Social media, traditionally reserved for social exchanges on the Internet, has been increasingly used by researchers to gain insight into different facets of human life. Unemployment is an area that has gained attention by researchers in various fields. Medical practitioners especially in the area of mental health have traditionally monitored the effects of involuntary unemployment with great interest. The question we want to address is as follows: while many researchers have been using data from social media and microblogging sites in the past few years, do they provide results consistent with traditional research? Furthermore, if the data are indeed consistent, are they detailed enough to deduce possible reasons and remedies? We believe that having a concise answer to these questions is imperative for a sustainable mechanism for medical practitioners and researchers to gather and analyze data. The stigma of mental health prevents a good portion of society from seeking help, but the anonymity provided by the Internet could shatter such barriers, thus allowing people affected by conditions such as mental health and unemployment to express themselves freely. In this work, we compare the feedback gathered from social media using crowdsourcing techniques to results obtained prior to the advent of social media and microblogging. We find that the results are consistent in terms of (1) financial strain being the biggest stressor and concern, (2) the onslaught of depression being typical and (3) possible interventions, including reemployment and support from friends and family, playing a crucial role in minimizing the effects of involuntary unemployment. Lastly, we could not find enough evidence to study effects on physical health and somatization in this work.
Background: COVID19 infection is associated with worse outcomes in patients admitted with diabetic ketoacidosis (DKA). The indirect impact of the pandemic on DKA admissions to COVID19 free hospitals has not been evaluated. In this study, we evaluate the characteristics and outcomes of DKA admissions before and during the pandemic. Materials and Methods: This retrospective study included 146 episodes of DKA for patients aged 16 years and above admitted to Tawam Hospital, A COVID-19-free hospital, between April and October from 2017 to 2020. Sociodemographic, clinical, and laboratory data were retrieved from the electronic records. Data from the (2017–2019) period were compared to those during the COVID19 pandemic in 2020. Results: We evaluated 79 pre-COVID19 and 67 during the COVID19 admissions. During the pandemic, patients were older (30 vs. 23 years, P 0.2) with higher proportions of male sex (66% vs. 25%) and non-Emirati nationals (Arabs 17.9% vs. 12.7% and South Asian 20.9% vs. 3.8%). In addition, only 64.2% of patients had medical coverage compared to 92.4% in pre-COVID19 time. More patients with newly diagnosed diabetes (25.4% vs. 7.6%) and type 2 diabetes mellitus (32.8% vs. 17.7%) were encountered during the pandemic. Overall, there was no significant difference in severity, time to resolution, and mortality. Length of stay was longer for DKA admissions during the pandemic (4 vs. 3 days). Conclusion: In our COVID19-free hospital, the pandemic has led to an increased rate of DKA admissions and significant change in the sociodemographic characteristics of patients with DKA. Clinical care, patients' management, and outcomes were not adversely affected. Assessing the indirect impact of the pandemic is essential for future service planning.
Copper is an essential cofactor in many enzymatic reactions vital to the normal function of the hematologic, vascular, skeletal, antioxidant, and neurologic systems. Parenteral nutrition and chronic tube feeding are used in various mal-absorptive syndromes, including following gastrectomy and gastric bypass surgery. Features of copper deficiency include hematologic abnormalities (anemia, neutropenia, and leukopenia) and myeloneuropathy; the latter is a rarer and often unrecognized complication of copper deficiency. We describe a 36 -year-old Emirati woman who was referred to endocrinology service because of generalized body weakness and fatigue post bariatric surgery. The patient initially noted a lower extremity swelling in feet bilaterally that worsened in severity over time and progressed up to knees. Over a 3 month period, her ability to ambulate gradually deteriorated. She also noticed maculopapular skin rash over both shins. Patient had Sleeve Gastrectomy in 2011. Followed by conversion of sleeve to RYGB surgery in 2018 due weight loss failure. Patient is known to have well controlled hypothyroidism on thyroxine. She was prescribed vitamin D, neurobion, iron and multivitamins tablets post surgery but never been compliant. The patient was admitted with severe malnutrition due to poor oral intake over the last 5 months prior to admission. Her total weight loss was 34.5 kg (32% weight change, BMI 28 .52kg/m2) in less than 9 months post surgery. Initial labs revealed severe hypoalbuminemia, normochromic anemia and neutropenia. Iron, folate, thiamine, and vitamin B12 levels were normal. Vitamin B6 level was normal at 11 mcg/L (normal = 5-50 mcg/L). The serum copper level was low at 310 µg/l (normal = 794-2023µg/l). Zinc level was low at 447 µg/l (normal = 551-925µg/l). Nutritional needs were estimated using the following formulas; 22-25 kcal/kg ideal body weight (IBW)/d and 1.5-2.0 g protein/kg IBW/d, 30-35 ml IVF/kg /d. The patient’s input/output, body weight, and clinical status were monitored. Parenteral nutrition additive copper 0.3 mg/day and oral copper 8 mg daily, resulted in the rapid correction of hematologic indices over one week. Combined multivitamins supplementation and oral copper supplements alone normalized serum copper levels over 4 weeks and resulted in resolution of weakness and body edema. This report serves to alert physicians of the association between bariatric surgeries and subsequent severe copper deficiency in order to avoid diagnostic delays and to improve treatment outcomes.
Idiopathic transient osteoporosis of pregnancy (ITOP) is a rare and under-reported condition that has affected healthy pregnancies. ITOP usually presents in the final trimester of a normal pregnancy. Radiographic studies detect drastic loss of bone mass, elevated rates of turnover in the bone, and edema in the affected portion. We present a 26-year-old previously healthy woman, who was admitted at 39 weeks of gestation with severe left hip pain and inability to walk for one month.The pain was constant, progressive, involving left lower limb, and associated with numbness and weakness. Neurological exam revealed diminished power in the left hip (motor power was 2/5), and inability to stand and walk due to pain in the left hip. She was unable to stand by herself. Investigations revealed anemia, low vitamin B12, low vitamin D and magnesium. Bilateral hip MRI showed increased T2WI signal in the left femoral head consistent with idiopathic transient osteoporosis of the left hip (ITOP). DXA scan showed bone mass density (BMD) below expected for age.The patient had induced vaginal labor without complication. The left hip pain improved after delivery. She was treated conservatively with Calcium, Magnesium and vitamin D. The patient symptoms completely resolved in 3 months post-delivery. DXA scan and Hip MRI at 1 year interval showed normal BMD and complete resolution of previous bone marrow edema and changes seen in MRI hip. This case report serves to highlight the effect of pregnancy on bone mass during third trimester which may result in transient osteoporosis of pregnancy leading to weakness and gait disturbance. Clinical symptoms can be misdiagnosed as a peripheral neurological complications instead of bone metabolism changes of pregnancy.
Anabolic steroid injections widely used by athletes during strength training period, all studies were done in this field showed transient effect of androgenic anabolic steroids on thyroid which were mainly causing hypothyroidism, However hyperthyroidism cases were never reported up to our knowledge. We present a 25-year-old Emarati male previously healthy, who is referred to endocrine service for hyperthyroidism management. He presented with thyrotoxicosis manifestations. Medical history revealed that he was using anabolic steroids, testosterone, and gonadotropin injection which were prescribed in private gym by trainer. Anabolic steroids were taken twice for few months over 2years prior to his current presentation with hyperthyroidism. Autoimmune profile was negative for thyroid disorder. Radioiodine uptake scan was normal initially then after a year showed diffuse uptake. No evidence of clear cause of his hyperthyroidism. He remained in thyrotoxic state for more than a year post stopping the anabolic steroids. He was treated with radioactive iodine ablation (RAI) according to his preference. Develop post-RAI thyroiditis treated with beta blockers and analgesia. Symptoms completely resolved after 6 weeks and thyroid function returned to normal. The patient has remained asymptomatic on continued follow up care. This case points to the effect of anabolic steroids on thyroid function. Hence all published studies showed that it could cause hypothyroidism not hyperthyroidism. few Literatures are showing that anabolic steroid’s prominent effect on human thyroid function is reduction of TBG with consequent reduction of Total T3 and T4. In rats, anabolic steroids also act in the peripheral metabolism of thyroid hormones and seem to exert an important proliferative effect on thyroid cells. By this effect we believe that, anabolic steroid might cause hyperthyroidism in our patient. To our knowledge, this is the first case report addressing anabolic steroids causing permanent hyperthyroidism. Our patient proved that the effect of anabolic steroid was not transient as he remained in thyrotoxic state for more than a year after stopping steroids and uptake scan showed diffuse high uptake which goes with thyroid cells proliferation hypothesis.
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