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1.
Ethnography ; 2022.
Article in English | Web of Science | ID: covidwho-2195240

ABSTRACT

Many ethnographers had to reconceptualize or withdraw from their fieldwork due to COVID-19. While the process of exiting the field has always interested ethnographers, the pandemic has spurred further thinking about the complexity of this element of the research process. This paper adds to the conversations around leaving a field site by unpacking the different situations that can trigger departure. Using data from our experience conducting ethnographic fieldwork before and during the pandemic to further our understanding of the complexity of exiting the field, we explore the concept of field collapsing events by elaborating on the differences between interruptions and disruptions. It is not the case that one form of stoppage has more weight, merit, or impact on an ethnographic project. Instead, we argue that to parse out the complexities of exiting the field, we must create more clarity around the kinds of exits that ethnographers experience.

2.
Open Forum Infectious Diseases ; 9(Supplement 2):S418-S419, 2022.
Article in English | EMBASE | ID: covidwho-2189687

ABSTRACT

Background. Literature shows early intravenous (IV) to oral (PO) antimicrobial transition for infective endocarditis (IE) and bone and joint infection (BJI) is noninferior to prolonged IV antimicrobial therapy. COVID-19 pandemic peaks resulted in critical shortages of staffed hospital beds spurring innovation. Outpatient parenteral antimicrobial therapy (OPAT), a well-established program using prolonged IV antimicrobials, faces challenges such as infusion resource needs and social circumstance limitations. Complex outpatient antimicrobial therapy (COpAT) uses PO in place of IV antimicrobials. We hypothesized rapid adoption of COpAT would decrease hospital length of stay and open beds while retaining satisfactory clinical outcomes. Methods. COpAT protocols (Image 1) and guidelines by infection type and isolated organism (Image 2) were created. Hospitalized patients including persons who inject drugs (PWID) were evaluated for IV to PO antimicrobial transition by an infectious diseases (ID) physician and then followed by an ID physician-pharmacist team. Demographic, ID, and clinical outcome data for the first 100 COpAT patients between December 2020 and February 2022 were obtained by retrospective chart review. Image 1. COpAT Inpatient and Outpatient Protocols Image 2. COpAT Guidelines by Infection Type and Isolated Organism MSSA = methicillin-susceptible Staphylococcus aureus;MRSA = methicillin-resistant Staphylococcus aureus;spp. = species;TMP/SMX = trimethoprim-sulfamethoxazole;DS = double strength;SSTI = skin and soft tissue infection;CAP = community-acquired pneumonia Results. PWID accounted for 78% of COpAT patients. BJI followed by mixed infection (IE and BJI) was most prevalent (Image 3) with bacteremia in 53% of cases. Staphylococcus aureus was most frequently isolated (Image 4). Oral linezolid and fluoroquinolones, often in combination, were most commonly used. IV and PO antimicrobials were taken for a median 28 and 14 days, respectively. The COpAT program saved 1425 IV antimicrobial and 1363 hospital days. Assuming daily inpatient cost of $2050, cost avoided was $2,794,150. COpAT patients participated in ID follow-up and adhered to PO antimicrobials with low 30-day readmission rates (Image 5). Image 3. Infection Type Image 4. Isolated Organism CoNS = coagulase-negative staphylococci Image 5. Clinical Outcomes Conclusion. In a sample of 100 COpAT patients including PWID, IV to PO antimicrobial transition safely saved hospital days and mitigated critical bed shortages during pandemic peaks. A successful COpAT program requires a multidisciplinary group: close ID physician-pharmacist collaboration extending to OPAT and antimicrobial stewardship teams. With a COpAT program in place, even earlier IV to PO antimicrobial transitions should be studied.

3.
Journal of the American Academy of Child and Adolescent Psychiatry ; 61(10 Supplement):S124, 2022.
Article in English | EMBASE | ID: covidwho-2076262

ABSTRACT

Objectives: Participants will become familiar with the Mental and Behavioral Health Services Team in the Unaccompanied Minors Program in the Office of Refugee and Resettlement (ORR). Participants will be able to identify the challenges in delivering mental health care to a large, transient, population of children exposed to significant trauma, who arrive in the United States without a parent or legal guardian. Participants will learn ways to become involved in the care of migrant children. Method(s): This presentation will describe the mission of the Mental and Behavioral Health Services Team in the Division of Health for Unaccompanied Children (UC) in the ORR. The presenters will share information about the perils of the journey to the United States, the care of migrant children after referral from border control until re-unification with sponsors, and the logistical hurdles in identifying sponsors and establishing ongoing care after reunification or long-term foster care placement. We will discuss the challenges of delivering preventative and clinical mental health services during COVID-19, during large influxes of children, and in unique populations such as during the Afghanistan evacuation. Finally, we will discuss ways in which we are continuously improving our program with partners in academic and governmental agencies. Result(s): Between January 2021 and February 2022, over 150,000 UCs were referred to ORR care. While awaiting reunification with an identified sponsor, the majority of the children are cared for in over 200 state-licensed shelters scattered throughout the continental United States. The medical teams are charged with providing for their physical and mental health. The mental health team guides the care of these children through various methods, including the monitoring of documentation and consultation with care programs, ORR colleagues, and community mental health providers. Conclusion(s): Children who arrive in the United States without parents/guardians present with unique mental health needs. Cultural sensitivity and trauma-informed approaches to care are essential in meeting these needs. ORR continues to evolve to meet these challenges and invites child and adolescent psychiatrists in the community to engage with this population. IMM, SP, TRA Copyright © 2022

5.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003344

ABSTRACT

Introduction: During the pediatric trials for Coronavirus disease 2019 (COVID-19) vaccine the patient population was limited, likely leading to an inappreciable amount of adverse events. As more of the healthy adolescent male population began receiving the COVID-19 vaccination, cases of myocarditis shortly after became more frequently seen. Case Description: A previously well 15-year-old obese male presented to a pediatric ER with 3 days of left arm pain and 1 day of acute left-sided chest pain three days after receiving his second Pfizer-BioNTech COVID-19 vaccine in his left anterior deltoid area. The patient felt unwell afterwards with myalgias, headache, numbness, tingling, emesis, and 1-day history of fever of 38.8°C. He denied feelings of dizziness, syncope, palpitations, change in pain with position or deep breaths. Motrin and Tums did not seem to provide any relief. He had no history of recent viral illness and no known COVID-19 exposure. Initial evaluation included a normal chest Xray and normal sinus rhythm on EKG. Laboratory work revealed elevated troponin-I at 3.18 ng/mL, elevated Total CK at 399 units/L, CK-MB at 19 ng/mL, and BNP <10 pg/mL. Cardiology was consulted and following a normal echocardiogram, the patient was sent for a stat cardiac MRI. The imaging revealed acute myopericarditis with a small pericardial effusion. Mild patchy delayed subepicardial enhancement was also noted in the mid cavity and basal posterolateral wall (suggestive of postinflammatory scarring related to localized myocarditis.) During this time, CK-MB and Troponin-I continued to trend upwards. The patient was then started on standard treatment with Ibuprofen 800 mg Q6H and pantoprazole for gastric protection. His CK-MB peaked at 174 and Troponin-I at 26 which both subsequently trended downwards and normalized prior to discharge. Discussion: Patients who present with chest pain require a broad differential to encompass other possible etiologies including Coxsackie virus, Echovirus, Mycoplasma, EBV, and even Syphilis. Infectious diseases also followed along with the patient throughout his hospital course. All work-up for other potential causes remained negative. 1 week after presentation, his cardiac markers returned to baseline normal values. Conclusion: The study included close to 3,000 adolescents with only 754 ranging in the 16-17 age group further emphasizing the limited power of the study. Myocarditis and pericarditis are known, however rare, side effect of vaccinations and is seen more commonly in males. As the time period between receiving the COVID-19 vaccination and presenting with cardiac symptoms is short it is crucial to provide rapid care and adequate treatment.

7.
Sexually Transmitted Infections ; 98:A25, 2022.
Article in English | EMBASE | ID: covidwho-1956902

ABSTRACT

Case A 20-year old was seen at the height of the Omicron wave of the COVID-19 pandemic with a two day history of a first episode of painful genital ulceration. Her last sexual contact was one week previously. She had no other symptoms and no medical or drug history. There was bilateral inguinal lymphadenopathy and a unilateral 1cm slightly indurated shallow vulval ulcer with slough. She was treated empirically for secondarily infected primary herpes. Three days later she presented with increased pain and negative HSV PCR and STI/ BBV tests. She had large bilateral genital ulcers (figure 1) and was admitted. Repeat swabs for HSV, VZV and syphilis were negative. She had a neutrophilia, raised CRP and negative EBV and CMV IgM. A routine nasopharyngeal swab identified SARS-CoV-2 and a full respiratory virus PCR panel was otherwise negative. She disclosed a sore throat and fevers the week before the onset of her vulval symptoms but was reassured by negative home antigen tests. She had received the second dose of an mRNA COVID-19 vaccine four months previously but no booster. She was discharged after five days and treated with a reducing course of oral steroids. At four weeks her ulcers were healing well. Discussion There are few published cases of Lipschütz ulcers associated with COVID-19 and this case adds to the burgeoning evidence of the possible dermatological manifestations of the disease and crucially it illustrates the value of prompt access to sexual health services during the pandemic. (Figure Presented).

8.
Topics in Antiviral Medicine ; 30(1 SUPPL):141, 2022.
Article in English | EMBASE | ID: covidwho-1880901

ABSTRACT

Background: The kinetics and functional profiles (granzyme-B production) of HIV-specific T-cell responses support that those targeting the early viral gene product Nef disproportionately recognize residual antigen expression during long-term antiretroviral therapy (ART). Here, we leveraged this insight to test whether SARS-CoV2 mRNA vaccines-which activate TLR and inflammatory signaling pathways-would reactivate latent HIV, stimulating T-cell responses with these characteristics. Methods: T-cell responses to individual HIV gene products were measured by IFN-g or granzyme B ELISPOT, and by activation induced marker (AIM) assays at baseline and ∼2 weeks after SARS-CoV-2 mRNA vaccine prime and boost, in 13 long-term ART treated adults. Total and unspliced HIV mRNA, as well as intact and defective (IPDA) HIV DNA were measured in parallel by digital droplet PCR (ddPCR). Results: We observed transient increases Nef-specific T-cell responses following vaccine prime by granzyme B ELISPOT (3.1-fold increase, p=0.002) and a trend by AIM assay (1.5-fold increase, p=0.06). Such increases were not observed in granzyme B responses to late gene products nor in any IFN-g responses. Both unspliced and total HIV mRNA decreased significantly across the study, unspliced-1.6-fold decrease p = 0.03;total-1.5-fold decrease p = 0.05. Changes in total HIV mRNA correlated inversely with Nef-specific granzyme B-producing (spearman's ρ =-0.73, p = 0.006) and Nef-specific CD8+ AIM T-cell responses (ρ =-0.76, p = 0.006) following vaccine prime. These reductions in HIV RNA were not accompanied by significant changes in total or intact HIV DNA. Conclusion: Consistent with our hypothesis, a restricted profile of HIV-specific T-cell responses showed significant increases following SARS-CoV-2 vaccine prime, each of which were then correlated with reductions in HIV RNA. This supports that vaccination promoted productive interactions between Nef-specific CTL and HIV-infected cells in vivo. We propose three scenarios for why this was not reflected in reductions in intact or total HIV DNA: i) meaningful depletions in inducible proviruses occurred but were lost against the background of non-inducible proviruses ii) interactions with CTL involved only a fraction of inducible proviruses, or iii) substantive proviral depletions occurred, but were counterbalanced by clonal expansion of HIV-infected cells.

9.
Journal of Clinical and Aesthetic Dermatology ; 15(4 SUPPL 1):S13, 2022.
Article in English | EMBASE | ID: covidwho-1866155

ABSTRACT

Background: ASLAN004 is a fully human monoclonal antibody that binds to IL-13Ra1 with high affinity and inhibits IL-4 and IL-13 signaling via the Type 2 cytokine receptor, an important target in atopic dermatitis (AD). Objective: To evaluate the emerging safety, tolerability, and efficacy of ASLAN004 in a multipleascending dose escalation phase in patients with moderate to severe AD. Methods: Twenty-five adult patients with moderate to severe AD were recruited from the US, Australia and Singapore and randomized 3:1 in three cohorts to receive once weekly 200, 400 or 600mg of subcutaneous ASLAN004 or matching placebo over eight weeks, with a 12-week recovery period. An interim data readout was conducted after Cohorts 1-3 completed eight weeks of treatment to evaluate various clinical endpoints in a limited number of patients before conducting an expansion cohort (Cohort 4, results reported elsewhere). Endpoints in the interim analysis include change from baseline in Eczema Area Severity Index (EASI) score at week 8 and safety assessments including local tolerability and incidence of adverse events (AEs). [NCT04090229] Results: Three of 25 patients randomized into Cohorts 1-3 discontinued due to restrictions imposed in response to the COVID-19 pandemic. 18 of the remaining 22 patients in the planned interim data readout completed at least 29 days of dosing and assessment and were evaluable for efficacy. The mean ± SD (n=18) baseline scores were 32.5±11.8 for EASI and 44% had severe Investigator Global Assessment (IGA) scores. At Week 8, mean reductions in EASI from baseline were 50 percent, 74 percent and 76 percent for the 200mg (n=4), 400 mg (n=6) and 600 mg (n=3) ASLAN004 dose groups respectively, compared with 42 percent (n=5) for placebo. Mean reductions of peak pruritus from baseline to Week 8 were 34 percent, 48 percent and 39 percent for 200mg (n=4), 400mg (n=6) and 600mg (n=2) ASLAN004 dose groups respectively, compared with 16% for placebo (n=5). Other secondary endpoints were also improved for ASLAN004 compared with placebo (EASI-50, EASI- 75, results reported elsewhere). The proportion of patients with AEs and treatment-emergent adverse events (TEAEs) were similar across ASLAN004 treatment and placebo arms. There were no TEAEs leading to discontinuation in the ASLAN004 treatment groups. Conclusion: ASLAN004 was well tolerated, with 400mg and 600mg showing promising eicacy in adults with moderate to severe AD.

10.
Water Resources Research ; 58(2):7, 2022.
Article in English | Web of Science | ID: covidwho-1758147

ABSTRACT

As we reckon with the effect of COVID-19 on the research enterprise in hydrologic science, it is important to acknowledge that disruptions will be persistent and that institutional-level adjustments, while helpful, are not sufficient to mitigate all impacts on hydrologic scientists. Here, we describe the breadth of research contributions in the hydrologic sciences, consider how the pandemic has impacted this portfolio of contributions, document one impact that is already being realized in publication of research, and suggest guidance to the hydrologic science community, institutions, review panels, and funding organizations in considering these impacts at various stages of hiring and promotion in our community. Acknowledging the diversity of contributions to research is particularly valuable because it provides a more objective, transparent, and holistic basis for evaluating individuals within the context of norms of the hydrologic science community. With clearly established values, it is easier to identify impacts of life events, such as those related to the COVID-19 pandemic, as they are manifested in individuals under a diversity of circumstances.

11.
Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617063

ABSTRACT

Background: Whilst the Irish Health Service Executive (HSE) currently recommends COVID-19 screening for all adult hospital admissions, current guidelines state that the screening of asymptomatic paediatric admissions is not necessarily required. However, clinically determining who requires testing can be difficult and subject to inter-carer variability. We sought to audit our acute admissions and swab results to determine rates of testing, characteristics of those being tested, and rates of positivity in a busy Irish tertiary paediatric unit. Methods: We reviewed the charts of 122 patients admitted acutely to our unit over the course of July 2021 to determine whether or not they had undergone COVID-19 screening using a nasopharyngeal PCR test and the clinical indication for testing. The clinical presentation of these admissions was analysed to try to determine positive predictive factors for COVID-19 screening and better streamline surveillance criteria. Results: A total of 122 admissions were analysed, with 74 (60.7%) having had a COVID-19 PCR test performed at the point of admission. Of these, 1 patient was found to be COVID-19 positive, giving an overall positivity rate of 0.8% amongst admissions analysed and 1.4% for admissions screened. The patient who returned a positive result was febrile at presentation but did not have any respiratory symptoms. Respiratory symptoms were documented for 45 of the 122 admissions (36.9%), and 42 of these underwent COVID-19 screening (93.3%). All swabs were negative. A total of 59 out of 122 were febrile at presentation, 55 (93.2%) of whom underwent screening. As above, 1 case tested positive. Of the afebrile patients, 19 out of 64 underwent COVID-19 screening. COVID-19 screening was performed in 12 patients who did not have a fever or respiratory symptoms at the time of presentation. In terms of non-respiratory presentations, screening was performed in 12 out of 14 (85.7%) presenting with gastritis/gastroenteritis, and 9 out of 12 (75%) presenting with a history and examination consistent with a UTI/pyelonephritis. Of 18 patients who were admitted with primarily psychiatric presentations, none had either a fever or respiratory symptoms at presentation, and none underwent COVID-19 screening. Conclusion: Our results reflect the existing data that COVID-19 appears to be less pathogenic in paediatric populations than in adult ones. Our low positivity rate compared to a high swab rate has repercussions in terms of bed allocation and isolation status. There is variation in terms of clinical criteria being viewed as sufficient to justify screening. Further study is required to determine consensus guidelines for COVID-19 surveillance in acute paediatric hospital admissions.

12.
Gastroenterology ; 160(6):S-389, 2021.
Article in English | EMBASE | ID: covidwho-1596227

ABSTRACT

Introduction: Colorectal cancer screening and surveillance colonoscopy declined drastically during the initial surge of coronavirus infectious disease (COVID-19) cases in the United States. In August 2020, the state of Georgia (GA) had the highest per-capita circulating infection rate in the nation, with an average of more than 25 cases per 100,000 people and was the "most likely" state where someone may be exposed to COVID-19. Our ambulatory endoscopy unit at Emory Healthcare, which is a large, tertiary referral care center in GA had a precipitous drop in show rate for screening and surveillance colonoscopy even after elective procedures resumed. Patients cited fear of acquiring COVID-19 as the primary reason for previously cancelling their procedure. Therefore, we implemented a quality improvement project aimed at improving show rates for screening and surveillance colonoscopy by providing patients structured education via a telephone call regarding the safety of inperson colonoscopy and addressing concerns regarding COVID-19. Methods: We contacted patients between the ages of 40-75 who were due for screening or polyp surveillance colonoscopy in August via a telephone call. Patients were provided a comprehensive overview of public health guidelines regarding COVID-19, and safety precautions at Emory Healthcare to minimize risk of transmission of COVID-19 including pre-procedural testing for COVID-19, social distancing, enforcing a universal masking policy, limited visitor/escort policy, and vigorous surface disinfection. Patients who completed their procedures were asked to complete a survey to provide feedback about the impact of the study phone call using a dichotomous response of agree/disagree. Results: 161 patients were contacted, of which 49% were Caucasian, 48.4% were African-American and 1.9% were Asian. 95% of the patients who were contacted completed their colonoscopies. 91.8% agreed that they received information about COVID-19 that they were previously unaware of;81.4% agreed that they are now more likely to follow public health guidelines of social distancing, hand washing, and wearing a mask. 91.1% felt safer about procedures after the study phone call, and 90.9% agreed that they felt less anxious about the risk of acquiring COVID-19 while in our facility. 70.3% agreed that they may not have come in for their procedures if they did not receive the study phone call. 94.4% agreed that they were satisfied with the procedural protocol at our facility and would come back for another procedure if needed. Conclusions: Our study suggests that specific communication of pandemic related issues are key to reducing peri-procedural concerns about COVID-19. Failure of timely colorectal cancer screening and colonoscopy will lead to a large burden of missed polyps and colorectal cancers leading to increased morbidity and mortality from CRC.

13.
Journal of the Association for Consumer Research ; 2021.
Article in English | Scopus | ID: covidwho-1550507

ABSTRACT

COVID-19 scams promise to alleviate the physical and financial risks associated with the ongoing coronavirus pandemic but in fact expose consumers to additional risk. The present research examines how one prominent and unequally distributed socioeconomic factor—resource availability during childhood—influences susceptibility to COVID-19 scams among US adults. One pilot and five preregistered studies (total N 5 1595) provide evidence that childhood adversity may often confer a protective advantage;when environmental threat is low, adults raised in scarcity are less susceptible to scams than those raised in abundance. However, heightened environmental threat—such as evidence of a worsening global pandemic—holds different consequences for those with different socioeconomic backgrounds: whereas adults raised in abundance become less susceptible to scams when the world seems more threatening, adults raised in scarcity become more susceptible to scams under these conditions. © 2021 Association for Consumer Research. All rights reserved.

14.
Perfect Beat ; 21(1):69-75, 2021.
Article in English | Scopus | ID: covidwho-1416934

ABSTRACT

In this article we explore a collaborative interdisciplinary Theatre and Music production as part of two undergraduate courses at the University of the Sunshine Coast, Australia, during COVID-19. Tertiary intuitions all over the world are currently being forced to adapt in radical response to the pandemic. The specific conditions of the authors’ experience prompted this collaboration where both teaching and learning occurred in an unstable, unpredictable and unprecedented environment. Experiences during the semester and the outcomes of the project were rich, multifaceted, and exceeded expectations. This included several weeks of intensive collaborative rehearsal and creative development, university-facing performances, and a public-facing performance at a NightQuarter event which had over 4,500 attendees. This article unpacks the ideas of Project-Based Learning (Bell 2010) and interdisciplinary collaboration, in order to understand the impact on teaching and learning and the potential of this model. © Equinox Publishing Ltd 2021

15.
British Journal of Dermatology ; 185:89-90, 2021.
Article in English | Web of Science | ID: covidwho-1396221
16.
Gastroenterology ; 161(1):E30-E30, 2021.
Article in English | Web of Science | ID: covidwho-1329499
17.
Sexually Transmitted Infections ; 97(Suppl 1):A130-A131, 2021.
Article in English | ProQuest Central | ID: covidwho-1301711

ABSTRACT

BackgroundWe aimed to examine the changes public sexual health services across Australia made during the national lockdown (March-May 2020) due to the COVID-19 pandemic.MethodsFrom July-August 2020, we emailed a link to an online survey to 21 sexual health clinic directors/managers who were part of the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmissible Infections and Blood-borne Viruses (ACCESS) network.ResultsAll 20 participating clinics remained open but reported changes during the lockdown, including suspension of walk-in services in 8 clinics.Some clinics stopped offering asymptomatic screening for heterosexuals (n=11), men who have sex with men (MSM) (n=3), or transgender persons (n=2). Most clinics offered a mix of telehealth and face-to-face consultations for asymptomatic MSM (n=11), asymptomatic transgender persons (n=12), post-exposure prophylaxis (PEP) prescription (n=13) or to initiate pre-exposure prophylaxis (PrEP) (n=14). People who were symptomatic for STIs and contacts of STIs were offered face-to-face and telehealth consultations across all clinics. Seven clinics suspended STI test-of-cure consultations and four clinics suspended hepatitis vaccinations for people not living with HIV. Nineteen clinics reported delays in testing and 13 reported limitations in testing during lockdown. Most clinics changed to phone consultations for HIV medication refill (n=15) with faxed (n=14) or mailed (n=13) prescriptions. Fourteen clinics had staff redeployed to assist the COVID-19 response;14 clinics reported a reduction in total number of full-time equivalent (FTE) clinical nurses from 74.4 to 45.6 FTE collectively and three clinics reported reduction in FTE clinical doctors, from 20.1 to 17.1 FTE collectively.ConclusionAustralian public sexual health clinics rapidly pivoted service delivery to reduce the risk of COVID-19 transmission in their clinical settings, managed staffing reductions and delays in molecular testing, released staff to support the COVID-19 response, and maintained a focus on urgent and symptomatic STI presentations and those at higher risk of HIV/STI acquisition.

18.
Gastroenterology ; 160(6):S389-S389, 2021.
Article in English | Web of Science | ID: covidwho-1250513
19.
Pediatrics ; 147(3):956-957, 2021.
Article in English | EMBASE | ID: covidwho-1177797

ABSTRACT

Introduction: Gliomas are the most common primary CNS tumors making up 50-60% of brain tumors inchildren. Prognosis for gliomas depends on histologic grade and location of tumor. Impingement on normalbrain tissue or increase in intracranial pressure is caused by either obstruction of CSF flow or by direct masseffect. Symptoms can include lethargy, headache and vomiting. Signs of slow growing CNS tumors can includeirritability, poor school performance and loss of developing milestones. Most arise with no known underlyingrisk factor or disorder. Case Presentation: 7-year-old male with no significant past medical history presented with left sided weakness that began 8 weeks prior to admission. Initially mother noticed the patient to have anasymmetric smile. Patient was seen by PCP and was referred to ophthalmology and neurology at that time. 4weeks later, he was noted to have left arm weakness and difficulty writing with his left hand. A week later hebegan having weakness in his left leg and was noticed to have increased instability. Patient was reevaluated byPCP who instructed him to complete a 5-day course of steroids and follow-up with neurology. On the day of admission he was seen by an outpatient neurologist using telemedicine due to COVID outbreak. It was notedthe patient had left sided paralysis, a dilated left pupil, weakness of the left arm and leg with elevation. Afterseeing the physical exam findings through a webcam, the neurologist suggested for the patient to have urgentevaluation in the emergency department. CT brain with contrast revealed a heterogenous, complex mass inthe region of the right hypothalamus. MRI brain showed mass that involved the right and left cerebralhemisphere, with infiltration of the left optic tract. A brain biopsy was performed by neurosurgery andpathology was GFAP positive confirming astrocytoma in the brainstem. Discussion: About 25% ofastrocytomas are aggressive or high grade. Brainstem gliomas make up 10-20% of CNS tumors in children lessthan 15 years old. Diffuse midline gliomas are infiltrative tumors, usually with astrocytic morphology and arelocated in the pons, thalamus or spinal cord. Most cases have high grade features and are histologicallyconsistent with Grade 4. Treatment includes surgery, radiotherapy and chemotherapy. For high grade tumorssurgery can be performed as well as radiotherapy and chemotherapy. But without reasonable resectionchemotherapy is palliative. Brainstem gliomas cannot be removed, and therefore have a poor outcome.Conclusion: Despite lack of in person evaluation, this case highlights the importance of prompt recognitionand action when performing history and physical exams even in this new era of telemedicine. In the setting ofthe COVID-19 pandemic, the use of telemedicine proved to be prominent in the diagnosis of this patient.

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