Many health care providers adopted telehealth during the coronavirus disease 2019 pandemic. This unprecedented transformation in medical practice posed challenges to both physicians and patients. However, little is known about the adaptation of attendings, residents, and patients to this new normal. Thus, a survey was sent out to investigate the feedback of both physicians and patients on telehealth. MethodsSurveys were administered via phone call to patients and electronic survey to physicians at an internal medicine resident clinic in one tertiary community hospital from April to June 2020. Demographic information and assessment of overall experience, satisfaction, and concerns of telehealth were collected. Statistical analyses were performed to compare feedback between patients and physicians. ResultsFifty patients and 45 physicians participated in the study. Eighty-four percent of patients were first-or second-time users, and 50% of patients were older than 60 years. Eighty-four percent of patients were very or extremely satisfied with telehealth, while 72% wanted to continue telehealth in the future. Ninety-four percent of patients believed that their concerns were adequately addressed, but 14% experiencing technical issues. Physicians' feedback to telehealth was less positive than the patients'. More than 60% of physicians experienced technical issues, and nearly 60% of physicians were neutral or not satisfied with telehealth. Nearly 50% of physicians had difficulty transitioning to telehealth, while only 29% believed that their patients' complaints were adequately addressed. Most physicians had to schedule in-person visits after telehealth. Patients were more satisfied with telehealth than physicians (84% vs. 42%; p<0.001) and were more likely to believe that their concerns were properly addressed by telehealth (94% vs. 29%; p<0.001). ConclusionThis survey revealed that patients were more satisfied with telehealth than physicians. Further research with a larger sample should be considered to confirm this conclusion, and subjective studies are needed to determine the imbalance of satisfaction.

Pyoderma gangrenosum (PG) is a rare non-infectious skin disease of undetermined origin. It is characterized by a single or multiple painful, necrotic ulcers. Formerly, PG was assumed to be infectious, but eventually, it was established to be an inflammatory disorder that is commonly associated with autoimmune and neoplastic diseases. We report a case of PG in a 70-year-old female who presented on the pretibial area as a single non-healing ulcer. It started as a small induration that worsened over the course of two weeks despite being on antibiotics. We started the patient on corticosteroids and high potency topical steroids that resulted in healing of the ulcer. PG can prove to be a diagnostic dilemma and can be inappropriately treated with antibiotics or even something radical like an amputation if misdiagnosed. Hence, physicians need to think of this entity even in the absence of any predisposing conditions.

Patients taking tacrolimus have an increased predisposition to hyperuricemia. Although literature has widely established the risk of gout in patients taking cyclosporine, the widespread use of tacrolimus in patients following liver transplantation necessitates further investigation into the potential connection between the drug’s use and gout. Moreover, hyperuricemia in the context of liver transplants is associated with increased morbidities and mortalities. We describe a case of gout in a liver transplant patient taking the calcineurin inhibitor tacrolimus.

A 70-year-old man with history of metastatic well-differentiated neuroendocrine carcinoma was presented to the hospital with a painful left lower extremity ulcer which started around 3 months prior to presentation. He was treated with antibiotics for cellulitis on multiple occasions with no improvement in his symptoms. On initial laboratory evaluation, he was found to have acute kidney injury and a normal calcium level. The patient underwent a skin biopsy and was found to have cellulitis and calciphylaxis of small-sized and medium-sized vessels. Since the patient did not have any underlying risk factors of calciphylaxis, the most likely cause of his calciphylaxis was thought to be his underlying malignancy. Physicians should keep this differential in mind while treating non-healing ulcers in such patients since they are at higher risk of superimposed infections and usually require aggressive wound care.

Urinothorax is a rare cause of pleural effusion, which is seen in patients with obstructive uropathy, blunt trauma, or ureteric injury during abdominal surgical procedures. Clinical symptoms may include dyspnea, chest pain, cough, fever, abdominal pain, and decreased urine output. Diagnosis is made by thoracentesis, which would reveal fluid with a urine-like odor, and pleural fluid analysis, which would show if fluid is transudative in nature with a pH lower than 7.30. Pleural fluid to serum creatine ratio of more than 1 is diagnostic for this condition. In our case, the patient underwent percutaneous nephrolithotripsy with a stent placement three days before presentation to the hospital. She was diagnosed with urinothorax, which led to further investigations, and she was found to have persistent hydronephrosis. Her condition improved after her underlying hydronephrosis was addressed with stent placement. She was discharged home in stable condition.