Objective The authors explored the experiences of psychiatry residents caring for patients during the COVID-19 pandemic on a medical unit. Methods From June 2020 through December 2020, structured, individual interviews were conducted with psychiatry residents deployed to internal medicine wards in a community hospital to provide medical care to COVID-19 patients for greater than or equal to 1 week. Interviews were recorded, transcribed verbatim, and analyzed using thematic analytical methods. Results Psychiatry residents ( n = 16) were interviewed individually for approximately 45 min each. During the interviews, many residents described emotions of fear, anxiety, uncertainty, lack of preparedness, and difficulty coping with high patient mortality rates. Many of the residents expressed concerns regarding insufficient personal protective equipment, with the subsequent worries of their own viral exposure and transmission to loved ones. Multiple residents expressed feeling ill-equipped to care for COVID-19 patients, in some cases stating that utilizing their expertise in mental health would have better addressed the mental health needs of colleagues and patients’ families. Participants also described the benefits of processing emotions during supportive group sessions with their program director. Conclusions The COVID-19 pandemic represents a public health crisis with potential negative impacts on patient care, professionalism, and physicians’ well-being and safety. The psychiatry residents and fellows described the overwhelmingly negative impact on their training. The knowledge gained from this study will help establish the role of the psychiatrist not only in future crises but in healthcare as a whole.
URCS) was negatively correlated with depression(rZ-0.39), anxiety(rZ-0.37), maladaptive alcohol use(rZ-0.31) and caregiver burden(rZ-.41), but not correlated with positive aspects of caregiving(rZ0.16). The 26 care partners included 22 spouses, 2 parents, and 2 children of care recipients. Adult children care partners reported the lowest perceived relationship closeness(median of 5.96[range:3.42-6.92]) compared to care partners who are spouses(median of 5.17[range:4.67-5.67]) or parents(median of 2.92 [2.08-3.75]). Relationship closeness may be dependent on the relationship of care partners to their care recipients. Conclusions: In this study, the closer the care partners viewed their relationship with their care recipient to be, the lower the depressive symptoms, general anxiety symptoms, maladaptive alcohol use, and caregiver burden they endorsed. Of the different types of relationships, children of care recipients reported the lowest relationship closeness. This may be the result of being "sandwiched" between the demands of caring for their older parents and their own children. Future work should explore care partners' feelings of obligation versus choice in their caregiving role and care partners' ability to balance other life roles demands with caregiving responsibilities.
We present the case of a newborn with 17q23.1q23.2 microdeletion and additional homozygosity of 11p11.2q13.4. In the literature, 17q23.1q23.2 microdeletion syndrome is a novel syndrome reported in nine patients. Our patient is a full-term baby boy admitted to a neonatal intensive care unit for hypoglycemia, respiratory distress, presumed sepsis, and thrombocytopenia. General appearance revealed microcephaly, micrognathia, ankyloglossia, small mouth, and high arch palate. The patient also presented with hypotonia, poor feeding, and poor weight gain in the first week of life followed by hypertonia and tremors from the second week of life. The phenotypic and clinical presentation lead to the genetic investigation of microarray which revealed 17q23.1q23.2 microdeletion and additional homozygosity of 11p11.2q13.4.
Background: Thoracic outlet syndrome represents a spectrum of diseases depending on the structures involved. Most cases of thoracic outlet syndrome (TOS) are neurogenic while arterial and venous TOS constitute only 5% of the cases. Paget-Schroetter syndrome represents an acute complication of venous thoracic outlet syndrome (vTOS) commonly occurring in physically active individuals participating in strenuous upper body exercises. Arterial thoracic outlet syndrome (aTOS) is usually associated with bony abnormalities. We discuss one patient of each type who presented with acute thrombosis to illustrate the different associated factors and treatment options. Case Report(s): An 18-year-old Hispanic male presented with six days of left upper extremity (LUE) edema and pain that began following an upper body exercise. He was treated by pharmacomechanical thrombectomy followed by ultrasound assisted catheter-directed thrombolysis. Subsequently the patient underwent trans axillary surgical decompression of the thoracic outlet. A 59-year-old South Asian woman presented with worsening LUE pain, weakness and paresthesia of 10 days duration. She underwent pharmacomechanical thrombectomy with angioplasty followed by supraclavicular thoracic outlet decompression. Conclusions: Treatment of TOS presenting with thrombosis should consist of prompt thrombectomy followed by surgical decompression.
Purpose: Aortic arch anatomical variations are of surgical importance. Many variations of the aortic arch and associated vessels may be found incidentally or post-mortem. Methods: A 61-year-old presented with symptoms suspicious of a cerebrovascular accident. Results: The patient was found to have the right internal and external carotid arteries emanating from the right subclavian artery in absence of a common carotid artery on computed tomography angiography of the neck. Conclusion: A recent comprehensive review noted 41 published cases of common carotid artery aplasia with the right internal carotid originating from the subclavian artery in only 4 of these cases. The current case represents a rare absence of the right CCA with the right ICA and ECA originating separately from the right subclavian artery.
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