Asymptomatic trigger of adrenal crisis in a patient with Sheehan syndrome: importance of timely recognition and intervention.

Our patient is a female in her 70s who initially presented following an episode of bowel and bladder incontinence, as well as unresponsiveness. Her family denied any preceding illness or sick symptoms. During her workup, it was noted that she was wearing a medical bracelet, which listed prednisone as one of her daily medications, raising concern for an acute adrenal crisis (AC). Ultimately, our patient's condition improved with high-dose intravenous steroids before being tapered to her home regimen. Current literature highlights the pathophysiological complexity of an AC but fails to identify clear risk factors that trigger such events, especially in asymptomatic patients. Accordingly, our case highlights this gap, arguing the importance of appropriate patient education and timely intervention for such clinically ambiguous yet life-threatening presentations.

Knowledge and willingness to use pre-exposure prophylaxis among men who have sex with men in Northeastern Brazil.

Few studies evaluate knowledge and willingness to use pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in middle-income countries. Brazil added PrEP to public drug formularies in December 2017, but little is known about local knowledge and attitudes about PrEP among MSM outside metropolitan areas in Southern Brazil. The cross-sectional HIV Surveillance Survey Project in Brazil estimates HIV and STD prevalence among MSM in 12 state capitals. Among 32 participants at the Salvador, Bahia study site, we used qualitative interviews to assess knowledge, willingness, and barriers to PrEP use among MSM; few MSM had previous knowledge of PrEP and were willing to use PrEP. Clinical, behavioural, social, and structural factors influencing participants' knowledge and willingness to take PrEP included concerns about efficacy and side effects, access to culturally congruent services for MSM, and stigma. Some participants reported that learning about PrEP online positively influenced their willingness to use PrEP. Participants' opinions about PrEP's contribution to risk compensation varied. Interventions to provide culturally congruent care and destigmatise PrEP for MSM at high risk for HIV acquisition, particularly those conducted collaboratively with Brazil's civil society movement, may enhance the public health effort to expand access to PrEP in Brazil.

Successful Fetal Tele-Echo at a Small Regional Hospital.

BACKGROUND: Prenatal diagnosis of complex congenital heart disease (CHD) has been shown to improve newborn outcomes. The rate of prenatal diagnosis and access to fetal echocardiography vary widely across the United States. INTRODUCTION: A clinical fetal tele-echo service was established at King's Daughters Medical Center (KDMC) in Ashland, KY, a region in eastern Kentucky that is 3 h from the nearest congenital heart surgeon. The aim of this study was to determine if fetal tele-echo utilizing local sonographers at a small regional hospital can accurately and efficiently identify fetuses with complex CHD. METHODS: Medical records were reviewed for all mother-infant pairs who had fetal tele-echoes performed at KDMC and interpreted by University of Louisville pediatric cardiology between March 2011 and December 2013. Findings on fetal tele-echo were compared to newborn echo and clinical course, and divided into four groups: (1) Correct-no difference between fetal tele-echo and newborn echo, (2) Likely Correct-normal fetal tele-echo and benign newborn course, (3) Major Difference-one that affected newborn clinical course, and (4) Minor Difference-did not affect clinical course. RESULTS: Seventy-five mother-infant pairs were analyzed. Fetal tele-echoes were Correct in 21%, Likely Correct in 56%, showed Major Differences in 0%, and showed Minor Differences in 23%. For identifying complex CHD, fetal tele-echo had a sensitivity and specificity of 100%. The average number of fetal echocardiograms per mother-infant pair was 1.1. DISCUSSION: Fetal tele-echocardiography performed by local sonographers at a small regional hospital can accurately and efficiently identify fetuses with complex CHD.