Use of Oculomotor, Vestibular, and Reaction Time Tests (OVRT) in Screening for Anomalous Health Incidents

In late 2016 - 2017 a group of US Diplomats in Havana experienced a seemingly sudden onset of vestibular, oculomotor and cognitive symptoms that persisted for months after first being reported. Those affected can be identified using OVRT yet no study has used these to identify AHI patients. OVRT data from all patients referred for evaluation of "Havana Syndrome" were compared to the original group of diplomats in Havana and controls. t-test for difference in means of OVRT metrics between the Havana cohort and Normative controls, and 95% CI were calculated. A multivariable linear regression model was fit to identify the two-way interaction effect of sex and age on results, and a sum score of "Havana-Like Metrics" was generated on each subject to develop a benchmark of likely affected with AHI or not likely affected. A total of 537 subjects were included in this study: 25 (4.7%) Havana cohort, 46 (8.6%) Clinical cohort, and 466 (86.7%) control. t-test between the Havana cohort and control group showed 19 of the 44 separate metrics had statistically significantly different means (p<0.05). Linear regression models then showed that one of these 19 metrics had a significant interaction effect, the other 18 had no significant interaction. The 95%CI of the mean of the Havana cohort for each of the 19 significant metrics were then used to evaluate each of the Clinical cohort subjects&rsquo; performance, each metric that a subject scored within the 95%CI of the mean was given one point, and the sum points of "Havana-Like metrics" were evaluated. The Havana cohort had a mean (median) sum score of 6 (7), the Clinical cohort had 5 (5), and Control group had 4 (4), thus a sum score of 6 "Havana-Like Metrics" was used as a benchmark. 19 of the 46 Clinical cohort subjects had 6 or more Havana-Like metrics and were identified as likely affected with AHI. This first quantitative benchmark for the identification of AHI in a clinical population could be useful in developing more precise diagnostic/screening tools to be used worldwide, and in federal efforts to determine who might be eligible for AHI-related treatment/compensation

The Role of Tranexamic Acid in the Management of an Acutely Hemorrhaging Patient

Background: Acute hemorrhage, both traumatic and nontraumatic, leads to significant morbidity and mortality, both in the United States and globally. Traditional treatment of acute hemorrhage is focused on hemostasis and blood product replacement. Tranexamic acid is an antifibrinolytic agent that may reduce acute hemorrhage through inhibition of plasminogen. Newer research suggests that coagulopathy, specifically fibrinolysis, may contribute significantly to the pathology of acute hemorrhage. Methods: We searched the PubMed database for relevant articles from 2000 to 2018 for the terms “tranexamic acid,” “TXA,” “antifibrinolytic,” “hyperfibrinolysis,” and “coagulopathy.” Our search was limited to studies published in the English language. Results: A total of 53 studies were included in this review. These articles suggest a potential role for tranexamic acid in the management of acute intracranial hemorrhage, epistaxis, hematuria, postpartum hemorrhage, gastrointestinal hemorrhage, and trauma-related hemorrhage. A theoretical risk of thrombotic events following tranexamic acid use exists, though large clinical trials suggest this risk remains exceedingly small. Conclusions: Recent studies suggest a mortality benefit with tranexamic acid following acute hemorrhage. First responders such as emergency medical technicians and emergency department clinicians should consider tranexamic acid as an adjunct therapy in the management of acute, severe traumatic and nontraumatic hemorrhage

Chemosensory function recovery in COVID-19 patients: A cross-sectional study

To determine whether subjects who have recovered from COVID-19 smell and taste disturbance perform similarly to their COVID-naïve baseline, on gold-standard smell and taste tests. Prospective cross-sectional study. University of Miami Department of Otolaryngology in Miami, FL between September 2021, and August 2022. Those previously COVID-19 positive composed the experimental group, those who reported being COVID-naïve composed the control group. Mean total score for the UPSIT Smell Test, and the Burghart Taste Strip test were the primary outcome measures. 70 adult subjects (35 former COVID-positive, 35 COVID-naïve) were enrolled, with 21 females and 14 males in each group. 87 % of all subjects were white and were almost distributed evenly between Hispanic and non-Hispanic. Mean UPSIT total score for the experimental group was 30.6 (95 % CI 28.9–32.3), mean UPSIT total score for the control group was 31.2 (95 % CI 29.7–32.8). Mean Burghart total score for the experimental group was 11.3 (95 % CI 10.6–12.0), mean Burghart total score for the control group was 10.7 (95 % CI 9.7–11.8). These showed a significant overlap of the 95 % CI of the mean total score between the control group and the experimental group, suggesting no significant difference between the two groups. These results suggest that COVID-19 patients who experience smell and taste disturbance and recover, regain sensory ability similar to their pre-COVID ability. Further study is needed to validate these findings, but the results are promising in the long-term recovery of COVID-19

Providing Virtual Support to Children With Mild Developmental Delays in Response to the Pandemic

The COVID-19 pandemic has had massive impacts across the globe. Children with developmental delays are an increasingly vulnerable population, highlighting the importance of ensuring they have access to high-quality virtual services during this time. The Early Discovery program currently provides therapeutic interventions for children with mild developmental delays. We sought to compare the outcomes of 2 cohorts within the Early Discovery program using different delivery approaches (n = 238 families): children who received services in person before the pandemic (n = 126) and children who received services via telehealth in the acute phase of the pandemic (n = 112). Both groups of children showed significant improvements in language skills posttreatment, and, with regard to auditory comprehension, both groups showed similar rates of improvement. However, children receiving in-person services before the pandemic showed greater improvements in expressive communication skills than children receiving telehealth services during the pandemic. Results indicate that the Early Discovery program was able to make adjustments during the pandemic that assisted families in maintaining progress in improving their child's language skills

Predictors for reactogenicity and humoral immunity to SARS-CoV-2 following infection and mRNA vaccination: A regularized, mixed-effects modelling approach

The influence of pre-existing humoral immunity, inter-individual demographic factors, and vaccine-associated reactogenicity on immunogenicity following COVID vaccination remains poorly understood. Ten-fold cross-validated least absolute shrinkage and selection operator (LASSO) and linear mixed effects models were used to evaluate symptoms experienced by COVID+ participants during natural infection and following SARS-CoV-2 mRNA vaccination along with demographics as predictors for antibody (AB) responses to recombinant spike protein in a longitudinal cohort study. In previously infected individuals (n=33), AB were more durable and robust following primary vaccination when compared to natural infection alone. Higher AB were associated with experiencing dyspnea during natural infection, as was the total number of symptoms reported during the COVID-19 disease course. Both local and systemic symptoms following 1 and 2 dose (n=49 and 48, respectively) of SARS-CoV-2 mRNA vaccines were predictive of higher AB after vaccination. Lastly, there was a significant temporal relationship between AB and days since infection or vaccination, suggesting that vaccination in COVID+ individuals is associated with a more robust immune response. Experiencing systemic and local symptoms post-vaccine was suggestive of higher AB, which may confer greater protection