Publications by authors named "Kaushal Shah"

136 Publications

Traumatic Pneumothorax: A Review of Current Diagnostic Practices And Evolving Management.

J Emerg Med 2021 Aug 29. Epub 2021 Aug 29.

Weill Cornell Medicine, Emergency Medicine, New-York Presbyterian Hospital, New York, New York.

Background: Pneumothorax (PTX) is defined as air in the pleural space and is classified as spontaneous or nonspontaneous (traumatic). Traumatic PTX is a common pathology identified in the emergency department. Traditional management calls for chest x-ray (CXR) diagnosis and large-bore tube thoracostomy, although recent literature supports the efficacy of lung ultrasound (US) and more conservative approaches. There is a paucity of cohesive literature on how to best manage the traumatic PTX.

Objective Of The Review: This review aimed to describe current practices and future directions of traumatic PTX management.

Discussion: Lung US has proven to be a potentially more useful tool in the detection of PTX in the trauma bay compared with CXR, and has the potential to become the new gold standard for diagnosing traumatic PTX. Computed tomography remains the ultimate gold standard, although in the setting of trauma, its utility lies more in confirming the presence and measuring the size of a PTX. The traditional mantra calling for large-bore chest tubes as first-line approaches to traumatic PTX is challenged by recent literature demonstrating pigtail catheters as equally efficacious alternatives. In patients with small or occult PTXs, even observation may be reasonable.

Conclusions: Modern management of the traumatic PTX is shifting toward use of US for diagnosis and more conservative management practices (smaller catheters or observation). Ultimately, this shift is favorable in reducing length of stay, development of complications, and pain in the trauma patient.
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http://dx.doi.org/10.1016/j.jemermed.2021.07.006DOI Listing
August 2021

Traumatic Pneumothorax: A Review of Current Diagnostic Practices And Evolving Management.

J Emerg Med 2021 Aug 29. Epub 2021 Aug 29.

Weill Cornell Medicine, Emergency Medicine, New-York Presbyterian Hospital, New York, New York.

Background: Pneumothorax (PTX) is defined as air in the pleural space and is classified as spontaneous or nonspontaneous (traumatic). Traumatic PTX is a common pathology identified in the emergency department. Traditional management calls for chest x-ray (CXR) diagnosis and large-bore tube thoracostomy, although recent literature supports the efficacy of lung ultrasound (US) and more conservative approaches. There is a paucity of cohesive literature on how to best manage the traumatic PTX.

Objective Of The Review: This review aimed to describe current practices and future directions of traumatic PTX management.

Discussion: Lung US has proven to be a potentially more useful tool in the detection of PTX in the trauma bay compared with CXR, and has the potential to become the new gold standard for diagnosing traumatic PTX. Computed tomography remains the ultimate gold standard, although in the setting of trauma, its utility lies more in confirming the presence and measuring the size of a PTX. The traditional mantra calling for large-bore chest tubes as first-line approaches to traumatic PTX is challenged by recent literature demonstrating pigtail catheters as equally efficacious alternatives. In patients with small or occult PTXs, even observation may be reasonable.

Conclusions: Modern management of the traumatic PTX is shifting toward use of US for diagnosis and more conservative management practices (smaller catheters or observation). Ultimately, this shift is favorable in reducing length of stay, development of complications, and pain in the trauma patient.
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http://dx.doi.org/10.1016/j.jemermed.2021.07.006DOI Listing
August 2021

The Impact of a Medical Education Research Faculty Development Program on Career Development, Through the Lens of Social Cognitive Career Theory.

AEM Educ Train 2021 Jul 22;5(3):e10565. Epub 2020 Dec 22.

and the Department of Emergency Medicine George Washington University, and Georgetown University Washington DC USA.

Objectives: The Medical Education Research Certificate at the Council of Residency Directors in Emergency Medicine (MERC at CORD), a specialized adaptation of the Association of American Medical Colleges MERC program, provides faculty development in education research in emergency medicine. However, its long-term influence on career development remains unknown. Our study explored the impact of MERC at CORD on career development through the lens of social cognitive career (SCC) theory.

Methods: This was a prospective qualitative study using a constructivist/interpretivist paradigm to assess long-term career development outcomes. A purposeful randomized stratified sampling strategy of MERC at CORD graduates (2011-2014) ensured diversity of representation (sex, region, number of research publications, and project group leadership). Subjects were invited by e-mail to participate in semistructured phone interviews. Thematic analysis by two independent reviewers followed an iterative process until saturation was reached.

Results: Twelve graduates were interviewed. All engaged with MERC at CORD early in their careers with minimal previous education research experience. Currently, all hold medical education leadership positions. Graduates had a mean of 19.3 publications (range = 9-43). Themes explaining reasons for participating in MERC at CORD include: desire for education research skills, recommendation of mentors/colleagues, and accessibility. Themes citing the program's value to career development include networking/collaboration, mentorship, informational framework to build upon, and the application of theoretical knowledge through experiential learning. MERC at CORD impacted career development aligning with the core domains of SCC theory including self-efficacy, outcome expectations, and goals.

Conclusion: MERC at CORD enhanced the long-term career development of participants by providing a core knowledge framework in a mentored, experiential learning environment. Participants identified themes aligned with SCC theory as influential in their long-term career advancement in medical education including the development of education research skills, successful completion of education research, career acceleration, promotion, niche development, and formulation of professional goals.
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http://dx.doi.org/10.1002/aet2.10565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171782PMC
July 2021

The Impact of a Medical Education Research Faculty Development Program on Career Development, Through the Lens of Social Cognitive Career Theory.

AEM Educ Train 2021 Jul 22;5(3):e10565. Epub 2020 Dec 22.

and the Department of Emergency Medicine George Washington University, and Georgetown University Washington DC USA.

Objectives: The Medical Education Research Certificate at the Council of Residency Directors in Emergency Medicine (MERC at CORD), a specialized adaptation of the Association of American Medical Colleges MERC program, provides faculty development in education research in emergency medicine. However, its long-term influence on career development remains unknown. Our study explored the impact of MERC at CORD on career development through the lens of social cognitive career (SCC) theory.

Methods: This was a prospective qualitative study using a constructivist/interpretivist paradigm to assess long-term career development outcomes. A purposeful randomized stratified sampling strategy of MERC at CORD graduates (2011-2014) ensured diversity of representation (sex, region, number of research publications, and project group leadership). Subjects were invited by e-mail to participate in semistructured phone interviews. Thematic analysis by two independent reviewers followed an iterative process until saturation was reached.

Results: Twelve graduates were interviewed. All engaged with MERC at CORD early in their careers with minimal previous education research experience. Currently, all hold medical education leadership positions. Graduates had a mean of 19.3 publications (range = 9-43). Themes explaining reasons for participating in MERC at CORD include: desire for education research skills, recommendation of mentors/colleagues, and accessibility. Themes citing the program's value to career development include networking/collaboration, mentorship, informational framework to build upon, and the application of theoretical knowledge through experiential learning. MERC at CORD impacted career development aligning with the core domains of SCC theory including self-efficacy, outcome expectations, and goals.

Conclusion: MERC at CORD enhanced the long-term career development of participants by providing a core knowledge framework in a mentored, experiential learning environment. Participants identified themes aligned with SCC theory as influential in their long-term career advancement in medical education including the development of education research skills, successful completion of education research, career acceleration, promotion, niche development, and formulation of professional goals.
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http://dx.doi.org/10.1002/aet2.10565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171782PMC
July 2021

Kratom: An Emerging Issue and Need for Regulations in the United States.

Prim Care Companion CNS Disord 2021 02 18;23(1). Epub 2021 Feb 18.

Department of Psychiatry, Griffin Memorial Hospital, Norman, Oklahoma.

Objective: To understand and highlight the current issues, emerging trends, and regulations of kratom in the United States.

Data Sources: PubMed and PubMed Central of the National Library of Medicine, MEDLINE, PsycINFO, and ClinicalTrials.gov databases were utilized.

Study Selection: Studies published between January 1, 2000, and June 30, 2020, were accessed by using the MeSH term mitragyna in the context of toxicity, safety, and legislation and jurisprudence.

Data Extraction: The final qualitative synthesis included 11 studies by following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement guidelines.

Results: The US Drug Enforcement Administration (DEA) initially proposed to place kratom under Schedule I of the Controlled Substances Act, but the DEA later withdrew the intent, and kratom is still a legal substance in most of the United States. A low to moderate kratom dose produces mild stimulant properties, whereas large doses produce sedative effects that are identical to opiates. Its regular use at a higher dose is associated with dependence. Management of overdose is similar to that of patients presenting with opioid abuse, although kratom may potentially pose a higher risk for drug toxicity and organ injury compared to opioids due to intrinsic properties and adulteration. There is no clinical evidence for its safety and efficacy. The US Food and DEA do not recognize any legitimate medical use of kratom.

Conclusions: Kratom is an emerging public health concern and is abused as an alternative to opioids. Stringent policies and public awareness campaigns are required to curb the perception of its safe use, which needs to be substantiated with well-designed clinical trials.
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http://dx.doi.org/10.4088/PCC.20r02770DOI Listing
February 2021

Letter to the Editor Regarding the Article, "Lithium in Late-Life Mania: A Systematic Review" [Letter].

Neuropsychiatr Dis Treat 2021 28;17:1229-1230. Epub 2021 Apr 28.

Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa, TX, USA.

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http://dx.doi.org/10.2147/NDT.S314159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8091420PMC
April 2021

Social Media Bridges the Training Gap Between Match Day and Internship With ACGME Milestone-based Clinical Case Curriculum.

AEM Educ Train 2021 Apr 6;5(2):e10503. Epub 2020 Aug 6.

Department of Emergency Medicine St. John's Riverside Hospital Yonkers NY USA.

Objectives: The objective was to bridge the relative educational gap for newly matched emergency medicine preinterns between Match Day and the start of internship by implementing an Accreditation Council for Graduate Medical Education Milestone (ACGME)-based virtual case curriculum over the social media platform Slack.

Methods: We designed a Milestone-based curriculum of 10 emergency department clinical cases and used Slack to implement it. An instructor was appointed for each participating institution to lead the discussion and encourage collaboration among preinterns. Pre- and postcurriculum surveys utilized 20 statements adapted from the eight applicable Milestones to measure the evolution of preintern self-reported perceived preparedness (PP) as well as actual clinical knowledge (CK) performance on a case-based examination.

Results: A total of 11 institutions collaborated and 151 preinterns were contacted, 127 of whom participated. After participating in the Slack intern curriculum (SIC), preinterns reported significant improvements in PP regarding multiple Milestone topics. They also showed improved CK regarding the airway management Milestone based on examination performance.

Conclusions: Implementation of our SIC may ease the difficult transition between medical school and internship for emergency medicine preinterns. Residency leadership and medical school faculty will benefit from knowledge of preintern PP, specifically of their perceived strengths and weaknesses, because this information can guide curricular focus at the end of medical school and beginning of internship. Limitations of this study include variable participation and a high attrition rate. Further studies will address the utility of such a virtual curriculum for preinterns and for rotating medical students who have been displaced from clinical rotations during the novel coronavirus pandemic.
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http://dx.doi.org/10.1002/aet2.10503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052994PMC
April 2021

Multisystem Inflammatory Syndrome in an Adult.

J Emerg Med 2021 07 8;61(1):e1-e3. Epub 2021 Apr 8.

Department of Emergency Medicine, Weill Cornell Medical College, New York, New York.

Background: Multisystem inflammatory syndrome in children is a phenomenon that has emerged during the coronavirus disease 2019 (COVID-19) pandemic. There are, however, few reported cases of a similar disease in adults.

Case Report: We describe a 25-year-old man who presented with prolonged fever and conjunctivitis and was found to have a post-COVID inflammatory syndrome. His symptoms improved with colchicine, steroids, and a truncated course of intravenous immunoglobulin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Post-COVID inflammatory syndrome has the potential to lead to dangerous complications. In addition, the identification of occult COVID infections could have public health implications.
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http://dx.doi.org/10.1016/j.jemermed.2021.02.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026263PMC
July 2021

School-Based Approaches to Prevent Depression in Adolescents.

Cureus 2021 Feb 19;13(2):e13443. Epub 2021 Feb 19.

Psychiatry, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.

Depression is one of the highest prevalent mental illnesses and is one of the common illnesses that can have its onset during childhood or adolescence. It is estimated that up to 20% of children experience mental illness worldwide. Preventing the onset of depression in children and adolescents should be a vital public health goal that will improve public health and decrease health care costs. We reviewed literature that described school-based interventions to prevent the onset of depression, reduce the severity of depressive symptoms, and enhance global functioning in adolescents. Our research also provides strategies for school-based intervention programs that are mainly categorized into three main subtypes. We also discussed each subtype and its advantages and limitations. The goal is to bring the readers an understanding of the importance of preventing depression on a community level, beginning at schools.
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http://dx.doi.org/10.7759/cureus.13443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7978390PMC
February 2021

Considering Loxapine Instead of Clozapine: A Case Series and Literature Review.

Cureus 2021 Jan 26;13(1):e12919. Epub 2021 Jan 26.

Psychiatry, Texas Tech University Health Sciences Center, Midland, USA.

This case series highlights the importance of loxapine in psychiatric disorders when clozapine is unable to control agitation and psychotic symptoms due to medication noncompliance, intolerable side effects, or inadequate clinical outcomes. Loxapine is classified as a first-generation typical antipsychotic but displays atypical antipsychotic-like characteristics with structural similarity to clozapine. However, since the inception of second-generation antipsychotic medications, the role of loxapine in modern psychiatric practice has become limited. Loxapine has been underutilized due to concerns of side effects and lack of in-depth research about its safety, tolerability, and efficacy. This report revisits loxapine's clinical utility through two well-studied long-term inpatient cases, where it played a crucial role in controlling psychotic symptoms and achieving better medication compliance by eliminating significant barriers, including monitoring regular differential complete blood counts. We aim to add to the current evidence and literature about the advantage of using loxapine for specific clinical scenarios in psychiatric practice.
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http://dx.doi.org/10.7759/cureus.12919DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906363PMC
January 2021

Psychotic Symptoms in Heroin Withdrawal: A Case Report.

Cureus 2021 Jan 11;13(1):e12620. Epub 2021 Jan 11.

Psychiatry, Griffin Memorial Hospital, Norman, USA.

Opiate withdrawal-induced severe exacerbation of psychosis after the sudden withdrawal of an opiate is a known yet uncommon clinical manifestation. We present the case of opiate withdrawal-induced psychosis in a 25-year-old married male patient without any prior psychiatric history of illness, family history, or past hospitalization records. The patient presented with psychotic symptoms such as irritability, delusions of parasitosis, and auditory and visual hallucinations at the time of hospitalization. Symptoms were in a fluctuating course and were not constant throughout the day. Through this case report, our aim is to present a rare instance of heroin-withdrawal-induced psychosis and its successful treatment with antipsychotics.
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http://dx.doi.org/10.7759/cureus.12620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872486PMC
January 2021

Silicosis With Secondary Spontaneous Pneumothorax in the Western Rajasthan.

Cureus 2020 Nov 30;12(11):e11811. Epub 2020 Nov 30.

Psychiatry, Griffin Memorial Hospital, Norman, USA.

Objective Silicosis is one of the common occupational lung diseases caused by crystalline silica respiration. Pneumothorax is one of the most common and morbid complications of silicosis involving lung pleura. It is commonly seen unilaterally in chronic silicosis and can often be lethal. The purpose of this study is to report secondary spontaneous pneumothorax (SSP) in critically ill patients with silicosis. Methods A cross-sectional study was done between January 2019 and June 2019 at Sawai Man Singh (SMS) Medical College in Jaipur, India. A cohort of 50 patients with dyspnea and a history of silicosis were studied. A chest X-ray and sputum for acid fast bacilli were checked on all suspected cases. Results The present study showed that the mean age of patients was 38.7 years, all silicosis patients had dyspnea, and 96% of patients had severe chest pain. The results of chest X-rays concluded the evidence of silicosis. Bilateral pneumothorax was seen in three cases, right-sided pneumothorax in eight cases, and left-sided pneumothorax in 11 cases. The rate of pneumothorax incidence in silicosis patients was about 44%, which is higher than the current evidence. Six patients were managed conservatively with oxygen and bronchodilators, and 16 patients underwent through tube thoracostomy. Conclusion This study highlights the importance of considering spontaneous pneumothorax in patients who are presenting with shortness of breath and/or chest pain especially with a known history of silicosis, as the timely diagnosis can alter the management of this morbid condition which carries a high mortality rate if left untreated, compromising the lung expansion, venous return, cardiac output, oxygenation and eventually leading to death.
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http://dx.doi.org/10.7759/cureus.11811DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781496PMC
November 2020

Role of Bupropion and Naltrexone in Managing Depression With Polycystic Ovary Syndrome: A Case Report and Literature Review.

Cureus 2020 Nov 5;12(11):e11343. Epub 2020 Nov 5.

Psychiatry, Griffin Memorial Hospital, Norman, USA.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age. Women with PCOS may present with obesity, amenorrhea, oligomenorrhea, infertility, or androgenic features. Studies have shown the association of psychiatric disorders with endocrine disorders, including PCOS. We present a case of a PCOS patient with no prior psychiatric history who presented with suicidal ideation. We emphasize the importance of screening women for PCOS when presented with mental disorders through this clinical case. It is crucial to rule out any medical causes in patients predominantly presented with psychiatric symptoms. We highlight the possible role of bupropion and naltrexone in managing PCOS symptoms, depression with suicidal ideation, and trichotillomania through this unique and rare case.
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http://dx.doi.org/10.7759/cureus.11343DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719465PMC
November 2020

The Burden of Rotavirus Gastroenteritis in Children: A Hospital-Based Prospective Study in Western Rajasthan.

Cureus 2020 Oct 18;12(10):e11020. Epub 2020 Oct 18.

Psychiatry, Griffin Memorial Hospital, Norman, USA.

Objective  Rotaviruses are the prime cause of gastroenteritis amongst infants and young children worldwide. In India, the mortality and economic impact caused by rotavirus are high. The objective of this is to understand the burden of rotavirus in acute watery diarrhea and its circulating genotypes in hospitalized children less than five years of age for acute gastroenteritis in western Rajasthan. Methodology This is a hospital-based prospective study conducted in the pediatrics department of Dr. Sampurnanand (S.N.) Medical College of Jodhpur in India for one year during 2018. The study included 399 children less than five years old, presenting with acute gastroenteritis who needed to be admitted for at least six hours. We enrolled subjects after obtaining informed consent from the guardian. Stool samples of 5 gm or ml were collected in a sterile container and stored at minus 20 degrees centigrade while transporting to Christian Medical College (CMC) virology lab in Vellore, India. The stool samples were subjected to Enzyme-Linked Immunosorbent Assay (ELISA) testing, followed by genotype determination. We investigated data through statistical analysis from all collected data. Results A total of 399 patients fulfilled the enrollment criteria; out of them, 92 (23.05%) were positive for rotavirus, and maximum cases were seen in the age group of six months to two years (78.26%). Rotavirus positivity was more in males (64.13%) than females (35.86%). The rotavirus infection was seen throughout the year, with a peak in cases from November to February (73.91%). G3P8 (55.43%) was the most common strain causing rotavirus diarrhea, followed by G1P8 (9.72%) and G3+G12P8 (8.69%). Based on the Vesikari clinical severity score, 70.65% of patients had severe diarrhea. Conclusion This prospective study highlights the healthcare and economic burden of rotavirus, especially in children of less than five years. The incidence of rotavirus is observed in winter months, and its prevalence in all cases of acute diarrhea in our study is 23.05%. G3P8 was the most common genotype causing rotavirus diarrhea in our region in both non-vaccinated and vaccinated children, followed by G1P8 and G3+G12P8, respectively.
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http://dx.doi.org/10.7759/cureus.11020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671170PMC
October 2020

Psychiatric Manifestations in Fahr's Syndrome: A Case Report.

Cureus 2020 Oct 2;12(10):e10770. Epub 2020 Oct 2.

Psychiatry, Griffin Memorial Hospital, Norman, USA.

Fahr's syndrome is a rare neurological entity, primarily impacting basal ganglia with bilateral intracranial calcium deposition. It mainly manifests motor and psychiatric symptoms in affected individuals. After the patient and her family members' consent and proper ethical clearance from the institutional ethical committee, we here report a case presented with a few motor symptoms, features of delirium, and prominent psychiatric symptoms such as disorganized behavior, auditory hallucinations, and delusions. The imaging study found bilateral basal ganglia calcification and edema in the parietal region, primarily on the right side. Laboratory studies revealed mildly low parathyroid hormone and calcium levels, but no significant findings in other investigational tests. Her past medical and psychiatric history were negative, except for her well-adjusted pre-morbid personality. Our aim through this case is to highlight the psychiatric manifestation of a rare neurological syndrome. It also showcases the importance of ruling out medical causes when a patient presents primarily with behavioral symptoms.
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http://dx.doi.org/10.7759/cureus.10770DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606226PMC
October 2020

Impact of COVID-19 on the Mental Health of Children and Adolescents.

Cureus 2020 Aug 26;12(8):e10051. Epub 2020 Aug 26.

Medicine, University of Oklahoma, Norman, USA.

The coronavirus disease 2019 (COVID-19) outbreak was first reported in Wuhan, China, and was later reported to have spread throughout the world to create a global pandemic. As of August 18th, 2020, the coronavirus had spread to more than 216 countries with at least 21,756,357 confirmed cases, resulting in 771,635 deaths globally. Several countries declared this pandemic as a national emergency, forcing millions of people to go into lockdown. This unexpected imposed social isolation has caused enormous disruption of daily routines for the global community, especially children. Among the measures intended to reduce the spread of the virus, most schools closed, canceled classes, and moved it to home-based or online learning to encourage and adhere to social distancing guidelines. Education and learnings of 67.6% of students are impacted globally due to coronavirus in 143 countries. The transition away from physical classes has significantly disrupted the lives of students and their families, posing a potential risk to the mental well-being of children. An abrupt change in the learning environment and limited social interactions and activities posed an unusual situation for children's developing brains. It is essential and obligatory for the scientific community and healthcare workers to assess and analyze the psychological impact caused by the coronavirus pandemic on children and adolescents, as several mental health disorders begin during childhood. Countries across the globe, including the United States, are in the dilemma of determining appropriate strategies for children to minimize the psychological impact of coronavirus. The design of this review is to investigate and identify the risk factors to mental health and propose possible solutions to avoid the detrimental consequence of this crisis on the psychology of our future adult generations.
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http://dx.doi.org/10.7759/cureus.10051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520396PMC
August 2020

Solitary Sign of Third Nerve Palsy in a Conscious Patient With Epidural Hemorrhage.

Cureus 2020 Aug 24;12(8):e10003. Epub 2020 Aug 24.

Psychiatry, Griffin Memorial Hospital, Norman, USA.

Epidural hematoma is a life-threatening complication of head injury, which often occurs as a result of blunt trauma to the skull. Unregulated hematoma expansion in any setting results in elevated intracranial pressure and may contribute to the compression of the oculomotor nerve among several other adversities culminating in various long-lasting complications in the future. In this case report, we present the findings of a rare, insightful case of a 47-year-old Southeast Asian male with no established prior medical history apart from being a victim of blunt trauma attributable to a fall four days before presenting to the emergency department with abrupt onset of diplopia and drooping of the left eyelid. The initial physical examination helped to establish a diagnosis of third nerve palsy. A non-contrast CT of the head was conducted, and its findings revealed the presence of a right temporal-parietal-occipital epidural hemorrhage, with no mass impact on the cerebral hemisphere. The patient later underwent a successful left temporoparietal craniotomy, during which 100-125 ml of blood was drained out. Post-surgery, a near-full reduction of ptosis was recorded at the end of the first week. This case report summarizes this ingenious depiction of a partial third nerve palsy presenting as the sole sign of the epidural hemorrhage in a cognizant patient.
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http://dx.doi.org/10.7759/cureus.10003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7515150PMC
August 2020

Joubert Syndrome: A Molar Tooth Sign in Disguise.

Cureus 2020 Aug 13;12(8):e9718. Epub 2020 Aug 13.

Psychiatry, Griffin Memorial Hospital, Norman, USA.

Joubert syndrome (JS) is a rare genetic ciliopathy characterized by the aplasia or malformation of the midbrain and or hindbrain structures. It usually manifests during the early stages with nonspecific neurological symptoms that progress to involve multiple systems. Its presentation similarity to other neurological disorders makes the diagnosis difficult, hence causing a delay in treatment and worse prognosis due to complications. If undiagnosed during childhood, it often presents during adolescence with the most common complication of acute kidney injury due to nephronophthisis. Here, we present a case of JS in late adolescence with renal complications and other neurological abnormalities. We aim to emphasize the importance of its early diagnosis by physicians in childhood to prevent further complications. It also highlights the possible diagnostic value and significance of brain imaging in the early stages when only mild mental retardation signs may be the only clues.
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http://dx.doi.org/10.7759/cureus.9718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489322PMC
August 2020

Addressing Mass Shootings in a New Light.

Cureus 2020 Jul 20;12(7):e9298. Epub 2020 Jul 20.

Psychiatry, Griffin Memorial Hospital, Norman, USA.

Locations change, casualties change, but the choice of weapon remains the same: firearms. With mass shootings gaining continuous limelight, we aim through this article to provide the readers an overview of the perpetrator's profile, along with various opinions proposed by the media, government, National Rifle Association (NRA), and health professionals. With mental health linked as a common factor for such incidents, we need to explore the different stances to eliminate such events. This article also provides a collaborative approach to alter the narrative and view it in a new light.
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http://dx.doi.org/10.7759/cureus.9298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437101PMC
July 2020

Neuropsychiatric Atypical Manifestation in Wilson's Disease: A Case Report and Literature Review.

Cureus 2020 Jul 20;12(7):e9290. Epub 2020 Jul 20.

Psychiatry, Griffin Memorial Hospital, Norman, USA.

Wilson's disease (WD) is a rare genetic disorder of copper metabolism that often manifests several clinical signs at the time of diagnosis. Typically it affects the liver in the early stages of the disease course and tends to show neuropsychiatric involvement in the later stages. Early diagnosis of WD holds a prognostic value, and an atypical presentation of the disease adds complexities in diagnosis. Even though we need to consolidate further the treatment guidelines for managing psychiatric and neurological symptoms optimally in the patients of WD, identifying signs at the early stages of the disease is crucial to avoid its detrimental effects on the human body. In this case presentation, a patient with no family history of psychiatric condition showed an early onset of neuropsychiatric symptoms without any other clinical signs of WD. Through this clinical case, we emphasize the importance of ruling out WD in patients that predominantly presents with psychiatric symptoms as a lone symptom. It also highlights the possible diagnostic value and significance of the ceruloplasmin level in identifying WD disease in early stages, when other clinical signs are absent, including liver abnormalities.
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http://dx.doi.org/10.7759/cureus.9290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437118PMC
July 2020

Tramadol for the Management of Opioid Withdrawal: A Systematic Review of Randomized Clinical Trials.

Cureus 2020 Jul 11;12(7):e9128. Epub 2020 Jul 11.

Psychiatry and Behavioral Sciences, Griffin Memorial Hospital, Norman, USA.

The increase in the prescription of opioid medications has resulted in a wildfire of misuse of opioids, both for medical and non-medical reasons, with over 1.7 million people in the United States (US) suffering from distinct disorders owing to opioid use. While various medications, such as methadone, buprenorphine, and naloxone, among others, have been used in treating opioid withdrawal symptoms, concerns of the potential abuse of these drugs, the cost of procurement, legislations, and prescription policies have risen. In recent times, tramadol has been considered a viable replacement for some of these treatment regimes. Tramadol is a synthetic analgesic that acts centrally, possessing opioid-like effects due to the binding of its metabolite with the mu (µ)-opioid receptor, yet with low potential for abuse. Several clinical studies conducted in the past ten years have identified the effects of tramadol in opioid withdrawal cases. The results showed that it exhibits better efficacy and tolerance with fewer side effects in specific clinical scenarios as compared to existing available detox management. We aim to examine the properties of tramadol in opioid withdrawal through this systematic review of clinical studies on humans.
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http://dx.doi.org/10.7759/cureus.9128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417126PMC
July 2020

The Role of Psychological First Aid to Support Public Mental Health in the COVID-19 Pandemic.

Cureus 2020 Jun 25;12(6):e8821. Epub 2020 Jun 25.

Psychiatry, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.

Psychological first aid (PFA) is one of the vital tools in delivering psychological interventions to those who have undergone or experienced traumatic events. Traumatic experiences during calamities, outbreaks of infections, and war can induce a significant amount of stress in the absence of early and effective intervention provided by trained caregivers. The coronavirus pandemic has caused significant levels of fear as governments impose quarantine and lockdown to contain the infection. Countries around the globe have halted several social and economic operations to curb the spread of coronavirus disease-19 (COVID-19). However, panic, helplessness, and horror aided by the infection due to the lack of a definitive cure has exposed the population to significant mental distress, thus warranting psychological intervention.
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http://dx.doi.org/10.7759/cureus.8821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384717PMC
June 2020

Association of Opioid Use With Cardiometabolic Disease Risk Factors: Evidence From the 2009-2018 National Health and Nutrition Examination Survey.

Cureus 2020 Jun 20;12(6):e8719. Epub 2020 Jun 20.

Psychiatry, Harlem Hospital Center, New York, USA.

Objective To investigate the association between opioid drug use and cardiometabolic risk factors in an adult sample data acquired from the National Health and Nutrition Examination Survey (NHANES). Methods A retrospective cross-sectional analysis was performed using the data from the NHANES for the period 2009-2018 provided by the Centers for Disease Control and Prevention (CDC), amounting to a total of N = 10,032 eligible participants. The data were analyzed to study the relationship between opioid drug use (dividing into four dichotomy groups: drug use (DU) group, illicit drug use (IDU) group, repeated drug use (RDU) group, and current drug use (CDU) group) and cardiometabolic disease risk factors (CDRF) (i.e., hypertension, abnormal triglyceride levels, low-level of high-density lipoproteins (HDLs), high waist circumference, insulin resistance, serum cotinine levels, higher C-reactive protein, hypercholesterolemia, and increased BMI). The statistical correlation was evaluated using the chi-square analysis, and a p-value of less than 0.05 was considered statistically significant. Alcohol use, age, race, ethnicity, education level, and poverty to income ratio (PIR) were analyzed as covariates.  Results Overall, our analysis found that males were more likely than females (p ≤ 0.001) to have ever reported using drugs at least once in their lifetime. In fact, males were more likely than females to report ever using cocaine (p = 0.01), heroin (p = 0.01), and marijuana (p = 0.01). Additionally, males were significantly more likely than females to disclose the current use of illicit drugs (p = 0.002), and also tend to have consumed more with at least 12 alcoholic beverages per year (p < 0.001). Overall, we found no association between substance use and having a cluster of three or more CDRF variables for both males and females. Conclusion Study results highlight the prevalence of gender differences in DU and its reporting. With the rising popularity of illicit drugs, clinicians must be aware of its association with CDRF.
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http://dx.doi.org/10.7759/cureus.8719DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7372186PMC
June 2020

Cannabis-Induced Catatonia: A Case Series.

Cureus 2020 Jun 13;12(6):e8603. Epub 2020 Jun 13.

Psychiatry, Griffin Memorial Hospital, Norman, USA.

Catatonia is a psychomotor condition characterized by physical presentations ranging from severe immobility to excessive psychomotor agitation with an array of accompanying emotional aspects. Though initially thought to be a subform of schizophrenia, it is now recognized to be associated with many different psychiatric, neurological, and medical diagnoses. The emergence of catatonia is becoming more prevalent with its changing pattern and extensive use of recreational and illegal drugs. With the legalization of marijuana, its use is on the rise leading to several mental health conditions, including catatonia. If left untreated, catatonia has a significant morbidity and mortality rate; hence, prompt evaluation and diagnosis are critical for the prevention of adverse events. Benzodiazepines (BZDs) and electroconvulsive therapy (ECT) have been found to be most effective and remained as the preferred treatment options. In this paper, we present the case of two patients who presented with catatonia after cannabis consumption and discuss their treatment course and management.
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http://dx.doi.org/10.7759/cureus.8603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362598PMC
June 2020

Perspective on Melatonin Use for Sleep Problems in Autism and Attention-Deficit Hyperactivity Disorder: A Systematic Review of Randomized Clinical Trials.

Cureus 2020 May 28;12(5):e8335. Epub 2020 May 28.

Psychiatry, Griffin Memorial Hospital, Norman, USA.

Melatonin is a hormone produced by the pineal gland and is available over the counter for treating sleep problems in the pediatric population. We conducted a systematic review of randomized clinical trials (RCTs) on MEDLINE and included six studies that met our inclusion criteria. RCTs were conducted in patients from two to 18 years of age with a diagnostic and statistical manual of mental disorders (DSM)-IV diagnosis of autism spectrum disease (ASD) and/or attention-deficit hyperactivity disorder (ADHD) in both short-term and long-term RCTs ranging from eight-week to 52-week studies. The mean difference in the children's sleep disorder showed statistically significant improvement in sleep duration and sleep latency onset compared to the placebo. Overall, a high response rate was observed in the melatonin group compared to the placebo in treating sleep problems in children. Melatonin is a well-tolerated and safe medication in the dose range of 2-10 mg/day in the child and adolescent population.
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http://dx.doi.org/10.7759/cureus.8335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325410PMC
May 2020

Prevalence, trends and in-hospital outcomes of takotsubo syndrome among United States cannabis users.

Int J Cardiol 2020 10 6;316:43-46. Epub 2020 Jun 6.

Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA; Division of Cardiology, Medical College of Georgia, Augusta, GA, USA; Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, USA.

Background: Recent reports suggest a link between increased cannabis (marijuana) use and stress-cardiomyopathy (Takotsubo Syndrome, TTS) and related complications. Amidst recent trends in cannabis legalization and a paucity of data, it remains essential to evaluate the prevalence, trends and outcomes of TTS in cannabis users on a large-scale.

Method: We studied prevalence and trends in TTS among adult cannabis users vs. non-users using the National Inpatient Sample (2007-2014). Baseline characteristics, comorbidities, and in-hospital outcomes of TTS were compared between cannabis users vs. non-users. Weighted logistic regression was performed adjusting for confounders to estimate the inpatient outcomes of TTS with vs. without cannabis use.

Results: The overall prevalence of TTS in cannabis users (47/100,000) was lower as compared to non-users (62/100,000). Rising trends in TTS among cannabis users (<11 to 82, ~8-fold) were more pronounced as compared to non-users (19 to 108, ~6 fold) per 100,000 hospitalizations from 2007 to 2014 (p<0.001). Of all inpatient encounters for TTS (n=156,506), 1565 (0.1%) reported cannabis use. Polysubstance use including alcohol (4.1% vs. 24.4%), cocaine (0.4% vs. 8.5%), amphetamine (0.2% vs. 8.0%), and smoking (31.2% vs. 64.8%) was significantly higher in TTS-cannabis cohort. Although cardiovascular comorbidities were lower in TTS-cannabis cohort, the adjusted odds of all-cause mortality (aOR1.50, p<.05) were 50% higher in cannabis users compared to non-users without statistically significant difference in cardiac complications.

Conclusions: Cannabis users showed lower prevalence but a more pronounced rising trend of TTS and subsequent risk of in-hospital mortality compared to non-users.
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http://dx.doi.org/10.1016/j.ijcard.2020.05.088DOI Listing
October 2020

Imaging & other potential predictors of deterioration in COVID-19.

Am J Emerg Med 2020 07 28;38(7):1547.e1-1547.e4. Epub 2020 Apr 28.

Department of Radiology, Weill Cornell Medical Center, 525 East 68(th) Street, New York, NY 10065, United States of America.

This case report describes a young patient with COVID-19 who is initially diagnosed with CT chest imaging. Upon admission to the hospital, his clinical condition deteriorates requiring ventilatory support. We explore the value of imaging and other potential predictors of deterioration.
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http://dx.doi.org/10.1016/j.ajem.2020.04.075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195283PMC
July 2020

How Essential Is to Focus on Physician's Health and Burnout in Coronavirus (COVID-19) Pandemic?

Cureus 2020 Apr 4;12(4):e7538. Epub 2020 Apr 4.

Psychiatry, Griffin Memorial Hospital, Norman, USA.

An infection of novel coronavirus (COVID-19) that originated from Wuhan city of China in December 2019 converted rapidly into pandemic by March 11, 2020. To date, the number of confirmed cases and deaths has risen exponentially in more than 200 countries, with an estimated crude mortality ratio of at least over 2%. The unpreparedness to tackle the unprecedented situation of coronavirus has contributed to the rising number of cases, which has generated an immense sense of fear and anxiety amongst the public. It has further resulted in the inadequacy and unavailability of essential medical supplies, physicians, and healthcare workers (HCW). Although the chief focus is on minimizing transmission through prevention, combating infection, and saving lives by ramping up the development of treatment and vaccines, very little attention is on the critical issue of physician burnout, resident burnout, and the psychological well-being of HCW. Until now, no significant steps have been taken by the authorities to minimize the COVID-19 specific contributing factors for burnout. The COVID-19 has posed strain on the entire healthcare system already, and it is vital to remediate the issue of physician and resident burnout urgently with concrete actions to avoid subsequent potential short-term and long-term adverse implications.
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http://dx.doi.org/10.7759/cureus.7538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7198080PMC
April 2020

ACR Appropriateness Criteria® Acute Trauma to the Foot.

J Am Coll Radiol 2020 May;17(5S):S2-S11

Specialty Chair, Mayo Clinic, Phoenix, Arizona.

Acute injuries to the foot are frequently encountered in the emergency room and in general practice settings. This publication defines best practices for imaging evaluations for several variants of patients presenting with acute foot trauma. The variants include scenarios when the Ottawa rules can be evaluated, when there are exclusionary criteria, and when suspected pathology is in anatomic areas not addressed by the Ottawa rules. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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http://dx.doi.org/10.1016/j.jacr.2020.01.019DOI Listing
May 2020
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