Laparoscopic Splenectomy for Hairy Cell Leukemia in Pregnancy

Objective. We present a successful case of laparoscopic splenectomy for a massively enlarged spleen at 25 weeks of gestation for hairy cell leukemia in pregnancy in a woman with initial hemoglobin of 4.3 gm/dl and platelet count of 18,000/mm3. Study Design. Case report. Results. This report provides an approach to management that may be applicable in those cases where thrombocytopenia or other clinical imperatives preclude delaying treatment till after pregnancy. Conclusion. Hairy cell leukemia is a clonal B-Cell malignancy, for which there is very limited experience worldwide for its management when it occurs during pregnancy. Laparoscopic splenectomy should be considered as a therapeutic option, even with a significantly enlarged spleen, in order to avoid the risks of fetal exposure to chemotherapeutic agents. Unique considerations relating to pregnancy are highlighted

The Psychological Impact of COVID-19 on Hospital Staff

Introduction: The coronavirus 2019 (COVID-19) pandemic has created a mental health crisis among hospital staff who have been mentally and physically exhausted by uncertainty and unexpected stressors. However, the mental health challenges and complexities faced by hospital staff in the United States has not been fully elucidated. To address this gap, we conducted this study to examine the prevalence and correlates of depression and anxiety among hospital staff in light of the COVID-19 pandemic.Methods: The design is a single-center, cross-sectional, online survey evaluating depression and anxiety among all hospital employees (n = 3,500) at a safety-net hospital with a moderate cumulative COVID-19 hospitalization rate between April 30–May 22, 2020. We assessed depression with the Patient Health Questionnaire-9. Anxiety was measured with the Generalized Anxiety Disorder-7 scale. Logistic regression analyses were calculated to identify associations with depression and anxiety.Results: Of 3,500 hospital employees, 1,246 (36%) responded to the survey. We included 1,232 individuals in the final analysis. Overall, psychological distress was common among the respondents: 21% and 33% of staff reported significant depression and anxiety, respectively, while 46% experienced overwhelming stress due to COVID-19. Notably, staff members overwhelmed by the stress of COVID-19 were seven and nine times more likely to suffer from depression and anxiety, respectively. In addition to stress, individuals with six to nine years of work experience were two times more likely to report moderate or severe depression compared to those with 10 or more years of work experience. Moreover, ancillary staff with direct patient contact (odds ratio [OR] 8.9, confidence interval (CI), 1.46, 173.03) as well as administrative and ancillary staff with indirect patient contact (OR 5.9, CI, 1.06, 111.01) were more likely to be depressed than physicians and advanced providers.Conclusion: We found that a considerable proportion of staff were suffering from psychological distress. COVID-19-associated depression and anxiety was widespread among hospital staff even in settings with comparatively lower COVID-19 hospitalization rates. Ancillary staff, administrative staff, staff with less job experience, and staff overwhelmed by the stress of COVID-19 are particularly susceptible to negative mental health outcomes. These findings will help inform hospital policymakers on best practices to develop interventions to reduce the mental health burden associated with COVID-19 in vulnerable hospital staff

Microaggressions in the Learning Environment: A Systematic Review

Microaggressions entail everyday brief, low-intensity events that convey negative messages toward marginalized groups. A systematic review of the literature on microaggressions in the learning environment of higher education was performed from 1998 to 2018 using a modified PRISMA outline. Forty articles on racial microaggressions were categorized as microaggression experiences of all races/ethnicity (27.5%), microaggression experiences of minorities (22.5%), difficult racial dialogues (10%), coping strategies for microaggressions (17.5%), and system interventions strategies (22.5%). Microinsults were reported in 82.5%, microinvalidations in 4.5%, microassaults in 20%, and institutional microaggressions in 27.5%. Microaggressions were prevalent and “invisible” in colleges with minority students seemingly worn down by ongoing strategies used to confront the inherent associated stresses. Difficult racial dialogues were characterized by intense emotions in both professors and students that interfered with successful learning experiences. Coping strategies that correlated positively with microaggression and psychological stress included disengagement, cultural mistrust, stigma for seeking psychological help, alcohol use, and intolerance of uncertainty. Factors tending to ameliorate microaggression and psychological stress included engagement, dispositional forgiveness, help-seeking attitudes, self-efficacy in coping with daily hassles, and social connectedness. Political activism was helpful in Latinx, but exacerbated microaggression related stress in African American students. Multicultural curricula were associated with increased racial awareness. Innovative intervention strategies included brief video interventions and utility of mobile apps. Microaggressions are associated with ongoing major negative impact on the learning environment. By ameliorative coping mechanisms and institution intervention strategies, the associated toll and stresses from microaggressions may be reduced