Retained Copper Intrauterine Device Fragment in Pregnancy: A Case Report.

Copper intrauterine device (IUD) failure and fragmentation are rare, with minimal documentation on their effects in pregnancy. Recommendations from professional organizations highlight the importance of prompt identification and surgical removal, as case reports have noted various acute and chronic intra-abdominal pathologies. However, limited guidance exists around counseling patients who are pregnant with a retained IUD fragment. Here, we present a case of a normal pregnancy with a retained copper IUD fragment, while reviewing existing data on management and counseling.

Obesity Hypoventilation Syndrome-Related Challenges in Acute Respiratory Failure.

Obesity hypoventilation syndrome (OHS) is a condition commonly found in severely obese patients in which they fail to breathe deeply or rapidly enough to offset the body's need for oxygen consumption and carbon dioxide release. This report presents a case of a 49-year-old super-super-morbid obese female with a body mass index (BMI) of 90 kilogram per meter squared (kg/m²), chronic obstructive pulmonary disease (COPD), and end-stage cor pulmonale, who was brought to the emergency department for altered mental status and requiring emergent airway due to respiratory failure secondary to OHS. The continued increase in rates of obesity worldwide, especially in those with BMI ≥ 50 kg/m², may lead to an increase in the incidence of OHS. With comorbidities secondary to obesity and associated complexity, this medically challenging case emphasizes the need for refined management strategies in caring for OHS in super-super-morbidly obese patients.

Complications of COVID-19 Pneumonia and Multiple Sclerosis Exacerbation.

Multiple sclerosis (MS) is the most common autoimmune disease in the United States, in which demyelination of the brain and spinal cord disrupts the transmission of signals throughout the body. With an average life expectancy of 30 years from the start of the disease, treatment relies on symptom management through steroids and disease-modifying agents, as there is no cure. While MS patients have not been shown to be at increased risk for coronavirus disease 19 (COVID-19) infection, prolonged hospitalizations and severe COVID-19 sequelae have been linked to various MS subgroups. Limited studies, however, have reported on the role of COVID-19 in precipitating MS exacerbations, as flare-ups often occur during times of stress or immunological insult. Here we present a 45-year-old patient with relapsing-remitting multiple sclerosis whose neurological symptoms worsened sharply in the weeks following an inpatient admission for COVID-19 pneumonia.

COVID-19 Pneumonia and Exacerbation of Multiple Sclerosis Flares Necessitating Placement of Suprapubic Catheter and PEG Tube: A Case Study

One of the public health challenges posed by the COVID-19 pandemic is the management of patients with chronic neurological conditions, including multiple sclerosis. Here, we present the case of a 45-year-old male patient with severe multiple sclerosis without disease-modifying therapy who was admitted for COVID-19 pneumonia, treated with dexamethasone and Remdesivir, and then discharged. Subsequently, the patient was readmitted twice in the next month for complications arising from worsening dysphagia, musculoskeletal weakness, and neurogenic bladder. On the first of these re-admissions, the patient presented with altered mental status, secondary to uremic encephalopathy due to acute kidney injury precipitated by lack of adequate PO hydration. This admission was complicated by multiple pulmonary emboli necessitating transfer from the floor to the ICU, in addition to central line placement, candidemia, Pseudomonas urinary tract infection, and hemorrhagic cystitis. Despite this protracted course, the patient's mental function and orientation slowly improved as his renal function improved secondary to intravenous fluid administration. Because the patient's worsening dysphagia and weakness made adequate hydration by mouth untenable, the possibility of PEG tube placement was broached with the patient and his family. After consent was obtained, a PEG tube was placed, and the patient was subsequently discharged home under the care of his family. Two days after discharge, however, the patient presented to the Emergency Department, again with altered mental status due to uremic encephalopathy secondary to dehydration. During this admission, blood cultures also revealed Pseudomonal sepsis, likely secondary to recurrent UTI ultimately caused by neurogenic bladder. Accordingly, a suprapubic catheter was placed, and the care team worked with the patient's family to develop an adequate hydration regime before discharge. This case study suggests that COVID-19 may exacerbate ongoing neuropathological processes in patients with chronic neurological disease, and illustrates strategies clinicians and patients use to grapple with these changes.

Influenza Vaccination Quality Improvement as a Model for COVID-19 Prophylaxis.

INTRODUCTION: Many comparisons have been made on the effect and impact of COVID-19 on influenza pandemics of history. Therefore, it is reasonable to infer that the strategies utilized by healthcare providers to improve influenza vaccination rates can similarly be applied to the administration of a COVID-19 vaccine. The purpose of this study was to determine the rationale of low influenza vaccination rates in an urban allergy clinic and how to improve patient education and knowledge regarding the importance of influenza vaccination. A three-year comparison of interventions is presented as well as its application to future COVID-19 vaccinations. METHODS: This study was performed at an outpatient allergy and clinical immunology practice (MSBI) with hospital affiliation in New York City, New York. A quality improvement medical committee was formed to optimize influenza vaccination rates to greater than 71% and established standardized protocols regarding patient intake workflows, vaccine counseling, and documentation. Patient records from four providers were used for this study to compare pre-and post-intervention rates. RESULTS: 984 patients met inclusion criteria, with a normal distribution of ages (18-80), race, and sex. Average vaccination rates prior to the intervention were 9.25-13.60%. The average vaccination rate after the intervention was 91.34%. DISCUSSION: The MSBI quality improvement study identified key areas to address in improving influenza vaccination rates. Vaccine hesitancy, public misinformation, and ambivalence surrounding vaccination with egg allergies or during a subcutaneous immunotherapy injection were all topics addressed during the 2018-2019 intervention year. Additional attention was also put toward provider education and standardization of documentation. Shared decision making and intensive education/outreach efforts are needed by physicians and patients alike to overcome vaccine hesitancy. In comparing this to upcoming COVID-19 vaccine challenges, similar barriers will likely also need to be addressed. Greater research is needed to understand patient motivations regarding hesitancy specific to the COVID-19 vaccine. CONCLUSION: As evidenced in the yearly battle with influenza and now the COVID-19 pandemic, it has become essential to identify and implement multi-level strategies to maximize vaccination rates, especially amid a global pandemic. With COVID-19 vaccines reaching emergency approval stages, it is important for healthcare providers to start creating workflows and strategies to address patient inquiries. The influenza vaccination quality improvement project presented here can be used as a guideline for future evaluations of COVID-19 vaccination efforts.

Further Reduction in Help-Seeking Behaviors Amidst Additional Barriers to Mental Health Treatment in Asian Populations: A Contemporary Review.

Under diagnosis and treatment of mental health illnesses lead to chronic presentations and consequences. Multiple factors contribute to gaps in treatment, including the role culture plays in the development or suppression of help-seeking behaviors (HSBs). In the Asian community, conversation and recognition of mental health and its disorders are considered shameful. This review presents an analysis of literature to identify barriers to mental health treatment pronounced in Asian populations and discusses how culture influences these barriers and treatment-seeking behaviors, particularly in the context of the Asian-origin Coronavirus disease 2019 (COVID-19) global pandemic. It is the purpose of this review to discuss Asian American underutilization of mental health services and understand the factors the contribute to psychiatric care resistance in Asian communities.

Providing Culturally Competent Care for COVID-19 Intensive Care Unit Delirium: A Case Report and Review.

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization in March 2020. Caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, its high transmissibility required infected individuals to be placed in negative pressure isolation rooms when admitted to intensive care units (ICU). Studies have shown that limited social support can increase the risk of developing delirium during ICU stays. Minimal research exists on COVID-19-associated ICU delirium as hospitals and government organizations focus on combating equipment shortages and case surges. Here, we present the case of a 64-year-old Filipino male with COVID-19 ICU delirium status post-intubation and ventilation. His hospital course was complicated by the medical staff's assumption that the patient spoke Spanish and improved after being assigned a Tagalog-speaking nurse who facilitated family communication. This case highlights the importance of cultural competency and communication in the management of COVID-19 associated ICU delirium. In particular, Filipino cultural practices and their intersection with healthcare in the larger context of providing culturally competent care are highlighted. The use of culturally competent care serves to assure the use of appropriate services and reduces the occurrence of medical errors due to misunderstandings caused by differences in language or culture. Familial involvement is critical for ICU delirium; however, the COVID-19 pandemic has required healthcare providers to think beyond conventional means. The use of technology to virtually communicate with family also serves as a helpful tool to treat signs of delirium. As seen in this case, a lack of understanding of the Filipino culture resulted in assumptions on the part of the healthcare provider which led to the prolongation of delirium in a COVID-19 ICU patient, but the correct utilization of cultural competence helped the patient recover successfully.