The Rating of Perceived Exertion-Pediatric (RPE-P) Scale: Preliminary Validation.

Physical activity is critical to functional rehabilitation for youth with chronic pain, which may be especially true for those with co-occurring obesity. To facilitate the development of physical activity interventions for youth with chronic pain, the newly developed "Rating of Perceived Exertion-Pediatric" scale was modeled after the widely used pain numeric rating scale-11. This study is an initial evaluation of the scale in a sample of adolescents (n = 157, 13-17 years, 51% female) with four subgroups: (1) healthy controls (healthy weight/no pain); (2) chronic pain/healthy weight; (3) obese (no pain); (4) chronic pain/obese. Participants rated perceived exertion using the new scale and the Borg 6-20 Scale of Perceived Exertion while holding a three-minute yoga pose (Warrior II). In the whole sample, the Perceived Exertion-Pediatric scale showed good concurrent (p < 0.001), convergent (all ps < 0.05), discriminant (p = 0.431), and known-groups validity (all ps < 0.05). The chronic pain subgroup also showed good concurrent (p < 0.001), mixed convergent (ps < 0.001 to 0.315), and good discriminant validity (p = 0.607). Limitations include the restricted age range, lack of diversity, and lack of test-retest reliability. The RPE-P shows promise as an assessment tool for perceived exertion in adolescents with and without chronic pain.

Identification of Wernicke Encephalopathy in a Patient Presenting With Altered Mental Status and Dehydration.

INTRODUCTION: Providing glucose before thiamine can cause or exacerbate Wernicke encephalopathy, a potentially life-threatening condition associated with a variety of neurological impairments. CASE PRESENTATION: An emaciated, middle-aged woman with a longstanding history of alcohol abuse and an undifferentiated seizure disorder presented to a local emergency department with altered mental status of unknown duration. Initial labs showed signs of acute kidney injury and she could not tolerate oral intake. Overnight, dextrose-containing maintenance fluids were started. The next day, she had an acute deterioration of mental status. Empiric therapy for Wernicke encephalopathy was begun, resulting in resolution of most of her symptoms over a matter of days. DISCUSSION: It is generally recommended to administer thiamine treatment prior to glucose in patients with suspected thiamine deficiency. The Caine criteria can assist in the decision to start empiric treatment to prevent delays in thiamine therapy. CONCLUSION: Wernicke encephalopathy is a disease with high morbidity that is usually treated with the generally benign therapy of thiamine. Given the risk of harm of untreated Wernicke encephalopathy and the benign nature of treatment, clinicians should have a low threshold to provide thiamine therapy.

Pericarditis as a Secondary Complication of COVID-19 in a Renal Transplant Patient.

INTRODUCTION: A wide range of complications from COVID-19 are being reported, including cardiac complications. CASE PRESENTATION: A 71-year-old woman with systemic lupus erythematosus complicated by focal segmental glomerular sclerosis status post kidney transplant presented with worsening left-sided chest pain after receiving treatment for COVID-19 pneumonia at an outside hospital. She was subsequently diagnosed with acute pericarditis, likely secondary to viral infection with COVID-19, and was successfully treated with aspirin and colchicine for 90 days without complications. DISCUSSION: NSAIDs and colchicine are mainstays in acute pericarditis treatment. Though treatment presented a potential challenge given this patient's prior kidney transplant, aspirin and colchicine proved to be effective in treating her case of COVID-19-associated pericarditis. CONCLUSION: This report has implications for future treatment of renal transplant patients with COVID-19-related pericarditis and emphasizes the need for research into the pathophysiology of pericarditis in the context of COVID-19, including risk factors and treatment.