More than Meets the Eye: Orbital Swelling in an Adolescent with Sickle Cell Disease.

Periorbital swelling is a clinical presentation with a broad differential and potentially deleterious consequence. Causes range from benign, including allergic reaction, to vision- and life-threatening, including orbital cellulitis and orbital infarction. The recent climate of SARS-CoV-2 has further complicated this differential, as the virus poses broad clinical presentations with new manifestations reported frequently. Rapid identification of the underlying etiology is crucial, as treatment approaches diverge greatly. Here, we report the case of an African American adolescent male with a history of homozygous sickle cell anemia presenting to an inner city hospital with bilateral periorbital swelling amid the coronavirus pandemic. Differentials, including orbital cellulitis, COVID-MIS-C, orbital inflammatory syndrome, Hoagland sign, and orbital infarction secondary to sickle cell crisis are contrasted. We contrast our case with 12 case reports of orbital infarction in the setting of sickle cell crisis within the past 10 years, highlighting how these presentations, along with commonly reported findings of orbital infarction, compare with our patient.

The Effect of Attitudes Towards Individuals with Sexual Convictions on Professional and Student Risk Judgments.

Attitudes towards individuals with sexual convictions is an area with growing research interest, but the effects of such attitudes on professional judgments is largely unexplored. What is known from the existing literature is that attitudes guide the interpretation of sexual crime related information, which cascade into potential biased or heuristically driven judgments. In this study we recruited samples of both students (n = 341) and forensic professionals (n = 186) to explore whether attitudes towards individuals with sexual convictions predicted risk judgments of hypothetical sexual offense scenarios, and whether this relationship is moderated by professional status or perpetrator characteristics. Forensic professionals expressed more positive attitudes overall, but the significant effect of attitudes on risk judgments was consistent between participant groups and was not moderated by perpetrator age or sex. We suggest that relying on attitudes as a basis for risk judgments opens the door to incorrect (and potentially dangerous) decision-making and discuss our data in terms of their potential clinical implications. An open-access preprint of this work is available at https://psyarxiv.com/rjt5h/.

Fooled by the fragments: vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura.

Background: Thrombotic thrombocytopenic purpura (TTP) is a hematological emergency requiring prompt plasmapheresis. Conversely, vitamin B12 deficiency is a relatively benign diagnosis that can mimic microangiopathic hemolytic anemia, characterized by the presence of anemia, thrombocytopenia, indirect hyperbilirubinemia, markers of hemolysis, and schistocytes. This case series highlights the association of vitamin B12 deficiency and its TTP-like presentations. Cases: The first case describes a 72-year-old man with shortness of breath and weakness. Diagnostics were notable for pancytopenia, schistocytes, and a low reticulocyte index. Intriguingly, total bilirubin was only mildly elevated however LDH and Haptoglobin were elevated and low, respectively. Additional diagnostic workup demonstrated an undetectable B12, elevated methylmalonic acid and elevated homocysteine. Initiation of B12 supplementation resolved his pancytopenia. The second case describes a 57-year-old man with chest tightness, dyspnea on exertion, and night sweats. Diagnostic evaluation demonstrated pancytopenia, schistocytes, a low reticulocyte index, and a remarkably low B12. He had associated high methylmalonic acid and homocysteine levels, confirming the diagnosis. B12 supplementation resolved his pancytopenia. Conclusion: The polysymptomatic presentation of vitamin B12 deficiency-induced pseudothrombotic microangiopathy highlights the vitamin's role in essential physiological cellular functions. Rapid recognition of the underlying etiology of microangiopathic hemolytic anemia is necessary as treatment approaches diverge greatly.

Where Does the Patient Fit? An Analysis of Word Use Within the Context of Interprofessional Collaborative Care.

Patient-centeredness is considered central to interprofessional collaborative patient care as a participatory, partnered approach between health care professionals and patients. Content analysis of 501 articles from the 1986, 1987, 1988, 1996, 2006, 2013, 2014, and 2018 volumes of a selected journal was undertaken. The purposes were to identify contexts in which the term patient was used in articles with a primary focus on interprofessional care and to identify trends in its usage. With Dilthey's ideas on language as a framework, patient and its variations in the articles were coded under five categories. Findings suggest that the term patient appears predominantly as a modifier for activities enacted by experts and a platform for the discussion of relationships among professionals. There is limited evidence that use of the term patient fits within the context of partnership, suggesting that the language in published interprofessional collaborative research and discussion is currently largely expert, not patient-centered.

Breakfast Cereal Consumption Moderates the Association Between Body Composition and Body Esteem in Young Women but not in Young Men.

PURPOSE: To explore the role of breakfast cereal consumption on the relationships among BMI, percent fat mass (%FM), and body esteem in young adults. METHODS: Weight, height, and %FM (by air displacement plethysmography) were measured in 29 males (aged 25.1 ± 4.0 years) and 28 females (aged 24.6 ± 4.0 years). Body esteem was measured using the Body Esteem Scale for Adolescents and Adults (BESAA). Three-day food records classified participants as breakfast cereal consumers (n = 27, any amount of ready-to-eat or cooked cereal consumed at breakfast) versus nonconsumers (n = 30, no cereal consumed at breakfast). RESULTS: The %FM was significantly (P ≤ 0.05) inversely correlated with weight esteem (r = -0.769), appearance esteem (r = -0.723), and external attribution (r = -0.620) in female noncereal consumers. BMI was similarly correlated with BESAA scores. These relationships were not significant in female cereal consumers (all r < 0.426), despite no difference in confounding variables between female cereal consumers and nonconsumers. Neither BMI nor %FM were correlated with measures of body esteem (all r < 0.466, NS) in either male cereal consumers or nonconsumers. CONCLUSIONS: Breakfast cereal consumption may moderate the relationship among BMI, %FM, and body esteem in young adult women and may be useful for improving body esteem without focusing on weight loss.

Autophagy has a significant role in determining skin color by regulating melanosome degradation in keratinocytes.

Melanin in the epidermis determines the wide variation in skin color associated with ethnic skin diversity. Ethnic differences exist regarding melanosome loss in keratinocytes, but the mechanisms underlying these differences, and their contribution to the regulation of skin color, remain unclear. Here, we explored the involvement of autophagy in determining skin color by regulating melanosome degradation in keratinocytes. Keratinocytes derived from Caucasian skin exhibit higher autophagic activity than those derived from African American (AA) skin. Furthermore, along with the higher autophagy activity in Caucasian skin-derived keratinocytes compared with AA skin-derived keratinocytes, Caucasian skin-derived keratinocytes were more sensitive to melanosome treatment as shown by their enhanced autophagic activity, which may reflect the substantial mechanisms in the human epidermis owing to the limitations of the models. Melanosome accumulation in keratinocytes was accelerated by treatment with lysosomal inhibitors or with small interfering RNAs specific for autophagy-related proteins, which are essential for autophagy. Furthermore, consistent with the alterations in skin appearance, the melanin levels in human skin cultured ex vivo and in human skin substitutes in vitro were substantially diminished by activators of autophagy and enhanced by the inhibitors. Taken together, our data reveal that autophagy has a pivotal role in skin color determination by regulating melanosome degradation in keratinocytes, and thereby contributes to the ethnic diversity of skin color.