scholarly journals 77 Routine outpatients visits during SARS-CoV2 global pandemic

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N135-N137
Author(s):  
Teresa Fedele ◽  
Silvia Orefice ◽  
Ludovica Fiorillo ◽  
Vittoria Cuomo ◽  
Valentina Capone ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Lifestyle Changes ◽  
Panic Attacks ◽  
Office Visits ◽  
Current Crisis ◽  
Outpatient Visits ◽  
Global Pandemic ◽  
Patient Reported ◽  
Almost All ◽  
New Onset

Abstract Aims The inability to carry office visits was collateral damage caused by the Coronavirus (COVID-19) pandemic. Tele-health is a relatively new, and yet fundamental amid the current crisis, resource to bridge the gap between phisicians and patients. Methods and results We report our experience with telemedicine and describe the major events occured in our patients. 121 consecutive adult patients with arterial hypertension (F/M: 56/65; mean age: 66.8 years) were enrolled. 33 patients (27%) had also diabetes, 94 (78%) were also affected from dyslipidemia and 11 (9%) had CAD. They all referred to our ambulatory of hypertension, in most of case for several years. Given the impossibility to continue routine outpatient visits during lockdown, they were all phone called by three residents in order to detect their state of health or any events they could have experienced over this period. They were all asked about their own blood pressure values, the occurrence of new symptoms and of new-onset both cardiovascular and non cardiovascular events. We also followed a self-made preset form. 31 of them (26%) experienced cardiovascular symptoms/events during this period: 11 had hypertensive peaks, in one case associated with nausea and vomiting while 2 of them had hypotensive episodes; 10 had typical angina and/or dyspnoea while 4 had atypical angina; 6 had palpitations; 1 of them developed new onset atrial fibrillation resolved with pharmacologic cardioversion during hospitalization; 1 had syncope; 1 patient reported new onset peripheral oedema; 2 patients died during lockdown for non cardiovascular causes. 17 of them also developed non cardiovascular symptoms, 7 of whom were severe anxiety and/or panic attacks. Almost all patients had important lifestyle changes, in 15 cases (12.3%) associated with weight increase. Conclusion The impossibility to access to routine outpatient visits during lockdown due to global pandemic of SARS-CoV2, has brought out the risk of underestimating consequences of chronic disease, in absence of appropriate Follow-up. Nevertheless, the two deaths we report were not related to cardiovascular disease. The risk is that both the missing of cardiovascular control visit and the extension of the waiting list, could provoke serious complications in patients suffering from chronic cardiovascular disease.

Early-Onset Preeclampsia with Pulmonary Edema and Massive Ascites: A Rare Presentation of Severe Preeclampsia or Concomitant Diagnoses?

2020 ◽  
Vol 2020 ◽  
Author(s):  
Elizabeth St. Laurent ◽  
Rebecca Fryer-Gordon ◽  
Tom McNeilis, ◽  
Leonard B. Goldstein
Keyword(s):  
Pulmonary Edema ◽  
Early Onset ◽  
Hellp Syndrome ◽  
Disease Process ◽  
Massive Ascites ◽  
Elevated Liver Enzymes ◽  
Biophysical Profile ◽  
Patient Reported ◽  
Early Onset Preeclampsia ◽  
New Onset

Preeclampsia, eclampsia, and HELLP syndrome, are a continuum of a dangerous disease process that can occur in pregnancy. Preeclampsia is defined by new onset hypertension and proteinuria. In more severe cases, preeclampsia can be associated with pulmonary edema, oliguria, persistent headaches, and impaired liver function. These symptoms reveal maternal end organ damage which may result in danger to the fetus such as oligohydramnios, decreased fetal growth, and placental abruption. The defining difference between preeclampsia and eclampsia is the presence of new onset seizure activity. HELLP syndrome occurs when the mother experiences hemolysis, elevated liver enzymes, and low platelets. This syndrome is seen in about 0.6% of pregnancies. Each of these conditions (preeclampsia, eclampsia, and HELLP) increase both the fetal and maternal morbidity and mortality rates with the most definitive cure being delivery of child and placenta.A 28 year-old Caucasian, G1P0 female at 26w4d presented to OB triage on the recommendation of her physician due to elevated uric acid levels and a recorded blood pressure of 180/110. The patient reported rapid onset of weight gain, facial edema, diminished fetal movements, and frequent headaches. Although the patient denied labor symptoms, she complained of back pain and was admitted to the hospital at 26w4d for observation due to elevated blood pressures. The patient was diagnosed with preeclampsia with severe features. As her presentation progressed, the patient developed massive ascites and pulmonary edema along with decreasing platelet counts and increasing liver enzyme values. Due to decreasing biophysical profile (BPP) scores of the fetus and decompensating lab values of the mother, an emergency cesarean was performed for the safety of mother and baby.This case presentation demonstrates the progression of hypertensive disorders of pregnancy with a rare and severe presentation of early-onset preeclampsia with severe features, pulmonary edema, and massive ascites that ultimately led to class III HELLP syndrome and extreme prematurity of the infant.

scholarly journals New-Onset Seizure With Possible Limbic Encephalitis in a Patient With COVID-19 Infection: A Case Report and Review

2021 ◽  
Vol 9 ◽  
pp. 232470962098630
Author(s):  
Riwaj Bhagat ◽  
Barbara Kwiecinska ◽  
Nolan Smith ◽  
Matthew Peters ◽  
Christopher Shafer ◽  
...  
Keyword(s):  
Brain Magnetic Resonance Imaging ◽  
Nasopharyngeal Swab ◽  
Onset Seizure ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Global Pandemic ◽  
Elevated Protein ◽  
T2 Hyperintensity ◽  
Elevated Protein Level ◽  
New Onset

With the outbreak of COVID-19 (coronavirus disease 2019) as a global pandemic, various of its neurological manifestations have been reported. We report a case of a 54-year-old male with new-onset seizure who tested positive for severe acute respiratory syndrome coronavirus 2 from a nasopharyngeal swab sample. Investigative findings, which included contrast-enhancing right posterior temporal lobe T2-hyperintensity on brain magnetic resonance imaging, right-sided lateralized periodic discharges on the electroencephalogram, and elevated protein level on cerebrospinal fluid analysis, supported the diagnosis of possible encephalitis from COVID-19 infection. The findings in this case are placed in the context of the existing literature.

scholarly journals SAT0032 INCIDENCE OF RHEUMATOID ARTHRITIS IN PATIENTS WITH NEW ONSET OF MUSCULOSKELETAL SYMPTOMS AND ANTI-CPP POSITIVITY COMPARED TO ANTI-CPP NEGATIVE PATIENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 946.1-946
Author(s):  
S. Dauth ◽  
M. Köhm ◽  
T. Oberwahrenbrock ◽  
U. Henkemeier ◽  
T. Rossmanith ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Point Of Care ◽  
Early Arthritis ◽  
Clinical Parameters ◽  
Research Support ◽  
Point Of Care Test ◽  
Test Elisa ◽  
Patient Reported ◽  
New Onset

Background:Rheumatoid Arthritis (RA) is a chronic inflammatory joint disease. Strategies for its early detection and diagnosis are of high importance as prompt treatment improves clinical and structural outcome. Autoantibodies against cyclic citrullinated proteins (anti-CCP) have been associated with RA-development. Non-specific musculoskeletal (nsMSK) symptoms are often described prior to RA development. Majority of patients with nsMSK symptoms present to their general practice (GP) first. Studies of early arthritis cohorts have shown that many early arthritis patients cannot be accurately diagnosed at their first visit and are often referred as undifferentiated arthritis patients.Objectives:To evaluate the incidence of anti-CCP positivity in patients with new onset of nsMSK symptoms and the incidence of RA in these patients over a 3-year follow-up period compared to anti-CPP negative patients.Methods:In this prospective study (PANORA), 978 patients with new onset of nsMSK symptoms were included in 77 GP sites in Germany. Patients with a positive anti-CCP rapid-test (CCPoint®) were referred to Rheumatology Department (RD) for rheumatological assessment, RA-evaluation and an anti-CCP validation test (ELISA). ELISA anti-CCP positive patients without RA were monitored every 6 months for a total follow-up of 36 months or until RA-diagnosis. Patients with a negative anti-CPP result (CCPoint® or ELISA) are followed up with a questionnaire after 1 and 3 y.Results:From 978 included patients, 105 (10.7%) were CCPoint® positive. 96 were tested with ELISA and 27 (28.1%) were confirmed anti-CCP positive. 9 (33.3%) were diagnosed with RA at the first RD visit (study visit 2); 4 further patients were diagnosed with RA during the follow-up (FU) period so far. Overall, 48.1% of ELISA-positive (ELISA+) patients were diagnosed with RA up to now; 11 ELISA+ patients are still in the FU period of the study. Of the 868 CCPoint® negative patients, currently, 282 have filled out a 1-year FU questionnaire; 3.5% of those reported a RA diagnosis (Table 1). As expected, clinical parameters at V2 (e.g. CRP, swollen and tender joint count) were worse in the ELISA+/RA+ group compared to the ELISA-/RA- group, but no obvious differences were detected between ELISA+ patients who were diagnosed with RA during the FU period (after V2) and ELISA-/RA- patientsTable 1.Number and percentage of patients with a RA diagnosisAnti-CCP statusVisit 2Follow-up*TotalPoint-of-Care Test --3.5% (10 of 282)#3.5% (10 of 282)#Point-of-Care Test + / ELISA -2.9% (2 of 69)0% (0 of 34)#2.9% (2 of 69)Point-of-Care Test + / ELISA +33.3% (9 of 27)14.8% (4 of 27)48.1% (13 of 27)$* 1 year-questionnaire for Point-of-Care Test and ELISA negative patients or every 6 months follow-up for ELISA positive patients;#Patient-reported;$11 patients are still in the follow-up phase of the studyConclusion:Currently, 48.1% of anti-CCP+ (ELISA) patients have received a RA diagnosis, whereas 3.5% of the anti-CCP- (CCPoint®) received a RA diagnosis (patient reported), which underlines, that anti-CCP can be used as a marker to identify high-risk patients in GP setting. While clinical parameters are correlated with the diagnosis of RA, they are not suited for predicting future RA development alone. Anti-CCP, possibly in combination with additional parameters imaging, might increase the likelihood to early diagnose or predict RA development.Figure 1.Study overview: Patient distribution depending on anti-CCP results and RA diagnosis.Disclosure of Interests:Stephanie Dauth Grant/research support from: BMS, Michaela Köhm Grant/research support from: Pfizer, Janssen, BMS, LEO, Consultant of: BMS, Pfizer, Speakers bureau: Pfizer, BMS, Janssen, Novartis, Timm Oberwahrenbrock Grant/research support from: BMS, Ulf Henkemeier: None declared, Tanja Rossmanith Grant/research support from: Janssen, BMS, LEO, Pfizer, Karola Mergenthal Grant/research support from: BMS, Juliana J. Petersen Grant/research support from: BMS, Harald Burkhardt Grant/research support from: Pfizer, Roche, Abbvie, Consultant of: Sanofi, Pfizer, Roche, Abbvie, Boehringer Ingelheim, UCB, Eli Lilly, Chugai, Bristol Myer Scripps, Janssen, and Novartis, Speakers bureau: Sanofi, Pfizer, Roche, Abbvie, Boehringer Ingelheim, UCB, Eli Lilly, Chugai, Bristol Myer Scripps, Janssen, and Novartis, Frank Behrens Grant/research support from: Pfizer, Janssen, Chugai, Celgene, Lilly and Roche, Consultant of: Pfizer, AbbVie, Sanofi, Lilly, Novartis, Genzyme, Boehringer, Janssen, MSD, Celgene, Roche and Chugai

Development and Evaluation of a Prediabetes Decision Aid in Primary Care: Examining Patient-Reported Outcomes by Language Preference and Educational Attainment

2021 ◽  
Vol 47 (3) ◽  
pp. 216-227
Author(s):  
Keerthi Bandi ◽  
Maria C. Vargas ◽  
Azucena Lopez ◽  
Kenzie A. Cameron ◽  
Ronald T. Ackermann ◽  
...  
Keyword(s):  
Educational Attainment ◽  
Decision Aid ◽  
Patient Reported Outcomes ◽  
Office Visit ◽  
Decisional Conflict ◽  
Language Preference ◽  
Intention To Adopt ◽  
Patient Reported ◽  
Evidence Based Treatments ◽  
Almost All

Purpose The purpose of this study was to examine the development and preliminary effectiveness of a novel Prediabetes Decision Aid on adoption of intensive lifestyle interventions (ILIs) and metformin. Little research has focused on increasing uptake of these evidence-based treatments, especially among non-English speakers and those with low educational attainment. Methods Investigators developed an English and Spanish decision aid displaying information about type 2 diabetes (T2DM) risk and treatments to prevent T2DM and prompting patients to identify next steps for management. This pilot study was a single-arm, pretest-posttest trial of 40 adult patients with prediabetes, obesity, and ≥1 office visit within the prior 12 months. Participants reviewed this tool briefly with a study team member, and data were collected on 3 coprimary outcomes: knowledge about T2DM risk, decisional conflict, and intention to adopt treatment. Exploratory outcomes included subsequent documentation of prediabetes in chart notes and adoption of ILIs or metformin. Results Almost all participants were women, with nearly half expressing Spanish language preference and low educational attainment. A nonsignificant increase in knowledge was observed across all subgroups. Decisional conflict was significantly reduced from pretest to posttest and was similar between subgroups defined by language preference and educational attainment. While intention to adopt ILIs increased across all subgroups, this change was only significant among Spanish speakers and participants with low educational attainment. At 6 months, 17 participants had subsequent provider documentation of prediabetes, and 12 adopted ILIs or metformin. Conclusions The decision aid improved patient-reported outcomes and promoted treatment adoption in a diverse patient sample.

scholarly journals COVID-19 pandemic: A review of the global lockdown and its far-reaching effects

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110198
Author(s):  
Helen Onyeaka ◽  
Christian K Anumudu ◽  
Zainab T Al-Sharify ◽  
Esther Egele-Godswill ◽  
Paul Mbaegbu
Keyword(s):  
Mental Health ◽  
Global Economy ◽  
World Health ◽  
Global Pandemic ◽  
The World ◽  
Education Delivery ◽  
Environmental Air ◽  
Health Organization ◽  
Almost All ◽  
The Impact

COVID-19, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was declared a pandemic by the World Health Organization (WHO) on the 11th of March 2020, leading to some form of lockdown across almost all countries of the world. The extent of the global pandemic due to COVID-19 has a significant impact on our lives that must be studied carefully to combat it. This study highlights the impacts of the COVID-19 pandemic lockdown on crucial aspects of daily life globally, including; Food security, Global economy, Education, Tourism, hospitality, sports and leisure, Gender Relation, Domestic Violence/Abuse, Mental Health and Environmental air pollution through a systematic search of the literature. The COVID-19 global lockdown was initiated to stem the spread of the virus and ‘flatten the curve’ of the pandemic. However, the impact of the lockdown has had far-reaching effects in different strata of life, including; changes in the accessibility and structure of education delivery to students, food insecurity as a result of unavailability and fluctuation in prices, the depression of the global economy, increase in mental health challenges, wellbeing and quality of life amongst others. This review article highlights the impacts of the COVID-19 pandemic lockdown across the globe. As the global lockdown is being lifted in a phased manner in various countries of the world, it is necessary to explore its impacts to understand its consequences comprehensively. This will guide future decisions that will be made in a possible future wave of the COVID-19 pandemic or other global disease outbreak.

scholarly journals The Transmutation of the Symbolist Ethos: Mystical Anarchism and the Revolution of 1905

Slavic Review ◽  
1977 ◽  
Vol 36 (4) ◽  
pp. 608-627 ◽  
Author(s):  
Bernice Glatzer Rosenthal
Keyword(s):  
Current Crisis ◽  
The West ◽  
The World ◽  
Almost All ◽  
Religious Aspects ◽  
Social Upheaval ◽  
The Revolution

He [Chulkov] says to me, “mystical anarchism,” I say to him, “non-acceptance of the world, supra-individualism, mystical energism,” and we understand each other. . . .Viacheslav IvanovThe Revolution of 1905 challenged the symbolists’ belief that they could seclude themselves from the rest of society. Forced to reexamine their previous ideas, values, and attitudes, they developed new ideologies that took cognizance of the current crisis. Among the most prominent of the new ideologies was mystical anarchism, the doctrine of the symbolist writers Georgii Chulkov and Viacheslav Ivanov. Particularly attractive to the symbolists, mystical anarchism also influenced other artists and intellectuals; doctrines similar to it proliferated, and it engendered a polemic in which almost all the symbolists took part. Strikingly similar to the mystical anarchism of other periods of social upheaval, both in Russia and in the West, illuminating a facet of the little-known mystical and religious aspects of the Revolution of 1905, and providing an example of the response of apolitical writers and artists to revolutionary upheaval, Chulkov and Ivanov’s doctrine merits closer study than it has so far received.

Prevention of atrial fibrillation – non-modifiable and modifiable risk factors for AF

2020 ◽  
Vol 2 (55) ◽  
pp. 14-19
Author(s):  
Agnieszka Wojdyła-Hordyńska ◽  
Grzegorz Hordyński
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Cardiovascular Diseases ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Combined Treatment ◽  
Lifestyle Changes ◽  
Modifiable Risk Factors

Atrial fibrillation is one of the most common arrhythmias, with a significant increase in incidence in recent years. AF is a major cause of stroke, heart failure, sudden cardiac death, and cardiovascular disease. Timely intervention and modification of risk factors increase chance to stop the disease. Aggressive, multilevel prevention tactics are a component of combined treatment, including – in addition to lifestyle changes, anticoagulant therapy, pharmacotherapy and invasive anti-arrhythmic treatment – prevention of cardiovascular diseases, hypertension, ischemia, valvular disease and heart failure.

POVERTY REDUCTION, UNEMPLOYMENT AND RURAL DEVELOPMENT; AFTERMATH OF COVID-19 PANDEMIC IN NIGERIA

2021 ◽  
Vol 9 (1) ◽  
pp. 36-49
Author(s):  
Oderinu Hassana ◽  
◽  
Kadir Mumini ◽  
Tijani Adebayo ◽  
Keyword(s):  
Economic Development ◽  
Rural Development ◽  
Rural Areas ◽  
Poverty Reduction ◽  
Design Method ◽  
Gear Up ◽  
Global Pandemic ◽  
High Level ◽  
Almost All ◽  
Self Administered Questionnaire

Nigeria has one of the countries whose experience of poverty and unemployment is on the high side makes this study to look into the effect of the economic lockdown during the global pandemic in the country, with the aim of making effort on how this effect can be translated into economic development. Survey research design method was adopted with self-administered questionnaire used to collect data. Findings revealed that in Nigeria COVID -19 outbreak effects was felt in almost all sectors and the aftermath greatly affected the country’s GDP and this adversely affect rural development in the country, which translated to a worrisome rate of poverty and unemployment. Hence, both individual and government have now seen that campaigning for economic diversification is not sufficient for economic development but rather a prompt swing into action by all is needed for sustainable development of rural areas to respond to the worrisome rate of unemployment and in turn high level of poverty caused by the COVID-19 lockdown in the country. It was recommended that government at all level as well as individuals and stakeholders should put in place actions that would gear up rural development and set policies at their various helms of affairs that would encourage economic participation of all citizens in all sector of the economy.

scholarly journals Management of Hypertension: A Bangladeshi Perspective

1970 ◽  
Vol 39 (1) ◽  
pp. 40-43
Author(s):  
SM Mustafa Zaman ◽  
Mohammad Salman ◽  
Kaniz Fatema
Keyword(s):  
Cardiovascular Disease ◽  
Fruits And Vegetables ◽  
Lifestyle Modification ◽  
Clinical Care ◽  
Cost Effective ◽  
Developed Countries ◽  
Population Based ◽  
Lifestyle Changes ◽  
Optimum Level ◽  
Lifestyle Modifications

Hypertension is a silent killer. Bangladeshis are racially predisposed to cardiovascular disease, and the increasing burden of hypertension has only added to the problem. Economic constraints and the allure of additional benefits without adverse effects have made lifestyle modifications an attractive proposition in developing and developed countries alike. Blood pressure is a continuum and any increase above optimum level confers additional independent risk of cardiovascular disease. We review screening, diagnosis and management using lifestyle measures and pharmacotherapy. We then discuss the barriers and challenges to implementing this approach and what can be done regarding prevention, screening, lifestyle modification and pharmacotherapy in our country. By adopting a comprehensive population based approach including policy level interventions directed at promoting lifestyle changes; a healthy diet (appropriate calories, low in saturated fats and salt and rich in fruits and vegetables), increased physical activity, and a smoking free society, properly balanced with a high risk approach of cost effective clinical care, Bangladesh can effectively control hypertension and improve public health. DOI: 10.3329/bmj.v39i1.6232 Bangladesh Medical Journal 2010; 39(1): 40-43

scholarly journals TERMINATION OF EMPLOYEES’ EMPLOYMENT DURING COVID-19: A GUIDE FOR EMPLOYERS IN ACCORDANCE WITH EMPLOYMENT LAW

2021 ◽  
Vol 6 (22) ◽  
pp. 138-146
Author(s):  
Mumtaj Hassan ◽  
Anis Shuhaiza Md Salleh ◽  
Yusramizza Md Isa @ Yusuff
Keyword(s):  
Well Being ◽  
International Labor Organization ◽  
Secondary Sources ◽  
Legal Documents ◽  
Global Pandemic ◽  
International Labor ◽  
The Face ◽  
Huge Impact ◽  
Business Profit ◽  
Almost All

The global pandemic of COVID-19 has endangered the human and economic well-being in the world. It also has a huge impact on almost all industries at home and abroad. The International Labor Organization (ILO) expects the pandemic to increase layoffs and unemployment worldwide. In this case, employers are certainly in a dilemma, each looking for and juggling between workers' income and business profit. Thus, this article explores the aspect of termination of employees’ employment through library-based research that focuses on the use of statutes, courts’ cases, legal documents, and scholarly writings published in journals. Descriptive and critical methods are used to analyse the primary and secondary sources referred to. This article stresses that there are procedures and laws which employers need to obey in order to address the excessive number of employees in the face of pandemics. Dismissal of employees should not be done arbitrarily without justifications and procedures that have been outlined by law. The discussion ended with suggestions to employers so that any layoffs can be blocked and minimized.

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