Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel virus that causes COVID-19 infection, has recently emerged and caused a deadly pandemic. Studies have shown that this virus causes worse outcomes and a higher mortality rate in older adults and those with comorbidities such as hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and chronic kidney disease (CKD). A significant percentage of older American adults have these diseases, putting them at a higher risk of infection. Additionally, many adults with hypertension, diabetes, and CKD are placed on angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers. Studies have shown that these medications upregulate the ACE-2 receptor, the very receptor that the SARS-CoV-2 virus uses to enter host cells. Although it has been hypothesized that this may cause a further increased risk of infection, more studies on the role of these medications in COVID-19 infections are necessary. In this review, we discuss the transmission, symptomatology, and mortality of COVID-19 as they relate to older adults, and possible treatments that are currently under investigation. J Am Geriatr Soc 68:926-929, 2020.

Uptake of telepractice has drastically increased among speech-language therapists (SLTs) following the COVID-19 pandemic. This study aimed to explore the sudden uptake of telepractice in India among SLTs. An online survey consisting of 20 questions was carried out between 4 and 17 May 2020 using Google form. The participants comprised of SLTs who indicated that they had shifted their services to telepractice during the COVID-19 pandemic. Descriptive analysis was used to summarize the findings. Eighty-four SLTs participated in the study, working across different work settings and from 21 to 53 years of age. Forty-nine percent of SLTs had conducted more than 11 telepractice sessions, 89% conducted only individual sessions. Further, 85% had a mostly paediatric caseload with 75% working with child language disorders. They learnt about telepractice in a range of ways including from colleagues (19%), social media and the internet (18%), formal education (24%), reading (8%) and experience (8%). Overall, SLTs exhibited a positive attitude towards the use of telepractice. The most common platform used was WhatsApp video calling feature (82%), although more than one platform was being used. The greatest challenges faced were dealing with network issues (38%) and lack of cooperation from the child during sessions (27%). The findings highlight an acceptance and uptake towards telepractice. This might pave the path for serious consideration for telepractice in the field of speech-language therapy in India in the future.

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Emerging infectious diseases (EIDs) are an increasing threat to public health on a global scale. In recent times, the most prominent outbreaks have constituted RNA viruses, spreading via droplets (COVID-19 and Influenza A H1N1), directly between humans (Ebola and Marburg), via arthropod vectors (Dengue, Zika, West Nile, Chikungunya, Crimean Congo) and zoonotically (Lassa fever, Nipah, Rift Valley fever, Hantaviruses). However, specific approved antiviral therapies and vaccine availability are scarce, and public health measures remain critical. Patients can present with a spectrum of ocular manifestations. Emerging infectious diseases should therefore be considered in the differential diagnosis of ocular inflammatory conditions in patients inhabiting or returning from endemic territories, and more general vigilance is advisable in the context of a global pandemic. Eye specialists are in a position to facilitate swift diagnosis, improve clinical outcomes, and contribute to wider public health efforts during outbreaks. This article reviews those emerging viral diseases associated with reports of ocular manifestations and summarizes details pertinent to practicing eye specialists.

One of the major concerns of the health care community and the public surrounding the SARS-CoV-2 pandemic is the availability and use of ventilators. Unprecedented surges of patients presented to intensive care units across the country, with older adults making up a large proportion of the patient population. This paper illustrates contemporary approaches to critical illness myopathy (CIM), critical illness polyneuropathy (CIP), and critical illness polyneuromyopathy (CIPNM) in older patients, including incidence, risk factors, mechanisms for pathology, diagnosis, contemporary treatment approaches, and outcomes. We hope that the following analysis may help educate clinicians and ultimately decrease the duration of the mechanical ventilation required by these patients, resulting in improved clinical outcomes and an increase in ventilator availability for other patients in need.

Legionella pneumophila is a common, usually underreported and undiagnosed cause of community acquired pneumonia which can lead to significant morbidity and mortality. Diffuse alveolar hemorrhage rarely have been associated with legionella infection. We present a 61-year-old man with hypertension, diabetes mellitus and obesity admitted with severe acute respiratory distress syndrome. He was found to have Legionella pneumonia with associated diffuse alveolar hemorrhage diagnosed with bronchoscopic sequential bronchoalveolar lavage. He was successfully managed with antibiotics, lung protective strategies and intravenous pulse dose steroids. This patient highlights the unusual association of Legionella infection and diffuse alveolar hemorrhage. Additionally, the case re-enforces the need for early and aggressive evaluation and management of patients presenting with pneumonia and progressive hypoxia despite adequate treatment.

Sweet syndrome, otherwise known as acute febrile neutrophilic dermatosis, is an uncommon disorder characterized by the abrupt onset of painful cutaneous lesions, often with fever and leukocytosis, in patients with underlying infection, malignancy, pregnancy, or drug exposure. We present a case of a young female with long-standing Sweet syndrome refractory to standard treatments and several immunomodulators whose symptoms were ultimately controlled with anakinra.

Multiple myeloma (MM) is a neoplastic disorder characterized by the monoclonal proliferation of plasma cells in the bone marrow. It is estimated to account for only 1% of neoplastic diseases, and there is still a great deal of uncertainty about its precise etiology. Common risk factors with a proven association with MM include ionizing radiation exposure, age greater than 65, male gender, and the presence of monoclonal gammopathy of unknown significance (MGUS).More recently, research has shown that occupational exposures to pesticides also have a significant association with the development of MM. We present the case of an adult male who presented with rib pain, back pain, fevers, and progressive shortness of breath and was ultimately found to have multiple myeloma thought to be associated with occupational exposure to the pesticide captan.