Evaluating Patient Adherence to Routine and Symptom Indicated Colonoscopies During the COVID-19 Pandemic.

Background and aims The COVID-19 pandemic has led to significant changes in healthcare delivery. In response to these changes, patients have increasingly reduced healthcare utilization in several ways, such as medication compliance, cancer screenings, and routine wellness appointments. This study aims to quantify patient adherence rates to routine and symptom indicated colonoscopies during the COVID-19 and to assess patient medication compliance and utilization of healthcare facilities. Methods A cross-sectional study was performed at a single-center internal medicine clinic from January 2021 to April 2021. A 28-item survey was administered to patients to evaluate for adherence rates to routine and symptom indicated colonoscopies. Patients were also evaluated for rates of healthcare facility usage and medication compliance. Results Among 103 participants, 30.8% of patients who were due for routine colonoscopy either missed, refused, or rescheduled, while 16.7% of patients did so for symptom indicated colonoscopies. Nearly all respondents (94.2%) reported no change to medication compliance when compared to pre-COVID. A significant portion (36.9%) of patients reported missing a healthcare appointment at some point during the pandemic, and of the respondents who felt sick enough to visit the emergency department, 23.1% decided not to go. Conclusions During the COVID-19 pandemic, patients are deferring colorectal cancer surveillance, reducing the usage of acute care facilities, and missing routine healthcare appointments. It is important for providers to address the risks and benefits of delaying colorectal cancer screenings as well as identify physical and psychosocial barriers to patient utilization of both acute and chronic healthcare facilities. As COVID-19 restrictions inevitably continue to ease, medical providers should be aware of these potential lapses in cancer screenings and healthcare visits and be vigilant in catching patients up on their preventative health screenings.

Bilateral Facial Nerve Palsy and COVID-19 Vaccination: Causation or Coincidence?

Bell's palsy is a mononeuropathy of the facial nerve that typically causes unilateral facial paralysis. The incidence of unilateral Bell's palsy is not uncommon, but sequential or simultaneous bilateral Bell's palsy is exceedingly rare. While unilateral Bell's palsy is oftentimes idiopathic, bilateral Bell's palsy is almost exclusively explained by an identifiable trigger. In pre-clinical trials, Bell's palsy cases were recorded at higher rates in the vaccine cohort than the placebo cohort. Herein, we present a case of isolated sequential bilateral Bell's palsy that after an extensive workup, proved to be idiopathic. Notably, in the setting of a recent coronavirus disease 2019 (COVID-19) vaccine and absence of identifiable etiology, our case highlights a potential correlation of the COVID-19 vaccine and bilateral Bell's palsy.

Myeloneuropathy in the Setting of Hypocupremia: An Overview of Copper-Related Pathophysiology.

A posterior cord or dorsal column myelopathy due to neurosyphilis presenting as a tabetic gait is a classic neurological vignette and is taught to all medical students. Its clinical presentation is so graphic that its simulacrum with diseases other than neurosyphilis is labeled as pseudotabes. The latter can be seen with vitamin B12 deficiency as a subacute combined degeneration (SCD) of the spinal cord, another neurology classic. However, not all cases of pseudotabes are due to posterior cord myelopathy as some can arise with other deafferentation syndromes such as polyganglioneuropathies as seen with paraneoplastic syndromes, Sjogren's syndrome, idiopathic autoimmune diseases, and post-viral neuronopathies. A unique and interesting cause of pseudotabes is due to copper deficiency; copper being a metallic trace element that is fundamental to cellular life. Herein, we present a case of copper deficiency manifesting as pseudotabes and review the biochemical properties of copper and its effects on the nervous system.

Isolated Double-Positive Optic Neuritis: A Case of Aquaporin-4 and Myelin Oligodendrocyte Glycoprotein Antibody Seropositivity.

Optic neuritis (ON) causes acute vision loss with typical and atypical profiles, serological markers, imaging findings, and clinical outcomes depending on the associated underlying pathophysiology. Neuromyelitis optica (NMO) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD) are the usual causes of acute severe sequential or simultaneous bilateral optic neuritis. These conditions are usually accompanied by multi-level spinal cord demyelination, and notably, they are typically positive for either NMO or Myelin oligodendrocyte glycoprotein (MOG) autoantibodies, but rarely both. We present a case of isolated sequential bilateral optic neuritis that was seropositive for both NMO and MOG antibodies.

Steroid-Resistant Double-Seronegative Optic Neuritis Responds Favorably to Plasma Exchange.

The clinical presentation of optic neuritis is quite characteristic, and the epidemiology, differential diagnosis, and treatment protocol are well established. However, when the presentation of optic neuritis is atypical, bilateral, and intravenous steroid-resistant, the treatment guidelines are quite nebulous. We present a case of bilateral severe double-seronegative optic neuritis with catastrophic vision loss and intravenous steroid resistance. After an exhaustive investigation, we empirically treated our patient with plasma exchange therapy and obtained a dramatic recovery of vision. When an immune etiology is suspected, this case is instructive vis-a-vis the utility of plasma exchange in refractory cases of optic neuritis despite seronegativity.

Readability of endoscopy information leaflets: Implications for informed consent.

INTRODUCTION: Valid consent for gastrointestinal endoscopy is required for ethical and legal reasons. Patients are frequently met by an endoscopist for the first time on the day of their procedure. For valid consent to be possible, the patient needs to have received and understood generic information regarding endoscopy in advance. Patient information leaflets (PILs) need to be easily understood by the majority of the population. METHOD: PILs from 14 secondary care institutions and a sample PIL from the British Society of Gastroenterology were analysed using an online readability tool. Flesch reading ease, Flesch-Kincaid grade (F-K grade) and Simple Measure of Gobbledygook (SMOG) were calculated and compared against national recommendations and literacy standards. RESULT: Average Flesch reading ease score was 57.5, below the threshold of 60 which indicates a document that is easy to read. Average F-K grade and SMOG were 9.7 and 9.4, respectively; both indicating a reading age of 14-15, the recommended reading age being 11-12. There is considerable variation when documents are analysed by institution. Flesch scores varying from 49.7 to 66.1, F-K grade 8.2-11.4 and SMOG 8.3-10.8 (reading ages 13-17). CONCLUSION: All PILs analysed exceeded the recommended reading age for patient information. In the context of "straight to test" endoscopy where patients do not have a consultation with clinicians well versed in endoscopy prior to the day of the procedure, this risks invalidating consent. PILs need to be written carefully to ensure the information provided is accessible to patients, and that the language used is suitably aimed to achieve this.

Establishing a proactive geriatrician led comprehensive geriatric assessment in older emergency surgery patients: Outcomes of a pilot study.

INTRODUCTION: Increasing numbers of older adults are presenting with acute surgical disease to the unselected general surgical take. General surgeons have little training to manage these patients. We developed a pilot service of proactive geriatrician input into older emergency general surgical patients in a single institution. We wanted to demonstrate if geriatricians improve the management of these patients. METHODS: Patients aged 70 years or older admitted acutely under the general surgeons were assessed proactively by a geriatrician using comprehensive geriatric assessment (CGA). Data were collected prospectively using a data collection form of any new issues detected and interventions made by the geriatricians in addition to the surgical plan. This information was entered into an excel database and analysed. RESULTS: We obtained data for 447 patients between November 2016 and July 2017. CGA led to additional diagnoses or interventions in 83% of patients. The most common problems identified included a new medical diagnosis (35.2%), polypharmacy (30%), recent falls (19.7%), weight loss (17.2%) and uncontrolled pain (16.7%). Abbreviated mental tests were performed in 87.5% patients, with 22% being detected with cognitive impairment. Frailty screening was performed in 97% of patients resulting in 38% being identified as frail. New interventions included stopping medications (40%), starting medications (28%) and referral to multidisciplinary teams (70.1%). Length of stay was reduced by 0.55 days. CONCLUSION: Proactive geriatrician input identifies medical diagnoses and geriatric syndromes missed by the surgical teams. Managing these issues has contributed to a reduced length of stay in these patients.