Vitamin B12-induced acneiform eruption.

Cutaneous acneiform eruptions are a side effect of many medications, including vitamin B12 therapy. However, reports of vitamin B12-induced acne are rare. We present a 67-year-old woman with a new diagnosis of pernicious anemia who developed a sudden acneiform eruption on the face after treatment with high-dose vitamin B12.

From Headache to Handled: Advanced In-Basket Management System in Primary Care Clinics Reduces Provider Workload Burden and Self-Reported Burnout.

Background:  The electronic health record (EHR) has been associated with provider burnout, exacerbated by increasing In-Basket burden.

Objectives:  We sought to study the impact of implementing a team-based approach to In-Basket management on a series of primary care ambulatory sites.

Methods:  We performed a workflow analysis of the transition to the Advanced In-Basket Management (AIM) nurse team triage for six family medicine clinic locations in a large health system.

Racial Disparities in Parturient Urine Drug Screening at a Texas Level IV Maternal Care Centre: A Single-Centre Retrospective Study.

Objectives: We hypothesized that Black or African American (hereby referred to as Black) and Hispanic patients would have higher rates of urine drug screening (UDS) during pregnancy compared with White or Caucasian (herby referred to as White) patients at our hospital.

Methods: Patients who delivered at our hospital between 1 December 2020 and 31 May 2021 and between 1 December 2022 and 31 May 2023 and who were Black, Hispanic, or White were included in the final analysis. We performed separate bivariate analyses comparing White patients to either Black patients or Hispanic patients.

Differentiating Myelography Contrast from Intraventricular and Subarachnoid Hemorrhage Using Dual-Energy CT of the Head: A Case Report and a Review of Literature.

Single-energy computed tomography (SECT) head is a common diagnostic tool to evaluate for intracranial hemorrhage in emergency settings due to its widespread accessibility and non-invasive nature. However, SECT has densitometric evaluation limitations. For example, hyperdensities on SECT such as blood product and iodine contrast appear similarly.

Refining Cardiovascular Calcification in the Appraisal of Ischemic Heart.

Background: Even in asymptomatic patients, there is a high association of ischemia on myocardial perfusion scans in those with coronary artery calcification or valvular calcifications. Patients without coronary artery calcifications have exceeding-low rates of cardiovascular events. The absence of cardiovascular calcification, including coronary artery, valvular, and thoracic aorta is a strong negative predictor of myocardial ischemia.

Idiopathic toxic epidermal necrolysis in a pediatric patient.

Stevens-Johnson syndrome and toxic epidermal necrolysis are potentially life-threatening cutaneous diseases that are rarely seen in the pediatric population. We describe a case of a 7-year-old female who presented with fever, cough, mucosal erosions, and a widespread maculopapular eruption with flaccid bullae for 4 days. She had no sick contacts and no new medications, supplements, or vitamins.

An eruption of basal cell carcinoma after ibrutinib.

Ibrutinib is a therapy targeting tyrosine kinase that has been used for various hematologic malignancies. It is associated with a variety of adverse effects, several of which are dermatologic. While there are few discussions of basal cell carcinoma as an adverse event, there have not yet been reports of a significantly increased incidence.

Sclerodermatous Graft-Versus-Host Disease: A Rare Sequela of Hematopoietic Stem Cell Transplantation.

Although graft-versus-host disease (GVHD) is a common immunologic reaction after an allogeneic hematopoietic stem cell transplant (HSCT), progression into sclerodermatous GVHD is a rare sequela. It can present locally or generalized with various cutaneous and mucocutaneous manifestations, resulting in loss of skin elasticity and reduced functional capabilities. One of the most debilitating consequences of sclerodermatous GVHD is its effect on a range of motion due to fibrosis of the skin and subcutaneous fat.

Formalizing the curbside: digitally enhancing access to specialty care.

Asynchronous medical care has increased in utilization, patient interest, and industry demand. While E-consults have been discussed extensively in the literature, there are rare examples of a multispecialty implementation within a large health system. Here, we describe our experience in implementing an internal E-consult program for asynchronous, nonurgent communication between ambulatory specialists and primary care providers in our large multispecialty regional health system.

Low rate of secondary surgery and implant removal following superior, precontoured plating of midshaft clavicle fractures.

Background: Surgical fixation of midshaft clavicle fractures with a single 3.5 mm superior clavicular plate has been associated with a high rate of hardware removal due to symptomatic hardware. Because of this, dual-plating techniques with lower-profile implants have been proposed.

COVID-19 online medical education and outcomes on Internal Medicine In-Training Examination scores.

Background: COVID-19 presented a unique opportunity to explore new methods to deliver medical education virtually due to requirements for social distancing. We provided webcams and microphones in each of our core teaching team rooms. We used existing teleconferencing systems with share screen, polling, and audio/video capabilities to continue fostering a group learning environment.

Management and outcomes of chest pain telemedicine visits in a cardiology clinic during the COVID-19 pandemic.

Background: Beginning in March 2020, the COVID-19 pandemic forced many outpatient chest pain evaluations to be performed via telemedicine. The purpose of this study was to examine the impact of telemedicine on management and outcomes of patients who presented with chest pain.

Methods: This retrospective chart review study included 771 unique patients, age >18 years, who were seen face-to-face in cardiology clinic visits from March 2019 through September 2019 with an encounter diagnosis of chest pain or angina, compared with 172 unique patients of age >18 who were seen via telehealth visit from March 2020 through September 2020.

Mechanical circulatory support for thyrotoxicosis-induced cardiomyopathy.

Thyroid storm is a life-threatening condition which, in rare cases, may lead to cardiogenic shock and dysrhythmias. Mechanical circulatory support with an Impella device or extracorporeal membrane oxygenation may be used as a bridge to recovery in these cases. This case involves a patient with thyrotoxicosis and reduced ejection fraction and hemodynamic instability requiring Impella device placement.

Medical and social determinants of health as predictors of adverse outcomes in patients with inflammatory bowel disease.

There is a growing recognition that social determinants of health (SDOH) influence outcomes in patients with chronic diseases. This study aimed to investigate the influence of SDOH on outcomes in patients with inflammatory bowel disease (IBD). We conducted a retrospective cohort study of adult patients with IBD from 1996 to 2019.

Long-term patency of rescue stenting of an anomalous left circumflex coronary artery after transcatheter aortic valve replacement.

Transcatheter aortic valve replacement (TAVR) in the setting of an anomalous left circumflex coronary artery (LCX) has had a variety of outcomes. Most commonly an anomalous LCX originates as a separate ostium arising from the right coronary sinus or is found branching off of the proximal right coronary artery. The artery courses around the aortic annulus before taking the course seen in typical anatomy.

Iatrogenic ventricular septal defects following transcatheter aortic valve implantation.

Ventricular septal defect (VSD) rarely occurs following transcatheter aortic valve implantation (TAVI). We report two patients who developed VSD following TAVI. One case was a Gerbode defect treated by percutaneous closure, and the second was a restrictive perimembranous VSD managed conservatively.

Sagittal mechanical ratio: A novel technique to define sagittal alignment of the femur independent of distal anatomic landmarks.

Background: Radiographic measurements to study sagittal alignment in the setting of knee are frequently difficult to evaluate due the presence of a prosthesis or implant that obscures traditional radiographic landmarks. In this paper we present a novel method of determining sagittal femoral alignment in the presence of obscuring implants.

Methods: 98 full-length femoral radiographs were reviewed and divided into two groups.

An analysis of physician reviews in relation to quality and social media presence.

Press Ganey patient engagement survey scores are used among health care facilities throughout the US to evaluate patients' perception of the quality of care provided. The relation of Press Ganey score to primary quality metrics has not been reported before; thus, we studied it in a cohort of Baylor Scott and White Health primary care physicians. Using simple linear regression, we evaluated Press Ganey scores and compared them with primary care quality metrics associated with improved patient outcomes, including cancer screening, depression screening, blood pressure, and glucose control, in addition to well-child visits.

Dietary supplements and bleeding.

An estimated one-third of US adults use herbal supplements, often without reporting that use to their physicians. These supplements can potentially alter bleeding and coagulation during surgery and when used concomitantly with anticoagulants. Our objective was to provide a comprehensive review of the evidence of bleeding risks of the most popular herbal and dietary supplements.

Dermatomal rash after Shingrix vaccination: cause or coincidence?

Dermatological reactions have been reported following Shingrix vaccine administration in previous published cases, but dermatomal rash after Shingrix vaccination has not been reported in the United States. This case describes a 73-year-old immunocompetent woman with a dermatomal rash after Shingrix recombinant vaccine administration. This case highlights the rare possibility of an acute reaction after Shingrix vaccine administration, which should be recognized.

Optimal cardiovascular medical therapy: current guidelines and new developments.

Coronary artery disease is a leading cause of mortality worldwide, and patients with obstructive coronary artery disease require optimal cardiovascular medical therapy along with lifestyle modification for secondary prevention of future cardiac events. Optimal medical therapy includes antiplatelet agents, high-intensity statins, beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, aldosterone antagonists, and calcium channel blockers. There are differences in the medical therapy guidelines of the American Heart Association/American College of Cardiology and the European Society of Cardiology.

Nonarthroplasty options for massive, irreparable rotator cuff tears have improvement in range of motion and patient-reported outcomes at short-term follow-up: a systematic review.

Purpose: To compare various nonarthroplasty treatment options for massive, irreparable rotator cuff tears, including allograft bridging/augmentation, debridement, partial repair, superior capsule reconstruction (SCR), subacromial balloon spacer, and tendon transfer.

Methods: A comprehensive search was conducted through the PubMed, MEDLINE, and EMBASE databases for all articles pertaining to nonarthroplasty treatment options for irreparable rotator cuff tears. Inclusion criteria included manuscripts published between 2009 and 2020 with at least 1 year follow-up and Level I-IV evidence.

COVID-19-from emerging global threat to ongoing pandemic crisis.

In December 2019, China witnessed the emergence of a novel coronavirus, SARS-CoV-2. Its ability to spread quickly made it a global pandemic. The United States has been greatly affected, with more than 980,000 lives lost so far.