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.

Association of a Patient's Type of Insurance With Preventive Service Delivery.

Introduction Chronic disease or death associated with chronic disease is often avoidable with proper interventions, including preventive services in healthcare settings. However, preventive service delivery rates by physicians are low. This study examined the association between preventive services and the type of patient insurance, as well as the association between the duration of an office visit and the type of patient insurance. Methods A retrospective observational cohort study was conducted using multivariate logistic regression. Pooled data on physician office-based visits from the 2011-2016 and 2018 National Ambulatory Medical Care Survey (NAMCS) were used in this analysis. The main measures observed were the odds of providing preventive services as they related to the type of patient insurance. Preventive measures assessed were those recommended by the United States Preventive Services Task Force with an A or B grade, applicable to most adults 18-64. Additionally, the mean office visit duration was analyzed based on the type of insurance. Results The odds of receiving cervical cancer screenings and tobacco smoking cessation screenings were 47% (p <0.01) and 31% (p =0.10) lower with Medicaid than private insurance, respectively. The odds of receiving blood pressure screenings and cervical cancer screenings were 43% (p =0.01) and 62% (p <0.01) lower in uninsured office visits compared to private insurance, respectively. Compared to private insurance, Medicaid and uninsured visits were 2.68 minutes and 1.97 minutes shorter in duration, respectively (p <0.05). Conclusions An association was found between the type of patient's insurance and the odds of providing preventive services. If the aim of healthcare is to improve the incidence of chronic disease or death associated with chronic disease, preventive services should be provided regardless of insurance type.

Intentional use of topical latanoprost with resulting macular edema to help in the closure of a failed, chronic, macular hole.

Purpose: To report a case where the induction of macular edema with topical latanoprost coupled with in-office gas injection effectively sealed a persistent, chronic, macular hole. Observations: A 70-year-old, pseudophakic, patient presented with a stage three, chronic, macular hole (MH) and vision reduced to 20/200. The symptoms had been present for 18 months. Patient had surgery with pars plana vitrectomy (PPV), complete internal limiting membrane (ILM) peel to the arcades, 30% SF6 gas, and excellent face down positioning for five days. Two weeks after surgery the macular hole failed to close, and the edges of the hole were blunted with very little retinal edema and vision reduced to 20/400. The patient did not want to go back to the operating room. After informed consent, the patient was started on topical latanoprost 0.005% on the operative eye twice a day for six weeks. After latanoprost induction of cystoid macular edema (CME), the patient had 0.7 cc of pure C3F8 injected into the vitreous cavity in the office and was instructed to be face down for five days. Two weeks later the macular hole was closed with vision of 20/80. Last corrected vision eight months later was 20/50. Conclusions and Importance: The findings in this case suggest that induction of CME facilitated the closure of a chronic, persistent, macular hole with a simple gas injection in the office and face down positioning for five days.