Acute Isolated Diastolic Hypotension and History of Substance Abuse in the Development of Delirium

INTRODUCTION: In a prior analysis, delirium was seen more often in patients with at least one incident of IDH in the first 48 hours compared to those who remained normotensive (8.1 vs 3.0%). Here we explored events over the entire hospital stay and focused on a subpopulation of patients with a history of substance abuse (SA). Their treatment would include a narcotic or benzodiazepine, as potential vasodilators they could increase the likelihood of IDH. METHOD(S): We performed Aa retrospective chart review of patients >18 years with blunt trauma, Glascow Coma Scale >= 14 and head/neck Abbreviated Injury Score <= 1 admitted to our Level I trauma center from 8/1/16 to 4/1/20, to avoid potential confounding from COVID-19., was doneperformed. This study focused on two groups: normotensive (systolic blood pressure (SBP) >100 and diastolic blood pressure (DBP) >60) throughout their stay and IDH (SBP > 100 and DBP < 60) at any point during their admission. We compared them these two groups on the occurrence of delirium after an IDH episode using. The statistical comparisons were done using chi-square tests and logistic regressions, which included other patient characteristics associated with IDH and delirium. RESULT(S): A total of 1656 patients met inclusion criteria and were assessed for delirium (613 normotensive and 1043 IDH). As hypothesized, delirium was significantly more likely in the IDH than in the normotensive group (5.1 vs 1.5%;p < 0.001). As predicted patients with SA history were more likely to have IDH (62.2 vs 56.0%) and were more likely to develop delirium (6.2% vs. 3.4%) although these differences were not statistically significant. The IDH effect on delirium was significant only for patients without SA history and SA history was significant for delirium only in the normotensive group (both p <.0.001). The effect of IDH and its interaction with SA remained significant in multivariate analysis. Age also remained an independent risk factor for delirium. CONCLUSION(S): These results confirm our prior work on the association of IDH and delirium and suggest that SA has an impact on IDH. Surprisingly, these two factors do not appear to compound each other. This pattern remains significant in a multivariate approach. More exploration of the interaction of substance abuse on IDH and other factors is needed.

Recurrent Acute Pancreatitis Secondary to Hypertriglyceridemia in an Adolescent With Type 2 Diabetes, Symptomatic Hypocalcemia, and COVID-19 Infection

Introduction: Hypertriglyceridemia is the third most common cause of acute pancreatitis, leading to increased morbidity and mortality. Hypocalcemia is a frequent complication of pancreatitis, attributed to saponification of calcium by the release of pancreatic lipase. Free fatty acids are released by the breakdown of triglycerides, then react with extracellular calcium, forming fatty acid salts that deposit in the retroperitoneum and reduce calcium availability.1We present a case of an adolescent female with recurrent episodes of acute pancreatitis, hypertriglyceridemia, and hypocalcemia. Her first presentation of pancreatitis coincided with new-onset type 2 diabetes, while this third episode with COVID-19. Case: An 18-year-old morbidly obese female with type 2 diabetes, hypertriglyceridemia, hepatomegaly, and recurrent acute pancreatitis was admitted for a third episode of pancreatitis secondary to severe hypertriglyceridemia.On admission, triglycerides were 3213 mg/dL (reference 35-134mg/dL), lipase 12,721 units/L (145-226u/L), amylase 323 units/L (<106u/L), AST 90 units/L (10-26u/L), and ALT 109 units/L (19-49u/L). A1C was 7.5%, blood glucose 301 mg/dL, bicarbonate 25 mmol/L, and large urine ketones. Initial calcium was 8.7 mg/dL (9.0-10.7mg/dL) and albumin 4.0 gm/dL (3.8-5.6gm/dL). The next day, she developed hypocalcemia with numbness and tingling. Serum calcium was 5.3mg/dL, ionized calcium 0.74 mmol/L (1.12-1.37mmol/L), and albumin <0.6 gm/dL. 25-hydroxy vitamin D level was 16.5 ng/mL (30-100). QTc was 470 ms (350-440ms). She was transferred to pediatric intensive care and initiated on an insulin drip at 0.1 units/kg/hour for hypertriglyceridemia. She received four IV calcium gluconate boluses (1000-2000 mg each). Symptoms improved within one day. Triglycerides decreased to 642 mg/dL, calcium and albumin normalized, and subcutaneous insulin regimen was resumed. She started vitamin D 3000 IU daily and elemental calcium carbonate 26 mg/kg/day. During her hospitalization, she was found to be COVID-19 positive and had become hypoxemic requiring 2.5 liters of oxygen. Upon resolution, she was discharged with outpatient follow-up.Of note, there is a strong maternal family history of type 2 diabetes and hypertriglyceridemia. The mother had three strokes in her forties. The patient has not previously undergone pancreatitis genetic testing. Discussion: To conclude, this case affirms the importance of detecting hypertriglyceridemia-induced pancreatitis early on and improved outcomes with insulin drips. It is important to determine triggers for recurrent pancreatitis in those with underlying genetic etiologies of hypertriglyceridemia. Additionally, it is crucial to monitor for secondary hypocalcemia, particularly given the risk for prolonged QT interval and ventricular arrhythmias. Lastly, the COVID-19 pandemic may be associated with more severe presentations of pancreatitis.Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 12:30 p.m. - 12:35 p.m.

COVID-19 and Pakistani academic libraries: documenting the realities, challenges and state of services

The sudden rise of global pandemic has disrupted almost each and every segment of the society. On March, 2020, educational institutions in Pakistan including Libraries were forced to shift to online teaching, learning and provision of services. The need of the time is not only to document the systems, processes and procedures being implemented in Higher Educational Institutions including libraries, but learn from and build on these experiences. This survey is first of its kind effort to understand how Academic Libraries in Pakistan paved their way towards online transition, the challenges faced by them, the inclusion of library staff in overall decision making, the procedures and SOPs being implemented and their readiness to understand and respond to challenges. The study also provides recommendations for the Educational institutions and Higher Education Commission (HEC), Pakistan highlighting the importance of creating systems and resources to document, implement, share and build capacities of library staff at the National Level. © 2021. All Rights Reserved.