COVID-19 Disease and Viral Characteristics in a Long-Term Care Facility

Abstract Due to the combination of age, comorbidities, and close living quarters, residents at long-term care facilities (LTCFs) are at particularly high risk of severe symptoms and death due to COVID-19. This cross-sectional study examines the relationship between demographic characteristics, symptom severity, and length of viral shedding in 49 residents testing positive for SARS-CoV-2 at a LTCF in West Virginia (WV). Over half of the residents were asymptomatic while nearly a quarter experienced severe symptoms. Women were more likely to be asymptomatic and age was not associated with symptom severity. While no specific medical condition was associated with symptom severity, having more chronic illnesses was associated. The length of time from initial positive to PCR negative ranged from 2 to 63 days with an average of 29 days. Given the variability in PCR testing reliability, 30 days of isolation and 2 consecutive negative PCR tests are recommended before reintegrating residents

Rural Appalachian Women Will Suffer Disproportionately if Attempts to Further Restrict Emergency Contraception are Successful

The removal of federal abortion protection has incited fear that restrictions on contraception may be next. Many states now imposing abortion restrictions and bans are in the South and Appalachian Regions of the U.S., where rates of unplanned pregnancy and poor health outcomes are already disproportionately high. Numerous studies have documented variable access to levonorgestrel EC (LNG EC) in community pharmacies, with particularly low rates of access at independent pharmacies that are more likely to be located in rural communities than chain pharmacies. Since the overturn of Roe v. Wade, some large chain pharmacies and online retailers are restricting the purchase of LNG EC, limiting its availability. Some legislators and activists are calling for a ban on EC based on a misunderstanding about its mechanism of action, equating it with abortion. At a time when access to the full range of contraceptive options is more critical than ever, already limited access to LNG EC is worsening. Extensive data on LNG EC availability in 509 pharmacies and 400 health clinics across West Virginia, contextualized with socioeconomic demographics, illustrate existing disparities in LNG EC access

Methylene blue for hemolytic crisis in patients with met-hemoglobinemia secondary to hemoglobin volga: A case series

There is a rare subset of patients with a genetically abnormal hemoglobin structure initially discovered in the Volga region of Europe known as Volga anemia. Key features of this condition include compromised delivery of oxygen to peripheral tissues and altered red blood cells that have a higher likelihood of being broken down or hemolyzed, which can lead to significant hemolytic anemia. Methylene blue is a dye that acts as a reducing agent of oxygen and is commonly used in toxic states that lead to methemoglobin build-up. This paper explores the pathophysiology of this genetic condition and documents three cases across two patients—a father and son—when methylene blue was used during an anemic crisis

Palliative Opioids May Be a Bridge to Care for Rural Long-Term Care Facility Residents with Severe COVID-19 Symptoms

Purpose Long term care facility (LTCF) residents are at high risk for severe COVID-19 symptoms, but those in rural and resource-limited areas, such as West Virginia (WV) and the larger Appalachian region, may experience delays in obtaining higher levels of medical care due to isolated geography and limited transportation. The study examined the outcomes between residents from 1 LCTF in WV who were moved to a hospital as compared to those remaining in the facility. Methods This cohort study compares mortality outcomes among severely symptomatic residents desiring hospitalization and those electing to stay at the facility receiving palliative opioids with supplemental oxygen. Findings Forty residents tested positive for COVID-19 with 11 developing severe respiratory symptoms. Eight residents elected to receive care at the LTCF while 3 desired hospitalization. Mortality was assessed at 4 time points and was not statistically different between those who were hospitalized versus those who received palliative opioids at the LTCF. Although not significant, the difference in mortality between those hospitalized (66.7%) and those receiving opioids at the LTCF (12.5%) in the acute phase trended toward significance ( P  = .072). Overall mortality at the 6-month time point among all residents who developed severe respiratory symptoms at this LTCF was 54.5%. Conclusions LTCF residents choosing different levels of therapeutic intervention for severe COVID-19 symptoms had no mortality difference. Palliative opioids may be an effective treatment for LTCF residents with severe COVID-19 and also a bridge to care in rural areas with limited resources until more advanced treatments can be accessed

Going Off-Script: Dilemmas in the Evaluation and Treatment of Syphilis in Four Patients

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. Currently, rates of infection are increasing across all populations worldwide, with disproportionate impact on men who have sex with men, adolescents, and young adults. Syphilis is well-known for its variability in disease progression and clinical presentation, which complicates prompt and accurate diagnosis. Acute care settings have become the frontline in the battle against this syphilis surge, and providers must be prepared to recognize syphilis presentation, initiate appropriate testing, and establish contact tracing for individuals who may have been exposed. The purpose of this manuscript is to serve as a teaching tool for syphilis diagnosis and treatment, and we present four cases that showcase the risks and variable clinical presentation, discussing the challenges involved in managing each case. The authors then summarize key learning points related to diagnosis, treatment, and follow-up

Video Intervention to Increase Perceived Self-Efficacy for Condom Use in a Randomized Controlled Trial of Female Adolescents

Study Objective—To assess the effects of the Seventeen Days interactive video on young women’s perceived self-efficacy for using condoms 6 months after being offered the intervention, relative to a control. Design—Multisite randomized controlled trial. Setting—Twenty participating health clinics and county health departments in Ohio, Pennsylvania, and West Virginia. Participants—Sexually active female adolescents ages 14 to 19 years. Interventions—Seventeen Days (treatment intervention; sex education) vs Driving Skills for Life (control intervention; driving education). Main Outcome Measures—Perceived self-efficacy for condom use. Results—Participants in the Seventeen Days group reported higher perceived condom acquisition self-efficacy after 6 months than those in the driving group. This finding held after controlling for baseline self-efficacy scores and other covariates. Conclusion—The Seventeen Days program shows promise to improve perceived self-efficacy to acquire condoms among sexually active female adolescents—an important precursor to behavior change