Kevin Varghese

Patient education has been transformed using digital media and online repositories which disseminate information with greater efficiency. In dermatology, this transformation has allowed for patients to gain education on common cutaneous conditions and improve health literacy. Xanthelasma palpebrarum is one of the most common cutaneous conditions, yet there is a poor understanding of how digital materials affect health literacy on this condition. Our study aimed to address this paucity of literature utilizing Brief DISCERN, Rothwell’s Classification of Questions, and six readability calculations. The findings of this study indicate a poor-quality profile (Brief DISCERN < 16) regarding digital materials and readability scores which do not meet grade-level recommendations in the United States. This indicates a need to improve the current body of educational materials used by clinicians for diagnosing and managing xanthelasma palpebrarum.

Minocycline is an antibiotic used for several dermatologic conditions, including rosacea. The development of skin, scleral, and nail hyperpigmentation may occur with long-term use of minocycline, and this is associated with no adverse effect on function. We present a case of a 66-year-old male who developed blue-gray hyperpigmentation of his nail beds after treating rosacea with systemic minocycline for over 20 years. The remainder of the physical exam was unremarkable for hyperpigmentation elsewhere. The patient was informed that this was likely an adverse effect of his chronic minocycline use. He insisted upon the continuation of minocycline, so he was counseled on the adverse effects of the medication and scheduled for follow-up.

In downtown Kansas City, patients who face homelessness or unstable housing situations may have been negatively affected by the shutdown of Sojourner Health Clinic (SOJO), a free student-run clinic that provides primary care predominantly to these patients. Research shows that blood pressure (BP) increases within weeks or months of interruption of antihypertensive therapy, especially in patients with advanced age and polypharmacy. Therefore, this study will examine how patients’ blood pressure changed after the closure of Sojourner Health Clinic. The study population consists of Sojourner Health Clinic patients who were seen both before March 2020 (shutdown) and during/after July 2020 (clinic reopening). Participants are selected at random. No additional data is collected outside of routine treatment for this institutional review board (IRB)-exempt project. A study coordinator reviews charts via Sojourner electronic medical record (EMR) and collects the latest BP available before March 2020 and the first BP available during/after July 2020. No identifying information is collected. The mean systolic pressures, mean diastolic pressures, and mean arterial pressures (MAP) are compared via paired t-test for statistical significance. There was a statistically significant decrease in patients’ MAP and diastolic BP after the closure of the clinic. However, there was not a statistically significant change found in patients’ systolic BP. The clinical significance of these results is limited by the minimal magnitude of change. These findings run counter to our expectations since we believed that the closure of Sojourner Health Clinic would correlate with worsened markers of health, such as blood pressure control. It may be possible that the sampled patients turned to other sources for health maintenance and antihypertensive therapy during clinic closure. Future studies could explore these possibilities.