ABSTRACT
Introduction: Although most studies on the symptomatology associated with the coronavirus disease 2019(COVID-19) have been focused on the clinical presentations of hospitalized patients in acute settings, an increasingnumber of reports show a rise in “COVID-19 long haulers”-patients who continue to experience or developpersistent symptoms weeks or months after recovering from initial illness. Over 66-87% of COVID-19 patientsreported at least one persistent symptom related to the disease, the most common of which includes: fatigue,cough, dyspnea, anosmia, headaches, arthralgia, and chest pain. These lingering symptoms affect those whoexperienced mild as well as moderate or severe COVID-19 both as inpatients and outpatients. The field of NuclearMedicine offers non-invasive tests that has the potential to help monitor and evaluate COVID-19 long haulers. Methods: We discuss the role of Nuclear Medicine in evaluating COVID-19 long-haulers by presenting the relevanttechniques available in the field. We describe potential applications of these tests to provide both anatomic andfunctional evaluation with the potential to identify medical issues in the long-haulers. Results: COVID-19 has been shown to be a disease that affects multiple organ systems in a variety of ways.Infection and inflammation due to COVID-19 can damage several organs, most notably the lungs, heart, andkidneys. In examining injuries in the lungs, the use of 18F-FDG PET not only highlights the ground-glass opacitiesand lung consolidations consistent with CT findings of COVID-19 patients, but also shows increased 18F-FDGuptake in specific infected areas such as the lymph nodes, allowing us to detect and accurately map the location ofinfection and inflammation. On the other hand, myocardial injury due to COVID-19 can be observed by myocardialperfusion scintigraphy. This is especially useful when assessing microcirculation and coronary flow reserve for riskstratification and therapeutic planning. Finally, due to the high incidence of acute kidney injuries and subsequentrenal complications among COVID-19 patients, the use of renal scintigraphy with Tc-99m MAG-3 and DMSA mayhelp identify renal injuries and scarring. Conclusion: Diagnostic procedures in Nuclear Medicine such as PET/CTand body scintigraphy has the potential to allow us to detect, monitor and evaluate COVID-19 disease complicationsand related organ damage in long-haulers. When utilized in conjunction to other imaging techniques, NuclearMedicine can help provide additional anatomic and functional information to evaluate issues in COVID-19 longhaulers.
ABSTRACT
Objectives: Sundown syndrome, or sundowning, is a state of confusion occurring in the late afternoon andcontinues into the night. Sundowning can cause a variety of behaviors such as confusion, anxiety, aggression,agitation, and hallucinations. Sundown syndrome commonly occurs in patients with dementia, in inpatient elderlyfacilities and hospitals. This project seeks to identify the effects of sundowning on nuclear medicine studies,especially during the COVID-19 pandemic. Methods: Elderly patients with dementia can experience sundown syndrome when their daily routines are distorted.Sundowning in elderly patients can be avoided by maintaining a consistent daily schedule and routine. Anappropriate schedule to prevent sundowning may include getting the patient out of bed, walking, regular mealintervals, frequent reorientations, and regular patient to staff interactions. During the COVID-19 pandemic, patient-staff interactions have been limited which alters a patient's daily schedule, thus potentiating sundown syndrome.Elderly patients can undergo nuclear medicine studies at varying times during the day or night. The irregular timingof nuclear medicine studies can exacerbate and potentiate sundowning in elderly patients with dementia. Even priorto the pandemic, the performance of nuclear studies can be affected by sundowning, especially ones that are longand requiring the patient's cooperation. Anxious, agitated, and disoriented patients with sundown syndrome canmake the practice of nuclear medicine studies challenging and effect the potential efficacy of the study. Results: Nuclear medicine plays an important role in the care of elderly patients. Sundown syndrome in specificpatient populations may present as a challenge during nuclear medicine scans, therefore limiting the performance,diagnosis and efficacy of potential studies. We review the ways sundown syndrome occurs in the hospital during theCOVID-19 pandemic, prior to the pandemic and present methods to manage these challenges. Conclusions: Nuclear medicine provides important diagnostic information in the health of elderly patients. Wediscuss the implications of elderly patients with sundown syndrome and identify the challenges nuclear medicinephysicians and technologists face with sundowning patients in the practice of nuclear medicine, especially duringCOVID-19. We explore methods to prevent sundowning to ensure the best performance of nuclear medicine studiesin elderly patients. Bibliography Graff-Radford J. Sundowning: Tips for dealing with late-day confusion. Mayo Clinic.https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/sundowning/faq-20058511.Published April 23, 2019. White J. Avoid 'sundowning' in elderly hospital patients.https://www.healthcarebusinesstech.com/sundowning-elderly-patients/. Published November 18, 2020.