Comparison of virtual vs face-to-face medical nutrition therapy in patients with hyperlipidemia.

Since the COVID-19 pandemic, utilization of telemedicine visits has increased. The outcomes of virtual compared to face-to-face (F2F) visits for treating hyperlipidemia are uncharacterized. This observational study compared pre- to post-visit change in lipid markers between 41 virtual and 151 F2F visits with a registered dietitian nutritionist at the University of Michigan Preventive Cardiology program from 3/31/2019-9/31/2022. Total cholesterol (TC), high-density lipoprotein (HDL), and triglycerides (TG) were collected pre- and post-visit with a median 33 days between collections. Low-density lipoprotein (LDL-C) was calculated using the Sampson equation. We used paired T-tests to evaluate mean change in lipid markers for each visit type between pre and post timepoints, and linear regression to compare virtual to F2F visits. There was a significant decrease in TC, LDL-C, and non-HDL-C for both visit types. There was no significant difference in mean change in lipid markers between virtual and F2F visits. Telehealth is a promising strategy for increasing access to medical nutrition therapy.

Photo-Induced Sweet Syndrome: A Case Report.

Sweet syndrome is a rare dermatologic condition frequently accompanied by fever and neutrophilia. Underlying triggers and etiology of the sweet syndrome remain elusive, although infection, malignancy, medications, and more rarely, sun exposure have been associated with its development. We present a case of a 50-year-old female who developed a painful, mildly pruritic rash on sun-exposed areas of the neck, arms, and legs. She also reported chills, malaise, and nausea upon presentation. Before developing the rash, she had preceding upper respiratory infection symptoms, used ibuprofen for joint pain, and had extensive sunlight exposure on the beach. Laboratory findings were significant for leukocytosis with absolute neutrophilia, elevated C-reactive protein, and elevated erythrocyte sedimentation rate. Skin punch biopsy demonstrated papillary dermal edema with dense neutrophilic infiltration. Further evaluation for hematologic or solid organ malignancy was negative. Following the administration of steroids, the patient demonstrated significant clinical improvement. While rare, ultraviolet A and B sunlight has been shown in rare situations to be associated with the development of the Sweet syndrome. The underlying mechanism for the development of photo-induced Sweet syndrome remains unknown. However, excessive sunlight exposure should be considered a potential cause when evaluating the underlying triggers for the development of the Sweet syndrome.

Telemedicine in the Wake of COVID-19: A Statewide Demographic Study on Provider Utilization and Perspective In South Dakota.

INTRODUCTION: The COVID-19 pandemic has ushered in a rapid evolution of regulations surrounding telemedicine and the public's need for affordable, accessible, high-quality care at a distance. This necessity led to a rise in telemedicine demand that forced health systems to adapt, and for providers to witness the potential benefits and limitations of such services. METHODS: In this analysis, Sanford Health EMR data was evaluated from Q2 of 2019 to Q2 of 2020 to compare specialty utilization of telemedicine and quantify percentage change within the midst of the COVID-19 pandemic. A survey was conducted to evaluate provider opinion within the Sanford Health system regarding demographics, usage, perceived benefits, and perceived barriers to this rapid adoption. RESULTS: Results suggest that Sanford Health experienced a significant, 1,600 percent increase of telemedicine usage. Additionally, with this increased usage of telemedicine, provider opinion of telemedicine and its potential has improved. During the pandemic, a greater percentage of providers believe telemedicine is highly beneficial to their practice and a majority believe telemedicine will continue to play a vital role in their practice in the future. However, the barriers found within the survey included limited patient access, technical difficulties, reimbursement, and insurance coverage. CONCLUSIONS: With the rapid increase in provider usage and the subsequent approval of providers, telemedicine has the potential to facilitate higher quality healthcare going forward. The COVID-19 pandemic has necessitated evolution and adoption of virtual media in medicine and has provided a unique glimpse into telemedicine's limitations and exceptional potential.

Increased Incidence of Pyogenic Liver Abscess in a Midwest System With Emphasis on Rural Impact.

OBJECTIVE: To assess if hepatic abscess incidence in a Midwest cohort was higher in rural areas compared to metropolitan areas in relation to water infrastructure. MATERIALS AND METHODS: All cases of hepatic abscesses from Jan 1, 2016 through Dec 31, 2019 at Avera McKennan Hospital in Sioux Falls, South Dakota (SD), were retrospectively collected. Chart review was completed for each case for risk factor analysis. Microbiology cultures and patient demographic data were collected including age, gender, hometown, and ethnicity. Risk factors assessed included a history of abdominal surgery, gallbladder disease, sepsis, diverticulitis, cancer, and diabetes. The incidence of hepatic abscesses was calculated using the Poisson rate test and confidence interval equation. Averages of each risk factor were calculated. Finally, hometown was utilized to create a heatmap of disease burden and compared to the density of private wells. RESULTS: Our data yielded 116 confirmed adult hepatic abscesses between 2016 and 2019. The corrected incidence per 100,000 hospitalized patients per year is 95.66. The Poisson exact probability P-value was <0.01. Rural areas had a higher per capita incidence of abscesses and higher density of private wells. CONCLUSIONS: The incidence of hepatic abscesses is higher than national averages in this single-center study of Avera McKennan Hospital. Demographics, especially geographic location, play an important role in abscess rates. Rural location may be affecting the incidence of hepatic abscesses, explaining the much higher than expected incidence in this study. Infrastructure could be a contributing factor as much of the rural area is reliant on untreated groundwater.

Complex Coronary Intervention - When Time Is of Essence: Ping Pong Technique.

Coronary artery disease (CAD) continues to be a significant cause of morbidity and mortality in the U.S. The prognosis and treatment of which is dependent on various factors including type, size, localization and extent of the coronary plaque and severity of the stenosis. Management of critical ostial left main CAD poses peculiar challenges. The present case report demonstrates a unique percutaneous coronary intervention technique helpful in the management of such complex left main coronary lesions.

MODERNA mRNA-1273 vaccine-associated myopericarditis in a patient with a subclinical autoimmune predisposition.

We present a rare case of myopericarditis developing one day after the injection of the second dose of the MODERNA mRNA-1273 vaccine (Cambridge, MA, USA). The patient complained of typical positional chest pain with initial laboratory results significant for elevated troponin, erythrocyte sedimentation rate, and C-reactive protein. Autoimmune predisposition was suggested by elevated anti-nuclear antibodies and anti-Sjögren's-syndrome-related antigen A autoantibodies titers. Subsequent cardiac magnetic resonance imaging (cMRI) revealed mild global hypokinesis with an ejection fraction of 48%, diffuse pericardial hyperenhancement suggestive of acute pericarditis, and T2-weighted short tau inversion recovery apical septal hyperenhancement suggestive of myocardial edema. Based on clinical, laboratory, and cMRI findings, a diagnosis of acute myopericarditis was made and the patient was treated with colchicine and ibuprofen with prompt resolution of symptoms. Vaccine-associated myopericarditis is rare, however, there have been reports of myocarditis developing after smallpox vaccination. The American College of Rheumatology has expressed concern about flaring or development of autoimmune inflammatory rheumatic disease (AIIRD) after COVID vaccination. Further studies are required to quantify AIIRD flaring/development including myopericarditis after mRNA-1273 vaccination. .

Endoleak and Pseudoaneurysm Formation in the Setting of Stent Graft Infection Following Endovascular Uretero-Arterial Fistula Repair: The Dreaded Complication.

The complication of uretero-arterial fistula after prolong ureteral stenting is well recognized. The treatment is primarily endovascular stenting across the fistulous communication accepting the potential risk of stent graft infection. Herein we present a case of a 71-year-old female who developed an uretero-arterial fistula after prolong ureteral stenting and exchanges following ileal conduit obstruction. Initial treatment with left common iliac stenting controlled the hematuria, but only temporarily. Repeat angiography revealed a type 1b endoleak requiring stent extension. Unfortunately, persistent hematuria necessitating further angiography showed the development of a saccular pseudoaneurysm around the stent graft requiring proximal stent extension. A nuclear medicine indium 111-tagged white blood cell scan with single-photon emission CT (SPECT)/CT confirmed stent graft infection. Conservative therapy with antibiotics failed, causing graft failure that ultimately required bypass surgery.