Frequent Monitoring of Blood Glucose Levels via a Remote Patient Monitoring System Helps Improve Glycemic Control.

OBJECTIVE: This study aimed to evaluate the effectiveness of the Vivovitals diabetes platform in improving glycemic control and reducing hemoglobin A1c (HbA1c) levels in patients with uncontrolled type 2 diabetes mellitus by providing more accessible and direct patient care under the monitoring and oversight of their physician. METHODS: This 12-week, prospective, pragmatic, single-center, double-arm study assessed the impact of the Vivovitals diabetes platform on glycemic control in 78 adults aged ≥18 years with HbA1c levels of ≥7.5% (58 mmol/mol) at baseline. The participants were randomized into 2 groups. The control group received usual clinical care, whereas the intervention group was provided with a smartphone-linked telehealth application, a preconfigured glucometer, and access to a glycemic reading diary. The blood glucose levels of the intervention group were transmitted to the providers daily. Patients whose blood glucose level was <70 mg/dL or >180mg/dL were contacted, and modifications were made to their diet and medication. The 2 groups were compared at the baseline and at 12 weeks using nonparametric tests, with P <.05 considered statistically significant. RESULTS: Over 12 weeks, the average HbA1c level in the control group reduced by 0.474% (P = .533; 95% CI, -0.425 to -0.523), whereas the average HbA1c level in the intervention group reduced by 1.70% (P = .002; 95% CI, -1.02 to -2.39). The estimated treatment difference was expressed using Cohen d, which yielded 0.62. After 12 weeks, the HbA1c values between the control and intervention groups were statistically significant (P = .001). CONCLUSION: The use of the Vivovitals platform may help to improve glycemic control among individuals with type 2 diabetes mellitus.

The Dilemma of Use of Anticoagulation in Patients With Heart Failure With Reduced Ejection Fraction and Sinus Rhythm: A Case Report and Literature Review.

Heart failure results in significant morbidity and mortality. Heart failure with reduced ejection fraction (HfrEF) in the absence of atrial fibrillation has been increasingly considered an independent risk factor for ischemic stroke, partly because of the development of left ventricular thrombus and subsequent cardioembolic stroke and partly because of hemodynamic impairment. Here, we present a case of a 60-year-old male with heart failure with reduced ejection fraction, who presented with cardioembolic ischemic stroke. In the investigation to localize the source, he was found to have slow intra-ventricular blood flow, which over shorter periods of follow up lead to the development of left ventricle intra-mural thrombi. Meanwhile, the patient also developed hemorrhagic conversion in the ischemic stroke, which further complicated the choice of anticoagulation. To date, no consensus has been developed on the choice of anticoagulation and clinical criteria for the use of anticoagulation in patients having HfrEF and sinus rhythm. This case brings forth a need for further research on whether anticoagulation would be beneficial in patients with HfrEF and sinus rhythm.

An Unusual Case of Schwann Cell Hamartoma in Colon.

Schwann cell tumors are benign tumors originating from Schwann cells of the peripheral nervous system and are extremely rare in the gastrointestinal system. They usually originate in the colon or rectum but can also occur in the esophagus and small intestine. Their occurrence is rare in GI tract and mainly in the sigmoid colon. Schwann cell tumors have no association with any familial cancer syndromes. We present a 65-year-old female patient who underwent routine colon cancer screening. In addition to open mouth diverticulosis, she was found to have a 3 mm polyp, which was diagnosed as a Schwann cell hamartoma after a biopsy. This study aimed to present this rarely reported case in the literature as an example of a tumor that should be included in the differential diagnosis when considering submucosal colonic lesions. Though the reported reoccurrence rate is low, this case highlights the lack of published guidelines regarding appropriate follow-up surveillance periods.

Torsades De Pointes in a 71-Year-Old Female With Normal Qt Interval After Azithromycin Use.

A 71-year-old female visiting from Colombia presented to the emergency room with a productive cough, subjective fever, and chills for the past three days. Baseline EKG demonstrated a QT interval of 385 milliseconds with left ventricular hypertrophy and T wave inversions in leads V4, V5, and V6. Azithromycin was administered, and she was subsequently found to have torsades de pointes (TdP) on telemetry. In high-risk individuals, medications with reduced effects on cardiac conduction should be considered to avoid potentially lethal reactions. This case highlights the importance of clinical history prior to the administration of medications that have a propensity to cause abnormalities in cardiac conduction. Our patient had a grossly normal QT interval prior to the administration of azithromycin; however, she subsequently developed torsades de pointes. The patient was on telemetry monitoring, and cardiopulmonary resuscitation was quickly initiated as she was in a hospitalized setting; however, in an outpatient community setting, she likely would not have survived. By examining all the elements which contribute to QT prolongation, clinicians can have a deeper understanding of the complexities, particularly in individuals with multiple co-morbid conditions prior to the administration of medications that have a propensity to affect the QT interval.

Polyarticular Sepsis Secondary to Staphylococcus aureus Bacteremia Post-acute Hemodialysis: A Case Report.

Polyarticular septic arthritis (PASA) is less common than monoarticular septic arthritis (MASA). There is a low incidence of PASA in immunocompetent patients. This case report describes the development of PASA after hemodialysis through the permcath after a single session.

Hypertension in the Setting of Hypertrophic Obstructive Cardiomyopathy and Cocaine Use.

Hypertrophic obstructive cardiomyopathy (HOCM) is most commonly an inherited genetic condition where hypertension can be challenging to treat as many antihypertensive medications cannot be used in this patient population. Any agent that decreases preload or afterload should be avoided in this condition, leaving beta-adrenergic receptor antagonists as the preferred agent of choice in these patients. However, a patient with HOCM and cocaine use can pose a significant challenge due to the risks associated with initiating beta-adrenergic receptor antagonists in cocaine users because of the unopposed alpha receptor effect of the treatment, which would in turn cause worsening hypertension. The fact that cocaine itself causes hypertension further complicates the issue. The only remaining class of medications that can be used are non-dihydropyridine calcium channel blockers, which may not be effective on their own against the vasoconstrictive properties of cocaine. Hence, it is paramount to educate all patients with HOCM to avoid cocaine use even more so than other patients.

Effects of Interferon Beta in COVID-19 adult patients: Systematic Review.

BACKGROUND: The high rate of transmission and infection of coronavirus disease 2019 (COVID-19) is a public health emergency of major epidemiological concern. No definitive treatments have been established, and vaccinations have only recently begun. We aim to review the efficacy and safety of Interferon Beta (IFN-ß) in patients who have a confirmed COVID-19 diagnosis. MATERIALS AND METHODS: A search from PubMed, Science Direct, Cochrane, and Clinicaltrials.gov databases were conducted from December 2019 to December 2020 to review the efficacy and safety of IFN-ß in adult patients with COVID-19 confirmed. We included randomized controlled trials, case reports, and experimental studies. Correspondences, letters, editorials, reviews, commentaries, case control, cross-sectional, and cohort studies that did not include any new clinical data were excluded. RESULTS: Of the 66 searched studies, 8 were included in our review. These studies demonstrated that although IFN-ß did not reduce the time to clinical response, there was an increase in discharge rate at day 14 and a decrease in mortality at day 28. The time to negative reverse transcription polymerase chain reaction (RT-PCR) was shown to be significantly shortened in patients receiving IFN-ß, along with a lower nasopharyngeal viral load. Further, patients receiving IFN-ß had a less significant rise in IL-6. IFN-ß was shown to decrease intensive care unit (ICU) admission rate, the requirement of invasive ventilation in severe cases, and improve the survival rate compared to control groups. There were no severe adverse events reported. Our review found that patients who received early treatment with IFN-ß experienced significantly reduced length of hospitalization, mortality, ICU admission, and mechanical ventilation. A greater chance of clinical improvement and improved imaging studies was noted in patients who received IFN-ß. There were no reported deaths associated with the addition of IFN-ß. Further randomized trials involving more significant sample sizes are needed to better understand the effect of IFN-ß on survival in COVID-19. CONCLUSION: This review identified encouraging data and outcomes of incorporating IFN-ß to treat COVID-19 patients. IFN-ß has been shown to decrease hospital stay's overall length and decrease the severity of respiratory symptoms when added to the standard of care. Also, in some studies, it has been demonstrated to reduce the length of ICU stay, enhance survival rate, and decrease the need for invasive mechanical ventilation. There were minor side effects reported (neuropsychiatric symptoms and hypersensitivity reaction). However, randomized clinical trials with a large sample size are needed to assess IFN-ß's benefit precisely.