Neuropsychiatric Side Effects of Steroids during Treatment for Pediatric Acute Lymphoblastic Leukemia: A Comprehensive Narrative Review

Background/Purpose: Pediatric Acute Lymphoblastic Leukemia (ALL) affects ~4000 young Americans each year. Steroids are essential to curative ALL treatment yet have significant neuropsychiatric side effects that decrease quality of life for patients and families. However, incidence and predisposing risk factors are not well understood. This review aims to describe the current literature on neuropsychiatric side effects of steroids in Pediatric ALL. Method(s): A precise search in PubMed and Embase was cultivated using controlled vocabulary terms (MeSH, Emtree) and keywords for the following concepts: pediatrics, steroids, side effects, cancer, and neurobehavioral manifestations. Keywords and controlled vocabulary for each subject were arranged logically and combined with other concepts by Boolean Logic, using the Boolean operator AND, resulting in 642 precise results exploring neurobehavioral side effects of steroids in children with cancer. Results (2010 to date of search) were imported into Covidence systematic review software, and reviewed by SB and AM. Result(s): Twenty-three articles met inclusion criteria. There is marked variability in research methodology and no standard measurement of neuropsychiatric symptoms. Commonly reported symptoms include mood swings, irritability, depression, anxiety, aggression, insomnia, mania, and psychosis with prevalence between 5% and 75%. Heterogeneous research methodology and descriptions of psychiatric symptoms make it difficult to determine risk factors, though dexamethasone, family psychiatric history, and younger age are consistently associated with greater risk of behavioral dysregulation. Genetic predisposition (Bcl1 polymorphism, SNPs in GR gene) may increase susceptibility to developing depression during treatment. Data suggest variable efficacy of antipsychotics, benzodiazepines, hydrocortisone, and potassium-chloride. Conclusions and Implications: Existing data about neuropsychiatric side effects of steroids in pediatric ALL is extremely heterogeneous, creating challenges for standardized assessment and treatment. The burden of these symptoms necessitates further research to identify and treat vulnerable patients. Standard measurement of these symptoms could be a first step in eventually alleviating this source of distress.

Cryptogenic Organizing Pneumonia Due to Mycoplasma

Introduction: Mycoplasma pneumoniae is a respiratory tract pathogen that most commonly causes acute bronchitis. Pneumonia is a less common manifestation. Herein we describe a patient who presented with COVID19 like symptoms after exposure but was later found to have Mycoplasma with cryptogenic organizing pneumonia (COP). Case Description: A 63-year-old lady presented to the emergency department with a cough with minimal sputum production and dyspnea for one week and a generalized itchy rash for four days. She had a recent travel history, exposure to a COVID-19 patient, and was unvaccinated against COVID-19. On admission, vitals were normal except for a heart rate of 121/min. On examination, she had a maculopapular rash involving the face, neck, back, palms, and soles (Fig A and B). Labs were significant for total leukocyte count of 12.9 X 103/ mm3, D-dimer of 1125 ng/mL which increased to 1635ng/mL in 24 hours, erythrocyte sedimentation rate of 38mm/h, and C-reactive peptide of 101.5mg/L. Chest x-ray revealed bilateral opacities worse on the right (Fig C). A CT pulmonary angiogram was negative for PE but showed bilateral peripheral opacities greater on the right side, suggesting COVID19 as the etiology (Fig D). But COVID19 PCR was negative. Due to the presence of diffuse rash, mycoplasma IgG antibodies were checked which were positive. During the hospital course, she became hypoxic requiring nasal cannula oxygenation. The patient underwent bronchoalveolar lavage (BAL) with transbronchial lung biopsy (TBLB) which revealed 60% eosinophils with COP. She was treated with IV methylprednisolone, IV ceftriaxone, and doxycycline. Her respiratory symptoms got better, and the rash significantly improved with residual hyperpigmentation. The patient was discharged on tapering doses of steroids and levofloxacin to complete 14 days of antibiotics. Discussion: Mycoplasma pneumoniae is known to cause atypical pneumonia most commonly in young children than in adolescents and adults. COP is rarely seen with it. Common dermatological manifestations include erythematous maculopapular rash, erythema multiforme. Our patient was an elderly female who presented with classic maculopapular rash and respiratory symptoms. The presence of rash and hypoxia prompted us to get BAL with TBLB which led to the diagnosis of COP and early initiation of steroids. Although open lung biopsy is considered the best approach for diagnosis, BAL with TBLB has a positive predictive value of around 95%. Symptomatic improvement in such patients is quite impressive with steroids with complete recovery in most of the patients. (Table Presented).

QR Technology based ID Proof for a Digitalized World

Today's world has been impacted by Covid-19 widely, and is moving towards a digitalized universe rapidly, wherein the future technologies that can play an important role in reviving the world cannot be forgotten. Nowadays, the use of Quick Response (QR) codes play an efficient role in a human's life, and id cards are always carried by a person since they are frequently required in his everyday life. The official documents being issued in the name of the person, or the records of his visit at various official places had to be kept handy for anytime use. So with this arising situation, a solution has been proposed serving two main vital goals: firstly, the person will be able to access all required documents only by scanning a single id card where the documents are being stored in a compressed format and represented in an augmented manner, and secondly, the person can easily maintain his visiting records with the help of a Unique Identity(UID) number provided to the users individually while registering. Thus, this paper attempts to promote the use of id digitalization in this futuristic world of technology. © 2022 IEEE.

Challenges in the Development of Drugs for Sarcopenia and Frailty - Report from the International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force.

Sarcopenia and frailty represent two burdensome conditions, contributing to a broad spectrum of adverse outcomes. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force met virtually in September 2021 to discuss the challenges in the development of drugs for sarcopenia and frailty. Lifestyle interventions are the current mainstay of treatment options in the prevention and management of both conditions. However, pharmacological agents are needed for people who do not respond to lifestyle modifications, for those who are unable to adhere, or for whom such interventions are inaccessible/unfeasible. Preliminary results of ongoing trials were presented and discussed. Several pharmacological candidates are currently under clinical evaluation with promising early results, but none have been approved for either frailty or sarcopenia. The COVID-19 pandemic has reshaped how clinical trials are conducted, in particular by enhancing the usefulness of remote technologies and assessments/interventions.

Professional challenges encountered by healthcare professionals and its impact on their well-being during the covid-19 pandemic

Background: The unprecedented public health concern of COVID-19 pandemic poses challenges at structural and psychosocial levels, increases the risk of psychological morbidity and affects the well-being of healthcare professionals (HCPs). Objective: The study aimed to understand the professional challenges faced by HCPs during the COVID-19 pandemic in India. It also aimed to understand the psycho-social impact of these challenges on the subjective well-being of HCPs. Method: A cross-sectional web-based survey was designed, consisting of twenty-eight multiple choice or Likert-type questions. The survey had four mental health domains to be explored. It was an anonymous survey with online informed consent and was circulated on social media groups of doctors and nurses in Delhi, India using snow-ball method. Multivariate analysis of variance (MANOVA) was performed to study demographic and COVID-19 related factors on psychological and occupational variables. Further, thematic analysis and Latent Dirichlet Allocation (LDA) were used for short answer qualitative questions. Results: Results of 253 HCPs showed that those dealing with COVID-19 patients, scored lower on perceived occupational preparedness (F1,251 = 6.266, p < 0.0001), work satisfaction (F1,251= 40.998, p < 0.0001) and well-being (F1,251 = 53.529, p < 0.0001) as compared to non-COVID-19 duty HCPs;although they displayed less challenges in adaptation and protection (F1,251 =17.413, p < 0.0001). Based on LDA and thematic analysis, seven clusters were identified each-to understand the greatest struggle and subsequent support needed by HCPs during the pandemic. Conclusions: The study highlights the immediate need to protect the mental health of HCPs by establishing comprehensive psychological interventions and services.