Recurrent Subglottic Stenosis in a 16-Month-Old Male in the Setting of Influenza A, Intubation, and Honey Consumption.

Recurrent episodes of subglottic stenosis are rare in the literature, and the etiologic causes are misunderstood but can be congenital, idiopathic, or iatrogenic in nature. Complications of intubation can result in subsequent inflammation and reactive processes. This case involves a 16-month-old male who suffered from a recurrent episode of subglottic stenosis in the setting of croup, influenza, and honey consumption. He had presented to the emergency department in respiratory distress after ingesting a home remedy of onion juice and honey. He had been discharged one day prior from the pediatric intensive care unit after four days of intubation and a seven-day hospital course with evidence of croup on imaging. He was readmitted, and subglottic edema and narrowing were confirmed via endoscopy, which prompted antibiotic treatment and close monitoring. After three days of monitoring and re-evaluation by bronchoscopy, the patient's condition began to improve, and no intubation was necessary. It is unclear what the cause of recurrent subglottic stenosis is due to the patient's clinical picture being clouded by a potential allergic reaction to honey versus an inflammatory reactive process post-intubation from the previous admission days prior. This case emphasizes the need for further research on the prevalence and etiology of recurrent subglottic stenosis and a deeper understanding of how to optimize diagnosis and treatment.

A RE-AIM Analysis of a Mental Health App for Undergraduate and Medical Students during the COVID-19 Pandemic: A Retrospective Cross-Sectional Study.

OBJECTIVE: The purpose of this study was to use the RE-AIM framework to evaluate the implementation of a mental health app designed for undergraduate and medical students during the COVID-19 pandemic. PARTICIPANTS: Medical (n = 270) and undergraduate students (n = 1386) from five universities in the Appalachian region in the United States participated in this study. METHODS: Universities from the United States were recruited to deploy the Sharpen app for medical and undergraduate students. The Sharpen app provided psychoeducational modules in mental health literacy, social-emotional learning, mindfulness-based stress reduction, and suicide prevention to promote protective factors for students. The utilization of the Sharpen app was analyzed using the RE-AIM framework using a retrospective, cross-sectional design. RESULTS: Reach: A total of 12.72% of medical students and 6.00% of undergraduate students participated in the study. EFFICACY: Medical students viewed significantly more pages, had a significantly higher unique page view average, and a statistically significant exit percentage when compared to undergraduate students. Adoption: A total of 100% of the universities that were recruited participated in the study. IMPLEMENTATION: Five out of six implementation criteria were included, indicating high implementation. Maintenance: All of the universities continued using the Sharpen app following the end of data collection, resulting in a 100% maintenance rate. CONCLUSIONS: The RE-AIM framework indicated usability and maintenance by medical and undergraduate students. Future research needs to implement a more rigorous design to determine the impact of the Sharpen app on mental health outcomes in medical and undergraduate students.