New-Onset Thyroid Eye Disease After COVID-19 Infection in Patient with Graves' Disease Post-Radioactive Iodine Treatment

Introduction: Coronavirus disease 2019 (COVID-19) has been associated with dysregulation of the immune system and abnormal thyroid function. The aim of this novel case report is to inform physicians of the possibility that COVID-19 infection may precipitate thyroid eye disease (TED) in patients with Graves' Disease (GD) even after treatment with radioactive iodine (RAI). Case Description: In this report, we describe a patient with GD treated with RAI who developed TED after COVID-19 infection. The patient was initially diagnosed with GD in 2018. A thyroid uptake scan (I-123) was consistent with GD with moderately elevated uptake. She was initially managed with methimazole and atenolol and was eventually treated with RAI (16.32 millicurie I-131) in February 2021. She had post-ablative hypothyroidism managed with levothyroxine. The patient contracted COVID-19 in January 2022. In February 2022, the patient started experiencing eye irritation, dryness, protrusion of eyes, eyelid swelling, and visual disturbances. Thyroid stimulating hormone (TSH) receptor auto-antibodies (7.33 IU/L, normal < /=1.00 IU/L) and thyroid stimulating immunoglobulin (4.30 IU/L, normal < /=1.00 IU/L) were elevated. TSH was normal (2.180 mIU/L, normal 0.270 - 4.200 mIU/L) on levothyroxine 125 mcg daily. She was later diagnosed with TED. Discussion(s): GD is an autoimmune thyroid disorder related to the presence of TSH receptor-stimulating antibodies and is often associated with ocular symptoms. Activation of an autoimmune response during COVID-19 infection, may induce onset or relapse of GD. A study using the national health insurance service database in South Korea noted an increase in the incidence of subacute thyroiditis in 2020 in association with the COVID-19 pandemic. TED is usually seen in patients with GD. Radioactive iodine is widely used in the treatment of GD and has been associated with development or worsening of TED. There are published cases of TED occurring in patients with GD after receiving COVID-19 vaccine. It is thought that the inflammatory syndrome induced by the adjuvants could induce molecular mimicry, which could trigger TED. In most cases this adverse effect was transient, lasting a few months after treatment. There have been case reports of TED occurring after 3 to 21 days of COVID-19 vaccination in patients with controlled GD. Symptoms improved in 4-8 months. Development of TED in patients with GD who have been treated with RAI typically occurs soon after RAI therapy. For TED to occur in a GD patient 11 months after receiving RAI therapy is unusual. COVID-19 infection appears to have been the trigger for this patient's eye disease. This is highly unusual and has not been published to our knowledge.Copyright © 2023

Mental health trainees: Experience of online classes during COVID-19 pandemic

Objective: To determine experiences of mental health trainees with their online classes. Methodology: It was an online cross-sectional study carried out during month of June, 2020. The sample comprised of 231 mental health trainees of BS (n = 114) and MS (n = 117) programs of a private university of Lahore. A google doc. consisting of 15 statements was prepared to for online delivery of their classes. Result(s): 45% students responded on "to some extent to no difficulty" experience of smooth running of online lectures. On the item of overall satisfaction with delivery of online lectures, 50% students (out of 114) from BS program and 51% students (out of 117) from MS program rated on "not at all" Although satisfaction was high on the online availability of teacher for the counselling of students however, on understand lectures Only 14% students showed highest level of satisfaction. Conclusion(s): Online classes remained a big challenge for trainees and it was associated with lack of satisfaction in terms of their own learning, evaluation comprehension and health issues.Copyright © 2023, Pakistan Medical Association. All rights reserved.

Eyeing up the pandemic: A literature review of the ocular manifestations of COVID-19

Background Since the onset of SARS-CoV-2, this novel virus has been the focus of many studies seeking to improve the ability of healthcare systems to withstand pandemics against it. COVID-19 has pulmonary and cardiovascular implications, but its ocular effects remain a subject of debate. Objectives The objective of our narrative review is to explore the ophthalmic manifestations of COVID-19, identify research gaps, and act as a guide for further research in the field. Methods The literature search involved original studies published from January 1, 2020, up until August 20, 2021, on the PubMed database. Title and screening and full text review were conducted by two independent researchers, with a third researcher resolving conflicts. Studies that met the set inclusion criteria were used for data synthesis. Results The preliminary search generated 59 articles, with 25 being data extracted. Conjunctivitis, epiphora and ocular irritation were consistently stated anterior segment manifestations. Posterior segment implications were mostly subclinical, including cotton-wool spots and retinal nerve-fiber layer thinning, but some cases were more detrimental, such as central retinal vein occlusion, posterior segment inflammation, retinal hemorrhages, and fungal infiltration. RT-PCR tests were unreliable in detecting SARS-CoV-2 infection in ocular tissues, potentially due to methodological limitations. Conclusion Anterior segment findings were significant manifestations of the novel coronavirus, but a clear resolution of posterior segment findings is yet to be made. In the absence of reliable COVID-19 ocular sample tests, all links made to SARS-CoV-2 etiology remain tentative;further research must be directed to the field with modified testing strategies. Copyright © 2022 University of Jordan,Deanship of Scientific Research. All rights reserved.

Knowledge and Practices of Parents Regarding Safe Handling and Disposal of Alcohol-Based Hand Sanitizers and Surface Disinfectants in Urban Sri Lanka

Aims Hand sanitizers are increasingly used in most households since the onset of the COVID-19 pandemic. However, improper use and accidental and deliberate ingestion of sanitizer solutions have been associated with numerous health risks to children. This study aimed to assess knowledge and practices regarding safe handling and disposal of alcohol-based hand sanitizers and surface disinfectants among a cohort of parents in urban Sri Lanka. Methods This observational cross-sectional study was performed including parents of children admitted to North Colombo Teaching Hospital for a period of six months from August 2021. Data were collected regarding parental knowledge regarding safe handling and disposal of hand sanitizers, and their health hazards by paediatric post-graduate trainees. Data were collected using a pre-tested interviewer administered questionnaire. All data were analysed using SPSS 17.0. Results Out of 153 children recruited to the study, the mean age was 5.3 years (range: 1 month - 14 years) and male children (92, 60.1%) outnumbered female children (61, 39.9%). The majority of mothers (126, 82.4%) and fathers (133, 86.9%) had received education at least up to secondary school. 124 parents (81%) had been using hand sanitizers at home regularly. Only 113(73.9%) parents believed that preschool children were the most vulnerable for accidental ingestion of sanitizers and 40 parents (26.1%) were unaware that sanitizer solutions can be accidentally inhaled by toddlers. Knowledge was poor regarding occurrence of potential symptoms and side effects such as sore throat (56, 36.6%), irritation of eyes (30, 19.6%), breathing difficulties (40, 26.1%), high heart rate (72, 47%), aspiration (43, 28.1%) and low blood sugar (108, 70.5%). Only 132 parents (86.2%) knew how to clean and disinfect their home premises safely and 29 parents (18.9%) didn't know how to store cleaning products safely. Sixty-four parents (41.8%) were unaware regarding how to get information on safe cleaning practices. Forty-two parents (27.4%) kept sanitizer bottles within easy access to children whilst 85 parents (55.5%) had been storing sanitizers in unlabeled bottles. Ninety-eight parents (64%) were not keen to read the signage alerts in sanitizer storage bottles. Only 25 parents (16.3%) safely disposed sanitizer bottles. Thirty-three parents (21.6%) put sanitizer bottles together with food items in carriage bags from super markets. Conclusion The findings of this study inform that knowledge in parents regarding safe use of sanitizers can further be improved specially, in areas of local and systemic effects of sanitizer poisoning and information resources of safe cleaning practices. As a number of parents use and dispose hand sanitizers unsafely, the effectiveness of awareness programs to improve safety practices among parents should be evaluated.

CHLORINE GAS EXPOSURE AND OBSTRUCTIVE AIRWAY DISEASE: A CASE REPORT AND CASE-BASED DISCUSSION

SESSION TITLE: Occupational and Environmental Lung Disease Cases SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Chlorine gas is a pulmonary irritant with pungent odor that damages the respiratory tract. Chlorine gas exposure occurs in industrial or household exposures,Chlorine gas has two forms either a liquid or gas, toxicity of chlorine gas depends on the dose and duration of exposure. Chlorine gas used in manufacturing products like paper, insecticides, Chlorine is used to treat bottled and swiming pool water. CASE PRESENTATION: A 37 Y.O Male, no PMH presents with progressive dyspnea for three days worse with activity,decreases with rest, denied cough fever or chest pain he is vaccinated for COVID,no smoking history. The patient worked at a chlorine gas factory in the Dominican Republic for 15 years. Exam: Vitals: BP 124/72 mmHg. HR 100 BPM. RR 21 BPM. SpO2 84%. General: acute distress. Heart: normal S1, S2. RRR. Lung: wheeze bilaterally. Abdomen: Soft. Musculoskeletal: no pitting edema. he was placed on 6 LPM NC saturation improved to 90%. CBC and Chemistry were unremarkable, he was started on steroid, breathing treatment with antibiotics. ABG showed hypoxemia. he was placed on Venturi mask and his saturation improved to 95%.CTA was negative for PE. EKG, troponin were unremarkable. A proBNP normal. The antibiotics were discontinued because of a negative workup. A TTE study was normal. HRCT scan of the chest, showed atelectasis and infiltrates of lower lobes. No interstitial fibrosis.A PFT showed obstructive airway disease. He was discharged on oral and inhaled steroids.Hi new onset obstructive airway could be due to chlorine gas exposure. DISCUSSION: Chlorine gas causes cellular injury through oxidative damage but further damage results from activation and recruitment of inflammatory cells with subsequent release of oxidants and proteolytic enzymes. Humans can detect chlorine gas odor at a concentration between 0.1-0.3 ppm. At 1-3 ppm,it causes irritation of oral,eye mucosal membranes. At 30-40 ppm causes cough, chest pain, and SOB. At 40-60 ppm, toxic pneumonitis and pulmonary edema and can be fatal at 430 ppm concentration or higher within thirty minutes. Chronic exposure to chlorine gas lead to chest pain, cough, sore throat, hemoptysis, recurrent asthma. Physical exam findings include tachypnea cyanosis, wheezing, intercostal retractions, decreased breath sounds. Pulmonary function tests may reveal obstructive lung function disease. Chronic exposure to a low level was found to be associated with an increased risk of asthma in swimmers. CONCLUSIONS: Chlorine exposure results in direct chemical toxicity to the airways with acute airways obstruction or airways hyperreactivity, presentation varies from acute overwhelming intoxication with acute lung injury and or death, occupational exposure increase the likelihood of chronic bronchitis or isolated wheezing attacks. Treatment for chlorine exposure is largely supportive. Reference #1: 1- Center of disease control and prevention website/emergency preparedness and response/ https://emergency.cdc.gov/agent/chlorine/basics/facts.asp Reference #2: 2- C- Morim A, Guldner GT. Chlorine Gas Toxicity. [Updated 2021 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537213/. Reference #3: A- Gummin DD, Mowry JB, Beuhler MC, et al. 2020 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021;59(12):1282-1501. doi:10.1080/15563650.2021.1989785 DISCLOSURES: No relevant relationships by Abdallah Khashan No relevant relationships by Samer Talib no disclosure on file for Matthew Yotsuya;

Increased occupational exposure to disinfectants during the COVID-19 pandemic in 2020

Objective: Health authorities' recommendations for containment of COVID-19 have led to a wide spread availability and use of disinfectants in Germany. The study investigates if the frequency and characteristics of poisonings with disinfectants at the workplace have changed in 2020 in comparison to previous years. Methods: The German Federal Institute for Risk Assessment (BfR) receives reports on workplace poisonings on a legal basis (German Chemicals Act §16e). Occupational exposures with disinfectants between 2018 and 2020 were evaluated in terms of frequency and characteristics (Poisoning Severity Score (PSS), route of exposure, product category). Results: The BfR received 19,431 cases of workplace exposures in 2018-2020. Biocidal disinfectants were involved in 1,066 cases (5.5%). Due to variations in the total number of annually notified cases, the proportion of cases involving biocidal disinfectants in relation to all cases was calculated for each year. With 6.9%, the highest percentage of cases involving biocidal disinfectants was registered for 2020, compared to 4.9% in the two previous years. In the majority of cases (83.5%) only minor symptoms (PSS1) were registered, mostly eye irritation (78.4%). The distribution of PSS assigned to cases showed no significant differences between 2020 and previous years (Table 1). Conclusion: The COVID-19 pandemic has led to an increase in general disinfection measures. Professional publications from numerous poison information centres around the world report an increase in the number of cases of disinfectants. This trend is also reflected in our study, analysing exposures with disinfectants at workplace. While the total number of reported cases decreased in the “shutdown year” 2020, the proportion of cases with disinfectants increased. The distribution of severity remained almost the same. In the work environment too, care should be taken to handle disinfectants and, if necessary, appropriate protective clothing, should be worn. (Table Presented).

Spectrum of Ocular Manifestations in SARS COV – 2 Patients at Tertiary Care Center

Introduction: The outbreak of the novel coronavirus disease (COVID-19), a highly contagious and deadly infection. Aim: To evaluate the epidemiological pattern and spectrum of the covid ocular morbidity and appraise the typical presentation of ocular manifestations in hospitalized covid patients. Methods: A prospective, cross-sectional study was conducted on individuals, who were hospitalized for COVID treatment between May 2021 and June 2021. The Data on patient history, physical exam, thorough ocular examination, laboratory results, and hospital disposition were collected and analyzed. Results: A total of 658 patients were included. Ocular signs and symptoms were noted in 162 (24.62%) patients. 51.6% patients wereof >50 years of age and 54.1% were males. 71.6% of them belonged to urban community.75.3% patients developed ocular discomfort with in acute (<1 week) period of covid infection. The most common ocular abnormality was watering with conjunctival irritation, followed by conjunctival injection and lid swelling. Among the 162 patients, 30 (79.0%) developed ocular involvement prior to day 30 of onset of their COVID symptoms. 56.7% patients relieved from ocular discomfort after treatment. 5.7% patients reported deterioration of visual acuity. 65.8% patients reported ocular discomfort associated with regular oxygen mask wearing. Most significant ocular morbidity was black discoloration of lids and peri ocular skin, lid swelling, and redness and purulent discharge of conjunctivitis needed emergency ophthalmic reference. Conclusion: spectrum of covid sore eyes extends from ocular irritation to mucormycosis and other long-term complications.

Combating with poor Indoor air quality to improve work environment at IndianOil

Introduction: Indoor air quality have a great impact on physical and psychological health of employees working in buildings. IndianOil Institute of Petroleum Management (IiPM), located in National Capital Region of Delhi(NCR) is a premiere institute consisting of multiple training halls & auditoriums. In view of COVID-19 pandemic, modifications were carried out in air handling unit system at IiPM. Materials and methods: A detailed study of air movements, intake and return path was carried to find out measures to ensure adequate air exchanges. Additional air inlets with Dual PM10 filters were fixed on all air intake paths to reduce the pollutant level in air entering the building. The air handling unit at the institute was also fitted with special grade air filter for bringing down the PM2.5 level below 60. Special grade filters filtered the pollutants and reduced the pollutant level of air. An online air image sensor was installed to measure the quality of ambient air after filtration. Stand-alone air cleaner/filter units were also installed in training halls, lobbies and waiting areas. Result: Following modifications there was improvement in air quality by 90%. This resulted in building confidence level and provided a stress-free safe environment for employees working at the institute. Employees working at IiPM confirmed reduction in eye irritation, headaches and fatigue due to air pollution. Discussion: Installation of air filters inside the building helps in improving air quality which in turn prevents common health issues at workplace. This has prompted us to provide similar solutions in other office buildings in NC