A rare case of pericardial sarcoidosis presenting as chest pain.

Key Clinical Message: Pericardial sarcoidosis is an uncommon cause of chest pain to consider, and it requires a heightened level of suspicion and thorough history gathering. If there is suspicion of inflammatory disease, pursuing advanced imaging and biopsies is crucial, as early immunosuppressive treatment can enhance outcomes. Abstract: Pericardial involvement in sarcoidosis is a rare condition with limited research. This case study discusses a 52-year-old African American woman who presented with subacute chest pain and was diagnosed with pericardial sarcoidosis. Diagnostic evaluation revealed extensive lymphadenopathy and pericardial effusion, and a pericardial biopsy confirmed non-caseating granulomatous inflammation. Treatment with steroids and methotrexate resulted in clinical improvement. Eight months follow-up showed near resolution of pericardial disease. This case emphasizes the importance of considering cardiac sarcoidosis in sarcoidosis patients, utilizing advanced imaging for accurate diagnosis, and tailoring treatment to the level of cardiac involvement.

LV-predominant arrhythmogenic cardiomyopathy related to pathogenic DSP-variant.

Key Clinical Message: In contrast to previously thought, arrhythmogenic cardiomyopathy can occur exclusively in the left ventricle in association with autosomal dominant mutation, even without any skin manifestations. Abstract: We present a case of a 43-year-old male with left ventricle (LV)-predominant arrhythmogenic cardiomyopathy (ACM) caused by a novel p.Q1830 mutation in the desmoplakin (DSP) gene. The patient had a significant family history of sudden cardiac death (SCD) and presented with presyncope and exertional dyspnea. The patient's electrocardiography (ECG) showed frequent premature ventricular complexes (PVCs) with bigeminy and couplet patterns. Cardiac magnetic resonance imaging (CMR) revealed late gadolinium enhancement of the left ventricle (LV) and ventricular systolic dysfunction, suggesting LV-predominant arrhythmogenic cardiomyopathy. The patient was started on guideline-directed medical therapy (GDMT), and an implantable cardioverter-defibrillator (ICD) was implanted for primary prevention. The patient reported significant improvement in his heart failure symptoms at the 2-year follow-up. The article highlights the importance of timely diagnosis with multimodality imaging and genetic testing and management of the rare DSP-related LV-predominant ACM associated with a high risk of SCD.

Legionella-induced dysarthria and rhabdomyolysis with acute renal failure achieving recovery.

Key Clinical Message: Legionnaires' disease, often presenting as pneumonia, can uncommonly manifest with extrapulmonary symptoms such as cerebellar involvement and rhabdomyolysis. This case emphasizes the successful resolution of dysarthria and renal dysfunction with prompt Legionella treatment, underscoring the importance of vigilance for diverse manifestations in Legionella infections. Abstract: Legionnaires' disease usually presents with pneumonia and a few extrapulmonary manifestations, such as neurological, musculoskeletal, and cutaneous manifestations. However, cerebellar involvement and rhabdomyolysis as an association with Legionella are not frequently encountered. We present a case of Legionella-induced rhabdomyolysis requiring hemodialysis and dysarthria that resolved with Legionella treatment.

Gastric sarcoidosis diagnosed with endoscopic ultrasound.

Key Clinical Message: Endoscopic ultrasonography (EUS) is crucial in diagnosing gastrointestinal sarcoidosis, especially when patients exhibit refractory abdominal symptoms. Our case highlights the significance of considering sarcoidosis in such cases and emphasizes the utility of EUS for accurate diagnosis and guiding appropriate treatment. Abstract: Gastrointestinal sarcoidosis is a rare and challenging manifestation of sarcoidosis that often presents with nonspecific abdominal symptoms, making diagnosis a complex process. We report the case of a 46-year-old African American female who experienced chronic epigastric abdominal pain, recurrent nausea, vomiting, and diarrhea for 15 years. Despite extensive investigations, including multiple biopsies, she was misdiagnosed with cyclic vomiting syndrome. Subsequently, an endoscopic ultrasound (EUS) revealed prominent lymph nodes and gastric granulomas, leading to a diagnosis of GS. This case underscores the importance of considering sarcoidosis in patients with refractory abdominal symptoms and highlights the utility of EUS in diagnosing this rare condition.

An Interesting Case of Recurrent Postprandial Cardiogenic Syncope Caused by Type III Hiatal Hernia.

Patients with syncope often present a diagnostic challenge due to the diverse causes of this condition. While a careful assessment can identify the underlying cause in many cases, syncope can arise from a variety of sources, including structural anomalies. Among these, hiatal hernia (HH) is a relatively common yet unusual condition associated with syncope. HH involves the protrusion of abdominal organs into the mediastinum through the diaphragmatic esophageal hiatus, with types III and IV being capable of causing cardiac problems. We report a case of a 92-year-old patient with a known HH history who experienced recurrent syncope episodes triggered by heavy meals. Extensive evaluation ruled out cardiac and neurological causes. Imaging revealed a large HH compressing the left atrium. Despite being an infrequent occurrence, such cases highlight the potential for atrial compression-induced syncope, which can be effectively managed with proton pump inhibitors and lifestyle modifications, as demonstrated by our patient's positive outcome.

Beyond the norm: A rare case of cardiac and extracardiac metastatic urothelial carcinoma.

Screening echocardiography aids in identifying cardiac emboli causes and asymptomatic cardiac metastases in high-grade neoplasms. Conversely, cardiac MRI provides advanced tissue characterization and broader extracardiac assessment.

A Rare Presentation of Zoledronate-Induced Systemic Inflammatory Response.

Zoledronic acid is a bisphosphonate commonly used to treat various conditions involving bone loss. While it is generally well-tolerated, the occurrence of severe inflammatory reactions is rare. We present the case of an 82-year-old female who developed a severe immune reaction, including weakness and tenderness in her upper and lower extremities, following a single dose of zoledronic acid infusion for the treatment of osteoporosis. The onset of symptoms occurred one week after the infusion and persisted, progressively worsening over time, leading to functional impairment and the need for a walker for ambulation. Laboratory studies revealed an elevated erythrocyte sedimentation rate while other autoimmune markers were within normal limits. Differential diagnosis included an adverse reaction to zoledronic acid or underlying polymyalgia rheumatica. The patient showed significant improvement with a prednisone taper, suggesting an immune-mediated response. This case highlights the importance of considering severe immune reactions as a potential side effect of zoledronic acid and emphasizes the need for further research to better understand the underlying mechanisms and optimize patient management.

Mortality and Discharge Location of Intensive Care Patients With Alzheimer Disease and Related Dementia.

BACKGROUND: Intensive care unit (ICU) utilization has increased among patients with Alzheimer disease and related dementia (ADRD), although outcomes are poor. OBJECTIVES: To compare ICU discharge location and subsequent mortality between patients with and patients without ADRD enrolled in Medicare Advantage. METHODS: This observational study used Optum's Clinformatics Data Mart Database from years 2016 to 2019 and included adults aged >67 years with continuous Medicare Advantage coverage and a first ICU admission in 2018. Alzheimer disease and related dementia and comorbid conditions were identified from claims. Outcomes included discharge location (home vs other facilities) and mortality (within the same calendar month of discharge and within 12 months after discharge). RESULTS: A total of 145 342 adults met inclusion criteria; 10.5% had ADRD and were likely to be older, female, and have more comorbid conditions. Only 37.6% of patients with ADRD were discharged home versus 68.6% of patients who did not have ADRD (odds ratio [OR], 0.40; 95% CI, 0.38-0.41). Both death in the same month as discharge (19.9% vs 10.3%; OR, 1.54; 95% CI, 1.47-1.62) and death in the 12 months after discharge (50.8% vs 26.2%; OR, 1.95; 95% CI, 1.88-2.02) were twice as common among patients with ADRD. CONCLUSIONS: Patients with ADRD have lower home discharge rates and greater mortality after an ICU stay than patients without ADRD.

Assessment of A new Strategy to Prevent Prescribing Errors Involving COVID-19 Patients in Community Pharmacies.

Background: Because COVID-19 patients are vulnerable to prescribing errors (PEs) and adverse drug events, designing and implementing a new approach to prevent prescribing errors (PEs) involving COVID-19 patients has become a priority in pharmacotherapy research. Objectives: To investigate whether using WhatsApp to deliver prescribing error (PE)-related clinical scenarios to community pharmacists could enhance their ability to detect PEs and conduct successful pharmaceutical interventions (PIs). Methods: In this study, 110 community pharmacies were recruited from different regions across Jordan and equally allocated to 2 groups. Over the course of 4 weeks, WhatsApp was used to send PEs-related clinical case scenarios to the active group. The second group was controlled with no clinical scenarios. After completion of the 4-week phase, pharmacists from both groups were asked to document PEs in COVID-19 patients and their interventions using a data-collection form. Results: The incidence of PEs in COVID-19 patients documented in the active group (18.54%) was higher than that reported in the control group (3.09%) (P = .001). Of the 6598 and 968 PIs conducted by participants working in the active and control group pharmacies, 6013 (91.13%) and 651 (67.25%) were accepted, respectively. The proportions of wrong drug (contraindication), wrong drug (unnecessary drug prescribed/no proof of its benefits), and omission of a drug between the active and control groups were 15.30% versus 7.21% (P = .001), 11.85% versus 6.29% (P = .03), and 17.78% versus 10.50% (0.01), respectively. Additionally, the proportions of lethal, serious, and significant errors were 0.74% versus 0.35% (P = .04), 10.52% versus 2.57% (0.002), and 47.88% versus 9.57% (0.001), respectively. Addition of drug therapy interventions (AOR = 0.62; 95% CI, 0.21-0.84) and errors with significant clinical seriousness (AOR = 0.32; 95% CI, 0.16-0.64). Conclusions PEs involving COVID-19 patients in community settings are common and clinically significant. The intervention assessed in this study could be promising for designing a feasible and time-efficient interventional tool to encourage pharmacists' involvement in identifying and correcting PEs in light of COVID-19.

The patterns and determinants of telemedicine use during the COVID-19 crisis: A nationwide study.

BACKGROUND: Although telemedicine services have been adopted on a large scale in the United Arab Emirates (UAE) during the coronavirus disease 2019 (COVID-19) pandemic, a little is known about the public experience. OBJECTIVES: This study aimed to investigate consumers' patterns, nature, and predictors of telemedicine utilization and consumers' attitude toward this technology. METHODS: A quantitative, self-administered questionnaire was developed, validated, and delivered randomly to adults living across the United Arab Emirates (UAE) between January 2021 and January 2022. The questionnaire included questions about categories of telemedicine used, purpose of use, challenges encountered during the use of telemedicine, and reasons for not using telemedicine technology. We adopted a proportionate random sampling technique to recruit participants by 3 ways: social media, phone calls, and face to face. RESULTS: The final dataset included 1584 participants, of which 496 (31.3%) used telemedicine during the coronavirus disease 2019 (COVID-19) pandemic. The most common reasons for not using telemedicine during COVID-19 was having no idea that telemedicine exists (38.3%, 417 of 1088) or having no idea how to use it (33.5%, 365 of 1088). Telemedicine users reported that that telepharmacy (89.7%), teleconsultation (78.2%), and telediagnosis (23.0%) were the most frequently used telemedicine services during the COVID-19 crisis. Of the 496 telemedicine users, 469 (94.6%) reported using telemedicine for seeking a pharmacist advice about medication instructions, 422 (85.1%) for ordering nonprescription drugs, and 401 (80.8%) for seeking a physician advice. Those with high activity on social media were less likely to be associated with telemedicine users versus nonusers. DISCUSSION: Although telepharmacy has been increasingly used by consumers, more attention is needed to fix its limitations and improve patient safety. CONCLUSION: This study shows a positive attitude and a general acceptance of telemedicine services among the UAE population. Some sociodemographic and clinical characteristics were significantly associated with the use of telemedicine during the pandemic.

Virtual Coaching Delivered by Pharmacists to Prevent COVID-19 Transmission.

Background: While the role of pharmacists in the current pandemic control has been recognized worldwide, their coaching efforts to improve public's behaviors that could prevent COVID-19 transmission has been rarely investigated. Objectives: To assess whether pharmacist-based virtual health coaching sessions could increase the proportion of people who practised healthy social behaviors, to test whether this model can increase the public acceptance of COVID-19 vaccines, and to measure whether these behaviors could actually prevent contracting COVID-19. Method: In this randomized controlled trial, adults who matched specific criteria were randomly allocated into 2 arms. The active arm received 12 pharmacist-based virtual coaching sessions delivered via Zoom® over a month. Participants allocated to the control arm received no coaching. At the end of the last coaching session, both groups were asked to complete a structured questionnaire for outcome assessment. Participants in the active group were followed up to 2 weeks after the end of the last coaching session to check if they contracted COVID-19 or not. The SPSS software version 26.0 (IBM Corp., Chicago, IL) was used for statistical analysis. Results: Of the 300 participants who gave consent for participation, 295 completed the study (147 from the active arm and 148 from the control arm). The proportion of those using face masks, avoiding crowds, and willing to be isolated if infected in the active arm was increased from 51.70%, 53.74%, and 59.86% at baseline to 91.83%, 80.27%, and 96.59% at the end of coaching, respectively (all with P < .05). In addition, the proportion of behaviors, such as disinfecting surfaces, not touching the T-zone, and avoid sharing personal belongings with colleagues at work was increased from 36.05%, 27.89%, and 46.93% at baseline to 63.94%, 52.38%, and 87.75% at the end of coaching, respectively (all with P < .05). Avoid touching the T-zone (OR = 0.43; 95% CI, 0.24-0.89) and using disposable tissues (OR = 0.30; 95% CI, 0.18-0.77), each versus using face masks appropriately were more likely to get COVID-19. Conclusion: Pharmacist-based virtual health coaching could be a potential strategy to increase the proportion of behaviors that could curtail the spread of COVID-19.

Pharmacists-physicians collaborative intervention to reduce vaccine hesitancy and resistance: A randomized controlled trial.

PURPOSE: Given their negative influence on community health, vaccine hesitancy and resistance are emerging challenges that require healthcare intervention. Therefore, this study aimed to assess the impact of physician-pharmacist collaborative health coaching on rates of hesitancy and resistance for a COVID-19 vaccine. METHODS: After an initial assessment of rates of hesitancy and resistance for a COVID-19 vaccine was conducted, hesitant and resistant participants were approached, recruited, and randomized into an active and control group. Pharmacists-physicians collaborative coaching intervention was delivered to active group subjects over two months through Facebook live sessions. The outcome measures were assessed in both groups before coaching, directly after coaching, and a month after coaching. RESULTS: The proportions of hesitancy and resistance for a COVID-19 vaccine among subjects in the active group were significantly reduced from 64.3% and 35.7% before coaching to 20.1% and 7.8% directly after coaching, respectively. These proportions were further reduced to 11.1% and 3.3% a month after coaching, respectively. Furthermore, the mean scores for knowledge on, and attitude towards COVID-19 vaccine were significantly increased from 4.6 ± 1.8 and 4.1 ± 1.7 before coaching to 7.5 ± 3.1 and 8.9 ± 3.8 directly after coaching, respectively. However, the change in mean score of beliefs about COVID-19 vaccines among active group subjects was not significant. CONCLUSION: High rates of hesitancy and resistance for a COVID-19 vaccine were found in Jordan. These rates can be significantly reduced through online pharmacists-physicians collaborative coaching, which can also improve knowledge of and attitude towards COVID-19 vaccines.