Cutibacterium acnes sternoclavicular joint osteomyelitis in an otherwise healthy 55-year-old man

Sternoclavicular joint osteomyelitis is extremely rare, with only 225 reported cases in the last 45 years. We present an unusual case in an otherwise healthy 55-year-old man with a history of well-controlled type 2 diabetes mellitus and hypertension. He presented to the emergency department after a week of left knee pain that worsened to full-body joint pain with left sternoclavicular swelling. He was started on antibiotics with multiple washouts of the left knee and treated for septic arthritis. By MRI and CT, he was found to have left sternoclavicular joint osteomyelitis and abscess and underwent debridement and resection. We believe that the initial joint injection resulted in haematogenous spread to the left sternoclavicular joint, stressing the importance of a sterile field for joint procedures

Cultural Safety Training for Health Professionals Working with Indigenous Populations in Montreal, Québec

Urban Indigenous populations face some of the most significant barriers to access to health services out of any population in Canada. The Indigenous community in Montreal developed a cultural safety training program to help decrease some of these barriers. An extensive review of published literature on cultural safety in health care was performed. A training program was developed to: describe the diversity of Indigenous populations in Montreal; explain historic and present-day determinants of health inequities in this population; develop competencies to respect clients’ diversity and promote cultural safety in care. A pre-test survey was circulated to participants to establish baseline knowledge and attitudes towards Indigenous populations. The program was divided into 3 half-day sessions. After each session, a satisfaction evaluation grid survey was circulated to participants. The Indigenous Cultural Safety Training Program was presented to a total of 45 nurses, social workers, and physicians with frequent interactions with the Indigenous community in Montréal. Having an Elder and community member present appeared to have been successful in increasing participants level of awareness of the importance of improving the quality of health care services provided. Challenges were identified regarding the transmission of the political aspect of the cultural safety concept, and the importance of decolonizing health care systems. Reflections on how to address these in the future will be discussed. Cultural safety training for health professionals is challenging, yet, a necessity to improve access to care and improve health outcomes in urban Indigenous populations

The seroprevalence of COVID-19 in patients living with HIV in metropolitan Detroit

BACKGROUND: COVID-19, a novel respiratory illness caused by SARS-CoV-2, has become a global pandemic. As of December 2020, 4.8% of the 941 people living with HIV in our Ryan White clinic have tested polymerase chain reaction positive for SARS-CoV-2. The aim of our study was to estimate the seroprevalence of COVID-19 in our Ryan White people living with HIV, irrespective of known past infection. METHODS: We conducted a cross-sectional study that recruited people living with HIV in the Ryan White program at Henry Ford Hospital in Detroit, Michigan, from September 2020 through May 2021. All Ryan White patients were offered participation during clinic visits. After informed consent, patients completed a survey, and had blood sampled for SARS-CoV-2 antibody testing. RESULTS: Of the 529 individuals who completed the written survey, 504 participants were tested for SARS-CoV-2 antibody and 52 people living with HIV were COVID-19 immunoglobulin (Ig) G positive resulting in a seroprevalence of 10.3%. Among 36 persons with PCR-confirmed COVID-19, 52.8% were IgG negative. Inclusion of PCR positive but IgG-negative people living with HIV yields a COVID-19 infection prevalence of 14.1%. CONCLUSIONS: These findings suggest that passive public health-based antibody surveillance in people living with HIV significantly underestimates past infection

Outpatient Antibiotic Prescribing Patterns for Adult End-Stage Renal Disease Patients in New York State

IMPORTANCE: Infections are important complications of end-stage renal disease (ESRD) with few studies having investigated oral antibiotic use. Inappropriate antibiotic prescribing can contribute to multi-drug resistant organisms (MDRO) and Clostridioides difficile (CDI) infections seen in ESRD. This study investigates antibiotic prescribing practices in ESRD across New York State (NYS). METHODS: Retrospective case-control study from 2016 to 2017 of NYS ESRD and non-ESRD patients analyzing Medicare part B billing codes, 7 days before and 3 days after part D claims. Frequencies of each infection, each antibiotic, dosages, and the antibiotics associated with infections were assessed using chi-square analysis. A NYS small dialysis organization comprising approximately 2200 patients was also analyzed. Outcomes measured were the frequencies of infections and of each antibiotic prescribed. Incidence measures included antibiotics/1000 and individuals receiving antibiotics/1000. RESULTS: 48,100 infections were treated in 35,369 ESRD patients and 2,544,443 infections treated in 3,777,314 non-ESRD patients. ESRD patients were younger, male, and African American. ESRD and non-ESRD patients receiving antibiotics was 520.29/1000 and 296.48/1000, respectively (p\u3c0.05). The prescription incidence was 1359.95/1000 ESRD vs 673.61/1000 non-ESRD patients. In 36%, trimethoprim-sulfamethoxazole dosage was elevated by current ESRD guidelines. Top infectious categories included non-specific symptoms, skin, and respiratory for ESRD; and respiratory, nonspecific symptoms, and genitourinary in non-ESRD. CONCLUSIONS: This study Identifies issues with appropriate antibiotic usage stressing the importance of antibiotic education to nephrologist and non-nephrologist providers. It provides support for outpatient antibiotic stewardship programs

A pilot randomized controlled trial of a fruit and vegetable prescription program at a federally qualified health center in low income uncontrolled diabetics

Eating a healthy diet is important for managing diabetes. Although there are high rates of diabetes in low-income urban areas, these patients often have limited access to fruits and vegetables. The 15-week Fresh Prescription (Fresh Rx) program was designed to improve access and consumption of fruits and vegetables among low-income patients with diabetes in Detroit, MI. The purpose of this study was to evaluate the effects of a fruit and vegetable prescription program on changes in hemoglobin A1C (HbA1C), blood pressure (BP), and body mass index (BMI) in patients with diabetes in a randomized controlled trial at a federally qualified health center (FQHC). Patients randomized to the Fresh Rx group (n = 56) were allotted up to $80 ($10 for up to eight weeks) for purchase of produce from a farmers market based at the FQHC. The control group (n = 56) received standard treatment plus information on community resources to improve health. Outcomes were compared at baseline and within three months of program completion. There were no significant between-group differences for any of the outcomes at program completion (p > .05); however, there was a small effect size for HbA1c (partial η2 = 0.02).Within the Fresh Rx group, HbA1c significantly decreased from 9.64% to 9.14% (p = 0.006). However, no changes were noted within the control group (9.38 to 9.41%, p = 0.89). BMI and BP did not change from pre- to post-study in either group (p > .05). Results from this study offer preliminary evidence that produce prescription programs may reduce HbA1C in low-income patients with diabetes