Administration of Tranexamic Acid as Treatment for Angiotensin Converting Enzyme Inhibitor-Induced Angioedema: A Case Report

<b>Background</b> Angiotensin converting enzyme inhibitor-induced angioedema is a major cause of angioedema-related hospitalizations each year. Common swelling predilection sites include the face, periorbital skin, lips, pharynx, larynx, and tongue. Involvement of airway structures could lead to airway obstruction and ultimately death if not treated promptly. A 62-year-old man presented to a rural clinic with a massively swollen tongue that obscured visualization of the retropharynx and mildly swollen lips. The patient stated that he had been taking lisinopril for many years and never had a swelling episode similar to this. The patient was initially administered epinephrine, antihistamine, steroids, and Tranexamic acid. A second dose of Tranexamic acid was administered 30 min later followed by close monitoring. Seven hours after the first administration, the patient had near-complete resolution of tongue swelling and was later discharged. Angioedema treatment is still variable and hospitals in different settings may be able to take advantage of available resources for treatment. Tranexamic acid is a cheap and widely available antifibrinolytic that may be used to treat angiotensin converting enzyme inhibitor-induced angioedema, especially if more specific therapeutics are unavailable.

An Evolutionary Approach for the Enhancement of Dermatological Images and Their Classification Using Deep Learning Models

Dermatological problems are the most widely spread skin diseases amongst human beings. They can be infectious, chronic, and sometimes may also lead to serious health problems such as skin cancer. Generally, rural area clinics lack trained dermatologists and mostly rely on the analysis of remotely accessible experts through mobile-based networks for sharing the images and other related information. Under such circumstances, poor image quality introduced due to the capturing device results in misleading diagnosis. Here, a genetic-algorithm- (GA-) based approach used as an image enhancement technique has been explored to improve the low quality of the dermatological images received from the rural clinic. The diagnosis is performed on the enhanced images using convolutional neural network (CNN) classifier for the identification of the diseases. The scope of this paper is limited to only motion blurred images, which is the most prevalent problem in capturing of the images, specifically when any of the two (device or the object) may move unpredictably. Seven types of skin diseases, namely, melanoma, melanocytic nevus, basal cell carcinoma, actinic keratosis, benign keratosis, vascular lesion, and squamous cell carcinoma, have been investigated using ResNet-152 giving an overall accuracy of 87.40% for the blurred images. Use of GA-enhanced images increased the accuracy to 95.85%. The results were further analyzed using a confusion matrix and t-test-based statistical investigations. The advantage of the proposed technique is that it reduces the analysis time and errors due to manual diagnosis. Furthermore, speedy and reliable diagnosis at the earliest stage reduces the risk of developing more severe skin problems.

Characteristics of Neonatal Abstinence Syndrome (NAS) in a rural clinic population: Tracking with Electronic Medical Health Records (EHR)

PurposeThe impact of intrauterine exposure of opioids and other addictive substances on pediatric patients is concerning for health care providers in rural WV. NAS patients must be identified, screened, and treated during the pediatric years to facilitate improved outcomes. The purpose of this research was to evaluate the ability of rural providers to use EHRs to identify, describe, and monitor aspects of NAS across the pediatric health span. MethodsThe research team used de-identified data of patients that had the NAS diagnosis from a rural clinic. One hundred fifty-five charts were evaluated. Demographics, clinical characteristics, and developmental milestone status were extracted from charts. ResultsThere were differences in characteristics across age groups. Reported secondhand smoke was higher among the 0-3 year olds. Normal BMI percentile was highest among 4-5 year olds. The Ages and Stages Developmental screening was abnormal more in those aged 6-19 years. Foster care was highest among the ages 0-3 years. The 4-12 age groups highest amount of no show visits. Respiratory illness was the most frequent diagnosis and was highest in the 4-5 age group. Eye and ear diagnosis were noted as a recurrent diagnosis in the 4-5 year old group. Diagnosis related to mental health were highest in the 6-18 age group. DiscussionThe EHR can be used to describe and track special populations such as NAS in rural areas. Tagging and tacking patients with NAS can help primary care providers manage care and anticipate age related health care needs. Tracking high risk populations assures that the patient care is maintained. Tracking no show rates assists providers in assuring that patient’s caregivers are compliant in necessary treatments and referrals. Child Protection can also be involved if medical neglect is noted. EHRs are useful in identifying high risk populations such as NAS to facilitate treatments and continuity of care. DOI: http://doi.org/10.14574/ojrnhc.v20i2.625

Prevalence and Factors Associated With Liver Fibrosis Among Adult HIV-Infected Patients Attending Urban and Rural Care Clinics in Uganda

Background Liver fibrosis is common among HIV-infected patients. Risk factors vary by location. Understanding this variation may inform prevention strategies. We compared the prevalence and correlates of liver fibrosis among HIV-infected patients attending care clinics in Uganda. Methods This was a cross-sectional study involving 2030 HIV-infected patients attending care clinics in urban and rural Uganda. Liver fibrosis was defined as liver stiffness measurement (LSM) &gt;7.1 KPa. Proportions and correlates of liver fibrosis were assessed and compared using logistic regression stratified by gender and site. Results Prevalence of liver fibrosis was higher among participants in the rural clinic (15% vs 11%; P = .017). History of tobacco use (urban P = .022; rural P = .035) and serologic evidence of hepatitis C infection (HCV; urban P = .028; rural P = .03) was associated with liver fibrosis in all men. Elevated liver transaminases (urban P = .002; rural P = .028) and increasing age (urban P = .008; rural P = .052) were risk factors among all women. Tobacco use among women was only a risk factor in those attending the rural clinic (P = .003), and detectable HIV viral load (P = .002) for men in the urban clinic. Conclusions Liver fibrosis is prevalent among HIV-infected persons in Uganda. HIV viral suppression and avoiding tobacco may be strategies to prevent liver fibrosis and cancer risk.

Evaluation of a clinical pharmacist team-based telehealth intervention in a rural clinic setting: a pilot study of feasibility, organizational perceptions, and return on investment

Background Remote, centralized clinical pharmacist services provided by board-certified clinical pharmacists have been shown to effectively assist in chronic disease management. We assess the feasibility of implementing a pharmacist-led, remote, centralized pharmacy service to improve A1c levels in patient with diabetes in a rural clinic setting. Methods This was a non-randomized pilot and feasibility study. Participants were enrolled in a pharmacist-led telehealth intervention service, with data prior to enrollment used as baseline data for control. To be included, patients needed to have A1c readings of greater than 7% to be considered uncontrolled. A1c changes were reported for two groups based on A1c ranges: between 7 and 10% and ≥ 10%. Clinical pharmacists and clinical pharmacy interns initiated contact with patients via telephone communication and managed the patients remotely. The following outcomes were evaluated: organization perceptions (patients, providers, and clinic staff), changes in A1c, medication discrepancies, impact of an internally operated Patient Assistance Program, and potential return on investment (ROI). Results Fifty-two patients were initially identified and referred to the service with 43 patients consenting to participate in the intervention. Patient and provider survey responses were recorded. In the initial analysis occurring during the first 3 to 5 months of the program, there was considerable improvement in diabetes control as measured by A1c. For patients with uncontrolled diabetes with a baseline A1c > 7% but less than < 10% and ≥ 10%, the intervention resulted in an A1c decrease of 0.57% and 2.55%, respectively. Clinical pharmacists and clinical pharmacy interns identified at least one medication discrepancy in 44% of patients, with number of discrepancies ranging from 1 to 5 per patient. At the conclusion of the study window, 42 potentially billable encounters were documented, which would have generated a net profit of $1140 USD, had they been submitted for reimbursement. Given the potential revenue generation, the service theoretically yields a ROI of 1.4 to 1. Conclusions Initial results suggest that a pharmacist-led telehealth intervention has potential to decrease A1c levels in patients with diabetes, assist in identification of medication discrepancies, provide a positive return on investment for rural clinics, and potentially increase reimbursement for providers and clinics tasked with managing patients with uncontrolled diabetes.