabdoviridae family of viruses. It causes about 59,000 human deaths per year (although this number may be under-reported) and is generally fatal, once signs and symptoms begin to appear. Rabies is still very prevalent and under- reported, particularly in low to middle-income countries such as Asia and Africa, where there is lack of access to healthcare and domestic dogs are not widely vaccinated. Although not commonplace in the USA, rabies is mostly transmitted by wild animals such as bats, raccoons, skunks and foxes. Domesticated cats and dogs are also at risk of acquiring rabies, if they have not been vaccinated. Larger carnivores, such as coyotes, bobcats, mountain lions, wolves, bears, woodchucks, and beavers, should also be considered rabid (unless proven otherwise) if they are involved in an unprovoked attack on a person. The rabies vaccine can prevent 99% of deaths if administered promptly after exposure. There are two main vaccination strategies for rabies prevention pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). This article reviews background and epidemiology of rabies and current guidelines for rabies PrEP and PEP regimens for the United States.Travelers to 24 endemic countries in Asia may be at risk for Japanese encephalitis. The ACIP has recently expanded guidelines on the use of Ixiaro, the inactivated Japanese encephalitis vaccine. https://www.selleckchem.com/products/piperacillin.html This article reviews the disease burden of Japanese encephalitis and the role of a travel clinic in guiding travelers to Asia regarding decision-making about the use of this highly protective vaccine.The danger of vaccine hesitancy is perhaps one of the most critical challenges we face as practitioners. This riveting narrative helps us find common ground and courage as it reaches into the hearts of those of us who have encountered parents who also want what's best for their child.Use of hepatitis A vaccine is a main component of travel vaccination practices. In the United States, fluctuations in the number of annual hepatitis A infections have occurred recently due to large outbreaks related to imported foods and urban transmission among homeless individuals, warranting consideration for wider local use of hepatitis A vaccine. Hepatitis B vaccine is indicated for all adults, and especially healthcare workers. Since 1992, it has been administered at birth. A new novel hepatitis B vaccine given in two doses one month apart is available and has increased efficacy in adults. This article reviews the complete administration of these hepatitis vaccines.Neisseria meningitidis bacterial infection can cause severe life-threatening meningitis. Individuals who survive may be left with profound sequelae. In epidemic regions such as the meningitis belt of Africa, the case rate is drastically higher than in nonepidemic regions and is due to distinct outbreak serogroups. Two highly effective conjugate meningococcal vaccine against serogroups A, C, W and Y are licensed and indicated for prevention in childhood vaccination schedules and for travelers to outbreak regions. In the US, meningococcus serogroup B is the main cause of outbreaks, in areas with crowding such as college dorms. It has taken over 40 years to develop a meningitis type B vaccine and now there are 2 brands available for children and teens. All college-bound individuals should complete schedules of both conjugate ACWY serotypes and meningitis B vaccine series. This paper reviews details on who to vaccinate and how to use the currently available meningococcal meningitis vaccines.Tetanus is a life-threatening but vaccine-preventable disease caused by the toxin of the bacterium Clostridium tetani and is characterized by muscle spasms and autonomic nervous system dysfunction. It is prevented through vaccination with tetanus toxoid, but because the causative agent is widespread in the environment, eradication is impossible. Therefore, efforts to reduce incidence are aimed at reaching elimination, rather than eradication. This article reviews the pathogenesis, clinical manifestation and treatment of tetanus, and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) regarding prevention and control of tetanus in the United States.