Hydroxychloroquine-Induced Hypoglycemia in a Patient Without Diabetes.

Hydroxychloroquine is a disease-modifying antirheumatic drug commonly used in the treatment of autoimmune diseases. Although rare, hydroxychloroquine is associated with hypoglycemia in patients with or without diabetes due to its ability to alter insulin metabolism. There have been several cases described in the literature, but none of which, to our knowledge, detail follow-up and time to resolution of hypoglycemia. We describe a 55-year-old female who presents for episodes of hypoglycemia. She reported hypoglycemic symptoms and fasting blood glucoses in the 60-70s mg/dL regularly. Based on the Naranjo adverse drug reaction probability scale, hydroxychloroquine was the probable etiology of her hypoglycemic episodes due to the improvement at her 3-month follow up appointment after discontinuing the drug. Providers should be mindful of the hypoglycemia risk when using hydroxychloroquine and be aware that the effects may take an extended amount of time to resolve given the drug's long half-life.

Retropharyngeal hematoma mimicking angioedema after intravenous thrombolysis for acute ischemic stroke.

Tissue plasminogen activator (tPA) is a cornerstone treatment for acute ischemic stroke (AIS). Administration of tPA is not without risk, and can provoke life threatening adverse reactions. Retropharyngeal hematoma (RPH) following tPA administration has only been reported after tenecteplase (TNK) administration for ST elevation myocardial infarction (STEMI). A 78 year old patient received tPA for AIS. Following administration of tPA, this patient developed acute signs and symptoms of what appeared to be a more well-known adverse reaction of tPA administration - angioedema. After CT and laboratory findings, our patient received cryoprecipitate for tPA reversal. Our case highlights a unique case of RPH mimicking angioedema following tPA administration.

Factors influencing likelihood of COVID-19 vaccination: A survey of Tennessee adults.

PURPOSE: To examine the vaccine-related beliefs and behaviors associated with likely hesitancy toward vaccination against coronavirus disease 2019 (COVID-19) among nonelderly adults. METHODS: A cross-sectional survey was conducted in June 2020. Responses were sought from Tennessee adults 18 to 64 years of age who were not healthcare providers. The survey instrument focused on vaccine-related beliefs, prior and planned influenza and pneumococcal vaccine use, and attitudes toward receiving a COVID-19 vaccination. Inferential statistics assessed survey responses, and logistic regression determined predictors of the likelihood of COVID-19 vaccination. RESULTS: A total of 1,000 completed responses were analyzed (a 62.9% response rate), and respondents were mostly White (80.1%), insured (79.6%), and/or actively working (64.2%); the sample was well balanced by gender, age, income, and political leaning. Approximately one-third (34.4%) of respondents indicated some historical vaccine hesitancy, and only 21.4% indicated always getting a seasonal influenza vaccination. More than half (54.1%) indicated at least some hesitancy toward vaccination against COVID-19, with 32.1% citing lack of evidence of vaccine effectiveness as the leading reason. COVID-19 vaccine hesitancy was more likely among those with more moderate (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.749-3.607) or conservative (OR, 3.01; 95% CI, 2.048-4.421) political leanings, Black Americans (OR, 1.80; 95% CI, 1.182-2.742), and residents of nonmetropolitan areas (OR, 1.99; 95% CI, 1.386-2.865). CONCLUSION: Subgroups of the population may prove more challenging to vaccinate against COVID-19, requiring targeted approaches to addressing hesitancy to ensure more-vulnerable populations are adequately covered.

Extent of and Reasons for Vaccine Hesitancy in Adults at High-Risk for Pneumococcal Disease.

PURPOSE: To determine the extent of and reasons for hesitancy toward vaccination among adults at high-risk for pneumococcal disease. DESIGN: Cross-sectional. SETTING: Online survey in March-April 2019 via QuestionPro. SUBJECTS: Tennessee adults (18-64 years) at high-risk of pneumococcal disease (n = 1,002). MEASURES: Modified version of the validated Vaccine Hesitancy Scale assessed vaccine-related beliefs, reasons for hesitancy, external influences on vaccination, and prior vaccination. ANALYSIS: Descriptive and inferential statistics provided an overview of the responses and comparisons among subgroups. Logistic regression determined the odds of being hesitant using the listed beliefs and influencers as predictors. Thematic analysis was performed on the qualitative data gathered from free response questions throughout the survey. RESULTS: Analysis included 1,002 complete responses (12% response rate [total viewed = 8,331]) with 34.3% indicating hesitancy toward one or more recommended vaccinations, with 53% of which indicating hesitancy to the pneumococcal vaccine despite it being recommended by the Advisory Committee on Immunization Practices (ACIP) for all respondents. The odds of vaccine hesitancy or resistance were higher in minorities (OR: 1.6; 95% CI: 1.19-2.11), those not believing others like them get vaccinated (OR: 1.82; 95% CI: 1.262-2.613), and respondents recalling negative media about vaccines (OR: 2.56; 95% CI: 1.797-3.643). CONCLUSIONS: Patients at high-risk of pneumococcal disease lack awareness of the need for the recommended vaccine, and provider education may need improving to increase vaccination in this population.