Dealing with the psychological well-being of mompreneurs in millennia India: A psychedelic perspective

Mompreneur refers to “An individual who discovers and exploits new business opportunities within a social and geographical context that seeks to integrate the demands of motherhood and business ownership.” In every decade a new set of challenges wait for the Mompreneurs[2,4] to conquer their dream by overcoming the hurdles. One such major challenge is dealing effectively with the psychological well-being and developing the art of balancing the motherhood and business ownership. Psychological well-being refers to the life moving well. It combines the factors of “feeling good” and “effective functioning”. Psychological well-being implies to the ability of an individual to manage the painful or negative emotions effectively – that which is essential for a person’s long-term well-being.Many community services and other social media groups are in existence but there is a remarkable gap in the field of academic research for the emerging community of Mompreneurs. Thus, primary objective of the paper is to explore the levels of psychological well-being experienced by Mompreneurs in Gujarat. It aims at proposing a theory which may offer a possible solution to overcome the challenges to the Mompreneurs across India. The current study is a quantitative study

Pulmonary Embolism Presenting as Abdominal Pain: An Atypical Presentation of a Common Diagnosis

Pulmonary embolism (PE) is a frequent diagnosis made in the emergency department and can present in many different ways. Abdominal pain is an unusual presenting symptom for PE. It is essential to maintain a high degree of suspicion in these patients, as a delay in diagnosis can be devastating for the patient and confers a high risk of mortality if left untreated. Here, we report the case of a 53-year-old male who presented to the emergency department with worsening right upper quadrant abdominal pain with fevers. Initial imaging was benign, although lab work showed worsening leukocytosis and bilirubin. Abdominal pathology seemed most likely, but the team kept PE on the differential. Further imaging revealed acute pulmonary embolus in the segmental branch of the right lower lobe extending distally into subsegmental branches. The patient was started on anticoagulation and improved drastically. This case highlights the necessity of keeping a broad differential and maintaining a systematic approach when dealing with nonspecific complaints. Furthermore, a discussion on the pathophysiology on why PE can present atypically as abdominal pain, as well as fevers, is reviewed. Using this information can hopefully lead to a subtle diagnosis of PE in the future and lead to a life-saving diagnosis

Acute Suppurative Thyroiditis in an Intravenous Drug User with a Preexisting Goiter

Acute suppurative thyroiditis (AST) is an uncommon, potentially life-threatening cause of a rapidly enlarging neck mass. It may present similarly to subacute thyroiditis, a relatively benign and self-limiting condition. We report a case of AST in an adult intravenous (IV) drug user with a preexisting goiter who presented with a left forearm abscess that grew methicillin-sensitive Staphylococcus aureus. In this particular case, clinical suspicion for AST was high. As a result, early IV antibiotic therapy was initiated, and this led to rapid clinical improvement furthermore preventing airway compromise. To our knowledge, this is the first case of AST in the literature resulting from likely hematogenous spread in the setting of IV drug use and a preexisting goiter. Overall, this case highlights the importance of assessing risk factors for AST in patients whose presentations may seem more typical of subacute thyroiditis. Such an approach will lead to timely diagnosis and treatment to avoid potentially devastating consequences

Critical Care Teamwork in the Future: The Role of TeamSTEPPS^® in the COVID-19 Pandemic and Implications for the Future

At our institution, we observed inconsistency in the application of structural facilitators for interprofessional teamwork such as handoffs and communication of contingency planning, complete formation and engagement of teams on interprofessional rounds, regular situation monitoring, interprofessional huddles, use of “check back” during code situations, and standard debriefings after codes and procedures (TeamSTEPPS®). To enhance team performance, we piloted TeamSTEPPS® training and reinforcement for all healthcare team members in the medical intensive care unit (MICU), inclusive of trainees, advanced practice providers (APPs), nurses, and respiratory therapists rotating through the unit. Seven months after the training launch, the initial COVID-19 surge interrupted the reinforcement stage of the pilot providing an opportunity to study the retention of TeamSTEPPS® principles and its potential role in response to a crisis. We conducted interprofessional focus groups after a year of crisis management during the pandemic. Themes revealed how TeamSTEPPS® training impacted teamwork and communication, as well as factors that influenced the use of TeamSTEPPS®. This work points to the value of team training in unexpected scenarios. Additional studies at multiple sites are needed to determine scalability for all MICU teams or for onboarding new team members

COVID-19 as a Trigger of Recurrent Guillain–Barré Syndrome

Coronavirus 2019 (COVID-19) has been reported to trigger Guillain–Barré syndrome (GBS). While uncommon, recurrent GBS (rGBS) episodes, triggered by antecedent viral infections, have been reported in a small proportion of GBS patients, here we describe a patient with a recurrent case of GBS, occurring secondary to COVID-19 infection. Before this patient’s episode, he had two prior GBS flares, each precipitated by a viral infection followed by complete recovery besides intermittent paresthesias. We also consider the nosology of this illness in the spectrum of rGBS and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), with their differing natural histories, prognosis, and therapeutic approaches. For patients who have a history of inflammatory demyelinating polyradiculopathies who develop COVID-19, we recommend close observation for neurologic symptoms over the next days and weeks

Predicting COVID-19 prognosis in hospitalized patients based on early status

ABSTRACT Predicting which patients are at greatest risk of severe disease from COVID-19 has the potential to improve patient outcomes and improve resource allocation. We developed machine learning models for predicting COVID-19 prognosis from a retrospective chart review of 969 hospitalized COVID-19 patients at Robert Wood Johnson University Hospital during the first pandemic wave in the United States, focusing on 77 variables from patients’ first day of hospital admission. Our best 77-variable model was better able to predict mortality (receiver operating characteristic area under the curve [ROC AUC] = 0.808) than CURB-65, a commonly used clinical prediction rule for pneumonia severity (ROC AUC = 0.722). After identifying highly predictive variables in our full models using Shapley additive explanations values, we generated two models, platelet count, lactate, age, blood urea nitrogen, aspartate aminotransferase, and C-reactive protein (PLABAC) and platelet count, red blood cell distribution width, age, blood urea nitrogen, lactate, and eosinophil count (PRABLE), that use age and five common laboratory tests to predict mortality (PLABAC: ROC AUC = 0.796, PRABLE: ROC AUC = 0.793), which also outperformed CURB-65. We externally validated PLABAC using data from the National COVID Cohort Collaborative Data Enclave from 7901 hospitalized COVID-19 patients from the pre-vaccination period and 1547 from the vaccination period, yielding ROC AUCs of 0.755 and 0.766, respectively. This study demonstrates that our models can accurately predict COVID-19 outcomes from a small number of variables obtained early in a patient’s hospital stay in patients from institutions around the United States after the initial pandemic wave. These models can serve as a clinical prediction aid and accurately capture a patient’s prognosis using a small number of routinely obtained laboratory values. IMPORTANCE COVID-19 remains the fourth leading cause of death in the United States. Predicting COVID-19 patient prognosis is essential to help efficiently allocate resources, including ventilators and intensive care unit beds, particularly when hospital systems are strained. Our PLABAC and PRABLE models are unique because they accurately assess a COVID-19 patient’s risk of death from only age and five commonly ordered laboratory tests. This simple design is important because it allows these models to be used by clinicians to rapidly assess a patient’s risk of decompensation and serve as a real-time aid when discussing difficult, life-altering decisions for patients. Our models have also shown generalizability to external populations across the United States. In short, these models are practical, efficient tools to assess and communicate COVID-19 prognosis

The Molecular Taxonomy of Primary Prostate Cancer

There is substantial heterogeneity among primary prostate cancers, evident in the spectrum of molecular abnormalities and its variable clinical course. As part of The Cancer Genome Atlas (TCGA), we present a comprehensive molecular analysis of 333 primary prostate carcinomas. Our results revealed a molecular taxonomy in which 74% of these tumors fell into one of seven subtypes defined by specific gene fusions (ERG, ETV1/4, and FLI1) or mutations (SPOP, FOXA1, and IDH1). Epigenetic profiles showed substantial heterogeneity, including an IDH1 mutant subset with a methylator phenotype. Androgen receptor (AR) activity varied widely and in a subtype-specific manner, with SPOP and FOXA1 mutant tumors having the highest levels of AR-induced transcripts. 25% of the prostate cancers had a presumed actionable lesion in the PI3K or MAPK signaling pathways, and DNA repair genes were inactivated in 19%. Our analysis reveals molecular heterogeneity among primary prostate cancers, as well as potentially actionable molecular defectsclose