Hereditary haemochromatosis discovered after COVID-19 hospitalisation.

COVID-19 infection and hereditary haemochromatosis (HH) have something in common; the disease course can be monitored with ferritin levels. Throughout the pandemic, physicians have looked for markers to help predict disease severity. Ferritin levels are commonly used to predict and monitor disease severity in hospitalised patients with COVID-19. While ferritin is elevated as part of the acute-phase reaction in response to infection, it can also be elevated due to iron overload. We report a case of undiagnosed, asymptomatic HH that was unveiled after COVID-19 infection via monitoring for resolution of ferritin levels that were found to be extremely elevated during a moderate COVID-19 infection. This diagnosis allowed the patient to initiate phlebotomy treatment before symptoms of HH arose.

Why Patients Miss Scheduled Outpatient Appointments at Urban Academic Residency Clinics: A Qualitative Evaluation.

INTRODUCTION: Missed outpatient appointments are a common problem for academic residency clinics, and reducing their rate improves office efficiency, income, and resident education. Identifying specific reasons why some patients miss outpatient appointments may provide insight into developing targeted approaches to reducing their rates. This study sought to find reasons associated with patients' missed appointments at two family medicine residency clinics. METHODS: The study utilized a qualitative research design involving patients at two urban, university-affiliated family medicine residency outpatient clinics. Twenty-five randomly selected patients who were dismissed from the clinics for missing three or more scheduled appointments during a five-year span (July 2012 to July 2017) were interviewed over the phone about reasons they did not keep their scheduled clinic appointments. The authors, individually and as a group, used an immersion-crystalization approach to analyze the content of the interviews. RESULTS: Responses from 25 participants (21 females and four males) are presented. Fifty-two percent of patients were Caucasian, 32% Black, 12% Hispanic, and 4% Asian. Five themes emerged from the data analysis as major reasons the patients missed their scheduled outpatient appointments: forgetfulness, transportation issues, personal health issues, family and employer obligations, and other issues, such as anticipated long clinic wait times, bad weather, and financial problems. CONCLUSIONS: The findings showed there are several logistical, situational, and clinical reasons for patients' missed scheduled outpatient appointments.

Evaluation of Online Consumer Health Information for Idiopathic Scoliosis Identified by a GoogleTM Search.

INTRODUCTION: This study sought to assess the quality of online consumer health information about idiopathic scoliosis. Previous studies showed that quality of online health information varies and often lacks adherence to expert recommendations and guidelines. Nevertheless, 72% of internet users seek health information online. A 2005 analysis of online scoliosis information found that the information was limited and of poor quality. METHODS: Two reviewers vetted the top 10 websites resulting from a GoogleTM search for "scoliosis." Content was organized into categories and rated by three physician evaluators using a 1 - 5 scale based on quality, accuracy, completeness of information, readability, and willingness to recommend. Additional information, such as number of ads and Flesch-Kinkaid reading level, also was collected. RESULTS: The average overall physician score was 47.6 (75 possible). All websites included content that was mostly accurate but varied in completeness. Physicians unanimously recommended Mayo Clinic, MedicineNet, and Kids Health; none recommended the GoogleTM Knowledge Graph. The Scoliosis Research Society website reached the highest overall physician score. Readability ranged from 7th grade to college level; only that of Kids Health was below 10th grade level. CONCLUSIONS: Most essential information provided by the websites was accurate and generally well rated by physicians. Website ranking by physicians was inconsistent with the ranking order by GoogleTM, indicating that health seekers reviewing the top GoogleTM-ranked websites may not be viewing the websites rated highest by physicians. Physicians should consider patient literacy in website recommendations, as many have an above average literacy level.

Hepatitis C: A New Era.

More than 2 million Americans are infected with hepatitis C virus (HCV), and only about half are aware that they are infected. Primarily blood-borne, risk factors for the virus include injection or intranasal drug use, unregulated tattoos, incarceration, and blood transfusion before 1992. In addition, 75% of those with the virus were born between 1945 and 1965, thus making the baby-boomer cohort a population of screening interest. Because acute and early chronic HCV are often asymptomatic, screening of at-risk individuals is of utmost importance. Left untreated, HCV can go on to produce significant hepatic and extrahepatic manifestations.

Status Epilepticus and Blindness in a Patient with Carfilzomib-Associated Posterior Reversible Encephalopathy Syndrome.

Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by headaches, visual disturbances, and seizures. A magnetic resonance imaging (MRI) scan of an affected brain typically shows symmetrical white matter edema in the posterior cerebral hemispheres. The onset of PRES can constitute a medical emergency, especially when accompanied by status epilepticus. If promptly recognized and treated, the clinical syndrome and associated radiological findings are usually resolved in a matter of weeks or months. Carfilzomib is a proteasome inhibitor that is newly approved for relapsing myeloma in a patient who has received one or more lines of therapy. In this paper, we report on a 52-year-old female on carfilzomib for multiple myeloma who developed PRES following her second dose of treatment. She was admitted for chronic obstructive pulmonary disease (COPD) exacerbation, and while she was in the hospital, she developed a severe headache, blindness, and status epilepticus. A brain MRI showed signs consistent with PRES. After carfilzomib was discontinued, her symptoms resolved within three days. Unfortunately, the patient passed away shortly after being discharged, so there was no opportunity to perform a repeat MRI.