Transient Hypoglossal and Lingual Nerve Injury Following the Use of I-gel Supraglottic Airway: A Case Report.

Injury to the hypoglossal and/or lingual nerve is a rare occurrence with the use of a laryngeal mask airway (LMA) or supraglottic airway (SGA) device. There has been one prior report of a lingual and hypoglossal nerve injury with the i-gel™ SGA. We are describing the second reported hypoglossal and lingual transient nerve injury in a male patient while using an i-gel™ SGA.

Asundexian: an oral small molecule factor XIa inhibitor for the treatment of thrombotic disorders.

Oral anticoagulants, including warfarin and direct oral anticoagulants, are the standard of care for thrombosis prevention and treatment; however, concerns of bleeding often dictate treatment decisions. Inhibition of the intrinsic coagulation system via factor XIa may allow for selective inhibition of the coagulation cascade without significantly impacting hemostasis after injury. Asundexian is an oral small molecule factor XIa inhibitor that, via this novel mechanism, may prove to be a safe and effective option compared with available anticoagulants.

DEA-registered clinical pharmacist practitioners: Progressing practice to increase patient care access.

Purpose: This descriptive review aims to describe the impact of controlled substance prescriptive authority (CSPA) among Drug Enforcement Administration (DEA)-registered clinical pharmacist practitioners (pharmacists) within the Veterans Health Administration (VA). The practice perspectives of pharmacists with CSPA are also reviewed. A 3-part methodology included identification and query of DEA-registered pharmacists, practice impact data analysis, and time and motion prescribing analysis.

Correction: Adenocarcinoma Arising From a Cervical Esophageal Inlet Patch: The Malignant Potential of a Small Lesion.

[This corrects the article DOI: 10.7759/cureus.9284.

The 13-year bleed: Exuberant amyloid angiopathies, angiodysplasias, and acquired coagulopathies of the gut.

Amyloidosis is a disorder characterized by extracellular deposits of proteins that are prone to aggregate and form insoluble fibrils. Amyloid deposits limited to a single organ or tissue without the involvement of any other site in the body is uncommon. We report a 75-year-old man with previously treated non-Hodgkin's lymphoma who presented with recurrent gastrointestinal hemorrhage.

Hiccups: You got to be kidney me!

Hiccups are usually benign processes that most people experience with spontaneous resolution. However, persistent hiccups with a duration greater than 48 h may prompt a thorough workup for structural, infectious, or inflammatory disorders. Moreover, toxic-metabolic states, including renal dysfunction and/or uremia, have also been identified as sources of hiccups.

Correction to: Review of Transthyretin Silencers, Stabilizers, and Fibril Removal Agents in the Treatment of Transthyretin Cardiac Amyloid.

On page 2 of the original publication, in the section on TTR Silencers dosing of patisiran in the APOLLO study was stated as being given every 3 months; this is inaccurate as patisiran was dosed every 3 weeks in the APOLLO study.

Retreatment of Hepatitis C Infection With Direct-Acting Antivirals.

Background: Treatment of hepatitis C virus (HCV) infection with direct-acting antivirals (DAAs) results in sustained virologic response (SVR) in > 90% of patients. However, some patients required retreatment with newer DAA options. Treatment was selected after consultation with a clinical pharmacy specialist.

Adenocarcinoma Arising From a Cervical Esophageal Inlet Patch: The Malignant Potential of a Small Lesion.

Inlet patches (IP) are heterotopic lesions consisting of gastric mucosa. Commonly located in the cervical esophagus, it is believed that they are remnants of fetal columnar epithelium arising from incomplete replacement during embryogenesis. A rare complication of IP is the development of proximal esophageal adenocarcinoma.

Review of Transthyretin Silencers, Stabilizers, and Fibril Removal Agents in the Treatment of Transthyretin Cardiac Amyloid.

Purpose Of Review: To provide a functional review for practicing clinicians on the current and emerging treatment considerations for transthyretin (TTR) cardiac amyloidosis (ATTR-CA).

Recent Findings: Current treatment considerations are characterized as those silencing TTR translation, stabilizing TTR tetramers, and disrupting amyloid fibril deposition. Historically considered a rare disease state, ATTR-CA is increasingly recognized as an important mediator of heart failure morbidity and mortality.

Managing Cancer Pain, Monitoring for Cancer Recurrence, and Mitigating Risk of Opioid Use Disorders: A Team-Based, Interdisciplinary Approach to Cancer Survivorship.

Palliative care (PC) teams increasingly care for patients with cancer into survivorship. Cancer survivorship transcends distinctions between acute, chronic, malignant, and nonmalignant pain. Partnering with oncologists, PC teams manage pain that persists after disease-directed treatment, evaluate changing symptoms as possible signs of cancer recurrence, taper opioids and mitigate risk of opioid misuse, and manage comorbid opioid use disorder (OUD).

Mucobilia: An Unusual Cause of Persistent Jaundice.

Mucobilia is defined as the abnormal secretion of copious amounts of mucus from within the bile ducts, manifesting as obstructive jaundice or cholangitis. A spectrum of mucin-producing hepatobiliary and pancreatic neoplasms have been associated with mucobilia. We report the case of a 63-year-old male with an intestinal type of intraductal papillary neoplasm of the intrahepatic bile duct.

Evaluation of Interventions by Clinical Pharmacy Specialists in Cardiology at a VA Ambulatory Cardiology Clinic.

Integration of CPSs into an ambulatory cardiology clinic may translate to cost avoidance and a reduction in workload burden for other cardiology health care providers.

Implementation and evaluation of Parkinson disease management in an outpatient clinical pharmacist-run neurology telephone clinic.

Parkinson disease (PD) is a progressive, debilitating neurodegenerative disease that often requires complex pharmacologic treatment regimens. Prior to this clinic, there was no involvement of a clinical pharmacy specialist (CPS) in the outpatient neurology clinic at the West Palm Beach Veterans Affairs Medical Center. This was a prospective, quality-improvement project to develop a clinical pharmacist-run neurology telephone clinic and evaluate pharmacologic and nonpharmacologic interventions in an effort to improve the quality of care for patients with PD.

Implementation and evaluation of an opioid overdose education and naloxone distribution (OEND) program at a Veterans Affairs Medical Center.

Background: In recognition of the importance of safe and effective pain management, the Department of Veterans Affairs and the Office of the Under Secretary for Health have encouraged implementation of opioid overdose education and naloxone distribution (OEND) programs at Veterans Affairs Medical Centers (VAMCs).

Methods: An OEND program was developed in August 2015 and implemented in September 2015 at a VAMC which allowed for pharmacist-lead individual and group patient education. An OEND consult service was developed to streamline referrals of patients for naloxone education and distribution.

Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients.

Prophylaxis for venous thromboembolism (VTE) in hospitalized acutely ill medical patients is a well-established practice. Despite the increased use of inpatient prophylaxis, the duration of hospitalization is typically shorter than the duration of VTE prophylaxis provided in clinical trials. In addition, VTE events after hospitalization are not unusual, with most events occurring within 30 days of hospital discharge.

Ultrafiltration versus intravenous loop diuretics in patients with acute decompensated heart failure: a meta-analysis of clinical trials.

Background Intravenous loop diuretics are the first-line therapy for acute decompensated heart failure (ADHF) but many patients are discharged with unresolved congestion resulting in higher re-hospitalization and mortality rates. Ultrafiltration (UF) is a promising intervention for ADHF. However, studies comparing UF to diuretics have been inconsistent in their clinical outcomes.

Integration of a Clinical Pharmacist into an Interdisciplinary Palliative Care Outpatient Clinic.

Objectives: The primary objective of this quality improvement (QI) project was to determine if the Interdisciplinary Palliative Care Outpatient Clinic (IPCOC) at the West Palm Beach Veterans Affairs Medical Center offered improved symptom assessment and palliative care treatment outcomes. Secondary objectives were to identify, classify, and resolve medication problems and calculate the number of pharmacist recommendations accepted by prescribing providers.

Methods: An IPCOC was created by selecting disciplines for a core group including a nurse practitioner, clinical pharmacist, social worker, chaplain, and physician.

Implementation and evaluation of a pharmacist-run mental health treatment clinic via clinical video telehealth.

Introduction: The Veterans Health Administration is extending its mental health services to reach those in rural areas who find it difficult to travel to a Veterans Affairs Medical Center (VAMC). This project aimed to outline implementation of a Pharmacy Mental Health Clinical Video Telehealth (MHCVT) clinic for veterans. Secondary endpoints were to assess patient satisfaction with MHCVT, describe the potential benefits of this clinic regarding travel saved, and summarize no-show rates.