South Dakota medicine : the journal of the South Dakota State Medical Association最新文献

{"title":"From Clinic to Comfort: The Impact of Frequent Pulmonary Clinic Visits on Advanced COPD Hospitalizations - A Retrospective Case-Control Study of Two University Hospitals.","authors":"Dawlat Khan, Carly Cooper, Rilie Curd, Holly A Gerberding, Maureen E Hurley, Leah J Naasz, Michael Roberts","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>About 25% of chronic obstructive pulmonary disease (COPD) patients have advanced disease that cause severe exacerbations that lead to hospitalizations and increase mortality. While outpatient visits are known to reduce COPD exacerbations, their impact on advanced COPD-related hospitalizations is less known. This study examines whether frequent outpatient pulmonary clinic visits help prevent hospitalizations and reduce inpatient mortality.</p><p><strong>Methods: </strong>We identified COPD patients admitted in 2019 with acute COPD exacerbation using billing codes at two university hospitals (N=1200). Home oxygen and FEV1 greater than 50% were used to identify advanced COPD patients (N=486). Retrospective data over 3 years for outpatient pulmonary visits was used to subdivide patients into frequent pulmonary clinic visitors in one calendar year and infrequent visitors (IFV).</p><p><strong>Results: </strong>Among our cohort, 46% were IFV and 54% were FV with a comparable mean age seen (FV: 64.8 vs. IFV: 63.3 years; p = 0.37). FV had 49% lower odds of advanced COPD-related hospitalization (aOR: 0.51, p = 0.004) and receive guideline-directed management (56.1% vs. 35.3%), all of which were statistically significant. Similarly, FV had higher rates of flu vaccination (87.1% vs. 79.8%; p = 0.051. The Charlson Comorbidity Index was higher in hospitalized patients (1.82 vs. 1.49; p = 0.024). While FV were 28% less likely to die (OR = 0.72, p = 0.124), this was not statistically significant. Hospitalization was a strong predictor of inpatient mortality (OR = 3.12).</p><p><strong>Conclusions: </strong>Our study suggests that frequent outpatient pulmonary clinic visits in patients with advanced COPD significantly reduce COPD-related hospitalizations, improve guideline-directed management, and enhance preventive care. While a direct mortality benefit was not statistically significant, the reduction in hospitalizations rate suggests potential indirect survival benefit. Further controlled studies are needed to validate these findings and inform future COPD-related healthcare policies.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s35"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unrecognized Steroid Exposure: Tawon Liar Induced Adrenal Insufficiency.","authors":"Hareem Tahir, Rafia I Waheed, Mamoon Ahmed","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Adrenal insufficiency can present with adrenal crisis as a life-threatening complication, especially following glucocorticoid withdrawal as exogenous steroids can disrupt the HPI axis. Any form of stress, like an infection, can act as the precipitating factor.</p><p><strong>Case report: </strong>A 65-year-old male with type 2 diabetes presented with weakness and confusion due to sepsis, requiring temporary intubation. Labs revealed severe hypercalcemia (calcium: 15.3 mg/dL) and mild acute kidney injury (creatinine: 1.55 mg/dL). PTH was appropriately suppressed, with normal vitamin D and PTHrP levels. Extensive malignancy investigations, including a CT scan, bone scan, and multiple myeloma workup, were negative. The patient denied using medications affecting calcium homeostasis, but further history revealed chronic use of \"Tawon Liar\" (containing ketorolac, meloxicam, and dexamethasone) for joint pain, which he had stopped a month prior. His rapid deterioration in the setting of sepsis suggested adrenal crisis, confirmed by a cosyntropin stimulation test. Given the negative workup otherwise, adrenal insufficiency was also likely contributing to hypercalcemia.</p><p><strong>Conclusions: </strong>This case highlights the importance of obtaining a thorough medication history, including over-the-counter supplements, when evaluating unexplained metabolic abnormalities. Despite no obvious steroid use, this patient's prolonged use of an unregulated supplement led to the suppression of the HPA axis. While such patients may maintain some baseline cortisol production under normal circumstances, their impaired stress response increases the risk of adrenal crisis during acute illness. Early recognition and prompt management of adrenal insufficiency are crucial in preventing life-threatening complications.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s37-s38"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circadian Rhythm Resynchronization as a Targeted Intervention for Mood Stability in Bipolar Disorder.","authors":"Delaram Moradpour, Lee Baugh","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The circadian rhythm is a ubiquitous process, primarily regulated by the fluctuation in light and temperature. Research has shown that the implication of the circadian rhythm spans all aspects of physiology, including cognitive and mood functions. The circadian rhythm is a highly conserved transcriptional translational feedback loop. Specifically, the protein products of Bmal1 and Clock genes heterodimerize outside the nucleus and re-enter to activate their repressing genes. All nucleated cells in mammalian body express this intrinsic clock, and all the tissues are synchronized by the Suprachiasmatic Nucleus (SCN) of the hypothalamus which receives light information from the retina. Emerging evidence shows that dysregulation of the circadian rhythm underlies the symptoms of many neurocognitive conditions such as bipolar disorder. The release of all neurotransmitters is circadian regulated. Therefore, studies that characterize the role of circadian rhythmicity in regulating cognitive and mood function in BD are essential for illuminating the therapeutic path. The efficacy of entrainment in managing symptoms of BD has been shown previously. Additionally, common therapeutic interventions for BD such as valproic acid, SSRIs and lithium have been shown to impact the circadian rhythm, partially explaining their therapeutic effect. I propose a bench protocol for enhancing the rhythmicity of SCN human explants. This will provide groundwork an in-patient regimen that stimulates the SCN activity through methods shown success in culture. I hypothesize that returning the circadian cycle in BD to a rhythmic baseline leads to physiological changes that are observable by the patient and psychiatrist in an encounter, such as changes in sleep quality and melatonin level in saliva. This approach can also promote insight and help the patient regulate their activities and emotions to improve their mood symptoms. The jet lag phenomenon is a stark example of observable physiological changes, showing that circadian reset provides the thermodynamic potentiality for introspection.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s33"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating AI Transcription Software in Medical Education: A Comparative Study of OSCE Documentation.","authors":"Molly Lien, Carson Max, Rachael Fanciullo, Roy Mortinsen, Arica Schuknecht, Mercedes Kotalik, Valeriy Kozmenko","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>As AI technology becomes increasingly embedded in clinical workflows, medical education must evolve to prepare students for AI-assisted documentation. Freed AI, a real-time transcription tool, offers potential benefits in both efficiency and documentation quality. This study compares the performance of Freed AI-generated notes to student-generated notes across simulated clinical encounters.</p><p><strong>Methods: </strong>First-year medical students participated in Objective Structured Clinical Examinations (OSCEs) covering three conditions: cough, falls, and back pain. Each encounter was transcribed both by students and Freed AI. Notes were scored for completeness, accuracy, and medical relevance. Two-way ANOVA and post-hoc tests were conducted to assess differences across source (AI vs. student) and condition.</p><p><strong>Results: </strong>Freed AI significantly outperformed student-generated notes overall, with a mean score advantage of approximately 3.78 points. A significant interaction was found between source and condition, with AI demonstrating a robust advantage in back pain scenarios. While AI also scored higher in falls and cough, these differences were not statistically significant after correction for multiple comparisons. Condition alone also had a significant effect, with back pain yielding the lowest overall scores.</p><p><strong>Conclusion: </strong>Freed AI transcription significantly enhances documentation quality, particularly in complex scenarios like back pain. These findings support the integration of AI tools into medical education to augment student performance, though continued attention to clinical reasoning and variance in case complexity remains essential.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s31-s32"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Study of Social Determinants of Health Effects on Clinical Trial Consideration.","authors":"Logan Stacey, Bing Xu, Crystal Hattum, Tobias Meissner, Rachel Elsey, Casey Williams","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical trials offer access to advanced treatments, yet only 2-10% of cancer patients participate. Many factors contribute to patient participation, including patient social determinants of health (SDOH) such as age, rurality, race, education, and socioeconomic status. The purpose of this study is to determine if SDOH measures are related to clinical trial participation in a community cancer center in the great plains.</p><p><strong>Methods: </strong>A retrospective study was conducted by evaluating all patients treated for malignancy in the oncology electronic health record (EHR) between 2018 and 2022. Demographic information was also obtained from the EHR. U.S. Census Bureau data was used to define location as urban or rural. Documentation available of formal consideration for clinical treatment trial screening came from cancer research departmental data.</p><p><strong>Results: </strong>During the study period, 15,514 patients were treated for malignancy (WCP). Of those, 1,311 had documentation available showing formal consideration for clinical treatment trial screening (SCT group). Urban patients made up 22.5% of the WCP and 32.0% of SCT group. SCT population lived a median distance of 69.9 miles from the study site whereas the median distance from study site for WCP was 89.8 miles. Screened patients had an average age of 67.2 while the average age for all patients was 72.3. SCT group was 94.7% Caucasian and WCP was 93.1% (p = 0.033). 78.1% of WCP spoke English while 79.9% screened did (p = 0.14).</p><p><strong>Conclusions: </strong>The available data from the EHR and ancillary data sources had significant limitations with potential for impacting validity of endpoints. While this data provides areas that are opportunities of focus for potential improvement, additional studies will be needed to further assess the true impact of SDOH in consideration for clinical trial involvement.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s37"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"South Dakota's Battle With Colorectal Cancer: Mortality Trends From 1999 to 2020 Using CDC WONDER Database.","authors":"Rafia I Waheed, Gulzar Ahmed, Hareem Tahir, Dawlat Khan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal carcinoma (CRC) is the third leading cause of death in the United States despite advancements in screening, early detection, and treatment. This study aims to outline the mortality trends among individuals residing in South Dakota from 1999-2020, categorized by various demographic factors to highlight high-risk populations.</p><p><strong>Methods: </strong>Data from the CDC WONDER database was analyzed, covering the years 1999-2020. CRCrelated deaths were identified using ICD-10 codes C18.0-C18.9. The age-adjusted mortality rates (AAMRs) per 100,000 populations were calculated. Joinpoint regression was used to assess mortality trends and calculate the annual percentage change (APC), with stratification by year, sex, and race/ethnicity.</p><p><strong>Results: </strong>The study extracted 3,686 CRC-related deaths in South Dakota between 1999 and 2020, with an average AAMR of 16.8 (AAPC: -2.85). The AAMR declined from 22.4 in 1999 to 12.1 in 2020 (APC: -2.85). Men had consistently higher AAMRs than women, decreasing from 26.3 in 1999 to 14.7 in 2020 (APC: -3.03), while women's AAMR declined from 19.2 to 10.5 (APC: -2.77). Only non-Hispanic Whites exhibited a significant decline among racial groups, from 22.9 in 1999 to 10.9 in 2020 (APC: -3.03); data for other races were suppressed or unavailable. AAMRs varied geographically, with the highest in noncore nonmetropolitan counties (18.9), followed by micropolitan (17.7) and small metropolitan (14.5) areas. Mortality risk increased sharply with age, rising from 2.32 in the 35-44 age group to 284.0 in those 85 and older.</p><p><strong>Conclusion: </strong>CRC mortality in South Dakota declined from 1999-2020, but disparities remain, especially among men, rural areas, and older populations. Enhancing screening, early detection, and healthcare access is crucial for further reduction.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s40"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Visibility and Mentorship for Future Women in Medicine: A Qualitative Study.","authors":"Phebie Rossi, Amanda Roesler, Alivia Ankrum, Arleigh Trainor","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Women in medicine have historically faced slower career advancement and limited visibility compared to their male counterparts. While progress has been made, disparities persist, particularly in mentorship opportunities. Babaria et al. (2011) found that female medical students receive less mentorship from senior faculty than their male peers, contributing to gaps in professional development and career guidance. Recognizing that medical students may not be able to change systemic mentorship barriers at higher institutional levels, we aim to address this issue by fostering mentorship at an earlier stage - among pre-medical students. Our project seeks to assess the impact of peer-led mentorship events on pre-medical students' knowledge of the medical school application process and their sense of connectedness with current female medical students.</p><p><strong>Methods: </strong>We will host an interactive mentorship event led by female medical students, providing premedical students with insights into medical education, career pathways, and challenges faced by women in medicine. Pre- and post-event surveys will assess participants' baseline understanding of the medical training process and quantify changes in their feelings of mentorship and support.</p><p><strong>Expected results: </strong>Our event, scheduled for April 3 in Sioux Falls, will generate data on how structured, peer-led mentorship impacts pre-medical students' perceptions of support and preparedness for medical school. We anticipate that fostering early connections between pre-medical and medical students will help bridge the mentorship gap and encourage more women to pursue medicine with confidence.</p><p><strong>Conclusion: </strong>By taking an active role in mentorship at the pre-medical level, medical students can contribute to greater visibility and support for future women in medicine. This initiative offers a scalable model for addressing gender disparities in mentorship and professional development.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s35-s36"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Therapist Assessed Initial Lower Back Pain: A Retrospective Cohort Study.","authors":"Brandon I Peterson, Micheal J Vasek, Thomas Tiahrt","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Treatment of patients with low back pain (LBP) amenable to improvement through physical therapy usually follows one of two pathways. The first is primary-care provider and nursing evaluation, often with imaging, pain medication, and a frequently delayed physical therapy referral. The second is a multi-disciplinary approach of embedding a physical therapist to assist with evaluations and active physical therapy treatment as early as possible. The present study compares the results of the first instance of LBP for the traditional pathway to the early physical therapy pathway for patients of the U.S. Department of Veterans Affairs hospital in Sioux Falls, South Dakota. The research comprised a retrospective review of electronic records of patients presenting the first onset of LBP evaluated in primary care. The patients on the first pathway had nursing and primary care providers assess patients during the initial visit and later referred them to outpatient physical therapy. Patients on the second pathway had a physical therapist on the primary care team. The results of this study show that second-pathway patients required fewer images, specialists, sessions, and pain medications; they had fewer no-shows at follow-up appointments.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 5","pages":"199-202"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Chart Review Characterizing Deviations in Underlying Pathology in Patients Undergoing Parathyroidectomy in South Dakota.","authors":"R A Cihak, Matthew Schmitz, Ben Kulesa, Emily Hilbrands, Sean McCann, William Spanos","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The two leading causes of primary hyperparathyroidsm are single gland adenoma and multigland hyperplasia. Classically, it has been reported that 85-90% of cases are due to a single adenoma, and the remaining 10-15% are primarily caused by multigland hyperplasia. Standard treatment is operative parathyroidectomy. An increase in cases of multigland hyperplasia in South Dakota has been observed recently, and this has not yet been analyzed.</p><p><strong>Methods: </strong>A retrospective chart review was performed on a cohort of 440 patients. Inclusion criteria were patients receiving a diagnosis of primary hyperparathyroidism in the state of South Dakota between the years of 2017-2021. The primary outcome was postoperative diagnosis, determined by examination of documented in operative notes and pathology reports. The secondary outcome was recurrence rates, measured by rates of a second parathyroidectomy.</p><p><strong>Results: </strong>Our data shows a statistically significant increase in cases of parathyroid hyperplasia as compared to single gland adenoma in patients undergoing parathyroidectomy in South Dakota, with 20.4% of patients receiving a postoperative diagnosis of multigland hyperplasia. Parathyroid disease recurrence rate was not significant at 2.5%.</p><p><strong>Conclusion: </strong>Our research shows a significant deviation from previously published trends regarding underlying pathology of primary hyperparathyroidism. Proposed explanations that would warrant further studies include potential referral bias from endocrinology, difference in practices between physicians, and advancements in medical therapy allowing for a higher threshold for surgical intervention.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s23-s24"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rickets in the New Age of Food Allergies: A Case Report and Comprehensive Review.","authors":"Cole D Tessendorf, Ryan Peldo, Henry Mullaney, Emily Wilde, Robert Van Demark","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Rickets is a disorder of defective bone mineralization resulting in skeletal deformities, growth retardation, and increased risk of fractures. Nutritional rickets, once a historical disease, has reemerged in select pediatric populations despite modern food fortification efforts. Many of the most common food allergens - dairy, eggs, and fish - are primary dietary sources of vitamin D, which presents a unique risk factor for development of rickets. Children with multiple food allergies are at a heightened risk, particularly if their diets are not adequately supplemented.</p><p><strong>Case report: </strong>This case report describes a 2-year-old male with multiple food allergies who developed vitamin D-deficient rickets. He was referred to a pediatric orthopedic surgeon by his primary care physician due to concerns about progressive bilateral bowing of his legs. Radiographic evaluation of the lower extremities revealed characteristic findings consistent with nutritional rickets, including irregular cupping, fraying, and flaring of the metaphyses at the distal femur, tibia, and fibula bilaterally. Laboratory testing confirmed a biochemical profile consistent with severe vitamin D deficiency and impaired bone mineralization. The patient's serum calcium level was 9.0 mg/dL and serum phosphorus level was 2.9 mg/dL. Alkaline phosphatase level was markedly elevated at 1060 U/L and serum 25-hydroxyvitamin D level was critically low at 4 ng/mL. Treatment was initiated with high-dose vitamin D supplementation at 6000 IU of cholecalciferol daily. Additionally, dietary counseling was emphasized, and follow-up was arranged with pediatric endocrinology, a metabolic specialist, and orthopedic follow-up is ongoing to evaluate for correction or progression of the bowing.</p><p><strong>Conclusion: </strong>This case highlights the intersection of pediatric metabolic bone disease and food allergies, emphasizing the need for heightened awareness of nutritional deficiencies in children with restricted diets. Despite public health advances, vitamin D-deficient rickets continues to emerge in select populations, underscoring the necessity for early diagnosis, supplementation, and interdisciplinary management.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s34"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}