Network Analyses of the Symptoms in the Coronavirus Anxiety Scale (CAS) and its Associations with Depression, Anxiety, Stress and Alcohol Use

Background The Covid-19 Pandemic and subsequent actions taken by national/international organizations has generated a large amount of anxiety which may roam into the realm of pathology – COVID Anxiety. In order to measure this phenomenon, measures such as the CAS have been developed. The CAS being a self-report measure of anxiety-related physiologically symptoms that are aroused by information and thoughts related to COVID-19. However, as the CAS is fairly new tit requires validation and examination. This study fulfils this need through the use of Network Analysis. Methods The study used regularized partial correlation network analysis (EBICglasso) to examine the network structure of ratings of COVID anxiety symptoms as presented in the Coronavirus Anxiety Scale (CAS) and how these symptoms are related to distress (combination of depression, anxiety, stress) and alcohol use. A total of 968 adults from an Australian community sample completed the CAS, and measures of depression, anxiety, stress and alcohol use. Results The findings showed that the most central CAS symptom was abdominal distress, followed by tonic immobility. The symptom with the lowest strength centrality value was dizziness. Also, the network revealed at least moderate effect size connections for tonic immobility with dizziness, sleep disturbances abdominal distress, and for abdominal distress with appetite loss. Additionally, distress was associated positively with dizziness, tonic immobility and appetitive loss. Alcohol use was associated positively with dizziness and abdominal distress, and negatively with tonic immobility and appetitive loss. Conclusions Overall, the findings showed a novel understanding of the structure of the COVID anxiety symptoms in the CAS, and how these symptoms are associated with distress and alcohol use. The clinical implications of the findings for assessment and treatment of COVID anxiety and its comorbidity with distress and alcohol use are discussed.

Sigmoid volvulus in children

Sigmoid volvulus in paediatric patients is a rare but potentially life-threatening condition. Since 1940, only 100 cases have been reported. There are no consensual guidelines for juvenile sigmoid volvulus unlike in adults, where the condition and the treatment is well described. We report a case of a 12-year-old patient, who presented with uncharacteristic symptoms of mild abdominal discomfort and lack of passage of stool. A CT-scan showed a sigmoid volvulus and emergency resection was performed with placement of a colostomy. With this case, we want to emphasise juvenile sigmoid volvulus as a probable differential diagnosis when symptoms of abdominal distress and constipation occur.

Physiology and pathophysiology of splanchnic hypoperfusion and intestinal injury during exercise: strategies for evaluation and prevention

Physical exercise places high demands on the adaptive capacity of the human body. Strenuous physical performance increases the blood supply to active muscles, cardiopulmonary system, and skin to meet the altered demands for oxygen and nutrients. The redistribution of blood flow, necessary for such an increased blood supply to the periphery, significantly reduces blood flow to the gut, leading to hypoperfusion and gastrointestinal (GI) compromise. A compromised GI system can have a negative impact on exercise performance and subsequent postexercise recovery due to abdominal distress and impairments in the uptake of fluid, electrolytes, and nutrients. In addition, strenuous physical exercise leads to loss of epithelial integrity, which may give rise to increased intestinal permeability with bacterial translocation and inflammation. Ultimately, these effects can deteriorate postexercise recovery and disrupt exercise training routine. This review provides an overview on the recent advances in our understanding of GI physiology and pathophysiology in relation to strenuous exercise. Various approaches to determine the impact of exercise on the individual athlete's GI tract are discussed. In addition, we elaborate on several promising components that could be exploited for preventive interventions.

Traumatic Rupture of Diaphragm

• Patient always felt a fullness in left hemithorax • No prior CXR • Remembered falling off pony as a child • After surgical repair, patient had a lot of abdominal distress—abdomen could not tolerate “new” contents

Invasive enteritis by Strongyloides stercoralis presenting as acute abdominal distress under corticosteroid therapy

Overwhelming helminthiasis is still a problem in endemic areas, especially in immunocompromised patients. We report a case of invasive intestinal strongyloidiasis that was clinically expressed as acute abdominal distress in a 73-year-old man from São Paulo who had been receiving methylprednisone, 20 mg/day, for one year for osteoarthritis. A surgical specimen from the ileum revealed invasive enteritis with severe infestation by Strongyloides stercoralis. The patient died of sepsis 6 days after surgery. The possibility of invasive strongyloidiasis should be considered in the differential diagnosis of acute abdominal distress in patients undergoing immunosuppressive therapy.

Responses of pigs fed wheat naturally infected with Fusarium graminearum and containing the mycotoxins 4-deoxynivalenol and zearalenone

Wheat naturally infected with Fusariurn graminearurn on a farm in south-eastern Queensland contained mean concentrations of 23 mg 4-deoxynivalenol (DON) kg-1 and 4 mg zearalenone (ZEA) kg-1. No other mycotoxins were detected. The wheat was incorporated into diets containing DON ranging from 0-14 mg kg-1 and corresponding ZEA concentrations. Diets were fed in two experiments to a total of 66 pigs of an improved synthetic breed (half each sex, initial liveweights about 27 kg). The first experiment lasted 14 days and tested short-term responses, while the second was a growth trial lasting up to 14 weeks. Pigs were fasted for 24 h before the diets were first offered. In the first experiment, the pigs ate readily for 10-15 min and thereafter sparingly or not at all for several hours. Vomiting commenced in pigs consuming the most DON after 10-20 min and continued for the next hour. A similiar pattern was seen in the growth trial. In total, vomiting was observed in 13 pigs on the first day of feeding, but not thereafter. Vomiting was accompanied by signs of abdominal distress and teeth grinding. This was followed by marked feed refusal, the extent being related linearly to increasing DON concentrations, so that pigs offered the most DON lost weight during the growth trial. Voluntary feed intake was depressed by about 6% for each 1 mg kg-1 of dietary DON, although some tolerance developed over time. Slight diarrhoea was noted in some pigs, and a few females showed oestrogenic effects due to the ZEA. The feed refusal was well correlated with that obtained by other workers using purified DON. Feed conversion was not adversely affected until DON concentrations exceeded about 8 mg kg-1.