Four cases of acute comitant esotropia associated with diffuse intrinsic pontine glioma in children.

BACKGROUND: Acute acquired concomitant esotropia (AACE) is usually a benign form of strabismus that infrequently is associated with intracranial pathology. Clinicians have noted an increase in its incidence and theorize that it may be related to public health "lockdown" measures taken in response to the COVID-19 pandemic. With an increased incidence of AACE clinicians must firstly differentiate AACE from common accommodative esotropia and secondly recognize AACE as a possible sign of serious neuropathology.Diffuse Intrinsic Pontine Glioma (DIPG) is a devastating diagnosis for affected families. Children typically present at age 6-7 years with cranial nerve palsies, long tract signs, and/or cerebellar signs. Diagnosis is made from characteristic findings on magnetic resonance brain imaging (MRI brain) and treatment includes radiotherapy and palliative care. Two years from diagnosis, 90% of affected children will have died from their disease. CASE SERIES: We present four cases that attended our pediatric ophthalmology clinic with AACE either as a presenting sign of DIPG or as a clinical finding following a DIPG diagnosis. Patient A (age 5 years) presented to the emergency eye clinic with sudden onset diplopia and intermittent esotropia. Suppression later developed, they had 0.00 logMAR visual acuity either eye, and bilateral physiological hypermetropia. MRI brain imaging requested as a result of the unusual presentation led to the DIPG diagnosis. The other 3 cases (ages 11, 5 & 5 years) were assessed post DIPG diagnosis and found to have an esotropia measuring bigger on 1/3-meter fixation than 6-meter fixation, full ocular motility, physiological hypermetropia or emmetropia, and visual acuity normal for age. Other than patient B (age 11 years), who had papilledema and gaze evoked nystagmus when they were assessed 2 weeks prior to death, no patient had any other clinical eye findings. CONCLUSIONS: This small series of 4 patients attending our clinic within a 12-month period supports the notion that children presenting with AACE should routinely be offered brain MRI. Not all children with DIPG-associated AACE have significant ophthalmic findings indicative of intracranial pathology. With the potential for increased incidence of AACE related to lockdowns, clinicians should be reminded of the infrequent possibility their patient has a more serious condition.

Hospital-acquired antibiotic-resistant organisms among patients with COVID-19

Background: We sought to use existing in-patient surveillance data to investigate the risk of hospital-acquired antimicrobial-resistant organisms (ARO) among patients with COVID-19 infection. Methods: Prospective case capture was done for patients admitted with COVID-19, as well as those admitted with ARO and Clostridioides difficile infections (CDI). Odds ratios (OR) were used to measure the strength of association between COVID-19 infection and the risk of acquiring hospital-acquired ARO and CDI. Results: The odds of acquiring ARO/CDI were statistically higher among patients with hospital-acquired and community-acquired COVID-19 infections (OR=2.68 and 1.79 respectively) compared to persons without COVID-19 (OR=0.53). Conclusions: Our results show an association between COVID-19 infection and the acquisition of ARO/CDI in the in-patient setting. This finding suggests that prolonged hospitalization may expose patients to hospital-acquired infections, and this may have relevance in the management of patients requiring hospitalization for extended periods of time.

An Exploratory Study of a Health and Wellness Intervention on STEM College Students During COVID-19

To address the growing health challenges faced by college students, campus recreation departments have evolved from a primary university intramural sport setting to organizations that have an increased emphasis on student recruitment, retention, and overall wellness. Among the strategies used to attract and engage students in campus recreation programs and services, health coaching shows some promise as a potentially effective intervention strategy. This study examined the efficacy of a university campus recreation health coaching program. Students from Science, Technology, Engineering and Math (STEM) disciplines (n = 34) were provided with individual, group, and virtual support to assist in developing effective strategies for academic success. Fitbit data measuring participants' sleep and physical activity were collected along with self-reported measures of stress and perceived happiness and focus group qualitative data focused on participants' perceptions of the program. Despite the COVID-19 pandemic forcing the program to adapt, findings suggest that health coaching may be an effective intervention strategy to help university students cope with the heightened anxiety and stress levels associated with campus life. © The Author(s) 2023.

Parental perceptions of the impact of COVID-19 and returning to play based on level of sport

This study examined the impact of COVID-19 on youth sport parents based on competition level to understand how the pandemic affected youth sport and factors associated with youth returning to sport. Survey data were collected from samples of US sport parents in two waves - early in the pandemic (N = 751) and as programs began to resume (N = 707). Data showed elite sport parents were more willing to return. Although most participants returned to play, significant numbers had not resumed participation. Parent comfort was the most important factor associated with resuming. However, parents allowed children to resume play due to perceived external pressure, potentially creating stress among parents regarding sport participation decisions. Attending school in person and household income were associated with the ability to resume sport suggesting the need to provide school sport environments and consider the financial impacts of COVID-19 on sport families.