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Attachment insecurity is associated with lower satisfaction and lower felt security in romantic relationships, especially during times of stress such as coping with a global pandemic. Heightened external stressors for couples are associated with poorer relationship quality, but how couples cope with stress together, or their dyadic coping strategies, is associated with the maintenance of relationship satisfaction. In the current study, we followed 184 couples living together during the COVID-19 pandemic to test whether specific coping strategies buffered people higher in attachment anxiety and avoidance from lower satisfaction and felt security in the early weeks and ensuing months of the pandemic. Our findings demonstrate that perceiving more emotion-focused dyadic coping—being affectionate and using intimacy—buffered the negative association between attachment anxiety and relationship satisfaction and felt security, both concurrently and over several months of the pandemic. In addition, problem-focused perceived dyadic coping backfired for people higher in attachment anxiety;they felt less satisfied when they perceived more problem-focused coping—which involves being solution-focused and using instrumental support—in their relationship. In contrast, people higher in attachment avoidance were buffered against lower relationship satisfaction when they perceived more problem-focused dyadic coping and were not buffered by emotion-focused coping. The current findings suggest the importance of tailoring coping strategies to a partner's attachment style for relationship quality and felt security during times of stress.
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The COVID-19 pandemic has had far-reaching impacts on many aspects of life, including sexual behaviours and preferences. In this longitudinal study, the authors used attachment theory to investigate changes in an individual's sexual desire for their partner as well as changes in their sexual desire for someone other than their primary romantic partner (extradyadic desire) over the first wave of the pandemic in Canada. Based on past research that has shown that avoidant individuals tend to avoid intimacy, the authors reasoned that increased contact with their romantic partner due to physical distancing guidelines and lockdown rules would contribute to avoidant individuals' experiencing less sexual desire for their partner and greater extradyadic desire over time. In contrast, individuals high on attachment anxiety tend to seek proximity, especially during times of stress. The authors predicted that individuals' sexual desire for their partner would increase and their extradyadic desire would decrease. They tested these hypotheses using a cohabiting, dyadic sample (N = 308 individuals);study participants were contacted at 1-month intervals for three successive months and asked to complete an online survey. Our hypotheses were partially supported. As predicted, individuals high on attachment avoidance experienced higher levels of extradyadic desire, and individuals high on attachment anxiety reported lower extradyadic desire over time. Contrary to predictions, however, neither attachment pattern was associated with changes in sexual desire for the partner. The authors examine the theoretical implications of these findings, highlighting the need for a more fine-grained assessment of stress and the interaction between stress and attachment orientations in future research.Copyright © Sex Information and Education Council of Canada, 2023.
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Objectives: Several populations are at greater risk of severe COVID-19 due to inadequate responses to COVID-19 vaccines. Many of these individuals, and their caregivers, continue practicing varying degrees of social isolation to avoid SARS-CoV-2 infection. Following the end of lockdowns, the behaviors and impacts of continued isolation on the quality-of-life of high-risk populations remain poorly understood. This study describes the main avoidance and protective behaviors and ongoing impacts experienced by adults and caregivers of adults at high-risk of severe COVID-19. Method(s): Four virtual focus groups (April-July 2022) were conducted with individuals at high-risk of severe COVID-19, or caregivers, recruited via a convenience sample from patient panels. A discussion guide of open-ended questions was prepared based on COVID-19 guidance documents and a literature review. For qualitative analyses, an inductive approach was used for behaviors, deductive for impacts. A pre-defined codebook was updated throughout as needed. Salient concepts were defined as those mentioned by >=30% of participants or in every focus-group session. Result(s): Fourteen participants were interviewed (12 patients, 2 caregivers). Participants highlighted continued behaviors greatly impacting their quality-of-life. Avoidance behaviors (staying home, avoiding bystanders, avoiding shopping facilities and gatherings, using delivery services, family protection [43%-64%]) and protective behaviors (masking [79%], vaccination [57%]) were reported. Negative impacts included family relationship impacts (71%), collapse of social relationships (57%), difficulties accessing healthcare (43%), anxiety, fear, loneliness and depression (36%-50%), and impacts on employment/finances (36%). Positive impacts included the advent of telehealth (57%) and recognizing family importance (36%). Lack of trust in authority (57%) and hoarding of medications (36%) were negative general impacts of the COVID-19 pandemic highlighted. Concepts reported by patients and caregivers were similar. Conclusion(s): Individuals at high-risk of severe COVID-19 and their caregivers maintained avoidance and protective behaviors similar to those reported during lockdowns. This study highlights the continued burden experienced by high-risk populations.Copyright © 2023
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Introduction: The COVID-19 pandemic necessitated multiple changes to the format of myeloma clinics to minimise the risk of infection among patients and staff. These included changing in-person clinic appointments to telephone appointments when there was no medical need for face-to- face review and instituting a courier service for delivery of oral or self-administered medications. As COVID-19 restrictions relaxed, we sought to investigate the acceptability of these changes to our patients and to determine which, if any, of the new arrangements should continue. Method(s): Patients who attended the Myeloma Clinic at The Royal Marsden Hospital, both in-person and by telephone, on four separate dates in August and September 2022 were asked to complete a questionnaire to provide their opinions using a combination of multiple-choice, Likert scale and free-text questions. These covered the main domains of change outlined above along with questions about blood test location and attendance with family and friends. Result(s): Questionnaires were returned by 59 patients, 11 relating to in-person appointments and 48 to telephone appointments. 86.0% of patients were in favour of continuing the option of telephone appointments, with many highlighting their convenience and the avoidance of long travel and waiting times, with some also mentioning their COVID-19 security. However, a number of patients expressed concerns including communication difficulties, the inability to effectively assess physical health with an examination and a lack of reassurance. Furthermore, those who attended in-person appointments felt they were very COVID-secure, assigning them a mean of score of 4.5, where 1 was very insecure and 5 very secure. Several suggested that the optimum schedule would include regular telephone appointments with occasional in-person meetings. Interestingly, only 25.5% of patients wanted a video calling option. Patients were also very positive about receiving medications by courier, with 94.1% of patients receiving their medications within two working days of their clinic appointment. 81.8% of patients expressed a wish for this option to continue, highlighting the increased convenience and reduction in waiting times. Conclusion(s): These results suggest that changes made to the Myeloma Clinic in response to the COVID-19 pandemic have improved the patient experience. A mixture of telephone and in-person appointments may be preferable for this cohort of patients, many of whom require regular appointments for chemotherapy approval but are medically stable, and whose frailty makes long travel and waiting times challenging. These findings have implications for the planning of myeloma clinics across the UK.
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Background: Many EP procedures are moving from the hospital to the ambulatory surgery center (ASC) outpatient setting. The COVID-19 pandemic and the CMS Hospitals Without Walls (HWW) program has been an impetus in accelerating this transition. Anesthesia provider perioperative management is critical in facilitating safe procedures with rapid, same-day discharge. Our EP-dedicated 2-OR ASC completed more than 3,000 procedures and more than 500 left-sided ablations utilizing general anesthesia with endotracheal intubation with same-day discharge. To our knowledge, this experience is unique within an ASC setting in both volume and complexity. Objective(s): We present our comprehensive anesthesia strategy and lessons learned to facilitate safe, efficient procedures and discharge in an EP ASC. Method(s): A nurse anesthesiologist with more than a decade of EP-dedicated experience developed and taught a perioperative anesthesia strategy to facilitate high volume, safe and quick discharge care. Fundamental to this is the avoidance of opioids and benzodiazepines whenever possible. Propofol or general anesthesia with sevoflurane and complete reversal with sugammadex allow for quick recovery. Mandatory video laryngoscope utilization minimizes airway trauma, while liberal antiemetic use eliminates most nausea. All femoral access is device closed. Positive inotropes are used liberally during anesthetic to avoid heart failure. The goal is to deliver all patients to PACU on room air with stable hemodynamics. Anesthesia providers manage the preop and recovery area. Result(s): More than 90% of all patients undergoing general anesthesia and heparinization for left-atrial ablation were discharged home in under 3 hours. Nearly all procedures not requiring femoral access were discharged within 30-60 minutes. High procedure volumes with efficiencies far exceeding our in-hospital experience were thus facilitated with improved patient safety. Since HWW began, five patients have required transfer to the hospital without any deaths. All others were discharged same day. Conclusion(s): We suggest that a dedicated anesthesia team with a tailored perioperative anesthesia plan facilitates performing nearly all EP-related surgical procedures in an ASC. This success is facilitated by appropriate patient selection, preoperative evaluation, intraoperative care prioritizing quick return to baseline, and end-to-end anesthesia perioperative management. We believe this type of anesthesia management is critical to the transition of EP procedures to ASCs.Copyright © 2023
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Objectives: The aim of this study is to evaluate the effect of the COVID-19 pandemic on myocardial perfusion scans (MPS) during the COVID-19 pandemic period. Method(s): We respectively reviewed single photon emission computed tomography myocardial perfusion scans (SPECT-MPS) performed between June and September 2020 during the COVID-19 pandemic at the Nuclear Medicine Research Center at Mashhad University of Medical Sciences. The findings of stress SPECT-MPS studies acquired in the corresponding months of 2019 were also evaluated for direct comparison. Result(s): In COVID-19 pandemic compared to period prior to the pandemic, no difference was observed in terms of age range of patients under study or their cardiovascular risk factors, except smoking which underwent a significant increase during the COVID-19 pandemic ( 19% vs. 13% , p = 0.009). While the number of patients with non-angina (19% vs. 31%, p = 0.000) or typical (11% vs. 19%, p = 0.000) chest pain significantly decreased during the COVID-19 pandemic, atypical (42% vs. 25%, p = 0.000) chest pain cases showed an increasing number. By considering pretest probability of the patients (high, intermediate and low/very low), during the COVID-19 period, cases of high pretest probability decreased (6% vs. 18%, p = 0.000) and intermediate pretest probability patients also increased (64% vs. 55%, p = 0.005) while low/very low pretest probability cases showed no changes between the two periods. All types of MPS stress tests in the COVID-19 period were pharmacological compared to exercise stress test. No statistically significant difference on the myocardial ischemia or cardiomyopathy between patients between the two periods was observed. Summed stress score (SSS) and summed rest score (SRS) was similar over the two periods,while summed difference score (SDS) significantly increased over the course of COVID-19, confirming a non- increasing pattern of myocardial ischemia. Conclusion(s): Previous research underscores the fact that the number of stress SPECT-MPS studies was significantly reduced during the COVID-19 pandemic compared to the corresponding months prior to the pandemic [1, 2]. Our study concluded that all types of MPS stress tests in the COVID-19 period were pharmacological. This is due to the fact that all related recommendations published in the literature [3] highlighted the avoidance of exercise stress tests during the COVID-19 pandemic to reduce the risk of droplet exposure. During the COVID-19 pandemic, patients in two ends of the spectrum (e.g., non-angina & typical chest pain) were referred less for MPS. However, patients in the middle of the spectrum (e.g., atypical chest pain) underwentMPS less frequently. Myocardial ischemia and cardiomyopathy were not decreased or increased in patients over the COVID-19 period.
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Background/Aims We report the features of chronic chilblain-like digital lesions newly presenting since the start of the covid-19 pandemic. Comparison with primary perniosis and acrocyanosis, reveals a unique phenotype which appears to be a long-covid phenomenon. Methods The case records of 26 patients with new onset persistent chilblain-like lesions presenting to the Rheumatology service of St George's University Hospital, London between Autumn 2020 and Spring 2022 were reviewed. Demographic and clinical features, serology, imaging, treatment response and outcome up to Summer 2022 were collated retrospectively. Results Chilblain-like lesions first occurred between September and March;2019/ 2020 6 cases, 2020/2021 18 cases and 2021/2022 2 cases. Mean age 35.4 (17-60) years, 88% female, 85% white, all non-smokers. Median body mass index (BMI) 20.2, range 17.0 - 33.2. BMI underweight (<18.5) in 27%. All cases reported new red-purple-blue colour changes of the fingers, some with pain, swelling and pruritis, affecting both hands in 12, one hand in 6, and both hands and feet in 8 cases. There was a past history of cold sensitivity or primary Raynaud's in 54%. Covid was confirmed in 3 cases, 2 - 8 months prior to onset of chilblain-like symptoms. Possible covid, unconfirmed, was suspected in 5 cases, 1 - 11 months earlier. Affected digits appeared diffusely erythro-cyanotic in 81%, with blotchy discrete maculo-papular erythematous lesions in 42%, some with both features. Involvement was asymmetric in 54%, thumbs spared in 69%. Complement was low in 50% (8/16), ANA positive in 26% (6/23). MRI of hands showed phalangeal bone marrow oedema in keeping with osteitis in 4 of 7 cases. More severe signs and symptoms were associated with low BMI, low C3/4 and a past history of cold sensitivity or Raynauds. Cold avoidance strategies were sufficient for 58%. Pain prompted a trial of NSAIDs, aspirin, nitrates, calcium channel blockers, hydroxychloroquine, oral or topical corticosteroid or topical tacrolimus in 42%. In general, these were minimally effective or not tolerated. 4 severe cases received sildenafil or tadalafil, effective in 2. In 27% complete remission occurred during the first summer season after symptoms commenced, median duration 6 (range 2 - 10) months. In the remaining 19 cases, chilblain-like symptoms returned or worsened in the subsequent second winter period, with 6 of 19 entering remission the following summer. For the remaining 13 persistent cases the total duration of symptoms spans more than a year, and in four cases more than 2 years. Conclusion This series illustrates a distinct chronic chilblain-like condition. Features similar to primary perniosis include female predominance, middle age, pruritic painful blotchy lesions, asymmetry and low BMI. Features in keeping with acrocyanosis include chronicity, extensive diffuse erythro-cyanotic discoloration, relative improvement in warm weather and lack of association with smoking.
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Introduction: Breathlessness is a common symptom in clinical practice and in many prevalent diseases including chronic obstructive lung disease (COPD), asthma, heart failure, lung cancers and post COVID-19 syndrome. Understanding patients' experience of living with breathlessness, their expectations of care and self-management needs is essential to support development of health services and resources that meet their needs. Aim(s): To explore the perspectives of patients and their careers, on living with chronic breathlessness, provision and quality of medical care, and accessing information and resources to assist self-management. The study also explored their views on three evidence-based breathlessness patient education materials (PEMs). Method(s): Qualitative study involving in-depth semi-structured interviews with 16 patients living with chronic breathlessness (>=2 weeks) and their careers. Topics explored included: (1) experience living with breathlessness;(2) current medical care experience and their expectations;and (3) self-management resources, needs and views on some current publicly available PEMs. Result(s): Fourteen patients (cardiac, respiratory, and non-cardiorespiratory) and two carers (50% female) were interviewed (mean age 57 years). Twelve main themes were identified - (1) Breathlessness controls their lives, (2) Breathlessness avoidance and the vicious cycle, (3) Coping vs Fatalism, (4) Feeling misunderstood by their surroundings and health providers, (5) Diagnostic delays, misdiagnosis, and knowledge gaps, (6) Discontinuity of care, (7) Focus on pharmacologic management of breathlessness, (8) Demand for choice, non-pharmacologic options and support, (9) Beyond curing disease: symptom relief and improving quality of life as a goal, (10) Being more aware and in control of their disease, (11) Self-management and limited support for it, and (12) Resources they would value. Conclusion(s): Breathlessness remains a neglected condition in Australia. Patients suffer from lack of clinician and community awareness, discontinuity of care, and too few clinical and self-management options.
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Introduction: ICU survivors may present symptoms of acute stress disorder(ASD) or post traumatic stress disorder (PTSD) [1], as defined by the Diagnostic and Statistical Manual of Mental Disorders. Prevalence of PTSD in ARDS affects 20% of survivors but is higher in SARS/ MERS patients [2];risk factors are delirium, ICU sedation, altered memories or ICU amnesia [3]. Method(s): We enrolled patients discharged from our ICU (Pavia-Italy) after admission for acute respiratory failure due to COVID-19. Written consent was collected. Inclusion criteria: age >= 18 years, ICU admission between February 2020 and July 2021 for severe COVID-19, SARSCoV-2 infection confirmed by positive nasal swab/tracheal aspirate, available follow-up visit. Exclusion criteria: refuse to attend the follow up visit, refuse to perform the psychological tests. To assess ASD/ PTSD we used the IES-R: a total mean score >= 33 was the cut-off value for ASD/PTSD;subscale scores for avoidance, intrusion, hyperarousal were calculated. Quantitative and categorical variables are expressed as median [IQR] and number (%). Result(s): Of the 491 patients admitted to ICU, 113 patients were included (males 84(74.3%), age 61.0[52.0-66.0] years, BMI 28.2[25.8- 31.6] kg/m2, SAPS2 31.0[26.0-41.5], ICU stay 17.0[8.0-28.0] days, invasive mechanical ventilation 61(54.0%). They were assessed in median 107.0 [82.0-150.0] days after ICU discharge. 37 patients (32.7%) had ASD/PTSD, higher than the expected 20% in general ARDS population (p < 0.001). Both intrusion 11.0[5.0-17.0] and avoidance 7.0[3.0-13.0] median scores were higher than hyperarousal 5.0[2.0-9.0]. Conclusion(s): ASD/PTSD is frequent after discharge to ICU for severe COVID-19, this prevalence is higher than other ARDS population, maybe for stigma, difficulties with quarantine and isolation. Patients have higher intrusion and avoidance scores, maybe because during the pandemic isolation was unavoidable.
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Introduction: Misinformation citing mechanical ventilation, not the virus, as causing death in COVID-19 patients with respiratory failure has led to ventilator avoidance (initial refusal of intubation) during the pandemic. Method(s): Prospective observational cohort study (March 2020- June 2021) evaluating the incidence and significance of initial refusal of intubation in patients with critical COVID-19 defined as ARDS requiring > 55% sustained FiO2 on high flow nasal canula (HFNC), non-invasive positive-pressure ventilation (NIPPV) or requiring intubation. Outcomes included in-hospital mortality and 1-year modified Rankin Scale (mRS) score. Logistic regression was used to estimate the age and Charlson Comorbidity Index adjusted odds ratio (OR) of in-hospital death. The Wilcoxon rank-sum test was used to evaluate differences in the mRs. Result(s): The cohort was predominantly non-Latino white (76%), male (65%), unvaccinated (99.4%), mean age of 66, and good pre- COVID-19 functional status (median mRs score of 0). Overall, 315 patients were critically ill due to COVID-19 with an in-hospital mortality of 41.9% (132/315;95% CI 36-47%). In patients in whom intubation was recommended 39% initially refused (40/102;95% CI 30-49%). Utilization of HFNC (90%) and NIPPV (72%) were similar between groups, however actual use of mechanical ventilation differed (98.4% in those that did not initially refuse compared to 20% in those that initially refused (p = 0.001)). In-hospital mortality was 79.3% (49/62) in those who initially did not refuse intubation compared to 77.5% (31/40) in those who refused (adjusted OR 1.3;95% CI 0.5-.5). The distribution of 1-year mRS was not significantly different between groups (p = 1.0) (Fig. 1). Conclusion(s): Among critically ill patients with COVID-19 associated ARDS, ventilator avoidance was common however, it was not associated with increased in-hospital mortality or a difference in 1-year functional outcome.
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The proceedings contain 369 papers. The topics discussed include: effective FiO2 delivered by a new frugal CPAP system with low oxygen needs: from bench to clinical observations;effect of non invasive respiratory support on interstitial lung disease with acute respiratory failure: a systematic review and meta analysis;causes of mortality of severe COVID 19 patients receiving high flow oxygen therapy;patient ventilator interaction during noninvasive ventilation with helmet: a comparison between pressure support ventilation and the new neural pressure support (NPS) software;tidal volume measurement during non invasive respiratory support by helmet continuous flow CPAP is feasible and accurate in a bench model;delayed intubation with high flow nasal cannula in COVID: a comparison between a first and second pandemic wave;outcomes following application of high flow nasal cannula and non invasive ventilation during the second COVID 19 wave in Singapore;ventilator avoidance among critically ill COVID 19 patients with acute respiratory distress syndrome;and mortality rate, intensive care unit length of stay and time to orotracheal intubation of COVID 19 patients under different non invasive ventilatory therapies: retrospective cohort study.
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The COVID-19 pandemic has led to an increase in users' knowledge anxiety, which has been further intensified by the diversity of information platforms and the emphasis on digital personal branding. While previous research has examined the relationship between digital personal branding and negative emotions, little is known about the mechanisms behind negative reactions to digital personal branding from non-direct factors or users' spontaneous negative emotions. To address this gap, this study draws on cognitive appraisal theory (CAT) and social identity theory (SIT) to explore the relationships between users' knowledge anxiety, cognitive processing biases, and brand avoidance, and the impacts of herding behavior and attachment anxiety on these relationships. A sample of 530 consumers completed an online survey, and the data were analyzed using a partial least squares path model. The results revealed that user knowledge anxiety directly and indirectly influenced brand avoidance behavior through cognitive processing bias, and attachment anxiety moderated the path between cognitive processing bias and user knowledge anxiety. However, herding behavior was not found to be significant in online knowledge sharing communities.
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INTRODUCTION: The COVID 19 pandemic caused unprecedented changes in treatment of breast cancer. The aim of this IRB approved retrospective study was to assess trends in surgical management and reconstructive choice after mastectomy during the pandemic. Even as an epicenter at the start of COVID, our hospital prioritized the treatment of breast cancer patients facilitating timely care within accepted standards. METHOD(S): We compared female patients with breast cancer (BC) treated with either lumpectomy (L) or mastectomy (M) during a 12-month period in 2017 and 2020-2021. We stratified based on no reconstruction (NR) versus surgical reconstruction (R), reconstruction using autologous tissue (AT) or tissue expander/implant (TE/I), and age above or below 60 years (< 60, >60). RESULT(S): 399 total patients were treated surgically in 2017 and 2020. In 2017, there were 50 M and 115 L (30.3%/69.7%) versus in 2020, 113 M and 121 L (48.3%/51.7%). In 2017, 9 patients had NR (18.0%) while in 2020, 37 had NR (32.7%). In 2017, 41 had R (82.0%), with 24 receiving AT (58.5%) and 17 had TE/I (41.5%). In 2020, 76 had R (67.3%), with 34 receiving AT (44.7%) and 42 had TE/I (55.3%). For age < 60, 29 had R (70.7%) and 2 had NR (22.2%) in 2017;51 had R (67.1%) and 16 had NR (43.2%) in 2020. For age >60, 12 had R (29.2%) and 7 had NR (77.8%) in 2017;25 had R (32.9%) and 21 had NR (56.8%) in 2020. These data show a 13.8% shift towards TE/I over AT with a 14.7% increase in NR. CONCLUSION(S): Breast cancer patients were prioritized and surgically treated within quality standards. With the changes in availability of hospital resources, staff, and limiting viral exposure, mastectomy rates versus lumpectomy increased dramatically. These trends were possibly due to avoidance of daily facility trips for radiation treatment. Tissue expander/implant rates increased substantially possibly from avoidance of prolonged versus overnight hospital stay. Mastectomy without reconstruction also increased and future studies are needed to determine the number of delayed reconstruction in this group.
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Case report The Food and Drug Administration (FDA) provided emergency use authorization (EUA) for the Pfizer/BioNTech (BNT162b2) COVID-19 vaccine in December 2020. Implementation of COVID-19 mass vaccination efforts were implemented soon after. However, following the FDAs EUA, COVID-19 vaccine allergic reactions were reported. These findings led to concerns about vaccine hesitancy and the possible avoidance of future doses. The Texas Children's Hospital COVID-19 Vaccine Hypersensitivity Clinic was established in December 2020 to help address these concerns and to evaluate both pediatric and adult patients with immediate allergic reactions to the COVID-19 vaccines, as well as evaluating patients with polyethylene glycol (PEG) or polysorbate (PS) allergy. We present the case of an 18yo female who experienced anaphylaxis following her second Pfizer mRNA COVID-19 vaccine. The patient developed symptoms of generalized hives, chest tightness and dyspnea 17 minutes after receiving the Pfizer mRNA COVID-19 vaccine. She was treated in the emergency department with IM prednisone and PO diphenhydramine. Of note, in 2018, she had a similar response to her HPV9 vaccine (containing PS 80). Tryptase wasn't obtained at the time of her COVID-19 or HPV9 vaccine reactions, but she did have a baseline that was normal around 4ng/mL. Skin testing was performed to the following: PEG 3350, PS 20 and PS 80. Skin testing (skin prick and intradermal) were negative for PS20 and PS80. PEG 3350 skin prick was negative but methylprednisone acetate (PEG 3350) was positive at the 4mg/mL intradermal testing strength. She underwent a Miralax (PEG 3350) oral challenge. Within 20 minutes of ingesting 0.17grams PEG 3350 she developed an itchy macular rash on neck and upper chest, nausea and a globus throat sensation. She was treated with PO cetirizine and symptoms improved. Tryptase level was obtained 30 min after the start of her reaction and was 4ng/mL. Given the patient's reaction, she was advised to avoid PEG containing products and will return to undergo a graded-step challenge to the Janssen (J&J) COVID-19 vaccine. The prevalence of COVID-19 mRNA vaccine anaphylaxis and PEG allergies is rare. However, allergy referral is warranted in cases of immediate reactions to the COVID-19 vaccine or history of PEG or polysorbate allergies.
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Case report Introduction: In the wake of the COVID-19 pandemic, occupational contact dermatitis related to the use of personal protective equipment (PPE) has become increasingly prevalent. While most cases are irritant in nature, allergic contact dermatitis (ACD) remains an important cause of occupational dermatitis. We report a case of ACD to rubber accelerators in the elastic bands of an N95 mask. Informed consent was obtained from the patient for this report. Case Report: A 27-year-old healthcare worker presented with a progressive pruritic eruption over her face and neck, 1 week after she began wearing N95 masks at work. She had only worn disposable surgical masks. She had no medical history apart from hand dermatitis, which was well controlled with topical medications. Examination revealed linear eczematous plaques along her lateral cheeks and posterior neck, corresponding to contact areas between the mask bands and her skin. Patch tests revealed a positive reaction to several rubber accelerators, including Thimerosal, 2-Mercaptobenzothiazole (MBT), and Methylisothiazolinone. We performed another patch test to several N95 mask straps, to which the patient developed an eczematous reaction to the elastic bands of 2 N95 mask types with elastic bands. Clarification with the manufacturer confirmed the use of rubber accelerators similar in properties to MBT in the production of these masks. A diagnosis of allergic contact dermatitis to rubber accelerator was made. The patient's dermatitis resolved with topical corticosteroids and the avoidance of N95 masks with elastic bands. Discussion and Conclusion(s): The use of facial PPE such as masks is a recognised cause of occupational dermatitis among healthcare workers. A variety of dermatoses are associated with the use of facial PPE, with contact dermatitis being the most common. However, while the majority of contact dermatitis are irritant in nature, ACD remains an important and preventable cause of occupational dermatitis. Commonly implicated allergens associated with mask use include preservatives and adhesives used in their production, as well as metals in the nose clip. Although less common, mask elastic bands have also been reported to be a potential source of ACD, with rubber accelerators being identified as potential allergens. However, there is often a lack of declaration of such chemicals used in the production of PPE. Given the need for continued use in the occupational setting, early identification and avoidance of allergens are key. Failure to do so may result in the progression of skin lesions, ultimately affecting the patients' quality of life and work performance. With the ubiquitous use of masks in the current climate, we wish to highlight the need for greater awareness of rubber accelerators as potential allergens, and their presence in the elastic bands of frequently used PPE.
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Background: In the context of the COVID-19 pandemic, it is especially important to understand why patients avoid or continuously postpone immunization. The authors aim to understand the impact of the increasingly active spread of anti-vaccine arguments of the vaccination opponents, as well as the general distrust in the pharmaceutical industry, science and healthcare professionals in patients with Hereditary Angioedema (HAE) and recurrent Angioedema (AE) in North Macedonia. Method(s): A total of 92 patients diagnosed with AE and 35 patients diagnosed with HAE underwent structured interview conducted during routine check-ups. Result(s): 52 of the AE patients and 10 of the HAE patients stated that they are indecisive or opposed to vaccination, mostly because of a generalized negative attitude towards vaccines. The patients often stated that their attitude is based on a personal or a family member's negative experience with vaccines (76.9% of AE and 60% of HAE patients opposed to vaccination). When asked about the basis of such opinion, the patients' answers were vague and unspecific. The majority stated that they do not recall the source of information, some speculated about possible role of vaccines in autism diagnosis of a close family member, allergies or other pediatric diseases caused by vaccines, despite the lack of proof of connection. Such examples can be explained with the human tendency to remember negative information, although they have read such information somewhere on the internet or social media with no reliable source or validation. Confirmation bias is the tendency of individuals to seek information that confirm their existing hypothesis, while avoiding explanations that do not fit in with their opinion. Because of this, the previously formed negative attitude towards vaccines, can cause any negative symptoms to be misinterpreted as vaccine side-effects, additionally reaffirming the negative attitude. 61.5% of AE and 70% of HAE patients opposing vaccination stated that they believe that vaccines lead to serious adverse events, do not protect the individuals and society from infective diseases and are not sufficiently tested prior to their use. Conclusion(s): In conclusion, the author considers that continuous education of patients is a key condition for an improved rate of COVID-19 immunization of HAE and AE patients.
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Background: The COVID-19 pandemic caused a large number of excess deaths. COVID-19 emerged as a prothrombotic disease often complicated by pulmonary embolism (PE). In light of this, we hypothesized that PErelated mortality rates (stable before the pandemic) would be characterized by an increasing trend following the COVID-19 outbreak. Purpose(s): To investigate the mortality rates associated with PE among deaths with or without COVID-19 during the 2020 pandemic in the United States (US). Method(s): For this retrospective epidemiological study, we analyzed public medically certified vital registration data (death certificates encompassing underlying and multiple causes of death) from the Mortality Multiple Cause-of-Death database provided by the Division of Vital Statistics of the US Centers for Disease Control and Prevention (CDC;US, 2018-20). We investigated the time trends in monthly PE-related crude mortality rates for 2018-2019 and for 2020 (the latter associated vs. not associated with COVID-19), utilizing annual national population totals from the US Census Bureau. Second, we calculated the PE-related proportionate mortality among COVID-19 deaths (overall and limited to autopsy-based diagnosis). We performed subgroup analyses based on age groups, sex and race. Result(s): During 2020, 49,423 deaths in association with PE were reported, vs. 39,450 in 2019 and 38,215 in 2018. The crude PE-related mortality rate without COVID-19 was 13.3 per 100,000 population in 2020 compared to 11.7 in 2018 and 12.0 in 2019 (Figure 1A). The PE-related mortality rate with COVID-19 was 1.6 per 100,000 population in 2020. Among non- COVID-19-related deaths, the crude PE-related mortality rate was higher in women;among COVID-19-related deaths, it was higher in men. PE-related mortality rates were approximately two-fold higher among black (vs. white) general population irrespective of COVID-19 status (Figures 1B and 1C). Among COVID-19 deaths, PE-related deaths corresponded to 1.4% of total;the value rose to 6.0% when an autopsy was performed. This figure was higher in men and its time evolution is depicted in Figure 2A. The proportionate mortality of PE in COVID-19 deaths was higher for younger age groups (15-44 years) compared to non-COVID-19-related deaths (Figure 2B). Conclusion(s): In 2020, an overall 20%-increase in PE-related mortality was reported, not being limited to patients with COVID-19. Our findings could be interpreted in the context of undiagnosed COVID-19 cases, uncounted late sequelae, and possibly sedentary lifestyle and avoidance of healthcare facilities during the pandemic that may have prevented timely diagnosis and treatment of other diseases. Whether vaccination programs had an impact on PE-associated mortality in the year 2021, remains to be determined.
ABSTRACT
A 51-year-old woman presented to our service with a 2-year history of severely painful, thickened skin of her bilateral hands and feet. She advised of considerable skin pain on mobilizing. She intermittently applied acrylate nails. This was on a background of chronic urticaria, asthma and allergic rhinitis. She described a positive family history of psoriasis. On examination, there was marked hyperkeratosis with welldemarcated erythema on the central palms and entire fingers with deep fissuring and scale. Similar finding were noted on the soles of the feet particularly affecting the heels, arch and also the tips of the toes. The morphology of the lesions favoured psoriasis, but the differential diagnosis included chronic hand dermatitis. She was referred for topical psoralen + ultraviolet A (PUVA) and patch testing to standard battery and acrylates. Treatment with topical PUVA was discontinued and patch testing lists were cancelled as a result of the emergence of COVID-19 in Ireland. Topical therapy of clobetasol propionate was initiated. On follow-up review, the appearances of her feet and hands had deteriorated significantly. She was commenced on acitretin 10 mg once daily, which was escalated to 20 mg 2 months later. Clinical improvement was noted, but appearances deteriorated once again following the application of acrylic nails. Further history revealed the patient had assisted with the application of acrylic nails to clients years prior to her initial review. Patch testing took place 18 months after initial review due to outpatient list cancellations secondary to the COVID-19 pandemic. Upon review 48 h after the application of the (METH) Acrylate Series, the patient was found to have a +2 reaction to 2- hydroxyethyl methacrylate and a further +2 reaction to 2- Hydroxypropyl methacrylate. At her 96-h review, both reaction sites were marked at +1. Following complete avoidance of acrylates, the palmoplantar inflammation entirely resolved. This case highlights the importance of a detailed clinical history where contact dermatitis is considered. In our patient's case, the clinical history and examination of the palmoplantar eruption combined with the first-degree family history of psoriasis were highly suggestive of a diagnosis of psoriasis. The episodic severe flares and its refractory nature to treatment raised suspicion for allergic contact dermatitis. Dermatologists should remain alert for potential contact allergens in cases of severe palmoplantar psoriasis. A further area for consideration is the deleterious effect the COVID-19 pandemic had on the successful diagnosis and treatment of dermatological patients through the cancellation of outpatient services.
ABSTRACT
Introduction: A significant number of patients admitted to hospital with COVID-19 have ongoing functional and radiological deficits which require follow up. Limited data exist to identify these patients, resulting in inefficient healthcare resource utilisation. Aims and objectives: To investigate which clinical characteristics of patients hospitalised with COVID-19 can be used to predict recovery and need for follow up. Method(s): Prospective observational study of 1317 adults with COVID-19 admitted to St Thomas' Hospital, London, UK, between December 2020 and March 2021. All patients were telephoned 5 weeks post-discharge and invited for in-person review if they had ongoing symptoms, or at their request. Clinical characteristics were recorded including duration of inpatient treatment with corticosteroids. Respiratory recovery was defined as no change in MRC dyspnoea score compared to pre-morbid state, no chest radiograph abnormality, and no desaturation during 1- minute sit-to-stand test. Receiver-operator curve analysis was performed to calculate sensitivity, specicifity, positive (PPV) and negative predictive values (NPV). Result(s): 363/519 (70.0%) patients reviewed in-person had recovered at 6 weeks post-hospital discharge. Avoidance of critical care admission predicted recovery (p <0.001), but age and co-morbidity did not. Three days or fewer of steroid treatment was found to be the optimum threshold to predict recovery, with AUC 0.80, NPV 92.0%, and sensitivity 94.5%. Conclusion(s): Patients receiving inpatient treatment for 3 days or fewer have a high probability of respiratory recovery from COVID-19. We propose that this cohort do not require respiratory follow up to be routinely offered.
ABSTRACT
Fear of choking is a relatively understudied phenomenon in older adults, despite the higher incidence of choking to death in this population and the associated mental health burden. This case report presents the use of a cognitive-behavioral (CBT) approach to treating choking phobia in an older adult in her 80s, with sessions conducted over the telephone during the COVID-19 pandemic. A reliable change in self-reported avoidance of solid food was observed, although indices of general distress appeared to have remained stable. By placing a seemingly focal problem (choking phobia) within a comprehensive conceptualization framework using gerontology, we were able to consider additional complexity related to aging-related beliefs and experiences of distress to address therapeutic opportunities and challenges, including the COVID-19 context.Copyright © 2022 Hogrefe.