ABSTRACT
Case Diagnosis: Asymmetric acute inflammatory demyelinating polyneuropathy as presenting symptom of COVID-19 infection. Case Description or Program Description: A 54-year-old male with history of alcohol use with fiveday history of left leg weakness with progression to numbness and weakness to the left side of his face. He then developed right sided weakness, more severe than his left side, primarily distally, as well as numbness and tingling into his bilateral hands. Imaging was negative for acute cause of his symptoms. He did test positive for COVID-19 but was asymptomatic except for occasional dry cough one week prior. His symptoms were initially thought to be from peripheral neuropathy secondary to alcohol use, however he then developed new dysarthria and dysphagia. Setting(s): Acute Inpatient Rehabilitation Hospital Assessment/Results: MRI brain, CTA head and neck, CT cervical spine were negative for acute causes of weakness. Negative HIV and paraneoplastic panel. Lumbar puncture showed albuminocytologic dissociation consistent with Guillain-Barre Syndrome (GBS) . Electrodiagnostic testing is scheduled and pending at this time. Discussion (relevance): GBS generally presents as a symmetric, ascending weakness secondary to a potential viral attack on myelin and Schwann cells. GBS can rapidly ascend and cause autonomic and respiratory failure, so early and accurate diagnosis and treatment are essential. This case demonstrates GBS related to COVID-19 with minimal other symptoms. It also demonstrates the importance of thorough investigation of the potential differentials for neuropathy, as this patient's diagnosis was initially thought to be from alcohol use, which can lead to inappropriate treatment with worse outcomes. In this case, there was a lower suspicion for GBS given its unusual presentation and non-definitive association with COVID-19 infection. Conclusion(s): There is growing research of a positive correlation between COVID-19 infection and GBS, which is further supported by this case with unusual presentation of asymmetric GBS. Continued research is needed to determine the risk of GBS with COVID-19 infection.
ABSTRACT
This article discusses two collaborative theatre projects developed virtually due to COVID-19 restrictions during the 2020-2021 academic year. These projects- Medieval Ballads in Miniature: A Shadow of Myself and Our New Gold-highlight the dynamics of theatrical collaboration outside the traditional performing arts setting or classroom and show how these can be truly synergistic and enriching for academic and non-academic audiences.
ABSTRACT
Background Colorectal cancer (CRC) screening programs worldwide have been disruptedduring the COVID-19 pandemic. CRC screening has been well-established to reduce longtermCRC incidence and mortality. Any disruption to screening would reduce these healthbenefits. This study aimed to estimate the impact of hypothetical disruptions to organizedCRC screening programs on short and long-term CRC incidence and mortality in threecountries using microsimulation modelling.Methods Using well-calibrated and validated CRC microsimulation models for Australia(Policy1-Bowel), Canada (OncoSim) and the Netherlands (ASCCA and MISCAN-Colon)participating in the COVID-19 and Cancer Global Modelling Consortium (CCGMC), wesimulated a range of hypothetical scenarios to assess the potential impact of disruptions toscreening on CRC incidence and mortality. All models simulate the adenoma-carcinomapathway, and ASCCA and Policy1-Bowel additionally simulate the serrated pathway. Modelledscenarios varied by disruption duration (3-, 6 and 12-months), post-disruption participationreduction (3-months -50% and 3-months -25%, and 6-months -50%), and catchupscreening strategies (no catch-up, immediate, and 6-months delayed catch-up).Results Without catch-up screening, CRC incidence would increase by 0.1-0.3%, 0.2-0.6%,and 0.4-1.2% over 2020-2050 among individuals aged 50 years and older in the three modelled countries after 3-, 6-, and 12-month disruptions, respectively (Figure 1). CRCmortality would increase by 0.2-0.5%, 0.4-1.0%, and 0.8-2.0% over 2020-2050 amongindividuals aged 50 years and older in the three modelled countries after 3-, 6-, and 12-month disruptions, respectively, compared to undisrupted screening (Figure 2). A 6-monthdisruption without catch-up would result in an estimated 3,552, 2,844 and 803-1,803additional CRC diagnoses and an estimated 1,964, 1,319, and 676-856 additional CRCrelateddeaths in Australia, Canada and the Netherlands, respectively, compared to undisruptedscreening. A post-disruption reduction in participation could increase CRC diagnosesby 0.2-0.9% and CRC-related deaths by 0.5-1.6% compared to undisrupted screeningdepending on the size of the reduction in participation. Providing catch-up could minimizethe impact of the disruption to an increase of 0.0-0.2% in CRC diagnoses and CRCrelateddeaths.Conclusion Although the relative impact of the modelled CRC screening disruptions (whenconsidered over the long-term, 30 years) due to the COVID-19 pandemic appears modest,given a high burden of CRC, there is a substantial impact on CRC diagnoses and deathsacross all countries considered. It is crucial that, if disrupted, screening programs ensureparticipation rates return to previously observed rates and provide catch-up screening whereverpossible, as the impact of any disruption could be considerably larger otherwise.(Image Presented)Change in CRC incidence relative to the comparator scenario (no disruption) by MISCANColon,ASCCA, Policy1-Bowel and OncoSim Abbreviations: CRC, Colorectal Cancer. Note:the base case scenario is the scenario in which a 6-month disruption period from Aprilto September 2020 was assumed, with no catch-up or changes to participation in therecovery period.(Image Presented)Change in CRC mortality relative to the comparator scenario by MISCAN-Colon, ASCCA,Policy1-Bowel and OncoSim Abbreviations: CRC, Colorectal Cancer. Note: the base casescenario is the scenario in which a 6-month disruption period from April to September2020 was assumed, with no catch-up or changes to participation in the recovery period.
ABSTRACT
Aims Colorectal cancer (CRC) screening programs worldwide have been disrupted during the COVID-19 pandemic. Thisstudy aimed to estimate the impact of hypothetical disruptions to organized FIT-based CRC screening programs on short-and long-term CRC incidence and mortality in three countries using microsimulation modelling. Methods Using CRC microsimulation models for Australia (Policy1-Bowel), Canada (OncoSim) and the Netherlands (ASCCAand MISCAN-Colon) participating in the COVID-19 and Cancer Global Modelling Consortium (CCGMC), we simulated a rangeof scenarios to assess the potential impact of disruptions to screening on CRC incidence and mortality. Modelled scenariosvaried by disruption duration (3-, 6-and 12-months), post-disruption participation reduction, and catch-up screeningstrategy (no catch-up, immediate and 6-month delayed catch-up). Results Without catch-up screening, CRC incidence increased by 0.1-0.3 %, 0.2-0.6 %, and 0.4-1.2 % over 2020-2050among individuals aged 50 years and older in the three modelled countries after 3-, 6-, and 12-month disruptions,respectively, compared to undisrupted screening and CRC mortality increased by 0.2-0.5 %, 0.4-1.0 %, and 0.8-2.0 % over2020-2050 among individuals aged 50 years and older compared to undisrupted screening. A 6-month disruption withoutcatch-up resulted in an estimated 3,552, 2,844 and 803-1,803 additional CRC diagnoses and 1,961, 1,319, and 678-881 additional CRC-related deaths in Australia, Canada and the Netherlands, respectively. A post-disruption reduction inparticipation increased CRC diagnoses by 0.2-0.9 % and CRC-related deaths by 0.5-1.6 % compared to undisruptedscreening. Providing catch-up screening minimized this impact to 0.0-0.2 %. Conclusions Although the relative impact of the modelled CRC screening disruptions due to the COVID-19 pandemicappears modest, given a high burden of CRC, there is a substantial impact on CRC diagnoses and deaths across allcountries considered. It is crucial that, if disrupted, screening programs ensure participation rates return to previouslyobserved rates and provide catch-up screening wherever possible, as the impact of any disruption could be considerablylarger otherwise.