Association of apolipoprotein E4 to the number of cerebral microbleeds in patients recovered from COVID-19

Background: COVID-19 has been associated with cerebral microbleeds (CMB). Previously, an association of ApoE4 with COVID-19 severity and CMBs in autopsy was found. In this study, we investigated if carrying the Apoe4 allele relates to the number of CMBs in magnetic resonance imaging (MRI) in patients recovered from COVID-19. Material(s) and Method(s): Adult patients recovered from COVID-19 and a control group without a history of COVID-19 was recruited. Exclusion criteria were major neurologic disease, developmental disability or pregnancy. The participants underwent brain MRI 6 months after infection, and a blinded neuroradiologist analyzed the findings. ApoE was genotyped using a microarray. Statistical analysis was performed using the statistical software R. A negative binomial model was chosen based on the distribution of CMBs. Result(s): Of the 216 subjects that underwent MRI, 168 consented to genetic testing, additionally 2 patients were excluded due to extensive CMBs and 1 due to diffuse axonal injury. We included 113 COVID-19 patients (49 ICU-treated, 29 ward-treated and 35 home-isolated) and 52 controls. The most prevalent comorbidities were hypertension, asthma and diabetes. CMBs was found in 47 subjects, with the number of CMBs ranging from 0 to 26. The ApoeE4 allele was carried by 37%, equally distributed among the groups. After adjustment, age (aRR = 1.06, p = 0.007) and COVID-19 (aRR = 2.59, p = 0.038) were independently associated with CMBs. The ApoE4 allele (aRR = 2.16, p = 0.07, CI = 0.94-5.10) was not significant. Conclusion(s): Age and previous COVID-19, but not possession of the ApoeE4 allele, were independently associated with the number of CMBs.

A Vaccine Clinic for Individuals with Neurodevelopmental Disabilities

Purpose of Study: Individuals with neurodevelopmental disabilities (NDD) encounter the healthcare system more frequently than their neurotypical peers, but most systems have not adapted a patient-centered approach to train staff and design spaces that are optimized for individuals with NDD. Certified Child Life Specialists (CCLS), Developmental-Behavioral Pediatricians, and a board-certified behavioral analyst at the Center for Excellence in Developmental Disabilities (CEDD) at the UC Davis MIND Institute partnered with nursing teams from the UC Davis COVID Vaccine Program to develop a dedicated Vaccine Clinic that addresses common barriers to vaccination for individuals with NDD. The program included training for vaccine program staff, and COVID vaccination and vaccine education for individuals with NDD in a safe, inclusive setting. Methods Used: MIND Institute staff obtained input from CEDD Community Advisory Committee and community partners to develop clinic protocols and dissemination strategies. Vaccine program staff received training about NDD and a website and video describing the clinic were created. After patients scheduled an appointment, they were contacted by CCLS who completed a structured intake interview that addressed each patient's likes and dislikes, sensory sensitivities, preferred method of communication, and history of previous experiences with medical procedures. Prior to the vaccine appointment, Child Life staff shared a social story with the families that provided a visual description of each step of their visit to the MIND Vaccine Clinic. Team huddles were completed the morning of vaccine clinic. Summary of Results: 321 doses of the COVID-19 vaccine were scheduled to be administered to individuals with NDD ages 5 to 67 years (225 M, 91 F, gender nonconforming 5). 8 appointments were either canceled or the individual did not attend. We were able to safely administer 310 (99.3%) doses. Conclusion(s): Strategies were developed to address common barriers to vaccination, some of which are more common in individuals with NDD, including sensory dysregulation, history of medical trauma, and concerns about how a novel vaccine might impact a patient's specific medical condition. A structured intake, staff training, daily huddles and a quiet dedicated space, longer appointments and dedicated parking were key elements of clinic success.

Mental health of caregivers of children with neurodevelopmental disorders during the pandemic.

Caregivers are especially likely to be more psychologically affected during the social and health care system constraints generated by the COVID-19 pandemic. Caregivers of children with neurodevelopmental disorders (i.e., autism, intellectual disability, attention deficit, hyperactivity, motor disability) have a more essential role than caregivers of healthy children. A quantitative cross-sectional study was designed, using descriptive, comparative and correlational statistical techniques to analyze health-related quality of life, emotional distress and overload in four subgroups of caregivers, classified according to the child's diagnosis. A total of 132 caregivers (86.4% women) were included. In group 1 (cognitive disability), 28 caregivers participated;in group 2 (ADHD), 51 were included;in group 3 (autism spectrum disorder), 33 caregivers participated, and in group 4 (motor disability), 20 were included. The main findings of this study were: i) alterations in physical role, bodily pain, general health and vitality;ii) very low percentages of depression, anxiety, stress and overload symptomatology;iii) differences in social functioning between the motor disability and ADHD groups;and in stress and overload between the autism and motor disability groups;and iv) moderate correlations between the dimensions of bodily pain and emotional role and depression, anxiety, stress and overload. It was concluded that there is more impairment in variables associated with physical health than with mental health.Copyright © 2023

Primary proximal hypospadias repair in in toilet-trained males is associated with a higher risk of post-operative complications and parental dissatisfaction

Introduction & Objectives: Hypospadias is the most common congenital malformation of the penis. There has been a lot of recent controversy in certain countries as to whether operating on distal hypospadias is warranted, and when this should occur. Proximal hypospadias, however, is much less common, with a putative aetiology within the male programming window of the first trimester. It has an association with differences of sexual development (DSD) when diagnosed alongside cryptorchidism and the operative approach is technically more challenging. The European Association of Urology (EAU) recommends initial repair between 6-18 months of age. Material(s) and Method(s): We prospectively gathered data from 24 consecutive toilet-trained children (3-7 years) who were initially listed for proximal hypospadias repair, but who were delayed as a result of resource limitations and the ongoing supply chain effects of COVID-19. The patients were operated between July 2020 and July 2022 with a mean follow-up of 7 months (3-24months). These were compared with a cohort of 16 patients who underwent proximal hypospadias repair between 12-18 months of age in the same institution. Both single and staged procedures were included. Institutional review board approval was obtained. Patients who had previously been operated on as an infant, or who were diagnosed with a DSD, or had an associated diagnosed neuropsychiatric developmental disorder were excluded. Pre-, peri- and post-operative data were statistically compared. Result(s): Overall, 40 children underwent a total of 75 primary procedures for their proximal hypospadias (7x single stage;31 x 2-stage;2 x 3-stage). All patients had an indwelling catheter placed post-operatively, were on antibiotic prophylaxis and oxybutynin for bladder spasms. Morphine was not used post-operatively in any case. Apart from age, there were no significant demographic or racial differences between these groups. The toilettrained cohort was associated with a higher rate of urethrocutaneous fistulas (58% vs. 31%;p=0.11), catheter/stent trauma (79% vs. 6%;p<0.001), pain (54% vs. 12%;p<0.01), constipation (75% vs. 37%;p=0.02). Both Likert Scales (4 vs. 8) and parental net promoter scores (-25 vs. +68.75) were worse for the toilet trained cohort compared to the infant cohort. There were no differences in glans dehiscence, or residual chordee between both groups. Conclusion(s): Primary proximal hypospadias repair is associated with a higher degree of perioperative complications in toilet-trained kids and lower levels of parental satisfaction. These cases are not deemed to be suitable to be managed conservatively and should be offered treatment within the 6-18 months window adjusted for gestational age as endorsed by the EAU.Copyright © 2023.

Management of Pediatric Pulmonary Hypertension Using Remote Pulmonary Artery Pressure Sensor Monitoring

Background Management of pediatric pulmonary hypertension (PH) may require manipulation of multiple receptor sites to maximize response to medical therapy. Assessment of response typically occurs through imaging, labs, physical exam and recurrent cardiac catheterization, with anesthetic exposure to assess pulmonary artery pressures (PAP) and vascular resistance (PVR). We aimed to assess feasibility, safety and utility of remote PAP monitoring in pediatric PH patients. Methods We reviewed 4 pediatric patients with significant PH, each of whom underwent cardiac catheterization with pulmonary vasoreactivity testing and placement of a CardioMEMS remote PAP monitoring device. Results Four patients (P1-4: ages 5, 6, 8 and 10 years old) underwent CardioMEMS insertion without procedural complication. P1, P2 and P3 presented with unrepaired VSD;ASD with partial anomalous pulmonary venous return;and ASD and PDA, respectively, while P4 had prior repair of atrioventricular canal. Three patients had Down syndrome. All had elevated PAP and PVR. Mean left lower PA branch size was 7 mm. Mean PAP prior to therapy was 70 mm Hg for P1, 82 for P2, 93 for P3 and 30 for P4. All 4 patients required initiation of triple therapy for treatment of PH, with improvement or normalization of PAP by CardioMEMS, which also included surgical or catheter based intervention for 3 patients. Post-repair of P2, he was unable to be separated from cardiopulmonary bypass and was placed on ECMO. Right ventricular cardiac output improved over 2 weeks, with improvement of PAP determined through serial CardioMEMS. He was successfully decannulated, utilizing CardioMEMS in the OR. Two patients also developed COVID respiratory infections at home with CardioMEMS assessments allowing for oxygen and medication titration. Conclusion Remote PAP monitoring is feasible and appears safe in pediatric patients with adequate PA size. It allows for manipulation of medical therapy with real time knowledge of impact on PAP and can augment management during weaning of mechanical cardiac support. It may also augment decision-making in management of PH patients with developmental disabilities in whom traditional assessments may be more challenging.Copyright © 2023 American College of Cardiology Foundation

Suicide and autism: A lifespan perspective

People who are diagnosed with Autism Spectrum Disorder (ASD) are at increased risk of suicidal behaviour compared to the general population;recent population-based studies demonstrate a three- to sevenfold increased risk of premature death by suicide. This chapter provides an overview of: (a) the current literature regarding risk and prevalence of suicide behaviour in autism;(b) the role of intellectual disability/intellectual developmental disorder in suicide in autism;(c) correlates, risk and protective factors;(d) dimensional constructs of suicide, including autistic traits;(e) current approaches to suicide assessment, including potential modifications;and (f) suicide prevention and service access. We consider these topics by drawing on state-of-the-art research, the perspective of lived experience, and consideration of the potential impacts of major events such as the coronavirus (COVID-19) pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Providing Comprehensive Services to Treat Patients and the Inpatient Psychiatric Bed Crisis

Objectives: A growing mental health crisis and a shortage of inpatient psychiatric beds have resulted in a surge of patients' boarded' in emergency departments awaiting acute inpatient psychiatric placement. This delays care and causes a further burden on already stressed emergency services. In June 2020, the Centers for Disease Control and Prevention (CDC) reported an increased incidence of anxiety and depressive disorders since March of 2020, in comparison to pre-pandemic data. This has further exacerbated the shortage of psychiatric beds nationwide. In addition, staff shortages at state psychiatric hospitals in the Commonwealth of Virginia led to temporary closures to admissions. State facilities in VA provide care for our most vulnerable population, including (involuntary) patients on a temporary detention order (TDO). Carilion Clinic implemented the Comprehensive Psychiatric Emergency Program (CPEP) in August 2020 with the goal of early identification and robust treatment of psychiatric patients while in the ED. Since implementation of the CPEP, providers have been able to redirect patients away from burdened state psychiatric facilities by rapid stabilization of patients in the ED. Patients were able to step down to a less restrictive environment, often no longer meeting criteria for TDO. This study aims to assess the rate of TDO releases pre- and postimplementation of the CPEP at Carilion Clinic. Method(s): A pilot program was launched in August 2020 at Carilion Roanoke Memorial Hospital through a collaboration of the Departments of Emergency Medicine and Psychiatry. The staff was comprised of a psychiatrist, a psychiatric nurse practitioner, and a social worker. Data was collected from May 2020 to June 2021 from the Epic electronic medical record and included all patients in the ED on a TDO, ages six and above. Patients who no longer met criteria for a TDO were released from involuntary status and either redirected as a voluntary patient to an inpatient psychiatric unit or discharged to the community. The rate of TDO releases three months prior to CPEP implementation was assessed and compared to the TDO release rate post-CPEP implementation. Result(s): Prior to CPEP implementation, the TDO release rate was 7%, amounting to four patients released from a TDO per month. After implementation of CPEP, the TDO release rate increased to 19%, equating to thirteen patients released from a TDO per month during the pilot period. This led to a decrease in the number of patients that would have previously been admitted to a state psychiatric facility. Patients who benefitted from implementation of the CPEP were those with conditions in the following categories: chronic mental illness (32%), individual/family crisis (24%), neurocognitive disorders (20%), substance use disorder (18%), autism spectrum disorders and intellectual/developmental disabilities (6%). Conclusion/Implications: Implementation of the Comprehensive Psychiatric Emergency Program (CPEP) in Carilion Clinic' Emergency Department was successful in reducing the number of state psychiatric admissions by redirecting 11% more involuntary patients to voluntary status. The results of this study highlight the benefits of having in-house psychiatry teams dedicated to early triage, rapid treatment, and comprehensive case management for psychiatric patients in the emergency department. References- CDC, National Center for Health Statistics. Indicators of anxiety or depression based on reported frequency of symptoms during the last 7 days. Household Pulse Survey. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Health Statistics;2020. https:// www.cdc.gov/nchs/covid19/pulse/mental-health.htm.

Anxiety in Paediatric Patients: A Summary of Routinely Recorded Data at Gosh

Aims We performed an analysis of GOSH's Electronic Patient Record (EPR) data derived insights relating to patients diagnosed with an ICD-10 anxiety code. This analysis examined trends in frequency distribution and duration of anxiety diagnoses over time, alongside the medication administrations and procedures performed on these patients. Methods Routine data for all patients diagnosed with an ICD-10 anxiety code (F41-) from July 2019 to March 2022 were extracted, de-identified, and analysed in the secure GOSH Digital Research Environment (DRE). The Python package Pandas was used to clean and analyse data. Interactive visualisations were created using Plotly. Medication drug classes for these patients (Hypnotics, Anxiolytics, and Antidepressants), and OPCS-4-classification-identified-procedures were analysed. Results Across 1573 patients in the cohort, 'Anxiety disorder, unspecified' (F419) was the most common anxiety type until 2021, gradually being replaced by 'Other specified anxiety disorders' (F418). The monthly sum of anxiety diagnoses demonstrated a seasonal variation, peaking in July 2019 and July 2021, with a trough spanning UK COVID-19 lockdowns. Chronic Kidney Disease, Autism, and other developmental disorders were the most prevalent comorbidities. Stratifying by drug class, Hypnotics & Anxiolytic administrations were more popular than Antidepressants for patients diagnosed with anxiety. Melatonin was the most administered medication. The OPCS-4 Class 'U' ('Diagnostic imaging, testing and rehabilitation') was the most common group of procedures performed on the same day as an anxiety diagnosis. Transthoracic Echocardiography and CSF Injection were most prevalent. Conclusion This analysis of EPR data found a seasonal variation in anxiety diagnosis frequency, with a gradual change in the specific type. Hypnotics & Anxiolytics are more popular than Antidepressants. Anxiety diagnoses relate mostly to imaging and testing procedures. Further work includes the same analyses and trends on earlier data.

Intrauterine device practices amongst adolescent patients

Background: Adolescent pregnancy is a worldwide public health issue, and the intrauterine device (IUD) has been shown to be a safe and highly effective method of long-acting reversible contraception (LARC) in this group. Patient concerns regarding IUDs are common, which should be addressed during routine office visits. Recently, both Pediatric and Gynecologic societies have recommended the IUD as a first line contraceptive for adolescents given their safety and efficacy. We are hoping to understand current IUD practices amongst providers, elucidate barriers to IUD insertion, and explore whether there have been any changes in IUD insertion patterns since the advent of the COVID-19 pandemic, which has increased telehealth and reduced operating room (OR) availability. Method(s): Survey was disseminated to NASPAG (North American Society for Pediatric and Adolescent Gynecologists) members via the listserv on two separate occasions. Consent was obtained upon completion of the survey. Results from the survey are anonymous. Results were tabulated with descriptive statistics. Ethics approval was obtained (REB22-0269). Result(s): There were 55 respondents, with the majority being Pediatric and Adolescent Gynecologists (71%) from North America (93%). As per providers, adolescents most frequently seek out the IUD for contraception (45%) and menstrual management (42%). Providers felt that the most common barrier to the IUD was misconceptions/myths (67%), as well as pain with insertion (64%). Most practitioners had no change in their IUD prescribing patterns since the start of the pandemic (62%), while some performed more office insertions (11%) and some reduced their IUD practice because of less operative time (15%) and less in-person appointments. Although many physicians perform office insertions, many found that a Procedural Sedation Center facilitated wait times (38%) or felt that such a center would be helpful (33%). Cases being done in the OR were often patients with disabilities/developmental delay (95%) or anxiety (75%). Conclusion(s): Our survey demonstrated that there are still some misconceptions surrounding the IUD. Education on contraception, specifically LARCs, is pivotal in decreasing adolescent pregnancy rates, reducing barriers to IUD use, and improving the attitude of adolescents toward the IUD. Pain with insertion is another limiting factor and a Procedural Sedation Center may be helpful in managing pain expectations and increasing acceptance of the IUD. Although there was no significant change in IUD practices during COVID, a decrease in operating room availability and increase in telehealth may impede IUD prescribing, especially in patients with developmental delay or disabilities who may require insertion in the OR.Copyright © 2023

A Competing Stimuli Intervention Package to Treat Automatically Reinforced Destructive Behavior

Behaviors maintained by automatic reinforcement are often more difficult to treat due to difficulty with identifying the relevant maintaining variable(s). One common intervention to treat automatically maintained behavior includes competing stimuli. Competing stimuli promote item engagement which may replace challenging behavior (i.e., response competition). Competing stimuli have shown to be a widely successful intervention across diverse topographies of challenging behavior;however, few studies have evaluated the use of competing stimuli on destructive behavior. The purpose of the current study was to treat automatically maintained destructive behavior with a competing stimuli intervention package for an adolescent with developmental disabilities. Results showed a decrease in destructive behavior when access to competing stimuli was a component of an intervention package in a clinic setting. Also, preliminary data are provided showing treatment effects when caregivers implemented the intervention. Due to the complexity of the final intervention package, recommendations for clinicians are provided which focus on improving feasibility, practicality, and sustainability of treatment components.Copyright © The Author(s) 2022.

Salud mental de cuidadores de ninos con trastornos del neurodesarrollo durante la pandemia.

Caregivers are especially likely to be more psychologically affected during the social and health care system constraints generated by the COVID-19 pandemic. Caregivers of children with neurodevelopmental disorders (i.e., autism, intellectual disability, attention deficit, hyperactivity, motor disability) have a more essential role than caregivers of healthy children. A quantitative cross-sectional study was designed, using descriptive, comparative and correlational statistical techniques to analyze health-related quality of life, emotional distress and overload in four subgroups of caregivers, classified according to the child's diagnosis. A total of 132 caregivers (86.4% women) were included. In group 1 (cognitive disability), 28 caregivers participated;in group 2 (ADHD), 51 were included;in group 3 (autism spectrum disorder), 33 caregivers participated, and in group 4 (motor disability), 20 were included. The main findings of this study were: i) alterations in physical role, bodily pain, general health and vitality;ii) very low percentages of depression, anxiety, stress and overload symptomatology;iii) differences in social functioning between the motor disability and ADHD groups;and in stress and overload between the autism and motor disability groups;and iv) moderate correlations between the dimensions of bodily pain and emotional role and depression, anxiety, stress and overload. It was concluded that there is more impairment in variables associated with physical health than with mental health. Copyright © 2023

Mental Health Status of Parents of Children Under Five Years of Age during Covid-19 Pandemic in Guwahati City, Assam

Background: Today the world is facing an unprecedented situation owing to the effects of COVID-19, an infectious disease caused by SAR-COV-2 virus, with clinical spectrum ranging from asymptomatic to mild respiratory symptoms to rapid death. COVID-19 was first reported in a hospital in Wuhan city, China on 29th Dec 2019. Subsequently the disease spread rapidly throughout the country. The first case of COVID-19 outside of China was confirmed in Thailand in January, 2020. The disease has spread far and wide all over the world effecting almost every country in the world making it a global pandemic. As of now more than 200 million people have been effected across 213 countries and territories leading to loss of lives. As there is no treatment for the novel corona virus till date, lockdown, and social distancing and vaccination is the only practical and safe option to slow down the spread of the virus. Since the onset of the pandemic in early 2020, 35% of the population has experienced mental distress. Material(s) and Method(s): It is a community based cross-sectional study on parents having children from 0-5 years of age. The study was conducted in different municipal wards of Guwahati city, Assam. 5 municipal wards are selected randomly out of which 260 parents will be selected randomly. Based on the previous study "Impact of COVID-19 Outbreak on mental health and perceived strain among the caregivers tending children with special needs" conducted by Sapna Dhiman and Shilpa Jain, School of Psychotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi India and published in Research in Developmental Disabilities, 6th October 2020. The prevalence of anxiety was found to be 20.5%. Result(s): Out of the 260 parents that were interviewed, 77 (29.6%) reported having a family member who was diagnosed with COVID-19, while 183 (70.4%) reported not having any family member who was diagnosed with COVID-19. Among the 87 parents who are govt. sector employees, 79 (90.8%) did not suffer from stress, while 8 (9.2%) suffered from stress. Among the 125 parents who are private sector employees, 93 (74.4%) did not suffer from stress, while 32 (25.6%) suffered from stress. Among the 30 parents who own business, 19 (63.3%) did not suffer from stress, while 11 (36.7%) suffered from stress. Among the 3 parents who reported being involved in agriculture, 2 (66.7%) did not suffer from stress, while 1 (33.3%) suffered from stress. Among the 15 parents who reported being unemployed, 9 (60%) did not suffer from stress, while 6 (40%) suffered from stress. Conclusion(s): Thus, through this study, one can conclude that the ongoing pandemic has certainly taken a toll on the mental well-being of parents and as such taking measures to identify and address the issue is the need of the hour. Thus, awareness should be created about identifying signs of various mental health issues so that people can identify and seek necessary medical help at the earliest. Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Precocious puberty and other pubertal disorders in females during the Italian lockdown and the coronavirus 2019 (COVID-19) pandemic

Background: At present few data have clearly showed an increased frequency of idiopathic central precocious puberty (CPP) in females during the COVID-19 pandemic. The role of environmental factors is not fully understood and various hypotheses have been formulated. Aims of the Study: To evaluate retrospectively the incidence of newly diagnosed CPP and other pubertal disorders (premature thelarche, early puberty, fast puberty and precocious menarche) in two regions of Italy (Tuscany and Emilia-Romagna) during and after the lockdown for COVID-19. Patients and Methods: The study included 440 females evaluated for pubertal disorders into the Centres of Florence, Parma, Reggio Emilia and Modena between the 1 January 2020 into the 31 December 2021. Subjects with endocrine or chronic diseases were excluded. Monthly incidence rates and clinical features were compared with a control group of patients evaluated for the same problems into 2019. Result(s): Our data confirmed a higher frequency of CPP in females (261 patients, mean age 7.6 +/- 0.6 years, without significant differences between the diagnoses carried out in 2020 and 2021) compared to 2019 (52 cases, mean age 7.5 +/- 0.7 years, p < 0.0001). Interestingly, CPP cases were significantly higher also in the first two months of 2020, so before the start of Italian lockdown and just before the Sars-COV-2 pandemic was declared (21 cases vs. 7 in the same period of 2019;p < 0.0001). Our preliminar data seem also to suggest an increased frequency of the diagnoses of premature thelarche (54 patients in 2021 and 31 patients in 2020 vs 21 patients in 2019, respectively p < 0.0001 and < 0.05;between 2020 and 2021: p < 0.0001), early puberty (31 patients in 2021 and 25 patients in 2020 vs 16 patients in 2019, respectively p < 0.0001 and p < 0.05), fast puberty (20 patients in 2020 vs 5 patients in 2019 and 2021;respectively, p < 0.0001) and precocious menarche (9 patients in 2021 vs 3 patients in 2019 and 4 patients in 2020;p < 0.0001). Conclusion(s): Our data, on the one hand, confirm an increase in the frequency of new cases of CPP during and after the lockdown for COVID-19 pandemic, but also show an increase, albeit differently distributed in these 2 years of epidemic, in other pubertal development disorders. Interestingly, this could delineate different factors involved in the genesis of these disorders. Further studies and insights appear necessary to better explain these aspects.

Clusters of SARS-CoV-2 infection across six schools for children with intellectual and developmental disabilities

Background. In-person learning is important for children with intellectual and developmental disabilities (IDD) because of the additional health, vocational, and functional services for students at these schools. It may be difficult to reduce SARS-CoV-2 transmission in IDD schools because students require assistance with activities of daily living such as eating, during which social distancing and masking cannot occur. Surveillance testing and cluster tracking in schools for children with IDD, which may be considered high-risk environments for transmissions, could have benefits for mitigating transmission and keeping students in schools. The objective of this study was to identify SARS-CoV-2 clusters in IDD specific schools to compare viral transmission in delta and BA.1 variant waves. Methods. A saliva-based PCR test was offered to students and staff for weekly SARS-CoV-2 screening at six Special School District (SSD) schools dedicated to children with IDD. Clusters, which are considered 2 or more positives cases in the same classroom having an epidemiological link, were then recorded. All weekly testing took place between November 23, 2020 and May 27, 2022. Clusters were recorded from November 15, 2021 to January 28, 2022. A Fisher's exact test was used to compare categorical variables. Results. 545 (90%) and 113 (16%) students participated in weekly testing. 160 participants tested positive throughout the study, 23 (14%) during the delta variant wave and 115 (72%) during the BA.1 variant wave. There was no significant variation in age, race, ethnicity, gender, or vaccination status between positive cases recorded from alpha, delta, and BA.1 variant waves (Table 1). Notably, the vaccination rate of positive participants was lower than the vaccination rate of participants who did not test positive. 42 clusters were recorded, 3 (7%) during the delta variant wave and 39 (93%) during the BA.1 variant wave (Fig. 1). Conclusion. The highly transmissible BA.1 variant resulted in an increase in clusters observed in IDD specific schools. Mitigation strategies for less transmissible alpha and delta waves were not as effective in reducing transmission during the BA.1 wave.

Suicide and autism: A lifespan perspective

People who are diagnosed with Autism Spectrum Disorder (ASD) are at increased risk of suicidal behaviour compared to the general population;recent population-based studies demonstrate a three- to sevenfold increased risk of premature death by suicide. This chapter provides an overview of: (a) the current literature regarding risk and prevalence of suicide behaviour in autism;(b) the role of intellectual disability/intellectual developmental disorder in suicide in autism;(c) correlates, risk and protective factors;(d) dimensional constructs of suicide, including autistic traits;(e) current approaches to suicide assessment, including potential modifications;and (f) suicide prevention and service access. We consider these topics by drawing on state-of-the-art research, the perspective of lived experience, and consideration of the potential impacts of major events such as the coronavirus (COVID-19) pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Gender differences in reaction to Covid19 in people with Autism Spectrum Disorder

Introduction: The Covid 19 pandemic has had an enormous psychological impact in which women were mentally more affected than men (Berthelot et al 2020 - Liu et al 2020). More over it exacerbated symptoms and suffering in individuals with psychiatric disorders. The question is how did it affect individuals with autism (ASD). And if so, did it affect women and girls more that men and boys or differently. Objective(s): To evaluate the impact of the covid 19 pandemic and the subsequent lockdown in patients with ASD Methods: a combination of literature review and assessement of the population of individuals with autism spectrum disorders in a large specialized unit for individuals with ASD Results: No seperate reports on individuals with ASD were found in the recent literature. Obviously the pandemic and confinement had great impact on individuals with intellectual disabilities amongst whom many individuals with comorbid developmental disorders as ADHD and/or Autism (e.g.Palacio-Ortiz et al 2020 - Guessoum et al 2020) In our population some remarkable outcomes were noted in the sense that a substantial part of the population with autism had positive experiences: e.g. clear social rules / less contact. Males enjoyed more online contact and games / experienced less loneliness - In females we found significantly more depressive symptoms, anxiety and suicidal behaviour. Conclusion(s): Covid 19 has had a great psychological impact with marked gender differences. Remarkably in ASD men enjoyed some of the benefits of the confinement. In women with ASD the emotional impact was significantly higher.

RARE CASE OF G6PD DEFICIENCY DIAGNOSED IN AN ADULT AFTER COVID-19 INFECTION

SESSION TITLE: Genetic and Developmental Disorders Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Glucose-6-phosphate-dehydrogenase (G6PD) deficiency is one of the more common hematologic disorders. Many individuals are asymptomatic until a triggering event. Events that lead to hemolysis in the setting of G6PD include certain medications, infections, and specific foods. We discuss a case of G6PD deficiency diagnosed in a hospitalized adult with COVID infection. CASE PRESENTATION: A 41 year old male presented to the hospital with altered mental status. On admission he was found to be in diabetic ketoacidosis and was COVID positive. He was admitted to the ICU and his acidosis was corrected with insulin. He did not require intubation but was treated with steroids, remdesivir, and supplemental oxygen for his COVID pneumonia. His hospitalization was complicated by hemolytic anemia. Testing for autoimmune hemolytic anemia and HIT (heparin induced thrombocytopenia) were negative. Genetic testing for G6PD deficiency came back positive. The patient was discharged and referred to hematology for follow up. DISCUSSION: Interestingly, our patient was asymptomatic prior to his COVID infection. It is likely that the stress from his COVID infection triggered worsening hemolysis. G6PD can be worsened with specific medications or foods but we cannot exclude infection. The inflammatory response secondary to COVID is the probable cause for the patient's hemolytic anemia presentation and subsequent G6PD deficiency diagnosis. CONCLUSIONS: G6PD deficiency should be included in the differential diagnosis for patients presenting with COVID infection and labs consistent with hemolytic anemia. Reference #1: Buinitskaya Y, Gurinovich R, Wlodaver CG, Kastsiuchenka S. Centrality of G6PD in COVID-19: The Biochemical Rationale and Clinical Implications. Front Med (Lausanne). 2020;7:584112. Published 2020 Oct 22. doi:10.3389/fmed.2020.584112 DISCLOSURES: No relevant relationships by Sarin Atam No relevant relationships by Kathleen Coppola No relevant relationships by Malik Muhammad Uzair Khan No relevant relationships by Mackenzie Kramer No relevant relationships by Rameesha Mehreen No relevant relationships by Stephanie Tzarnas No relevant relationships by Laura Walters

Outcomes for Paediatric Patients Awaiting Bilateral Myringotomy and Ventilation Tube Insertion for Otitis Media with Effusion Listed Prior to the COVID-19 Pandemic

Aim: The decline in the incidence of otitis media with effusion (OME) during the COVID-19 pandemic has become apparent. This review investigates the outcomes for children with OME awaiting bilateral myringotomy and ventilation tube (BMT) who were referred prior to the COVID-19 pandemic. Method: All patients were reviewed in otolaryngology clinics between 1st February and 30th April 2021. Patients included were referred due to hearing, vestibular or developmental disorders prior to the first COVID-19 lockdown on 23rd March 2020. Analysis of routine consultation and audiological assessment was completed from records. Results: There were a total of 48 patients awaiting BMT. The average age was 6.8 years, with a male to female ratio of 1.38:1. Most initial referrals (54.2%) were due to hearing loss, followed by recurrent ear infections (33.3%). Forty-four patients were diagnosed with OME. Of those, only 9% remained awaiting BMT. All others were removed from the waiting list. One patient remained listed for an adenotonsillectomy, 30 were discharged, and nine required follow-up appointments. Conclusion: Our review demonstrates a significant reduction of BMT for OME following COVID-19. Further research on public health measures and changes in clinical practice during the 2020 lockdown would clarify the impact on OME.

Impact of the COVID-19 Pandemic on Behavioral Health of People with Intellectual and/or Developmental Disabilities

Objective: To examine how the COVID-19 pandemic impacts the behavioral health of people with intellectual and/or developmental disabilities (IDD) in the US. Background: The general population has suffered increasing rates of mental health problems during the COVID-19 pandemic. Having an intellectual disability was the most significant independent risk factor for a diagnosis of COVID-19, and the second strongest independent risk factor to COVID-19 mortality. This study investigates how the pandemic uniquely impacted the behavioral health of people with IDD. Design/Methods: Data were collected using a modified version of the Coronavirus Health Impact Survey -Adapted for Autism and Related Neurodevelopmental conditions (CRISISAFAR). The survey was disseminated electronically to a non-probability (i.e., convenience) sample of community and advocacy groups through the authors' networks of IDD-affiliated organizations. Study data were collected and managed using REDCap electronic data capture tools from March to June 2021. Results: 437 individuals with IDD completed the survey. 52.2% listed having an intellectual disability and 48.7% listed autism spectrum disorder, among other diagnoses. 51.6% of the survey population reported that their mental health had worsened during the pandemic. 47.6% said that they were worrying more, 55.6% struggled with changes in routine, and 18.7% reported increased self-injurious behavior. Losing access to services and programs correlated with declining mental health. Loss of or decrease in community support also correlated with increased screen time, worse sleep, and needing more help with activities of daily living. Conclusions: The behavioral health of individuals with IDD was profoundly impacted by the changes caused by COVID-19. Despite pervasive needs for increased mental and physical health resources amongst individuals with IDD, the potential positive impact of physical activity and pandemic safe social supports and opportunities should be regarded as an important and accessible means to mitigate the overall gap in services.