Perspectives on Virtual Care for Childhood Cancer Survivors in Non-Metropolitan Areas during the COVID-19 Pandemic.

The COVID-19 pandemic paved the way for the widespread use of virtual care for childhood cancer survivors (CCSs). CCSs were virtual recipients of diverse care, including long-term follow-up (LTFU), primary care, mental health care, and several others. Virtual care comes with well-documented benefits and challenges. These are further magnified for CCSs living in rural or non-metropolitan areas. Here, we describe the virtual care of CCSs from two Upper Midwest cities with well-established childhood cancer survivor programs within large comprehensive cancer centers in the United States. CCSs from non-metropolitan areas, especially CCSs with two or more late effects, used virtual care more often during the COVID-19 pandemic compared to CCSs from metropolitan areas. A review of the related literature is also included and the identified challenges in providing virtual care, such as privacy concerns, technology-connectivity constraints, and medical license restrictions. Despite these limitations, the care of CCSs has evolved to leverage virtual care and its ability to increase access for patients and promote continuity of care for CCSs living in rural areas.

Bilateral nephrolithiasis following ingestion of guaifenesin and dextromethorphan.

Both guaifenesin and dextromethorphan are routinely available nonprescription medications that are also common drugs of abuse amongst young adults. We describe a presentation of guaifenesin and dextromethorphan misuse resulting in acute renal failure due to bilateral nephrolithiasis. The patient underwent placement of bilateral ureteral stents but again formed small renal stones bilaterally. While most renal calculi are not drug-induced, this case highlights the potential for nephrolithiasis after guaifenesin and dextromethorphan ingestion. It suggests that in this combination ingestion multiple mechanisms lead to a prolonged period of nephrolith formation.