Use of Complementary and Alternative Medicine in Children with Neuromuscular Disorders Followed at Penn State Health Pediatric Muscular Dystrophy Association Care Center Clinic.

The exact prevalence of complementary and alternative medicine (CAM) use is not known in pediatric patients with neuromuscular diseases followed by any of the 150 Muscular Dystrophy Association (MDA) Care Center Clinics nationwide. This study describes the prevalence and variety of CAM usage in this population, while also assessing the prevalence of caregiver disclosure of CAM use and caregiver perception of provider support for CAM. Fifty-two caregivers of pediatric patients seen at Penn State Health's Pediatric MDA Care Center Clinic completed our online survey. Overall, 19.2% of caregivers reported CAM use by their child. Less than half of caregivers reported discussing CAM use with their child's neurologist (41.5%); however, a majority of respondents reported interest in using CAM for their child in the future (52.8%). Understanding the prevalence of CAM usage and disclosure in pediatric MDA clinics may facilitate safer use of CAM in this community.

Use of Integrative, Complementary, and Alternative Medicine in Children with Epilepsy: A Global Scoping Review.

(1) Background: Epilepsy is one of the most common chronic neurological disorders in childhood. Complementary and alternative medicine (CAM) use is highly prevalent in patients with epilepsy. Despite CAM's widespread and increasing popularity, its prevalence, forms, perceived benefits, and potential risks in pediatric epilepsy are rarely explored. (2) Methods: We performed a scoping review of the available literature on the use of CAM in pediatric epilepsy. (3) Results: Overall, global cross-sectional studies showed a variable degree of CAM usage among children with epilepsy, ranging from 13 to 44% in prevalence. Popular types of CAMs reported were supplements, cannabis products, aromatherapy, herbal remedies, dietary therapy, massage therapy, and prayer. Families often report that CAM is effective, although there are limited objective measures of this. Potential risks lie in the use of CAM, such as herbal remedies, and/or unregulated, contaminated, or unpurified products. Studies also underscored inadequate patient-physician discussions regarding CAM. (4) Conclusions: A better understanding of this topic would aid clinicians in guiding patients/families on the use of CAM. Further studies on the efficacy of the different types of CAM used, as well as potential side effects and drug interactions are needed.

POCUS in Internal Medicine Curriculum: Quest for the Holy-Grail of Modern Medicine.

Point of care ultrasound (POCUS) is an essential component of emergency medicine training that has not taken hold in internal medicine training programs. Internal medicine residents can use POCUS to perform focused examinations and aid complicated procedures. However, while there is widespread interest in learning POCUS, training is not standardized amongst residency curriculums. Therefore, more strides are necessary to correctly implement POCUS training during residency training.

A concerning trend in geriatric pharmacy that merits evidence-based intervention.

The effects of polypharmacy on geriatric populations are an emerging concern that merits more exploration. The primary goal of this review was to evaluate the current body of knowledge on polypharmacy and explore the preventive and corrective measures to avoid negative outcomes. Even if a medication has an appropriate indication, polypharmacy in the geriatric population is associated with an increased risk of drug-drug or drug-condition interactions. Recent efforts to prevent polypharmacy include the development of interprofessional teams in clinics dedicated to medication review and reconciliation, deprescription plans aimed to safely discontinue potentially inappropriate medications, and inpatient screening tools that provide prescribing recommendations. In conclusion, polypharmacy affects a high percentage of the geriatric population. Current efforts to address and prevent polypharmacy are ongoing but have not been widely adopted.

Acute Calcific Cerebral Embolism Large Vessel Occlusion: A Unique Stroke Mechanism With Hard Challenges.

We present the case of an ischemic stroke associated with partially occlusive acute calcified cerebral emboli large vessel occlusion (CCE LVO). No revascularization strategy guidelines have been established for this unique acute ischemic stroke population, although many studies have reported impaired and inconsistent responses to both thrombolysis and thrombectomy. The patient in this case report, unfortunately, experienced a failed attempt at complete thrombolysis, resulting in a poor clinical outcome. Endovascular thrombectomy was not performed because of incomplete obstruction and risk of injury. Follow-up imaging revealed an acute ischemic stroke at the large middle cerebral artery and a new intraparenchymal hemorrhage with complete absence of the previously identified calcified embolus. This case and current literature demonstrate that more data are needed to determine the best revascularization approach for patients with CCE LVO stroke. With tissue plasminogen activator marginally effective in these patients, thrombectomy should be considered in highly unstable, clinically symptomatic patients even only with partial vessel occlusion.

Peripartum cardiomyopathy: a review of current literature.

Peripartum cardiomyopathy (PPCM) is systolic heart failure in a woman who is pregnant or in the early postpartum period. There are multiple theories regarding the pathophysiology of this disease, and it is suspected the true cause is a combination of these theories. Presenting symptoms are similar to that of systolic heart failure from other causes and must be carefully differentiated from normal changes that occur during pregnancy. PPCM may progress to chronic heart failure and result in various complications if not treated early. This paper offers a comprehensive review of currently accepted pathophysiologic theories, major signs and symptoms, possible complications and treatments of PPCM.

Peripartum cardiomyopathy is a heart disorder that involves decreased blood flow from the aorta to the rest of the body. This can occur during pregnancy, or shortly thereafter. The major symptoms are shortness of breath (especially at night), severe leg swelling and persistent cough. Some of these symptoms may also be present in normal, healthy pregnancies, so it is important for the patient to inform their doctor of any personal or family history of cardiac conditions prior to or within pregnancy. There are treatments that are used to improve symptoms; however, many medications that are normally used for cardiomyopathy outside of pregnancy are dangerous for the fetus; and therefore must be avoided. While many cases of peripartum cardiomyopathy resolve spontaneously after delivery, some patients require longer and more intense treatment. Patients with a history of this heart condition should talk with their doctor before deciding to get pregnant again, as recurrence is common and potentially life threatening. It is possible to have a normal, healthy vaginal delivery even with this condition, but in severe cases a c-section may be the safest option for the patient and her child.

Complementary and Alternative Medicine (CAM) use in Children with Epilepsy.

Complementary and alternative medicine (CAM) use by the pediatric population with epilepsy in rural Pennsylvania was studied to characterize the prevalence, perceived effectiveness, and reasons for CAM use. This study additionally assessed the adequacy of parent-physician communication regarding CAM usage. A telephone survey was administered to 200 parents/caregivers of children with epilepsy followed at Hershey Medical Center. Thirteen percent of respondents indicated CAM use by their child. Common types of CAM used were cannabis-related products such as CBD oil and medical marijuana. Forty-eight percent of CAM users chose to initiate CAM owing to dissatisfaction with the outcomes of antiseizure drugs. Fifty-nine percent noticed a decrease in seizure frequency with CAM use, and more than 11% of CAM users reported side effects from CAM. Eighty percent of CAM users had discussions regarding CAM with their child's neurologist. CAM use was found to be associated with increased seizure severity (P = .004) and the prior use of cannabidiol (Epidiolex) (P < .001) or the ketogenic diet (P = .001). Increased seizure severity and the prior use of Epidiolex or the ketogenic diet may be used as predictors for the identification of patients with a higher likelihood of using CAM. Interest in future CAM use, especially cannabis-related products, was expressed in a large percentage of non-CAM users. Given the high parental or caregiver interest in CAM, providers are encouraged to be proactive in initiating discussions about CAM and collaborate with parents/caregivers to ensure the safe usage of CAM among pediatric patients.

A narrative review of chronic alcohol-induced atrial fibrillation.

Alcohol use disorder (AUD) is highly prevalent and can lead to many cardiovascular complications, including arrhythmias. Chronic alcohol use has a dose-dependent relationship with incidence of atrial fibrillation (AF), where higher alcohol intake (>3 drinks a day) is associated with higher risk of AF. Meanwhile, low levels of chronic alcohol intake (<1 drink a day) is not associated with increased risk of AF. Mechanistically, chronic alcohol intake alters the structural, functional and electrical integrity of the atria, predisposing to AF. Increased screening can help identify AUD patients early on and provide the opportunity to educate on chronic alcohol use related risks, such as AF. The ideal treatment to reduce risk of incident or recurrent AF in AUD populations is abstinence.

Lay abstract Alcohol use disorder (AUD) affects many people and can lead to many cardiovascular consequences, including arrhythmias. Higher alcohol intake (>3 drinks a day) is associated with higher risk of atrial fibrillation (AF). Meanwhile, low levels of chronic alcohol intake (<1 drink a day) is not associated with increased risk of AF. Mechanistically, chronic alcohol intake alters the integrity of the atria, predisposing to AF. Increased screening can help identify AUD patients early on and provide the opportunity to educate on chronic alcohol use related risks, such as AF. The ideal treatment to reduce risk of AF in AUD populations is abstinence.

Pitt Hopkins-Like Syndrome 1 with Novel CNTNAP2 Mutation in Siblings.

Pitt Hopkins-like syndrome 1 (PTHLS1, OMIM # 610042) is an ultra-rare autosomal recessive condition with a prevalence of <1/1,000,000. Intragenic deletions of CNTNAP2 has been implicated in PTHLS1, however to our knowledge a compound heterozygous deletion of exon 4 and a c.1977_1989del13; p.V660Ffsx9 frameshift variant have not been published previously. In this case report, the proband is a seven year old female with PTHLS1, developmental delay, autism spectrum disorder, focal epilepsy, hypotonia, refractory errors, strabismus, and obstructive sleep apnea. Whole exome sequencing analysis revealed biallelic pathogenic variants of the CNTNAP2 gene. Proband has a three year old sister who has who has a similar phenotype including, developmental delay, epilepsy, gait abnormality, refractory errors, strabismus. Family variants were tested and she shared the same CNTNAP2 variants as her sister. The sisters described highlight two novel variants leading to PTHLS1. Genetic workup is essential in identification and management guidance in these populations.

Current Management Guidelines on Hyperlipidemia: The Silent Killer.

Given the high incidence of cardiovascular events in the United States, strict control of modifiable risk factors is important. Pharmacotherapy is helpful in maintaining control of modifiable risk factors such as elevated lipids or hypercholesterolemia. Hypercholesterolemia can lead to atherosclerotic disease which may increase the risk of acute coronary events. Statin therapy has long been a mainstay in the treatment of hypercholesterolemia, but while highly regarded, statin therapy also has side effects that may lead to patient noncompliance. Therefore, various medicines are being developed to manage hypercholesterolemia. This paper will discuss the role that lipids play in the pathophysiology of atherosclerotic disease, review the current lipid management guidelines, and discuss new treatment options that are alternatives to statin therapy.

COVID-19 mental health consequences on medical students worldwide.

Background: The COVID-19 epidemic has impacted medical education for medical students worldwide. As medical students are already vulnerable to poor psychological well-being, the mental health of medical students may be significantly affected by the changes caused by COVID-19. Objective: In this article, we discuss the curriculum and mental health ramifications of the COVID-19 epidemic on the international medical school population Methods: In this review, we analyzed 13 studies evaluating the impact of COVID-19 on medical school curriculum, medical student mental health, and subsequent medical student coping strategies. Results: Early in the COVID-19 outbreak, the Association of American Medical Colleges recommended to pause all student clinical rotations, while in-person curriculum moved to virtual modalities. Students expressed concern over their abilities to explore specialties of interest and their confidence in becoming a competent doctor. Medical students also reported higher levels of anxiety, stress, and exhaustion, with female students reporting this more than male students. Students have been coping with these challenges in quarantine through engaging in physical activity, spending time outdoors, and video chats. Conclusion: Medical education institutions must address the effects of COVID-19 on the mental health of their students in order to mitigate related consequences.

Re-Positive SARS-CoV-2 With Respiratory Failure and Cerebrovascular Accident: Is This a Reinfection?

The coronavirus disease 2019 ( COVID-19) pandemic is a global pandemic where healthcare providers are concerned about the reinfection of recovered patients. The reinfection with COVID-19 is not common and considered less likely, but as time passes by, there are reports of patients becoming positive after having tested negative previously. Here, we report a case of a 28-year-old male with diabetes mellitus type 1, hypertension, and end-stage renal disease on hemodialysis who presented initially in April 2020 with nausea, vomiting, and dyspnea. His severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) came back positive. He left against medical advice but was followed as an outpatient in the dialysis unit where he continued with dialysis in isolation for positive COVID-19 as per the dialysis unit guidelines. He presented three months later with altered level of consciousness in the setting of diabetic ketoacidosis. He also had gastrointestinal bleed and cerebrovascular accident. There was a strong possibility of reinfection in this patient as he was tested negative after the initial infection and then tested positive three months later, presenting with a different set of symptoms and more severe disease on his second admission.