Effects of COVID-19 pandemics on urinary metabolites in kidney stone patients: our kidney stone prevention clinic experience

Background The dietary habits and lifestyle changes during the COVID-19 pandemic could affect the urinary risk factors in kidney stone formers. In this study, we investigated the effects of the COVID-19 pandemic on 24-h urine metabolites, as a surrogate for dietary intake, in patients with kidney stones, in Tehran, Iran. Methods We evaluated the medical records of all patients with urolithiasis who visited in our stone prevention clinic from the beginning of COVID-19 in Iran to 1 year later (Feb 2020–Feb 2021) and compared it with the patients’ medical records in the same period a year before COVID-19 (Feb 2019–Feb 2020). Results The results of our stone prevention clinic showed a decrease in the number of visits during COVID-19. Twenty-four-hour urine urea, sodium, and potassium were significantly lower, and 24-h urine magnesium was significantly higher during COVID-19. Higher 24-h urine oxalate was only shown in patients with the first-time visit, whereas lower 24-h urine uric acid and citrate were only shown in patients with the follow-up visits. Conclusions COVID-19 pandemics may change some of the dietary habits of the patients, including lower salt, protein, and fruit and vegetable intake. Although economic issues, restricted access, or sanitation issues may be the reason for the undesirable dietary changes, the importance of a quality diet should be discussed with all patients, as possible. Since the number of patients visited in the stone clinic was lower during COVID-19, virtual visits could be an excellent alternative to motivate patients with kidney stones.

Suicidal Intent in Young Adults Attending the Suicide Prevention Clinic at a Tertiary Care Centre in Kerala, India

BACKGROUND Suicide attempts in young adults in the age group 18 - 25 years have grown exponentially across the globe in the last three decades. Suicide is the third leading cause of death among young adults worldwide and is the second leading cause of death in 15 – 29-year-olds. The studies on the factors affecting suicidal intent among young adult suicide attempters are few from the Indian context and young adult group is of utmost importance. So, this study was done to estimate the suicidal intent among young adult suicide attempters and to assess the various factors associated with suicidal intent among young adults. METHODS The study was an analytical cross-sectional study, which was carried out at the Suicide Prevention Clinic of the Department of Psychiatry at a Tertiary Care Centre in Kerala, India over a period of 1 year from October 2015 to September 2016. The consecutive 160 young adult suicide attempters were interviewed. Beck’s suicide intent scale was used to assess the severity of suicide attempts. Statistical significance of socio-demographic factors and suicidal intent score was assessed by independent student t test and one way analysis of variance (ANOVA). RESULTS Out of the 160 participants, 50 (31.2 %) had low suicidal intent, 71 (44.4 %) had medium suicidal intent and 39 (24.4 %) had high suicidal intent. The study showed significant association between marital status (t = 2.515, P = 0.011), Occupation (F = 7.991, P < 0.001), previous suicide attempt (t = - 2.586, P = 0.011), mode of attempt (F = 7.228, P < 0.001) and psychiatric disorder (F = 11.218, P < 0.001) with the suicidal intent score. The study has found a significant association between the caregiver and suicidal intent score (F = 4.339, P = 0.006) which needs to be researched further. CONCLUSIONS Our study showed significant association between the socio-demographic variables like occupation, marital status, caregiver, mode of attempt, previous attempt and psychiatric diagnosis with the suicidal intent scores of young adult suicide attempters attending the suicide prevention clinic. This finding throws light to the factors contributing to high suicidal intent among young adults. The suicidal rates among the young adults are on the rise and we as the health professionals should be aware of these factors which will help in preventing young adult suicides. KEYWORDS Suicidal Intent, Young Adults, Suicide Prevention Clinic, Suicidal Behaviour, Kerala

A Tale of Two Shitties

Based on 12 months of ethnographic data collection in an anal cancer prevention clinic, this article uses the extreme examples of patients involuntarily defecating through the anoscope during the procedure to highlight the relationship between the extreme and the everyday. Despite the rarity of this occurrence, I argue that these extreme examples shed light on the ways the daily clinical routines are embodied as an expert habitus. High Resolution Anoscopy procedures are specialized, highly routinized practices that are performed hundreds of times per month at the clinic. These routines result in the development of a clinical habitus that guides physicians in deploying techniques to efficiently conduct the invasive examination. Exemplary examples of ordinary procedures certainly help explain how this expert habitus is enacted through routine clinical practices; however, this expertise becomes especially observable in moments when habituated practices are disrupted, forcing clinicians to react and respond in unscripted ways. I discuss the only two instances of patients defecating through the anoscope that occurred while conducting my research, each with a different clinician. These extreme examples provide rich opportunities to analyze how clinicians with similar procedural habits navigate extraordinary situations in expert and professional but idiosyncratic ways. Whereas exemplary examples of everyday routinized procedures can show the process of developing an expert clinical habitus, these extreme examples more clearly demonstrate how this habitus enacts expertise and professionalism by highlighting the clinicians’ abilities to deftly navigate the technical and sociocultural aspects of such extraordinary disruptions.

Depressive Symptom Screening in Youth – Using a Community Diabetes Prevention Clinic

Background: Rates of youth diagnosed with diabetes and prediabetes are increasing and comorbidities like depression warrant strict monitoring to improve patient outcomes. Objective: The aim was to determine if increased depressive symptoms are associated with worse clinical findings, including BMI, obesity, diabetes, prediabetes, hemoglobin A1c (HbA1c), and demographic variables including age, gender, and race. Methods: The study is a retrospective chart review of patients referred to the Youth Diabetes Prevention Clinic (YDPC) based on increased risk for type 2 diabetes (T2D). The Patient Health Questionnaire (PHQ-9), a 9-question depressive symptom screening tool, was utilized to screen for depressive symptoms using a cut point of >=10 which indicates possible depression and a need for further evaluation. All available data were evaluated for clinic visits occurring between 2013 and 2020. Results: 178 patients filled out PHQ-9 screening forms and returned them to clinic. Age (p <0.01), sex (p <0.01), BMI (p <0.01), HbA1c (p <0.01), and obesity diagnosis (p = 0.01) were associated with increased depressive symptoms based on screening score cutoff. Race (p > 0.05), BMI z-score (p = 0.18), prediabetes diagnosis (p = 0.92), and diabetes diagnoses (p = 0.05) were not. Middle adolescent (ages 14-17) youth were 3.5 times more likely than early adolescents to fall into the moderate/high risk category for depression. Females were 2.6 times more likely and those with higher HbA1c or an obesity diagnosis were ~3 times more likely. A modest portion (36.5%) in this sample met criteria for possible clinical depression. Conclusion and Impact: Patients at risk for prediabetes and diabetes should be screened for depressive symptoms in order to intervene to decrease its adverse effects on diabetes management. Older youth, females, and those with obesity and higher HbA1c values are at particularly higher risk of having increased depressive symptoms.

Decreased Stroke Presentation Rates at a Comprehensive Stroke Center during COVID-19

ABSTRACT: We reviewed stroke care delivery during the COVID-19 pandemic at our stroke center and provincial telestroke system. We counted referrals to our prevention clinic, code strokes, thrombolysis, endovascular thrombectomies, and activations of a provincial telestroke system from February to April of 2017–2020. In April 2020, there was 28% reduction in prevention clinic referrals, 32% reduction in code strokes, and 26% reduction in telestroke activations compared to prior years. Thrombolysis and endovascular thrombectomy rates remained constant. Fewer patients received stroke services across the spectrum from prevention, acute care to telestroke care in Ontario, Canada, during the COVID-19 pandemic.