ABSTRACT
Objective: To describe a case report of Cerebral Venous Sinus Thrombosis (CSVT) and bilateral thalamic infarcts following Pfizer-BioNTech mRNA vaccine in a patient with ulcerative colitis. Background: CSVT has been reported as a rare but life-threatening side effect from SARS-CoV2 vaccines. Although the incidence of developing CSVT is higher following administration of viral vector vaccines (Oxford-AstraZeneca and Johnson&Johnson), six cases of CSVT have been reported following administration of mRNA vaccines (Moderna and Pfizer- BioNTech).1,2,3 In these six cases, only two patients had risk factors (oral contraceptives use and undiagnosed renal cell carcinoma).1,2,3 Our patient was diagnosed with ulcerative colitis (UC) after her presentation with CSVT. Current literature suggests the risk of thromboembolism is twice as common in patients with UC in comparison to the general population. Design/Methods: N/A Results: A 22-year female developed headache, vomiting, and altered mental status after 14 days following administration of the first dose of Pfizer-BioNTech mRNA vaccine. MRI/MRV confirmed bilateral symmetric thalamic infarctions with straight and inferior sagittal sinus thrombosis. She did not have other risk factors such as the use of oral contraceptive pills or pregnancy. ESR/CRP elevated, but platelet count, INR were normal. Hypercoagulable workup was unrevealing. Treatment with therapeutic anticoagulation led to an improvement in symptoms within a week. As the patient previously had rare intermittent bloody diarrhea, further workup (CT abdomen and colonoscopy with biopsy) led to a diagnosis of ulcerative colitis. Conclusions: The temporal association demonstrated between the development of CSVT and the administration of Pfizer-BioNTech mRNA vaccine in the patient is likely a result of the combined hypercoagulability effect of the vaccine and Ulcerative colitis. Active surveillance and continuous pharmacovigilance are necessary to clarify this association. This might help to identify at-risk populations where prophylactic short-term anticoagulation can be used to prevent CVST.
ABSTRACT
Introduction: In the face of the coronavirus disease 2019 (COVID-19) pandemic, the leadership of the institute felt a need for mental health interventions among patients admitted in COVID-19 isolation, university students, and health-care workers engaged in COVID-19 care. This article aims to share our experience in providing these services. Methodology: COVID-19 inpatients were telephonically counseled. Counseling protocol was based on national guidelines. Students of the university were assessed for emotional problems using a symptom checklist and Kessler 10-item Distress Scale. Subsequently, the faculty assigned as mentors were trained in providing telephonic psychological first aid (PFA) to the students. Psychosocial help was offered to health-care workers through daily guided relaxation sessions. Results: Forty-two of 69 COVID-19 inpatients were telephonically contacted. New-onset mental health problems were found in 40%. Half of the COVID-19 confirmed patients and half of the females had a higher prevalence of mental health problems. On the symptom checklist, 330 students were responded. Worry about the future, contagion, and boredom were reported by the majority of students. On the Kessler 10-item Distress Scale, 272 students were responded. Thirty-seven percent had likely mental disorders (22 males and 79 females). Twenty-two students contacted psychiatrists through mentors and were provided teleconsultation. Eighty health-care workers attended guided relaxation sessions. Twenty-nine responded on the feedback form. Most respondents felt guided relaxation was useful in reducing stress, with strongly agree (n = 12) and agree (n = 14) responses. Conclusions: Emotional problems were significantly prevalent among students and COVID-19 patients. Training faculty in PFA can help address students in distress. Guided relaxation may help frontline workers manage stress.& nbsp;