Myocarditis Following COVID-19 Vaccination: A Systematic Review of Case Reports.

Introduction: COVID-19, the infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), often presents with a spectrum of symptoms at varying levels of severity, ranging from asymptomatic patients to those with fatal complications, such as myocarditis. With increased availability of COVID-19 vaccines, the awareness of possible side effects has expanded as reports surface. This study reviewed cases of myocarditis following COVID-19 vaccination and with existing literature on COVID-19 infection-induced myocarditis to compare clinical courses and analyze possible mechanisms of action. Methods: A systematic review of literature was conducted to identify published case reports (as of February 3, 2022) pertaining to the development of myocarditis following COVID-19 vaccination with either Pfizer or Moderna for an in-depth analysis. Additional subgroup analyses were conducted based on age, past medical history, vaccine manufacturer, and dose number. Results: There were 53 eligible case reports that were included in this study. Patients were mostly male with a median age of 24 years, and the most reported symptom upon presentation was chest pain. Seventy percent of the cases involved the Pfizer vaccine with a majority of myocarditis developing subsequent to second dose. Resolution of symptoms was achieved in all but one patient. Clinical severity, as measured primarily by left ventricular ejection fraction, appeared to be worse among adult patients than pediatric, as well as for patients with comorbidities. Conclusion: This study revealed an observable association between COVID-19 vaccines and myocarditis. However, the clinical course and prognosis seem favorable and less prevalent than those conferred from natural infection.

Cytokine-Mediated Molecular Pathophysiology of Hidradenitis Suppurativa: A Narrative Review.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory condition of the skin that mainly affects the apocrine gland-rich intertriginous areas. The disease manifests as painful nodules, abscesses, and pus-filled tunnels, which can severely impact patient's quality of life. While diagnosis is clinical, successful treatment options for this condition are limited. There has been an increase in research and clinical trials focusing on biomarkers and cytokines for clinical use. Understanding the potential biomarkers and cytokines implicated in HS pathogenesis may allow efficacious and safe treatment options. Summary: A literature review was conducted on nine biomarkers and cytokines. IL-1, IL-10, IL-17, IL-23, TNF-α, YKL-40, G-CSF, NOD2, and the complement system were identified due to their potential clinical utilization and pathophysiological involvement in HS. Key Messages: With further research expanding our understanding of the pathophysiology of HS and the roles these cytokines and biomarkers play, there is potential for utilization as diagnostic markers or development of antagonists against these specific agents for HS management.

Online video resources pertaining to cerebral palsy: A YouTube-based quality control study.

Aim: To assess the content and quality of YouTube videos related to cerebral palsy to provide insights into the online video resources available for individuals affected by cerebral palsy and suggest strategies for improvement. Methods: YouTube videos were analyzed based on interaction parameters, content characteristics/category, and video source. Video reliability and quality were assessed using the Journal of American Medical Association benchmark, Global Quality Scale, and cerebral palsy-specific score. Statistical analyses examined associations between video characteristics and reliability/quality scores. Results: The average video (n = 48) length was 6.8 min, with 29 informational and 19 experiential videos. The mean Journal of American Medical Association score was 2.0, indicating moderate reliability. The Global Quality Scale suggested good quality content (average: 3.5), but only 14% were rated as good via cerebral palsy-specific score. Higher views were associated with higher Journal of American Medical Association score and cerebral palsy-specific score (p = 0.002 and p = 0.006), and nonphysician medical expert videos had lower Journal of American Medical Association scores than academic videos (p = 0.042). Video content was not significantly associated with either score. Conclusion: YouTube provides moderate to good quality information on cerebral palsy. Critical evaluation of video sources and content is essential. Findings can guide strategies to enhance the quality of cerebral palsy-related YouTube content, benefiting individuals with cerebral palsy, health care providers, and caregivers.

Systematic review of existing literature regarding the prevalence of pediatric atopic dermatitis in Honduras.

Background: Atopic dermatitis (AD) is an inflammatory skin condition, often multifactorial in origin, and most commonly manifests during childhood. Although there remains a deficit in literature, current data suggest Honduras may have the highest prevalence and severity of AD among all Latin American countries. Objective: To assess the current prevalence of pediatric AD in Honduras and evaluate existing gaps in available literature to monitor disease burden. Methods: A comprehensive literature search was performed in March 2023. Articles were removed if they were published before 2007, were of the incorrect study design, or were focused on countries outside of Honduras. The articles were independently reviewed by 2 authors. Results: The initial literature search yielded 174 studies, of which 7 met inclusion criteria. AD prevalence rates in children in Honduras ranged from 0.7% to 40.0%. Limitations: Limitations include elements of study design, analytic methods, study populations, and limited articles. Conclusion: There appears to be a disproportionately higher prevalence and disease burden of pediatric AD in Honduras. Future research should acquire accurate data to further understand the prevalence, incidence, and severity of AD in Honduras.

Phlegmasia cerulea dolens of the upper extremity treated with anticoagulation and leech therapy.

Phlegmasia cerulea dolens is a serious manifestation of venous thrombosis that has a high risk of morbidity and mortality. If not promptly treated on presentation, progressive extremity ischemia and potential gangrene can lead to emergency amputation of the affected limb. Most commonly, the lower extremities are affected, and reports of upper extremity phlegmasia are scarce. We report the successful treatment of phlegmasia cerulea dolens of the distal upper extremity using leech therapy combined with anticoagulation.

Obesity and malnutrition in children and adults: A clinical review.

Background: In the U.S., children and adults are consuming more low-nutrient foods with added sugar and excess fats as compared to healthy, high-quality calories and micronutrients. This diet is increasing the prevalence of malnutrition and nutritional deficiencies, despite high calorie intake. This is a review of the common micronutrient deficiencies, the risk factors for malnutrition, dietary plans, and the health consequences in children and adults with obesity in the U.S. Methods: This clinical review of literature was performed on the MEDLINE (PubMed) search engine. A total of 1391 articles were identified and after review, a total of 130 were found to be most pertinent. Discussion: The most common micronutrient deficiencies found in patients with obesity were vitamin A, thiamine (B1), folate (B9), cobalamin (B12), vitamin D, iron, calcium, and magnesium, especially prior and after bariatric surgery. Diets that produced the most weight reduction also further puts these individuals at risk for worsening malnutrition. Malnutrition and micronutrient deficiencies can worsen health outcomes if not properly managed. Conclusion: Adequate screening and awareness of malnutrition can improve the health outcomes in patients with obesity. Physiologic changes in response to increased adiposity and inadequate intake increase this population's risk of adverse health effects. Malnutrition affects the individual and contributes to worse public health outcomes. The recommendations for screening for malnutrition are not exclusive to individuals undergoing bariatric procedures and can improve the health outcomes of any patient with obesity. However, clearly, improved nutritional status can assist with metabolism and prevent adverse nutritional outcomes post-bariatric surgery. Clinicians should advise on proper nutrition and be aware of diets that worsen deficiencies.

Recurrent Erythema Multiforme Major Following COVID-19 Infection.

Erythema multiforme (EM) is a rare and potentially serious skin condition that can present as a myriad of mucocutaneous lesions. EM can be commonly confused with other cutaneous etiologies, leading to misdiagnosis and delay in proper treatment. This paper describes a case of recurrent erythema multiforme following COVID-19 infection in a 34-year-old male with no prior medical history. The patient had an extensive rash of the oral and genital mucosal areas, diffuse cutaneous involvement, and an extended length of recovery. This unexpected association of EM and COVID-19 provides additional insight into the limited research available regarding the correlation between these two pathologies.

Examining Barriers and Strengthening Community Collaboration as a Means to Increase Exclusive Breastfeeding Rates in Sarasota County, Florida.

Background Maternal and infant benefits of breastfeeding have been established and widely recommended by the American Academy of Pediatrics. However, there is a discrepancy between the number of mothers initiating breastfeeding and those continuing to breastfeed for six months and beyond. In this project, we investigated current breastfeeding practices and barriers to feeding for mothers in Sarasota County, Florida to develop an intervention aimed at increasing the rate of exclusive breastfeeding at six months and beyond. Methodology The PDSA framework was used to develop interventions aimed at increasing breastfeeding rates in Sarasota County. Initially, breastfeeding mothers were administered a survey to understand breastfeeding practices and barriers. Community agencies that supported breastfeeding practices were identified. Based on survey data and feedback, a community breastfeeding conference was organized to improve collaboration and increase breastfeeding rates. Attendees' knowledge and confidence were assessed through a conference pre-test and post-test. Additionally, attendees developed Smart, Measurable, Achievable, Relevant, and Timely goals that were recorded for data collection. Results Of the 28 completed community breastfeeding surveys, the respondents were of Caucasian or Hispanic ethnicity with an average age of 31. The majority of respondents had a goal of breastfeeding for 12 months, but only two participants reported that they continued to exclusively breastfeed to the 12-month mark. A total of 38 individuals from different agencies pre-registered for the conference; of these pre-registrants, 19 individuals checked in for conference attendance, 17 completed the conference pre-test, and 15 completed the conference post-test. Each domain surveyed demonstrated an increase in the values. Conclusions Following our intervention, there is an evident need for improvement in the pipeline of expanding collaboration among breastfeeding community agencies in Sarasota County. Upon completing our community breastfeeding conference, it was shown that this intervention provided both an educational improvement (demonstrated by increased mean domain scores) and a novel platform for providers to network. Our project highlights that strengthening the existing breastfeeding service infrastructure may directly increase exclusive breastfeeding rates at six months and beyond. Future interventions will aim to solidify recurrent infrastructural processes and policies.

Ectopic Pregnancy Observed With Kyleena Intrauterine Device Use: A Case Report.

Kyleena (levonorgestrel 19.5 mg), a type of intrauterine device (IUD), has an efficacy rate of 99% in preventing pregnancy. Because the overall failure rate of IUDs is low, ectopic pregnancy (EP) with IUD use is uncommon. This case reports an EP observed in a female with the Kyleena IUD in place. She had no known risk factors for an EP, which makes this case noteworthy. Ultrasound and surgery confirmed a 4 cm EP in the ampulla of the left fallopian tube. Insufficient evidence exists to conclude whether the Kyleena IUD has a higher risk of EP compared to other hormonal IUDs. As the Kyleena IUD becomes a more popular option for women in search of an effective contraceptive, patients and clinicians should be aware of this potential risk. Our case emphasizes that continued research on the prevalence of EP with Kyleena use is necessary.

Vitamins and Minerals for Blood Pressure Reduction in the General, Normotensive Population: A Systematic Review and Meta-Analysis of Six Supplements.

Hypertension is the leading preventable risk factor for cardiovascular disease and all-cause mortality worldwide. However, studies have shown increased risk of mortality from heart disease and stroke even within the normal blood pressure (BP) range, starting at BPs above 110-115/70-75 mm Hg. Nutraceuticals, such as vitamins and minerals, have been studied extensively for their efficacy in lowering BP and may be of benefit to the general, normotensive population in achieving optimal BP. Our study investigated the effects of six nutraceuticals (Vitamins: C, D, E; Minerals: Calcium, Magnesium, Potassium) on both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in this population. We performed a systematic review and pairwise meta-analysis for all six supplements versus placebo. Calcium and magnesium achieved significant reductions in both SBP and DBP of -1.37/-1.63 mm Hg and -2.79/-1.56 mm Hg, respectively. Vitamin E and potassium only yielded significant reductions in SBP with values of -1.76 mm Hg and -2.10 mm Hg, respectively. Vitamins C and D were not found to significantly lower either SBP or DBP. Future studies should determine optimal dosage and treatment length for these supplements in the general, normotensive population.