COVID Pandemic Impact on Nevada Adult Protective Services

Empirical data regarding Covid pandemic impact on the Nevada Adult Protective Services (APS) Program clients, casework, and staff was gathered and analyzed as part of a multi-faceted program evaluation. Key findings include: 66% of the staff agreed or strongly agreed that the pandemic made their jobs more challenging. Respondents reported Covid-related challenges faced by clients, the program, and themselves as social workers serving older and vulnerable adults. Adverse client impacts observed included increased social and emotional isolation, loss of housing, exacerbation of symptoms of mental illness, necessary services being cut from clients subsequent to testing Covid positive, and fear and reluctance to allow needed visiting service providers, such as home health aides, into their homes. We will discuss the implications of the findings on APS services and clients, and on related health and human services designed to promote the wellness and independence of older and vulnerable adults.

Adult onset stills disease: Newly diagnosed in pregnancy with rare clinical presentation as pleural effusion

Adult onset Still’ disease (AOSD) is a rare inflammatory disease which involves multiple systems and is of unknown etiology first described in 1971.It has more prevalence among young females and few studies show the exacerbation of symptoms during pregnancy. Patients usually presents with high grade fever, arthritis, arthralgia, salmon pink rash, organomegaly, lymphadenopathy but rarely can present with pleural symptoms, cardiac symptoms. Several criteria’s are used for diagnosis but Yamaguchi’s has the highest sensitivity of 93.5%. Yamaguchi’s classification criteria includes major and minor criteria’s and exclusion criteria’s. Although diagnostic criteria are there but AOSD till date is a diagnosis of exclusion. All the causes of clinical symptoms should be excluded which involves malignancies, infections, inflammatory conditions, autoimmune diseases before the diagnosis of AOSD is made. A 26-year-old female with G2P0010 and POG 6 weeks presented to medicine OPD with high grade fever associated with chills and rigors from 1 week. She was also complaining of stiffness and pain in multiple joints with chest pain, easy fatigability. She was having rashes on upper back below nape of neck. All the necessary investigations were carried out. It was found that she was also having right sided pleural effusion and severe microcytic hypochromic anemia. After batteries of investigations and consultation by obstetrician, rheumatologist, dermatologist diagnosis of Adult Onset Still’s disease was made. It was a diagnosis of exclusion. Patient was started on steroids and she responded well. All the symptoms including pleural effusion was subsided. Adult onset still’s disease is a form of still’s disease. It is a rare systemic auto-inflammatory disease. Yamaguchi is the most sensitive criteria but till date it is diagnosed after excluding possible causes of malignancies, infections and autoimmune conditions. Sometimes patients do present with rare symptoms like pleural effusion, pericarditis some may present as acute respiratory distress syndrome or mild symptoms like cough, pleuritic chest pain. In our case also all the possible causes were excluded as patient presented with pleural effusion for the first time during pregnancy, so the impact of the disease on the fetal outcome was also considered. AOSD has always been a diagnosis of exclusion but as in our case and cases with similar presentation AOSD should be consider as a differential diagnosis. Although there are only few studies which shows that there is fatal outcome of pregnancy in AOSD however there are studies showing exacerbation of symptoms of AOSD during pregnancy. Its early diagnosis and prompt treatment can be helpful in the better outcome of pregnancy as well as better prognosis of disease.

Laparoscopic Gastrojejunostomy for the Treatment of SIRT-Induced Duodenal Ulcer Complicated by Gastric Outlet Obstruction

Selective internal radiation therapy (SIRT) is an emerging therapeutic modality in patients with unresectable hepatocellular carcinoma or liver metastases. However, complications can occur due to migration of radiation microspheres such as gastrointestinal ulcer, cholecystitis, bleeding, pancreatitis, and many others. A 50-year-old woman with stage IV breast cancer who underwent radioembolization for unresectable hepatic metastasis 6 months ago presented to our hospital with 1 month history of nausea, vomiting, with food intolerance, and weight loss. Esophagogastroduodenoscopy showed large deep duodenal bulbar ulcer along with antral ulcerations and edematous gastropathy. Biopsies revealed typical black, duodenal yttrium-90 sphere, documenting radiation injury. After she was discharged on proton pump inhibitor, the patient came back 1 month later for exacerbation of symptoms; computed tomography scan of the abdomen showed gastric outlet obstruction. Although there is no consensus in treating radiation-induced ulcers, physicians should be aware of this complication in patient who underwent SIRT presenting for abdominal pain.

The use of e-cigarettes and its risk of respiratory diseases

There are increasing concerns about the impact of using e-cigarettes on the overall health and respiratory complications of users. These modalities were proposed to potentially reduce the harmful events that are associated with cigarette smoking. Nevertheless, the acute and chronic effects secondary to the exposure and use of this modality are still controversial. However, it has been demonstrated that using the modality is associated with remarkable damage to lung injury because it releases significant amounts of reactive oxygen species, furans, volatile carbonyls, furans and metals (chromium, lead, and nickel). We have discussed the impact of e-cigarette using and exposure to its aerosol and the development and progression of the different respiratory diseases at the different clinical and pathological levels. Asthma, chronic bronchitis were the most significant lung conditions, and evidence indicated that exacerbation of symptoms was reported in some patients. Furthermore, acute exposure was also associated with the development of respiratory-related symptoms. Accordingly, studies indicated severe inflammatory reactions and significant lung injury were observed among e-cigarette users concerning vaping or exposure. Therefore, further preventive approaches are required by healthcare authorities to increase public awareness of the different hazards of using these modalities.

The Impact of COVID-19 on Eating Disorder Risks and Symptoms in the General Population: A Systematic Review

Aims: This study aims to identify the risk factors of eating disorders, evaluate the impact of the pandemic on those with or without pre-existing eating disorders and compare the impact of COVID-19 on the various eating disorders. Methodology: We searched Public/Publisher MEDLINE (PubMed) and Excerpta Medica dataBASE (EMBASE) databases from January 2019 to May 2021, 11 observational studies were selected out of 81 initially identified articles. The sample size ranged from 15 to 22,374 participants, with a total of 31,404 participants. Results: Individuals, especially females aged 18-25 years and 30-45 years were shown to be more susceptible to eating disorder risks and symptoms. Depression and anxiety were shown to be the most prevalent risk factors among all subjects. Exacerbation of symptoms was observed in subjects with the eating disorders except for the anorexia nervosa subgroup which showed minimal changes. Conclusion: This study established the fact that COVID-19 pandemic had a negative impact on the eating habits of people with or without pre-existing eating disorders (ED). This study also highlights the need for efforts to specifically identify evidence-based measures to support patients with ED during and after a pandemic.

Reintroduction of running after ACL reconstruction with a hamstring graft: can we predict short-term success?

ABSTRACT Context: Return to running (RTR) after anterior cruciate ligament reconstruction (ACL-R) is a crucial milestone. However, there is uncertainty on how and when to start a running program. Objective: To explore the feasibility of a structured program to reintroduce running after ACL-R and to evaluate the predictive value of potential predictors of short-term success. Design: Longitudinal cohort study. Setting: Local Research Center / participant's home. Patients: Thirty-five participants were recruited after ACL-R. Intervention: Program with a progression algorithm to reintroduce running (10 running sessions in 14 days). Main outcome measures: The criterion for short-term success was no exacerbation of symptoms. Potential predictors included: (i) the International Knee Document Committee (IKDC) subjective knee form; (ii) ACL Return to Sport after Injury questionnaire; (iii) quadriceps and hamstring strength; (iv) Step-Down Endurance test; and (v) the modified Star Excursion Balance test. Descriptive statistics were performed to study the feasibility of the RTR program and Poisson regression analysis was used to evaluate predictors of success. Results: Of the 34 participants included, 33 completed the RTR program. Sixteen participants experienced some temporary exacerbation of symptoms, but only one had to stop the RTR program. Initial IKDC score was the only significant predictor of a successful RTR with an Area under the ROC curve of 80.4%. An ICKD cut-off of 63.7/100 differentiated responders and non-responders with the highest sensitivity and specificity (77.8% and 75.0%, respectively). There was a 3-fold greater chance of success with an IKDC score above this threshold. Conclusions: Our results confirm the feasibility of our RTR program and progression algorithm after ACL-R. Clinicians should use an IKDC score of >64 as a criterion to reintroduce running after ACL-R to increase the likelihood of short-term success.

Thymoma-associated myasthenia gravis coexisting with myotonic dystrophy: a case report

Background Myotonic dystrophy (dystrophia myotonica [DM]) is an autosomal-dominant inheritance, and myasthenia gravis (MG) is an autoimmune disease characterized by weakness of skeletal muscles. Cases of both DM and MG are extremely rare and distinguishing DM and MG symptoms is challenging. Case presentation We herein report a 49-year-old woman presenting with subacute dyspnea and muscle weakness. She had previously been diagnosed with DM 24 years earlier. Computed tomography (CT) revealed an anterior mediastinal 32-mm solid mass that was suspected of being thymoma. The clinical features and neurological examination findings confirmed the diagnosis of thymoma-associated MG coexisting with DM. Intensive treatment for MG, including surgery, resulted in an improvement in some of her neurological symptoms. Conclusions The symptoms of DM usually progress slowly, so the sudden exacerbation of symptoms indicates the involvement of other factors. It is important to be aware of these associations, as an early diagnosis with proper treatment will result in a better outcome.

A Comparative Study of Perceived Stress and Anxiety, among Patients with Bipolar Affective Disorder, and the General Population, during COVID-19 Pandemic, Conducted in Government Hospital for Mental Care, Visakhapatnam

BACKGROUND Generally during pandemic, mental health needs are largely neglected and patients with psychiatric illness are given less medical care as majority of the health professionals are involved in acute management of the pandemic. In this study we wanted to determine the difference between stress and anxiety in patients with bipolar affective disorder (BPAD) and the general population. METHODS It was a cross sectional study and convenient sampling was used. The study was conducted in Government Hospital for Mental Care, Visakhapatnam. The study included 60 participants of whom 30 participants are patients with bipolar affective disorder who were currently in remission and 30 participants were from general population and were evaluated using semi structured proforma for sociodemographic data and perceived stress scale to assess perceived stress, Hamilton anxiety rating scale to assess anxiety. Results were analyzed statistically. RESULTS The results showed statistically significant difference in severity of perceived stress and anxiety among patients with bipolar affective disorder and the general population. CONCLUSIONS Our study results re-emphasize the fact that there should be an increased awareness about patients with psychiatric illness like bipolar affective disorder as targets for care with regular psychiatric intervention during Covid-19 pandemic. With our study, we want to re-iterate the fact that patients with psychiatric illness experience exacerbation of symptoms during infectious disease epidemic. Patients diagnosed with bipolar affective disorder can also have comorbid anxiety disorder, even after treating the mood disorder episode. Residual anxiety may persist and in times of infectious diseases epidemic, these anxiety symptoms will exacerbate leading to poor quality of life and non-compliance to medication. With our study we want to recommend that proper care and regular follow-up schedules have to be formulated by mental health professionals and mental health institutions to reduce and prevent exacerbation of symptoms and improve treatment compliance which in turn helps in preventing relapse of bipolar affective disorder. KEYWORDS Bipolar Affective Disorder, Perceived Stress, Anxiety, Covid-19

Student reactions to traumatic material in literature: Implications for trigger warnings

Introduction While trigger warnings have garnered significant debate, few studies have investigated how students typically respond to potentially triggering material. Method In this study, three hundred and fifty-five undergraduate students from four universities read a passage describing incidences of both physical and sexual assault. Longitudinal measures of subjective distress, PTSD symptoms, and emotional reactivity were taken. Results Greater than 96% of participants read the triggering passage even when given a non-triggering alternative to read. Of those who read the triggering passage, those with triggering traumas did not report more distress although those with higher PTSD scores did. Two weeks later, those with trigger traumas and/or PTSD did not report an increase in trauma symptoms as a result of reading the triggering passage. Conclusions Students with relevant traumas do not avoid triggering material and the effects appear to be brief. Students with PTSD do not report an exacerbation of symptoms two weeks later as a function of reading the passage.

Exacerbation of Subthreshold PTSD Symptoms in a Great East Japan Earthquake Survivor in the Context of the COVID-19 Pandemic

Background. In 2011, the people of Fukushima, Japan, experienced the Great East Japan Earthquake (GEJE), a complex disaster of earthquake, tsunami, and nuclear accident. Its residents are experiencing a second global disaster, a COVID-19 pandemic in 2020. Objective. In this article, we aimed at discussing the effects of subthreshold PTSD in a previous disaster on an exacerbation of PTSD symptoms in another disaster. Method. We present a case of subthreshold PTSD in the context of a nuclear accident and exacerbation of symptoms due to the COVID-19 pandemic. Results. Exacerbation of subthreshold PTSD symptoms was likely due to the reemergence of an urgent atmosphere similar to the previously experienced traumatic event. Conclusions. PTSD may occur not only in those who experience the actual life-threatening like ICU admission but in those who experience the atmospheric change of society. This case demonstrated the characteristics of subthreshold PTSD caused by two disasters that shared a similar sense of insecurity, the scale of impact on the society, invisibility of the threat, restricted movement, and authoritative conflicts. These commonalities led to a recurrence and exacerbation of initial symptoms. This finding should be shared with those involved in the care system for victims’ mental health suffering from a large-scale disaster, and we need further research about the issue.