Successful resolution of left ventricular thrombuses in a patient with MIS-C

Background and Aim: A 15 year old young man with symptoms and signs consistent with MIS-C was admitted to the Intensive Care Unit for inotropic support as he was exhibiting signs of cardiogenic shock. He was previously fit and healthy and he had been exposed to Covid 19 confirmed cases 6-8 weeks prior to becoming unwell. Method(s): The patient received IVIG and steroids as an immuno-modulating regime. On the admission echocardiogram there was a structurally normal heart with large LV thrombuses. The D-Dimers were extremely elevated on admission and the patient received therapeutic heparin infusion. Other prothrombotic causes were excluded. Result(s): The surveillance echocardiogram 24h post admission showed resolution of the thrombuses. The patient never exhibited any signs or symptoms of cardiac ischaemia on the electrocardio-gram or regional wall motion abnormality on the echocardiogram or neurologic impairment and the brain MRI-MRA one week post admission was normal. The patient was discharged home 5 days post admission and on follow ups up to a year after the acute phase remains very well physically and clinically. Conclusion(s): Thromboembolic events are frequently described in COVID-19 patients and in some patients with MIS-C and are the consequence of a hyperinflammatory response and endothelial dysfunction. There might be a potential role of an antiphospholi-pid syndrome secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as has been proposed. An increase in D-dimer level has been shown to be associated with thromboembolic events, including arterial thrombosis especially in the older population and should be investigated promptly. With the appropriate immunomodulation and antithrombotic treat-ment adverse events are prevented. More studies to assess endothelial function and its role in the MIS-C prothrombotic state are necessary.

Treatment of vaginal atrophy using fractional microablative CO2 laser in post-menopausal women with breast cancer on aromatase inhibitors: A pilot study

Aims: Vaginal atrophy (VA) in post-menopausal women with breast cancer (BC) is common and often exacerbated by endocrine therapies. Fractional CO2 intra-vaginal laser is a non-hormonal therapy designed to treat VA by improving microcirculation and collagen formation. We evaluated the feasibility of CO2 laser in women with BC on aromatase inhibitors (AI). Methods : In this single-arm pilot study, post-menopausal BC patients receiving adjuvant AI with symptomatic VA had 3 laser treatments scheduled 4 weeks apart. Clinician assessment, vaginal cytology, biopsy and questionnaires were undertaken at baseline and 12-weeks post treatment. The primary endpoint was improvement in the Urogenital Atrophy Questionnaire (UAQ) and Vaginal Health Index Scores (VHIS). Secondary end points were improvement in epithelial cytology and vaginal atrophy by central review and the Female Sexual Function Index (FSFI). Results : Between May 2017 and July 2020, 33 patients were enrolled. Slow recruitment and COVID-19 restrictions lead to premature study closure. Participants: median age 52 years (range 32-76), bilateral oophorectomy (n = 15, 45%), prior chemotherapy (n = 24, 73%) and bilateral mastectomy (n = 9, 27%). 27 patients completed all 3 pre-planned treatments and post-treatment assessment (T1 n = 30;T2 n = 30;T3 n = 28;post-Rx n = 27) and were eligible for final analysis. patient-reported vaginal dryness (100 vs 48%), irritation/itch (56 vs 19%), pain (63 vs 11%) and dyspareunia (89 vs 78%) all reduced in frequency at 12-weeks post treatment. VHIS score improved by a median of 5-points, predominantly due to an increase in epithelial integrity score. Reported vaginal dryness for most/all the time on UAQ reduced from n = 21/27 (78% to n = 8/27 (30%). No clinically meaningful improvement in sexual function domains was detected on UAQ and FSFI questionnaires. Cytology and histological findings will be presented. Conclusions : Pilot work suggests CO2 laser may be a feasible non-hormonal option for management of vaginal dryness and clinician-assessed VA, with little impact on sexual dysfunction.

Thinking with Doors and Perspectives: Reimagining Early Childhood Spaces

This paper explores, through a posthumanist lens, child care as a communal responsibility, taking into account varied partial perspectives produced through human and more-than-human intra-actions. Multiple narratives illustrate embodied and experienced complexities within child care spaces allowing us to reflect on uncomfortable truths to enact affirmative ethics as a way to transform the ways we care for children, their families, each other, and the spaces of child care. Specifically, we think with actual and virtual doors as producers and enablers to create spaces where early childhood educators might collaboratively interrogate how materiality and socially constructed hierarchies are embedded in the inequities that separate us, inequities further exposed and exacerbated by the COVID-19 pandemic.

The experience of COVID-19 “lockdown” for people with a learning disability: results from surveys in Jersey and Guernsey

Purpose: The purpose of this paper is to outline a service evaluation that gathered feedback from people with a learning disability on their experience of lockdown in Jersey and Guernsey. This feedback was intended to guide planning for service provision during any future lockdown and for life as we exit lockdown. Design/methodology/approach: An accessible survey was sent to everyone accessing learning disability services across the two islands and Mencap in Jersey. Data was analysed quantitatively and qualitatively to identify patterns in the data and key themes. Findings: Most respondents felt safe, calm and happy and valued support from services. Key themes emerging from the data included the importance of relationships, messages of safety, keeping busy and communication. Originality/value: This survey has been undertaken at a time where there is a paucity of research and consultation with individuals with a learning disability self-reporting on their experiences of lockdown, during the COVID-19 pandemic. © 2021, Emerald Publishing Limited.