Introduction Patients with multiple sclerosis (pwMS) face barriers accessing specialty care for evaluation and treatment. Telemedicine, the practice of clinical care at a distance with the aid of technology, may be a potential bridge to close the access gap for pwMS separated by distance or disability. The objective of this review was to investigate the types of telemedicine being utilized and overall outcomes for pwMS and their providers. Methods A Boolean search of the medical literature was conducted between January 2000 and January 31, 2018. PubMed, EMBASE, PsycINFO and the Cochrane databases, were used to identify all relevant citations. Two reviewers independently appraised the articles for meeting study criteria and for study quality using the CASP system. Financial costs of the telemedicine applications were assessed. Results A total of 28 studies involving 3252 participants met criteria for inclusion. Telemedicine interventions were classified, and outcomes were assessed systematically by the following categories: general MS care; rehabilitation and exercise; and neuropsychology/mental health. Studies showed a range of outcomes with variable quality. Overall, remote clinical examinations, long-term telemedicine management interventions and telerehabilitation were shown to be beneficial, cost-effective and satisfactory for patients and providers. Discussion Telemedicine is a viable platform for delivering specialty MS care. Remote neurological assessments and several forms of therapy have been shown to be technically feasible. Optimal implementation and barriers to the use of telemedicine in the current healthcare system should be explored.

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Proximal tubular (PT) acidosis, which alkalinizes the urinary filtrate, together with Ca2+ supersaturation in PT can induce luminal calcium phosphate (CaP) crystal formation. While such CaP crystals are known to act as a nidus for CaP/calcium oxalate (CaOx) mixed stone formation, the regulation of PT luminal Ca2+ concentration ([Ca2+]) under elevated pH and/or high [Ca2+] conditions are unknown. Since we found that transient receptor potential canonical 3 (TRPC3) knockout (KO; -/-) mice could produce mild hypercalciuria with CaP urine crystals, we alkalinized the tubular pH in TRPC3-/- mice by oral acetazolamide (0.08%) to develop mixed urinary crystals akin to clinical signs of calcium nephrolithiasis (CaNL). Our ratiometric (λ340/380) intracellular [Ca2+] measurements reveal that such alkalization not only upsurges Ca2+ influx into PT cells, but the mode of Ca2+ entry switches from receptor-operated to store-operated pathway. Electrophysiological experiments show enhanced bicarbonate related current activity in treated PT cells which may determine the stone-forming phenotypes (CaP or CaP/CaOx). Moreover, such alkalization promotes reactive oxygen species generation, and upregulation of calcification, inflammation, fibrosis, and apoptosis in PT cells, which were exacerbated in absence of TRPC3. Altogether, the pH-induced alteration of the Ca2+ signaling signature in PT cells from TRPC3 ablated mice exacerbated the pathophysiology of mixed urinary stone formation, which may aid in uncovering the downstream mechanism of CaNL.

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Purpose of Review This review highlights clinically relevant updates to common and significant bacterial, viral, and fungal cutaneous infection within the past 5 years. Recent developments are presented so that the clinician may provide evidence-based, high-quality patient care. Recent Findings New resistance patterns in cutaneous pathogens have recently emerged as a result of inappropriate antimicrobial use. Several new FDA-approved antimicrobials have been approved to treat such infections, including multi-drug resistant pathogens. Several organizational guidelines for cutaneous infection management have been updated with new recommendations for screening, diagnostic, and treatment strategies. Summary Clinicians should be aware of the most recent evidence and guidelines for the management of cutaneous infections in order to reduce the emergence of antimicrobial resistance and most effectively treat their patients.

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Drug-induced hypersensitivity syndrome (DIHS) is a life-threatening severe cutaneous adverse reaction with multisystem involvement. DIHS usually occurs in the context of orally or intravenously administered medications, but can be reactivated with epicutaneous application of culprit medications. We present a case of a 31-yearold woman who developed vancomycin-induced DIHS after treatment of a prosthetic joint infection. Her total hip arthroplasty prosthesis infection was treated with removal of the prosthesis, IV vancomycin and implantation of a polymethyl methacrylate vancomycin-eluting spacer along with vancomycin-eluting absorbable calcium beads. 26 days after treatment, she developed a pruritic morbilliform exanthema along with malaise, nausea, dysphagia, neck-swelling, chills and was noted to have an AST of 389 and an ALT of 338. IV vancomycin was replaced with daptomycin and patient was started on 100mg of daily prednisolone. After initiation of prednisolone, she had rapid improvement of her neck-swelling and rash, but her AST and ALT remained elevated for 10 days despite treatment with corticosteroids. Given her persistently elevated AST and ALT, multidisciplinary discussions were held to consider removing the implanted vancomycin-eluting spacer. Surgery was deferred due to the patient's high dose corticosteroids, increased risk of infection and incremental clinical improvement. She continued to improve and eventually tapered off her steroids after discharge. This is the first reported case of DIHS in a patient treated with drug-eluting absorbable beads, implant and IV antibiotics. In conclusion, we recommend careful consideration of the relative risks and benefits along with close clinical monitoring before surgical revision in complex cases of DIHS.