The Effectiveness of Common Interventions in the Management of Sickle Cell Disease in Primary Care Settings: A Review.

Sickle cell disease (SCD), a chronic condition that affects men and women equally, continues to present a public health burden in the United States due to its associated morbidity and complications. Despite advances in medical knowledge and the design of novel therapies for managing the disease, its burden remains compounded because of increasing rates of immigration arising from global displacements and economic unrest in many countries. We thus conducted a comprehensive literature review of publications from 2000 to 2022 to gather guidelines on managing SCD, with a search through four databases, PubMed, Embase, Google Scholar, and Cochrane; 42 articles met the final inclusion criteria after the full-text article screening process. In the United States healthcare system, primary care physicians (PCPs) are generally providers who cater to the lifelong management of chronic medical conditions, SCD not being an exception. While more SCD patients now present to primary care clinics, many PCPs still lack the confidence and adequate experience necessary to manage the condition effectively. The gap created by the shortage of PCPs extensively equipped to provide comprehensive SCD care leads to poor health outcomes for patients. It is imperative now more than ever to continue to raise awareness about this condition at the provider level, to ensure that patients receive well-rounded care to improve their quality of life and clinical outcomes. Providing up-to-date knowledge about existing and novel therapies and/or modalities of SCD treatment would undoubtedly equip the PCPs with self-assurance to manage the condition adeptly. Thus, we explore various public health interventions such as hydroxyurea therapy, pneumococcal vaccination, penicillin therapy, iron chelation therapy, and clinical decision support tools that have been implemented in primary healthcare settings and shown to be effective in improving SCD care. We also discuss recent advancements that can lead to improved outcomes for SCD patients in the future.

Abiraterone-Induced Hypokalemia: A Case Report.

Abiraterone, an androgen biosynthesis inhibitor drug approved by the Food and Drug Administration (FDA) in 2011 for the treatment of metastatic prostate cancer, has seen an increase in prescriptions over the years, owing largely to the aging population and the association of prostate cancer with increasing age. As the rate of abiraterone prescription increases, it is important for physicians to be aware of its adverse effects profile to improve patient outcomes. This case report explains the mechanism, clinical presentation, and management of abiraterone-induced hypokalemia in a 67-year-old male with prostate cancer and highlights the importance of close monitoring and management of electrolyte levels for patients on abiraterone.

Thoracic Aortic Rupture Post Cardiopulmonary Resuscitation in a Patient With Previous Thoracic Aneurysm Repair.

Aortic dissection is characterized by a tear or rupture in the intimal layer of the aorta causing blood to flow between the layers of the arterial wall, thus separating them. While cardiopulmonary resuscitation (CPR) is a life-saving intervention, it can unintentionally contribute to the development or worsening of aortic dissection. The forceful chest compressions involved in CPR can put significant pressure on the fragile aortic wall, potentially leading to a tear or rupture. This highlights the delicate balance between life-saving measures and the potential risks they carry. Though studies have been done on the effects of CPR on the thoracic wall, few reports have studied the effects on the structures that lie in the thoracic cavity. The authors present a 63-year-old with a history of thoracic aneurysm repair who experienced a cardiac arrest while choking on food at home. The patient received CPR and a CT scan done thereafter revealed thoracic dissection and rupture. The patient received medical management in the Intensive Care Unit but eventually expired due to irreversible neurological damage. This highlights the importance of recognizing that CPR can pose a risk for aortic dissection and rupture, particularly in individuals with prior aortic repairs. It emphasizes the need for developing protocols to monitor patients who have undergone aneurysmal repair and adjusting CPR techniques to suit their specific needs. Additionally, further studies are needed to understand how often aortic complications occur after CPR and to provide guidance for follow-up care in patients who have had aortic repairs. By implementing these measures, we can improve outcomes and safety during resuscitation.