A Brief Literature Review of the Impact of COVID-19 on Eating Disorders in Adolescents

COVID-19 was an unprecedented time for the entire world. As cases rapidly rose globally, the primary focus was on preventing further spread of the virus and taking care of acutely ill patients. Unfortunately, this meant that getting adequate care for other chronic conditions, including eating disorders (EDs), was a lower priority. Adolescents with EDs were a particularly vulnerable population, as their source of social support and normalcy in the form of school and in-person activities was removed with social distancing and lockdowns. The purpose of this paper is to investigate how COVID-19 affected EDs in adolescents, including likelihood of accessing care, rates of hospitalizations, use of telehealth services, and development of co-morbid mental health conditions. This brief review of current research will explore how adolescents with EDs were negatively affected by the pandemic, and future research directions to better understand this topic

Delay in diagnosis of PD-1 Inhibitor induced Secondary adrenal Insufficiency

Introduction: Immune checkpoint inhibitors including PD-1 inhibitors, were initially approved for the treatment of metastatic melanoma but are now increasingly being used for different types of solid organ malignancies. Despite the important clinical benefits, they are associated with immune-related adverse events. The most critical endocrinopathy associated with PD -1 inhibitor is adrenal insufficiency (AI), which requires prompt diagnosis and management to avoid fatality. Case presentation: We present the case of a 78-year-old woman with colon adenocarcinoma treated with Nivolumab (PD-1 inhibitor) after her pulmonary metastases progressed on chemotherapy. She presented to the hospital with progressive generalized weakness, fatigue, headache, lightheadedness, nausea, myalgia, reduced oral intake. She had 2 prior hospitalizations on account of similar symptoms with workup negative for cancer progression or gastrointestinal obstruction. Her laboratory values showed Na 128mmol/L, K 3.4mmol/L, Cr 0.52mg/dL and blood sugar 42mg/dL. Morning cortisol was low at 2.2µg/dL and ACTH stimulation test was positive. She was diagnosed with AI secondary to Nivolumab use and was started on Hydrocortisone while Nivolumab was discontinued. Conclusion: Immune checkpoint inhibitors have a unique side effect profile of immune-related adverse events, the most critical of which is AI. However, the non-specific manifestations of AI can lead to misdiagnosis or delay in diagnosis. Therefore, it is important for physicians to have high index suspicion for AI in acutely ill patients on PD-1 inhibitors for prompt recognition, diagnosis and treatment of AI which is important to prevent life-threatening adrenal crisis

iCE (Interactive Curricula Experience) Platform & App Adoption, Use & Evaluation Across Thomas Jefferson University

iCE or the Interactive Curricula Experience Platform and App is a content delivery system designed specifically for the iPad but available to any learner with a web-enabled device. Poster presented at 2016 8th Annual Faculty Days at Thomas Jefferson University

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Arnold-Chiari Malformation-I Borderline Personality Disorder

Introduction:Arnold-Chiari Malformation I (AM-I) is a congenital anomaly that manifests with cerebellar dysfunction. There is a displacement of cerebellar tonsils into the foramen magnum. Several mood disorders, personality disorders, and intellectual disabilities are associated with AM-I. Borderline personality disorder (BPD) is characterized by symptoms of mood lability, impulsivity, extreme efforts of abandonment, splitting and dysfunctional relationships. Case Description:The patient is an early aged adult with a past medical history of AM-I, hypothyroidism, Wolff-Parkinson-White syndrome, and diabetes mellitus type II. The patient was admitted to the hospital after ingesting foreign bodies. He/she presented with mood lability, sad mood, anhedonia, insomnia, panic attacks, ruminative worries, feelings of emptiness, and recurrent suicidal gestures and threats. The patient was eventually diagnosed with borderline personality disorder. This case suggests a possible connection between AM-I and BPD. Discussion:Emerging from contemporary research involving the cerebellum, it is important to acknowledge that the current definition of control of fine motor and balance is inadequate. Symptoms associated with AM-I and BPD may be better explained by Cerebellar Cognitive Affective Syndrome (CCAS), a condition that ties the cerebellum with the higher cognitive functioning in the brain