Background As teledermatology has been widely adopted during the COVID-19 pandemic, it is essential to examine patients’ experiences and satisfaction with teledermatology. Objective We aimed to assess the teledermatology experiences of new and existing clinic patients in the context of the rapid shift toward teledermatology practices during the COVID-19 pandemic. Methods We conducted a cross-sectional study of 184 teledermatology patients who were assessed during the COVID-19 pandemic at a major southeastern medical center from May 13 to June 5, 2020. The primary outcome was patient satisfaction levels among new and existing patients. The secondary outcome was patients’ willingness to use teledermatology in the future. Results Of the 288 teledermatology patients who were assessed during the study period, 184 (63.9%) completed the survey. Patients reported high overall satisfaction with teledermatology, with 86.4% (159/184) of participants reporting positive overall satisfaction and experiences with teledermatology. New patients had significantly higher Likert scores for overall satisfaction with teledermatology than those of follow-up patients (new patients: mean 4.70; existing patients: mean 4.43; P =.03). Overall, patients’ satisfaction with teledermatology did not significantly differ based on age ( P =.36), race and ethnicity ( P =.46), education level ( P =.11), residence ( P =.74), or insurance status ( P =.74). There were no significant differences in overall satisfaction between patients with and without prior telehealth experience ( P= .53), between the video and telephone visit types ( P =.17), and among platform types ( P= .22). Prior telehealth experience was associated with higher odds of being willing to use telehealth in the future (odds ratio 2.39, 95% CI 1.31-4.35; P =.004). Conclusions This cross-sectional survey study demonstrates that during the rapid expansion of teledermatology, new clinic patients had significantly higher scores for overall satisfaction with their teledermatology experience compared to those of established clinic patients ( P =.03). Prior telehealth experience was associated with higher odds of being willing to use teledermatology in the future. Overall, teledermatology expansion was met with high levels of patient satisfaction during the COVID-19 pandemic.
Angiotensin II (ANG II) is a major mediator of hypertension pathogenesis. In addition, there are well-documented differences in expression of the renin-angiotensin system (RAS) components and ANG II responses between males and females, which may explain sex differences in blood pressure (BP) and hypertension epidemiology. We previously showed that type 1A angiotensin (AT) receptors in vascular smooth muscle cells (VSMCs) play a critical role in BP regulation and hypertension pathogenesis, but these studies were carried out in male mice. Therefore, the major goal of the current studies was to examine the impact of VSMC AT receptors on BP and hypertension pathogenesis in female mice. We found that elimination of VSMC AT receptors in female mice reduced (≈8 mmHg) baseline BP without altering sodium sensitivity. The severity of ANG II-induced hypertension was diminished (≈33% reduction in BP), particularly during the last 2 wk of chronic ANG II infusion, compared with controls, but natriuresis was not altered during the first 5 days of ANG II infusion. Urinary norepinephrine levels were enhanced in female SMKO compared with control mice. There was a virtually complete elimination of ANG II-induced kidney hemodynamic responses with attenuation of acute vasoconstrictor responses in the systemic vasculature. These findings demonstrate that direct vascular actions of AT receptors play a prominent role in BP control and hypertension pathogenesis in female mice.
Objectives/Hypothesis: Glottic stenosis is a discrete cause of airway compromise. We aimed to determine the surgical outcomes of transverse cordotomy with anteromedial arytenoidectomy (TCAMA), performed in the setting of isolated glottic stenosis resulting from two discrete etiologies: bilateral vocal fold paralysis (BVFP) and posterior glottic stenosis (PGS).Study Design: Retrospective, analytic cohort study. Methods: Twenty-six patients with isolated glottic stenosis were treated with TCAMA between 2006 and 2019. A retrospective analysis determined decannulation rates and intervals, voice outcomes, swallowing outcomes, and reoperation rates postoperatively. Outcomes between the two etiologic cohorts were compared.Results: Of the 26 patients, 16/26 patients were diagnosed with PGS and 10/26 with BVFP. Eighteen patients required tracheotomies during their clinical course (11/16 PGS, and 7/10 BVFP), and 100% were ultimately decannulated. The PGS cohort required two-sided interventions more frequently than the BVFP cohort (45.5% vs. 0%, P = .066). Trach-dependent PGS patients required a longer time to achieve decannulation than BVFP patients by a factor of 2.38, although the difference was not statistically significant (102.3 days vs. 42.9 days, respectively, P = .113). Patients demonstrated a significant change in maximum phonation time but no statistically significant differences with preoperative versus postoperative voice outcomes like voice-related quality of life. All patients ultimately returned to their baseline swallow function postoperatively.Conclusion: TCAMA is an effective treatment for surgical rehabilitation of glottic stenosis caused by both BVFP and PGS. Patient-reported outcomes of postoperative vocal function remain consistent following surgical intervention. Additional, prospective studies with greater power are warranted to validate the contrasting outcomes observed when applying this discrete surgical technique across two distinct diagnostic cohorts in this retrospective study.
A major pathway in hypertension pathogenesis involves direct activation of Ang II (AT1) receptors in the kidney, stimulating sodium reabsorption. AT1 receptors in tubular epithelia control expression and stimulation of sodium transporters and channels. Recently, we found reduced blood pressure and enhanced natriuresis in mice with cell-specific deletion of AT1 receptors in smooth muscle (SMKOs). While impaired vasoconstriction and preserved renal blood flow might contribute to exaggerated urinary sodium excretion in SMKOs, we considered whether alterations in sodium transporter expression might also play a role and therefore carried out a proteomic analysis of key sodium transporters and associated proteins. Here we show that levels of Na+-K+-2Cl- cotransporter isoform 2 (NKCC2) and Na+/H+ exchanger isoform 3 (NHE3) are reduced at baseline in SMKOs, accompanied by attenuated natriuretic and diuretic responses to furosemide. During Ang II hypertension, we find widespread remodeling of transporter expression in wild-type mice with significant increases in levels of total NCC, phosphorylated-NCCps71, and NKCC2-P, along with the cleaved, activated forms of the a- and g-ENaC. However, the increases in a- and g-ENaC with Ang II were substantially attenuated in SMKOs. This was accompanied by reduced natriuretic response to amiloride. Thus, enhanced urinary sodium excretion observed after cell-specific deletion of AT1 receptors from smooth muscle cells is associated with altered sodium transporter abundance across epithelia in multiple nephron segments. These findings suggest a system of vascular-epithelial cross-talk in the kidney, modulating expression of sodium transporters and contributing to regulation of pressure-natriuresis.
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