CMV reactivation in COVID-19 patients: pouring fuel on the fire

Severe SARS-CoV-2 infection could promote CMV reactivation, that further worsens disease prognosis. This study included admitted patients with recent COVID-19 for one year period in a tertiary hospital, having clinical criteria of CMV reactivation and positive CMV DNAemia. Fifteen of 559 COVID-19 patients were diagnosed with CMV reactivation (2.7%). 86.6% were male, with a mean age of 63.6 years. Immunodepression was significantly higher in the CMV positive group (p=0.008). Lymphopenia was significantly more important in patients who reactivated CMV (p=<0.001), whereas ferritin level (p=0.019) and IL-6 level (p=0.035) on admission appeared to be significantly lower in this group. There was no significant difference for COVID-19 treatments. ICU admission (p<0 .001) and bacterial infections (p<0.001) appeared to be significant for CMV reactivation. Also, the mortality was significantly higher in the CMV positive group (p=0.042). This study raises the possible incrimination of lymphopenia, immunosuppression, critical illness, and bacterial infections in CMV reactivation

Reproductive Health Counseling of Female Psychiatric Patients

Reproductive counseling for women hospitalized in inpatient psychiatric settings is a complex topic with recommendations and guidelines contingent upon fertility status, psychiatric diagnosis and any concomitant physical diagnosis, goals for childbearing, and possible risks of medication use to a pregnancy. Using data from female patients of reproductive age hospitalized in the GW Hospital Psychiatry department between 2016 and 2018, we conducted a comprehensive chart review of reproductive health counseling for psychiatric patients. We analyzed data from more than 500 unique cases on information elicited from women in the psychiatric inpatient setting including last menstrual period, history of childbearing, contraception use and plans for future pregnancy, as well as counseling provided on reproductive considerations in the setting of mental health diagnoses and psychotropic medication use. We further stratified findings by patient age, DC ward residency, race and ethnicity, and examined the interaction of these variables with reproductive health counseling. We present a comprehensive, qualitative report on two recent years in patient counseling, and provide evidence-based suggestions for quality improvement in patient care and future research

Reduced pain perception in patients with schizophrenia; A missed case of hand fracture

Altered pain perception among patients with schizophrenia is often underrecognized in the medical community. The cause is not known, and medical professionals are not sure whether these patients experience less pain or are simply unable to express it. There are documented cases of patients with schizophrenia presenting to hospital settings with serious injuries without obvious (expected) pain. Research into the underlying cause(s) is underway; meanwhile, ensuring awareness of this issue among medical providers is of upmost importance. We report a case of a patient with schizophrenia who presented voluntarily to the emergency department (ED) with a hand fracture that went unrecognized in the ED and further discuss the implications of reduced pain perception. Additionally, we summarize existing hypotheses regarding the source of this reduced pain perception in this population

Triple Negative Breast Cancer: Updates on Classification and Treatment in 2021

Breast cancer (BC) is the most common malignancy affecting women. It is a highly heterogeneous disease broadly defined by the differential expression of cell surface receptors. In the United States, triple negative breast cancer (TNBC) represents 15 to 20% of all BC. When compared with other subtypes of BC, TNBC tends to present in younger women, and has a higher mortality rate of 40% in advanced stages within the first 5 years after diagnosis. TNBC has historically had limited treatment options when compared to other types of BC. The mainstay of treatment for TNBC remains cytotoxic chemotherapy despite the emergence of new biologic and targeted agents. Defining the specific tumor molecular profile including PDL-1 and androgen receptor testing is expanding treatment options in the clinical setting. Identifying more targetable, novel biomarkers that may better define therapeutic targets or prognostic markers is currently underway. TNBC nomenclature is expected to be updated in favor of other nomenclature which would help direct therapy, and further redefine TNBC’s heterogeneity. Given the continuous advances in the field of TNBC, this review assesses the latest developments in basic characterization, subtyping, and treatment of TNBC, including novel drug developments with antibody-drug conjugates, immune checkpoint inhibitors, PARP inhibitors and androgen receptor targeted agents. Future trials are necessary in the face of these innovations to further support the use of new therapies in TNBC and the detection of the appropriate biomarkers

QTc monitoring in adults with medical and psychiatric comorbidities: Expert consensus from the Association of Medicine and Psychiatry

© 2020 Elsevier Inc. Objective: Several psychiatric medications have the potential to prolong the QTc interval and subsequently increase the risk for ventricular arrhythmias such as torsades de pointes (TdP). There is limited guidance for clinicians to balance the risks and benefits of treatments. Methods: After a review of the existing literature, clinical-educators from the Association of Medicine and Psychiatry developed expert consensus guidelines for ECG monitoring of the QTc interval for patients with medical and psychiatric comorbidities who are prescribed medications with the potential to prolong the QTc interval. A risk score was developed based on risk factors for QTc prolongation to guide clinical decision-making. Results: A baseline ECG may not be necessary for individuals at low risk for arrythmia. Those individuals with a risk score of two or more should have an ECG prior to the start of a potentially QTc-prolonging medication or be started on a lower risk agent. Antipsychotics are not equivalent in causing QTc prolongation. A consensus-based algorithm is presented for the management of those identified at high (QTc \u3e500 msec), intermediate (males with QTc 450–499 msec or females with QTc \u3e 470–499 msec), or low risk. Conclusions: The proposed algorithm can help clinicians in determining whether ECG monitoring should be considered for a given patient. These guidelines preserve a role for clinical judgment in selection of treatments that balance the risks and benefits, which may be particularly relevant for complex patients with medical and psychiatric comorbidities. Additional studies are needed to determine whether baseline and serial ECG monitoring reduces mortality