Letters to the Editor
No Difference in Mortality From Nonvariceal Upper Gastrointestinal Hemorrhage Between Racial Groups: A Nationwide Time Trend Analysis, 2008-2018
There is limited literature on recent trends in racial differences in incidence of and mortality from nonvariceal upper gastrointestinal hemorrhage (NVUGIH). Therefore, we studied these trends in the United States between 2008 and 2018 by conducting a retrospective longitudinal trend analysis using the National Inpatient Sample.1 All adult patients (≥18 years old) with NVUGIH were identified by International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes for the corresponding years (Supplemental Methods, available online at http://www.mayoclinicproceedings.org ).Immunity Acquired From the First Wave of COVID-19 Against Reinfections Up to Omicron Predominance
The protective effects of prior infection with SARS-CoV-2 against reinfection are of great public health interest. Among the limited literature covering delta and omicron variant predominance, a nationwide study in Qatar reported that the protective effects derived from prior infection are 92% and 56% against the delta and omicron variants, respectively.1 Malato et al2 found that a previous infection could have 50% to 75% protective effects against the most recent BA.5 variant reinfection, with the greatest protection from previous BA.1/BA.2 omicron infection.Rumpel-Leede Sign: Consider Underlying Vitamin C Deficiency
To the Editor: I read with interest the article by Mohammad et al.1 The authors report the case of a man in his 60s, in whom a petechial rash appeared on his arm after measuring his blood pressure early in his hospitalization. In the context of normal laboratory results, this finding was interpreted as an example of the Rumple-Leede phenomenon (intracutaneous hemorrhage produced by prolonged proximal pressure, signifying increased capillary fragility). Given the specifics of this case (the patient had a history of intravenous drug use, retained needles in the forearm give a picture of self-neglect), consideration should be given to underlying vitamin C deficiency (scurvy), which can also be manifested in this manner.In Reply—Rumpel-Leede Sign: Consider Underlying Vitamin C Deficiency
We thank Dr Martin Windpessl for his interest in our case of Rumpel-Leede sign. As was pointed out, the cutaneous manifestation of a petechial rash should also suggest vitamin C deficiency. On discovery of the rash, our team did include vitamin C deficiency as part of the differential, consulted with the dermatology service, and sent a vitamin C level that returned within normal limits. We regret not being able to elaborate on this work-up in our initial manuscript because of the word limit associated with submissions of this nature.NT-proBNP and High-Sensitivity Cardiac Troponin T Fail to Detect Cardiac Involvement in Erdheim-Chester Disease
To the Editor: Erdheim-Chester disease (ECD) is a rare non–Langerhans cell histiocytosis belonging to the L-group of the 2016 revised histiocytosis classification.1 Although frequent and associated with clinical complications, cardiac involvement is underdiagnosed in ECD.2 Cardiac magnetic resonance (CMR) imaging is the most robust way to detect cardiac involvement.3 However, access to this technique is limited. We evaluated the utility of B-type natriuretic peptides and troponin for the diagnosis of cardiac involvement in ECD.Newly Recognized α-Gal Syndrome in the Upper Midwestern United States
α-Gal syndrome is a recently recognized entity in which allergy to mammalian meat may be acquired by exposure to the disaccharide galactose-α-1,3-galactose (α-gal) antigen through the saliva of the Lone Star tick. Subsequent exposure to the antigen in meat may result in the delayed presentation (3 to 6 hours after ingestion) of systemic hypersensitivity reactions (eg, urticaria, angioedema), gastrointestinal symptoms, or life-threatening anaphylaxis.1,2 Anaphylaxis is potentially fatal, and identifying the cause is critical.Impending Arteriovenous Fistula Bleeding With Skin Ulceration
Arteriovenous fistulas are a common form of autogenous access in patients requiring renal replacement therapy.1-3 Aneurysmal degeneration of segments of the outflow vein and outflow stenosis are frequently identified.4 Albeit rare, arteriovenous fistulas bleeding can be a devastating and fatal dialysis access complication. Skin thinning and ulceration are signs of increased risk for bleeding or impending rupture.5 Immediate investigation of the fistula for any concerning signs of bleeding is imperative and any issues should prompt swift referral.Introducing Artificial Intelligence into the Preventive Medicine Visit
The artificial intelligence–enhanced electrocardiogram (AI-ECG) has been validated for the identification of multiple cardiac pathologies.1-3 We developed an AI-ECG algorithm that closely predicts chronologic age and demonstrated that the difference between AI-ECG age and chronologic age, or delta age (the first minus the latter), predicts long-term survival. Furthermore, AI-ECG age has been associated with cardiovascular diseases and risk factors such as hypertension and dyslipidemia.4,5 As this AI tool reflects potentially valuable information about overall fitness and cardiovascular health, we discuss an exemplary case where the AI-ECG showed a change towards youth following risk factor modification.Complement C5 inhibition as a Novel Therapeutic Approach in Severe Pre-eclampsia
Determining the clinical diagnosis underlying thrombotic microangiopathy (TMA), a pathologic entity, may be challenging, as is its effective management. This is especially true when TMA occurs in pregnancy. We report a case of a woman presenting in mid-pregnancy with severe pre-eclampsia and acute TMA who was successfully managed with eculizumab.
