Past History Research Articles

Common and distinct risk factors that influence more severe and distressing shortness of breath profiles in oncology outpatients.

Shortness of breath occurs in 10%-70% of oncology patients. Very little is known about interindividual variability in its severity and distress and associated risk factors. Using latent profile analyses (LPAs), purpose was to identify subgroups of patients with distinct severity and distress profiles for shortness of breath as single symptom dimensions. In addition, a joint LPA was done using patients' severity AND distress ratings. For each of the three LPAs, differences among the shortness of breath classes in demographic, clinical, symptom, stress, and resilience characteristics were evaluated. Patients completed ratings of severity and distress from shortness of breath a total of six times over two cycles of chemotherapy. All of the other measures were completed at enrollment (i.e., prior to the second or third cycle of chemotherapy). Separate LPAs were done using ratings of severity and distress, as well as a joint analysis using severity AND distress ratings. Differences among the latent classes were evaluated using parametric and nonparametric tests. For severity, two classes were identified (Slight to Moderate [91.6%] and Moderate to Severe [8.4%]). For distress, two classes were identified (A Little Bit to Somewhat [83.9%] and Somewhat to Quite a Bit [16.1%]). For the joint LPA, two classes were identified (Lower Severity and Distress [79.9%] and Higher Severity and Distress [20.1%]). While distinct risk factors were associated with each of the LPAs, across the three LPAs, the common risk factors associated with membership in the worse class included: a past or current history of smoking, poorer functional status, and higher comorbidity burden. In addition, these patients had a higher symptom burden and higher levels of cancer-specific stress. Clinicians can use the information provided in this study to identify high-risk patients and develop individualized interventions.

Treatment-relevant factors among adults receiving court-mandated substance use treatment: The role of emotion dysregulation.

Despite often being mandated to substance use treatment after release, many people on probation do not complete treatment. Several historical factors have been identified as relevant to substance use treatment in this population (i.e., past substance use, treatment history, and criminal history); however, less is known about the psychological characteristics, such as emotion dysregulation, that influence treatment-relevant factors among people in the criminal justice system. The present study used cross-sectional data to examine whether emotion dysregulation was associated with past-year substance use severity, engagement in prior drug and alcohol use treatments (yes/no, number of prior treatments), and previous criminal charges (total number of charges, number of charge types) in a sample of adults on probation who were receiving court-mandated substance use treatment (N = 163). We also examined whether these relationships varied across sex. Results showed that overall emotion dysregulation was more strongly linked to substance use severity and criminal charges for females than males. Emotion dysregulation dimensions of difficulties engaging in goal-directed behaviors and controlling impulsive behaviors when distressed were associated with more severe past-year substance use, more prior drug treatments, and a greater number of lifetime criminal charges and charge types. Emotion dysregulation plays a role in substance use treatment-relevant factors among people on probation. Sex-specific clinical implications of targeting emotion dysregulation in the context of mandated treatment in order to prevent treatment failures are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Abstract TP271: A Retrospective Analysis of Demographic and Clinical Variables Within a Single Center Young Stroke Cohort

Introduction: Despite significant efforts to increase public awareness of cerebrovascular disease, the incidence of stroke and transient ischemic attack (TIA) in young adults has remained elevated, representing a major public health concern. We sought to better characterize our young stroke population in order to gain insight as to where targeted interventions could be beneficial in community outreach and support of affected patients. Methods: We conducted a retrospective study evaluating young adults (under 50 years of age) presenting to a single urban academic medical center with acute ischemic stroke or TIA between 2013 and 2022. Demographic information and clinical variables (including past medical history, Trial of Org 10172 in Acute Stroke Treatment [TOAST] classification of stroke etiology, and discharge disposition) were extracted from the electronic medical record and descriptive statistics were calculated. Results: A total of 408 patients were reviewed. Within this study population, the median age was 43 years (IQR 38-47 years) and 235 (57.6%) were men. The median initial National Institutes of Health Stroke Scale upon presentation was 3 (IQR 1-7). The most common stroke risk factors were tobacco use (44.6%), pre-existing cardiovascular disease (26.2%), and other substance use (23.8%). The most common TOAST classification upon discharge was Stroke of Undetermined Etiology (32.9%). Most patients (244, 59.8%) were discharged directly to home from the hospital, although 140 (34.3%) were transitioned to another facility, including acute rehabilitation facilities (95, 23.3%), skilled nursing facilities (22, 5.4%), and long-term acute care hospitals (11, 2.7%). Conclusion: Our study highlights that the continued high incidence of stroke in the young may be at least partially attributable to a high prevalence of traditional cardiovascular risk factors, thus emphasizing the importance of smoking cessation counseling and early treatment of hypertension in the primary care setting. In addition, while most young patients will present with minor stroke symptoms, a significant portion are unable to return directly to home upon discharge from the hospital.

A case of truncal complex regional pain syndrome: literature review

Introduction and importance: Complex regional pain syndrome is a rare and chronic pain disorder characterized by an abnormal level of pain disproportionate to the initiating cause, often manifesting well after the triggering event. Case presentation: The authors present a free past medical history 33-year-old female, employed as a nurse in an intensive care unit, presented with a 9-year history of diffuse back pain. Her symptoms initially emerged at the neck with muscle spasms and restricted neck mobility, eventually progressing along the spine. Notably, the pain became episodic and intensified over time, significantly impeding her daily activities. Analgesic (non-steroidal anti-inflammatory drugs) treatments proved ineffective, and a distinct feature emerged—a change in skin colour to dark purple spots on her back, accompanied by hyperhidrosis and extreme tenderness. Despite an exhaustive evaluation involving bloodwork, inflammatory markers, serological tests, and radiographic imaging, a definitive diagnosis remained elusive until she responded positively to Pregabilin. Clinical discussion: Although typically associated with extremities, this case challenges the conventional understanding of complex regional pain syndrome by showcasing its manifestation in the truncal region. The patient’s clinical history, examination findings, and diagnostic journey are detailed herein, shedding light on the complexity and diagnostic considerations associated with this condition. Conclusion: The case underscores the importance of a comprehensive approach and prompts a reevaluation of the existing guidelines to encompass such atypical presentations.

Primordial Orbital Alignment of Sednoids

We examined the past history of the three most detached trans-Neptunian objects (TNOs)—Sedna, 2012 VP113, and Leleakuhonua (2015 TG387)—the three clearest members of the dynamical class known as sednoids, with high perihelia distances q. By integrating backward their nominal (and a set of cloned) orbits for the solar system’s age, we surprisingly find that the only time all their apsidal lines tightly cluster was 4.5 Gyr ago, at perihelion longitude ϖ of 200°. This “primordial alignment” is independent of the observational biases that contribute to the current on-sky clustering in the large-semimajor-axis Kuiper Belt. If future sednoid discoveries confirm these findings, this strongly argues for an initial event during the planet formation epoch, which imprinted this particular apsidal orientation on the early detached TNO population. Their apsidal orientations were then subsequently modified only by the simple precession from the four giant planets (and weakly by the galactic tide). If other sednoids also cluster around the same primordial value, various models suggesting a still present planet in the outer solar system would be incompatible with this alignment. We inspected two scenarios that could potentially explain the primordial alignment. First, a rogue planet model (where another massive planet raises perihelia near its own longitude until ejection) naturally produces this signature. Alternatively, a close stellar passage early in solar system history raises perihelia, but it is poor at creating strong apsidal clustering. We show that all other known 35 < q < 55 au TNOs are either too perturbed or orbits are still too uncertain to provide evidence for or against this paradigm.

Abstract TP257: Atherogenic Dyslipidemia Advances Crucially the Aortic Complicated Lesion in Cryptogenic Stroke

Background and purpose: The aortic complicated lesion (ACL) is a notable embolic source of cryptogenic stroke (CS) observed in 10-60 % of patients. Although the antithrombotic and statin therapy are certainly effective, the recurrence of aortogenic stroke is not rare. Atherogenic dyslipidemia (AD) is regarded as the significant residual risk of cardiovascular diseases even under the statin remedy and characterized by low high-density lipoprotein (HDL) and high triglyceride (TG). In the present study, we aimed to clarify the underlying association between ACL and AD. Methods: Clinical data of CS patients admitted between April 2014 and December 2016 in Japanese 8 institutes and underwent transesophageal echocardiography (TEE) were analyzed in the present study. Low HDL was defined as ≤ 40 mg/dl and high TG was defined as ≥ 150 mg/dl in the fasting condition, respectively. Furthermore, AD must satisfy both cut-off values. Based on these criteria, patients were divided into 4 groups as AD group, HDL group, TG group, and non-AD group to compare the clinical features. Results: Of 664 CS patients, 68 (57 men, 68.6 ± 11.1 years) met the criteria of AD (AD group), and 108 (90 men, 68.5 ±13.7 years) fulfilled the low HDL only (HDL group), 115 (76 men, 66.9 ± 11.7 years) merely met the high TG (TG group), 373 (223 men, 69.4 ± 13.1 years) satisfied the neither (non-AD group). In a univariate analysis, ACL in arch revealed with TEE was significantly more frequent in AD group (55.9 vs 38.0 vs 39.1 vs 33.8 %, p=0.007). In a multiple regression analysis, male (OR 2.57, 95%CI 1.23-5.38, p=0.012), body mass index (unit OR 1.16, 95%CI 1.08-1.25, p&lt;0.001), diabetes (OR 2.52, 95%CI 1.41-4.53, p=0.002), ACL in arch (OR 2.12, 95%CI 1.19-3.80, p=0.011) were independently, and past history of stroke (OR 0.35, 95%CI 0.14-0.90, p=0.030) was inversely associated with AD group. Conclusions: Although the previous study exhibited that AD was predominantly associated with intracranial stenosis in atherothrombotic brain infarction, AD was also crucially related to ACL in CS in the present study. Concerning the aortogenic stroke, more intensive and pleiotropic lipid-lowering therapy would be efficacious for further treatment.

Archives and children’s cultural heritage

ABSTRACT In this explorative and collectively written paper, researchers and archivists from the research project Children’s cultural heritage — the visual voices of the archive ponder, wrestle with, confront, and dig deeper into what it means to preserve and include children’s own voices in archives. The authors acknowledge that child-produced cultural objects are historical landmarks and significant parts of national heritage. The article raises questions about where and how the ‘doing’ of what is here called children’s cultural heritage takes place, what it means to archive from children’s perspectives, and what aspects of children are saved during these preservation and archival management processes. To collect, preserve and provide access to heritage might empower and affirm individuals and subordinated groups of people who have not been seen or heard in the historical past, in the present, or in future pasts. Children, as a category, is one such subordinated group in heritage contexts. Adults therefore have a responsibility to empower children by strengthening their position towards other social groups, towards society and the heritage domain. This article provides insights into the challenges that heritage establishments face in taking children’s cultural heritage seriously.

A comparative clinical study between laparoscopic-assisted vaginal hysterectomy versus nondescent vaginal hysterectomy in benign pathological conditions

Abstract Background: The need of hour is an ideal hysterectomy surgery which has shorter operative time and shorter duration of hospital stay, early resumption to work, avoidance of disfiguring scar on abdomen, and less postoperative morbidities. Nondescent vaginal hysterectomy (NDVH) and laparoscopic-assisted vaginal hysterectomy (LAVH) are both minimally invasive surgeries with more benefits than total abdominal hysterectomy. Objective: To compare NDVH and LAVH in terms of operating time for surgery, intraoperative blood loss, intraoperative, and postoperative complications. Materials and Methods: A hospital-based prospective comparative study was carried out among 50 cases requiring hysterectomy. Detailed history was collected and thorough examination was conducted in 25 women who underwent LAVH and 25 women who underwent NDVH as per the standard operating guidelines. Parameters such as blood loss, duration of surgery, duration of hospital stay, intraoperative and postoperative complications, pain score, and time taken for ambulation were compared in the two groups. Results: Both the groups were comparable in terms of age, body mass index, comorbidities present, size of the uterus, past history of surgery, and diagnosis (P &gt; 0.01). Both the groups were comparable for intraoperative or postoperative complications (P &gt; 0.01). The mean blood loss, time taken for ambulation, pain score, and duration of hospital stay were significantly lesser (P &lt; 0.01) in the LAVH group compared to the NDVH group even though the duration of surgery was significantly (P &lt; 0.01) more in this group. Conclusion: We conclude that LAVH has more advantages over NDVH and should be incorporated in selected patients requiring hysterectomy.

The Clock Drawing Task reveals executive dysfunction in the dialysis population – an underrecognized and underestimated problem

Aim of the study The study aimed to assess the prevalence of executive function impairment among patients with chronic kidney disease (CKD) undergoing dialysis, with no subjective cognitive problems and with normal global cognition on the Mini-Mental State Examination (MMSE). We also investigated the relationship between cardiovascular risk factors and cognitive test results. Rationale for the study Patients with CKD, including those undergoing renal replacement therapy, are at a higher risk of developing cognitive impairment (CI) than the general population. Recent research has shown CI to be a growing problem among CKD patients worldwide. Yet, it remains underdiagnosed, even though it may significantly influence the lives of patients. Materials and methods In this cross-sectional, prospective study, 58 dialysis patients with no cognitive decline on the MMSE screening were assessed for executive function impairment using the Executive Clock-Drawing Task (CLOX). Moreover, past medical history, demographic data, and laboratory test results were collected. Results The mean patient age was 59.47 ± 14.98 years, and the mean duration of dialysis was 45.93 ± 48.49 months. The prevalence of executive function impairment amounted to 8.6%. Moreover, remarkably similar pattern of clock drawing was observed, with numbers written outside the clock face in the CLOX1 test. Conclusions Executive dysfunctions in dialysis patients may manifest itself before the onset of global cognitive impairment. There appear to be a deficit in the spatial domain as well. Better education may play a protective role.

Cultural Heritage and the Social Dynamics of Building Strong Institutions in Nigeria

Several scholarly debates have proven the fact that, without solid Social Institutions, a society cannot realize even the basic societal task of growth and sustainable development. In a situation such as this, the tendencies for citizenry to tilt towards heinous crimes and other harmful practices would certainly be high. Therefore, interrogating the social dynamics that enable nations realize their past history, know what to preserve and how to connect such with existential realities of contemporary times becomes a necessary proposition especially in Nigeria. From a feminist perspective, if the dominant ideology in social institutions craves for women to be perceived as second fiddle and subservient to men in a society already experiencing Globalization, cultural diffusion and technology, then there will be suppression of the female gender, such as inheritance rights. The paper argued that, even in contemporary times, the Nigerian nation still lacks solid Social Institutions, and by means of that still struggling to adapt to new cultural conditions with dominant ideology that can help maintain powerful social, economic and political interest for both sexes. Needless to say that, in recent decades, there has been a lot of exchange of ideas and concepts, through a worldwide integration of cultures, social movements; government policies that the Nigerian nation is yet to key into. Using qualitative descriptive analysis of primary and secondary data centered on conflict theory which lays emphasis on the importance of interest over norms and values and how societies are characterized by inequality, the paper assert that, strong Social Institutions as mechanisms of social order should be encouraged to produce social needs such as family, education, healthcare, religion, and politics.

Patient-Reported Outcomes and Healthcare Practices: A Retrospective Analysis of Cystic Fibrosis Management During the COVID-19 Pandemic

Background: Cystic fibrosis (CF) is one of the most prevalent inherited diseases in children. Coronavirus can lead to more severe respiratory complications in patients with comorbidities, such as CF. Additionally, the coronavirus disease 2019 (COVID-19) pandemic has imposed a substantial burden on both national and international healthcare systems. Coronavirus disease could influence CF patients’ morbidities and mortalities. Methods: A descriptive retrospective study was performed at Mofid Children's Hospital to determine the effect of the COVID-19 pandemic on CF patients. A physician completed 128 valid and reliable questionnaires. Moreover, hospital medical records were also used to revalidate the data and complete the remaining part of the questionnaire. The information collected for this study included demographic data, patients' height, patients' weight, body mass index (BMI), past and current positive history of COVID-19-like symptoms, socially determined condition, and influence of COVID-19 on routine therapeutic measurements in CF. The data were analyzed using SPSS software (version 21). Results: The majority of cases continued to perform chest physiotherapy at home, maintained routine follow-ups with pulmonologists, and adhered to their previous medication regimens (59.4%, 42.2%, and 82%, respectively). Moreover, 65.5% of participants reported leaving home less frequently than before, and approximately 73% of patients’ parents also reduced their outings, with no statistically significant differences (P &gt; 0.05). Conclusions: The daily habits of CF patients did not undergo significant changes during the COVID-19 pandemic, particularly during the Omicron wave, despite the dramatic increase in infection rates.

Granulomatous Acute Interstitial Nephritis Revealing Multisystem Sarcoidosis Associated with Thyroiditis and Cushingoid Syndrome: Report of a Case and Review of the Literature

Introduction: Sarcoidosis can present with acute renal failure (ARF) due to granulomatous interstitial nephritis (GIN). We report the case of granulomatous acute renal failure (ARF) revealing multisystemic sarcoidosis in the nephrology department of the Aristide Le Dantec hospital in Dakar. Observation: Mrs. kD aged 54 with a past history of high blood pressure for 22 years, a multi nodular euthyroid goiter, referred to the nephrology department for impaired renal function. The clinical examination revealed at entry, deterioration in the general condition with weight loss and non-selective anorexia. Clinical anemia was also noted. The clinical examination also revealed Cushingoid syndrome and dry mouth syndrome. On biology, the blood count showed bicytopenia with anemia at 10.9 g/dl and leukopenia at 2620/mm3. There was an impairment of renal function with creatinine at 139.2 mg/l and blood urea at 1.76 g/l. The renal ultrasound became normal. Cervical ultrasound showed an aspect of abscessed thyroiditis of the right lobe. Chest computed tomography (CT) showed bilateral hilar adenomegaly and a band of bilateral basal linear atelectasis. The renal biopsy showed glomeruli of subnormal structure, the interstitium is riddled with tuberculoid follicles formed of epithelioid and multinucleated histiocytes of the Langhans type. The diagnosis of granulomatous acute interstitial nephritis revealing multisystemic sarcoidosis was kept. The evolution was favorable after 1 month of treatment with corticosteroid therapy with a clear improvement in renal function. Conclusion: Renal manifestations during sarcoidosis are rare. They can be indicative of the disease as in our patient. Renal biopsy is essential in any patient presenting with impaired renal function with extra-renal signs.

PULMONARY HISTOPLASMOSIS IN A PATIENT WITH CROHN’S DISEASE ON ANTI-TNF INHIBITOR THERAPY

Abstract INTRODUCTION Infliximab, an anti-tumor necrosis factor (TNF) alpha inhibitor, is a commonly used biologic therapy for patients with inflammatory bowel disease (IBD). However, the increased risk of serious infections, including both new and re-activated infections, is a major concern while patients are on this therapy. Often the presence or development of such serious infections necessitates stopping treatment with anti-TNF inhibitors. We describe a case of a patient who developed Histoplasmosis while on infliximab but was later restarted on the same therapy due to risk of severe Crohn’s disease while maintaining him on ongoing Histoplasmosis treatment. CASE DESCRIPTION We describe the case of a 34-year-old male with a past medical history of Crohn’s disease on infliximab, hypertension, depression, and nephrolithiasis who presented to the hospital with dyspnea on exertion, cough, malaise, and night sweats, and was found to have multifocal pulmonary infiltrates on imaging, concerning for atypical pneumonia. He underwent a bronchoscopy and BAL, with pathology reports showing small oval shaped yeast within necrotic granulomas suspicious for Histoplasmosis. He was taken off infliximab and started on liposomal amphotericin for Histoplasma treatment initially, subsequently transitioned to itraconazole for total of 12 months. He was discharged home but was subsequently re-admitted to the hospital with a Crohn’s flare after being taken off infliximab. He was treated with steroids and started on vedolizumab for more gut-selectivity after a multidisciplinary risk/benefit discussion. However, patient was subsequently re-admitted with diarrhea and hematochezia, due to a Crohn’s disease flare while still on steroid taper and having received 2 doses of vedolizumab. He was transitioned to IV steroids and had a colonoscopy which showed large ulcers and mucosal inflammatory changes with a Simple endoscopic score for Crohn’s disease of 18. After a multidisciplinary discussion, he was restarted on infliximab. He was slowly tapered off steroids as his symptoms improved. Repeat colonoscopy after restarting infliximab showed improved but ongoing mucosal inflammatory changes with a Simple endoscopic score for Crohn’s disease of 7. DISCUSSION While anti-TNF inhibitor biologics are commonly used for patients with IBD, opportunistic and fungal infections remain a significant concern while on immunosuppressing biologic therapies, which necessitates stopping the anti-TNF inhibitor. Previously, a study has shown that it is safe to restart anti-TNF therapy after treatment for Histoplasmosis is completed for a 12-month duration. Our case shows that in patients such as ours with severe Crohn’s disease flares while off infliximab, treatment with anti-TNF inhibitors can be resumed after having a multidisciplinary risk/benefit discussion. Figure 1 Colonoscopy findings showing large ulcers and significant mucosal inflammatory changes after patient started on vedolizumab and admitted for Crohn’s Disease flare. Figure 2 Colonoscopy findings showing ongoing mucosal inflammation but improved from prior after restarting treatment with infliximab.

FREE AIR FROM WHERE? SPONTANEOUS PNEUMOMEDIASTINUM AND SUBCUTANEOUS EMPHYSEMA IN A PATIENT WITH ULCERATIVE COLITIS IN THE ABSENCE OF COLONIC OR ESOPHAGEAL PERFORATION

Abstract INTRODUCTION The development of Spontaneous Pneumomediastinum and Subcutaneous Emphysema in patients with Inflammatory Bowel Disease (IBD) has often been associated with perforation related to toxic megacolon or prior endoscopic procedures. We describe a case of Ulcerative Colitis complicated by Clostridium difficile (C diff) colitis in which Spontaneous Pneumomediastinum and Subcutaneous Emphysema developed without any evidence of perforation. CASE REPORT A 20-year-old male with a past medical history of recently diagnosed Ulcerative Colitis presented for evaluation of rectal pain, dysphagia, hematochezia, fecal incontinence, and urinary hesitancy. He endorsed dysphagia with the inability to tolerate solids or liquids for 4 days. He was diagnosed with Ulcerative Colitis 5 months prior to presentation and had unintentionally lost 90 lbs over the past 2 months. His home medication regimen included infliximab started 2 weeks prior, mesalamine PO tablets and suppositories, and a prednisone taper initiated at 10 mg TID. Laboratory tests confirmed anemia, leukocytosis, thrombocytosis, and elevated ESR and CRP levels. Chest X-ray and CT scans of the neck and chest showed moderate pneumomediastinum and subcutaneous emphysema. Given the symptoms of dysphagia along with the imaging findings of pneumomediastinum and subcutaneous emphysema, there was concern for esophageal perforation. However, an Esophagram and Upper GI series were both unremarkable. Abdominal CT revealed colitis of the descending and sigmoid colon without any evidence of free air or free fluid. Fecal Occult Blood Test and C diff antigen and toxin assays were positive. He was treated with oral vancomycin, IV fluids, IV methylprednisolone, and total parenteral nutrition (TPN). His symptoms significantly improved with a decrease in stool frequency and bloody stools. TPN was weaned and he was able to tolerate an oral diet. A repeat CT scan of the chest showed a complete resolution of the pneumomediastinum. CONCLUSION There are only a few reported cases in the literature of spontaneous pneumomediastinum and subcutaneous emphysema in patients with IBD in the absence of colonic or esophageal perforation. The spontaneous isolated presentation of air leaking from a chronically diseased hollow organ remains rare. In our patient there was no evidence of perforation, therefore the pneumomediastinum and subcutaneous emphysema likely resulted from the release of free air from colonic micro-perforations caused by the severe inflammation related to his Ulcerative Colitis flare and C. diff infection. CT Chest demonstrating pneumomediastinum and subcutaneous emphysema of the neck CT Neck demonstrating subcutaneous emphysema

Septic Arthritis of the Sternoclavicular Joint.

Sternoclavicular joint (SCJ) septic arthritis is a rare but rapidly fatal joint infection. Without proper medical or surgical management, it can progress to osteomyelitis, chest wall abscess, mediastinitis, or myositis. A 57-year-old male with a past history of intravenous drug use presented to the emergency department (ED) with chest tenderness of one week duration. Vital signs were unremarkable, and exam was notable for tender, raised right SCJ without any fluctuance. On point-of-care ultrasound we noted fluid collection and capsular distention along the SCJ, which aided in rapidly diagnosing septic arthritis. The patient was immediately started on antibiotics and taken to the operating room for excision and debridement. While computed tomography is routinely used in the emergency department for diagnosing septic arthritis, ultrasound offers a rapid and safe alternative for diagnosis.

Disasters And Climatic Phenomena Today And In The Past

The current interest and frenzy discussion and attribution of all the evils in climate change, the climate crisis, has led to skepticism about its right research direction, as well as its management and priority implementation actions, extended to its impacted effects on humans, the environment, and the economy. Rather than being the result of a simple mistake, an adequate dispute is based on diversity. I argue that many aspects of the scientific and ethical debate on climate change can be usefully viewed from a different more human-environment-centered perspective. This opinion article presents the topic recalling the historical past and discussing the current opinions and policy orientations followed by scientists, and decision-making centers. Emphasis is given to the prioritized sectors for mitigating the currently undesirable effects, in parallel to re-orientation and breakdown of research on the contemporary causes of climatic change from the non-human interventions.

Anti-Immigrant Eurosceptic Worldview in Estonia: a Comparison of Russian-Speaking and Estonian-Speaking Communities

This article analyzes the transformation of the attitude of the Russian-speaking and Estonian-speaking communities of Estonia towards the reception of refugees from the 1990s until the present day. A comparison is made of the attitude towards immigrants of various origins (African, Asian, Ukrainian refugees, entrants from Russia) by ethnic Estonians with the perception of them by local Russian-speaking residents of this Baltic state. The author examines the reasons for the negative and positive perception of Estonians towards immigrants of various origins. It is noted that there is a direct connection between the current perception of immigrants in Estonia and the historical past of this country. The paper describes the sharp increase in Euroscepticism in Estonia after the start of the European migration crisis in 2015, as well as the serious joint opposition of the state’s authorities and its residents to the refugee distribution quotas imposed by the European Commission. In addition to the similarities in the approaches of the two largest communities on the issue of refugees, the author also identified a number of significant differences on this topic, which is sensitive for all Estonians. The paper concludes that the refugee crisis and anti-immigrant Eurosceptic worldview have largely united ethnic Russians and Estonians living in Estonia in the face of a “common threat”. It is also justified that the present warm and hospitable attitude of ethnic Estonians towards Ukrainian refugees in the medium term may be replaced by “fatigue” and apathy towards them.

Experiential avoidance as a mediator of risk factors for higher order internalizing psychopathology in the perinatal period.

Perinatal psychopathology can be damaging. This study examined the strength of the associations between risk factors and all perinatal mood and anxiety disorder symptoms while assessing the mediating effect of experiential avoidance. Participants (N = 246) completed assessments during pregnancy (28-32 weeks) and the postpartum (6-8 weeks). Structural equation modeling (SEM) was used to examine associations between risk factors and latent factors: distress (composed of depression, generalized anxiety, irritability, and panic symptoms); fear (social anxiety, agoraphobia, specific phobia, and obsessive-compulsive); and bipolar (mania and obsessive-compulsive). During pregnancy, past psychiatric history, anxiety sensitivity, maladaptive coping, and age were significant risk factors. In the postpartum, negative maternal attitudes and past psychiatric history were only risk factors for symptoms that composed distress. Experiential avoidance mediated the relation between maladaptive coping and symptoms that composed fear. It is important to assess for psychological risk factors starting in pregnancy. This study identified critical risk factors that are associated with the underlying commonality among perinatal mood and anxiety symptoms. Some of the risk factors as well as the mediator are malleable (negative maternal attitudes, experiential avoidance), creating new possibilities for prevention and treatment of perinatal mood and anxiety disorder symptoms.

Multisystem inflammatory syndrome in adult with features of Kawasaki disease

AbstractWe present a case of a 21‐year‐old woman with fever (&gt;38.0°C) for 5 days, mucocutaneous lesions and refractory hypotension requiring dual inotropic support. The only significant past medical history was an episode of COVID infection 4 months before admission. She was diagnosed to have multisystem inflammatory syndrome in adult (MIS‐A)—a relatively new entity which occurs as a severe complication in patients post‐COVID‐19 infection. This condition can present remarkably similarly to Kawasaki disease. Although the paediatric counterpart of MIS‐A typically occurs within 2–6 weeks post COVID‐19 infection, MIS‐A may occur up to 4 months post‐COVID‐19 infection. We wish to raise awareness of this rare entity, their similarities with Kawasaki disease and the importance of early initiation of intravenous immunoglobulin and high‐dose aspirin.

Severe Pulmonic Valve Endocarditis with Septic Pulmonary Embolism in a Teenager: Case Report

A 14-year-old boy with an uneventful past history suffered from one week of high-grade fever and progressive dyspnea. The patient developed necrotizing pneumonia with massive loculated pleural effusion and septic shock. Echocardiogram revealed a small perimembranous VSD with multiple vegetations at pulmonic valve and both pulmonary arteries. Intravenous antibiotic therapy, mechanical ventilatory support, chest tube placement, and intrapleural fibrinolytic therapy were performed. He was clinically improved after eight weeks of antibiotic therapy. Keywords: Septic pulmonary embolism; Pulmonic valve endocarditis; Infective endocarditis