Faculty Bibliography

BACKGROUND: The spread of SARS-CoV-2 has caused mortality and long-lasting morbidity worldwide. Acutely, COVID-19 may elevate risk of blood clots, cardiomyopathy, and acute kidney injury. For many critically ill patients, dialysis has been essential in managing infection. Long-term, the impact of COVID-19 on renal function remains unknown. This longitudinal observational study examines basic renal function indexed by serum creatinine and estimated Glomerular Filtration Rate (eGFR) measured ~10-26 weeks after COVID-19 onset.
METHOD(S): We queried the NYU Langone COVID Deidentified Dataset for adults with a positive SARS-CoV-2 PCR test and excluded End-Stage Renal Disease (ESRD) patients (3%). The cohort had a creatinine test from a Basic or Comprehensive Metabolic Panel >2 weeks before and >2 weeks after infection (n=501; 54% female; 18%=18-42 years, 39%=43-67 years, 43%=68+ year old). Within- patient pre- vs. post-COVID creatinine change change was normalized by the patient's latest pre- COVID creatinine test. To gauge the putative clinical relevance of creatinine change in understanding risk for deterioration to ESRD, renal function stratified by eGFR (ml/min/1.73m2 ), available only for n=221 (44% of cohort), is illustrated in the figure below.
RESULT(S): Post-COVID creatinine levels were greater (1.327 mg/dL +/- 0.06, mean +/- SEM) than pre- COVID levels (1.248 mg/dL +/- 0.07) representing a post-COVID increase change =0.093 (Cohen's d effect size=0.15, t500=3.3, p<0.001). This creatinine change was captured at a pre-/post-interval=192.5 +/- 3.1 days (mean +/- SEM), corresponding to 129.5 +/- 3.1 days after a COVID-19 infection (min=2 weeks, IQR=10-26 weeks, max=38 weeks).
CONCLUSION(S): In an early COVID-19 epicenter, we show preliminary evidence of sustained creatinine increases in a cohort without ESRD around 3- 6 months following COVID-19 onset. Future work should isolate the role of pre-existing risk factors and link potentially new renal dysfunction more directly to COVID-19. Given the long-term follow-up data available in this study, we recommend that primary care providers track renal function in patients following COVID-19 infection to screen for emergent renal disease and adjust any renally dosed medications. LEARNING OBJECTIVE #1: Identify changes in renal function after recovery from COVID-19 infection LEARNING OBJECTIVE #2: Depict patterns of long-term renal function changes post-COVID

Automatic emotion regulation (AER) plays a vital role in the neuropathology underlying both suicide and self-harm via modifying emotional impact effortlessly. However, both the effortless account and the neural mechanisms of AER are undetermined. To investigate the neural changes at AER, we collected functional MRI (fMRI) in 31 participants who attended to neutral and disgust pictures in three conditions: watching, goal intention (GI), and reappraisal by implementation intention (RII). Results showed that RII (but not GI) decreased negative feelings and bilateral amygdala activity without increasing cognitive efforts, evidenced by the reduced effort rating and less prefrontal engagement during RII compared with during watching and GI. These emotion-regulatory effects of RII cannot be explained by emotional habituation, as the supplementary experiment (N = 31) showed no emotional habituation effects when the same disgust pictures were presented repeatedly three times for each watching and GI condition. Task-based network analysis showed both RII and GI relative to watching increased functional connectivities (FCs) of the ventral anterior cingulate cortex to the left insula and right precuneus during conditions, two FCs subserving goal setup. However, RII relative to GI exhibited weaker FCs in brain networks subserving effortful control, memory retrieval, aversive anticipation, and motor planning. In these FCs, the FC intensity of putamen-operculum/lingual and paracentral-superior temporal gyri positively predicted regulatory difficulty ratings. These findings suggest that the setup of implementation intention automatizes emotion regulation by reducing the online mobilization of emotion-coping neural systems.

Equine-assisted services include novel approaches for treating children's mental health disorders, one of which is anxiety (Latella & Abrams, 2019). Reining in Anxiety is a manualized approach to adaptive riding drawing on evidence-based cognitive behavioral therapy elements for youth with anxiety. This intervention was delivered by PATH Certified Therapeutic Riding Instructors (CTRIs) in a randomized pilot study. Fidelity checklists, developed to match the core components of the manualized intervention, were collected by independent observers. Fidelity scores addressed an average of 98.7% of components, well beyond the threshold for high fidelity (e.g. >80%) established in the literature (Garbancz et al., 2014). These findings show that the PATH CTRIs trained in the Reining in Anxiety intervention for this study, with supervision and implementation supports, delivered this intervention with high fidelity. This has important implications for expanding access to evidence-based community mental health services beyond traditional clinic settings and providers, and for addressing the gap between the need for and use of evidence-based youth mental health services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Background: Despite evidence-based national guidelines for ADHD in the United Kingdom (UK), ADHD is under-identified, under-diagnosed, and under-treated. Many seeking help for ADHD face prejudice, long waiting lists, and patchy or unavailable services, and are turning to service-user support groups and/or private healthcare for help. Methods: A group of UK experts representing clinical and healthcare providers from public and private healthcare, academia, ADHD patient groups, educational, and occupational specialists, met to discuss shortfalls in ADHD service provision in the UK. Discussions explored causes of under-diagnosis, examined biases operating across referral, diagnosis and treatment, together with recommendations for resolving these matters. Results: Cultural and structural barriers operate at all levels of the healthcare system, resulting in a de-prioritization of ADHD. Services for ADHD are insufficient in many regions, and problems with service provision have intensified as a result of the response to the COVID-19 pandemic. Research has established a range of adverse outcomes of untreated ADHD, and associated long-term personal, social, health and economic costs are high. The consensus group called for training of professionals who come into contact with people with ADHD, increased funding, commissioning and monitoring to improve service provision, and streamlined communication between health services to support better outcomes for people with ADHD. Conclusions: Evidence-based national clinical guidelines for ADHD are not being met. People with ADHD should have access to healthcare free from discrimination, and in line with their legal rights. UK Governments and clinical and regulatory bodies must act urgently on this important public health issue.

In this case report, we present a patient with the rare plasmacytoid variant of urothelial cancer. Notable elements of his course include: complete response to neoadjuvant paclitaxel, gemcitabine, cisplatin, development of metastatic disease to the rectum, sustained disease control with dual HER2 targeting therapy, and subsequent complete response to enfortumab vedotin. Plasmacytoid urothelial cancer accounts for just 1-3% of all urothelial cancer cases and is associated with more aggressive disease, with a propensity for intra-abdominal spread and poor response to neoadjuvant therapy. Preliminary data indicate that the variant may generally have high levels of HER2 expression. We review the history of HER2 targeting in metastatic urothelial cancer, which has included single-agent as well as combination with chemotherapy; there are ongoing biomarker-based clinical trials. Furthermore, we highlight the complete response to enfortumab vedotin. To date, this is the first report of efficacy for enfortumab vedotin in the plasmacytoid variant.

As more young people feel safe to outwardly identify as transgender or gender expansive (TGE), meaning that their gender identity does not align with the sex they were assigned at birth, an increasing number of youth who identify as TGE seek gender-affirming medical care (GAMC). GAMC raises a number of ethical questions, such as the capacity of a minor to assent or consent, the role of parents or legal guardians in decisions about treatment, and implications for equitable access to care when differing parental or custodial viewpoints are present. These questions are further complicated by the difficulties in explaining the limits of long-term research in GAMC, with regard to the preservation of fertility, for example. We present two de-identified composite case studies to highlight dilemmas that may arise and offer recommendations to better support patient- and family-centered decision making for GAMC. These include employing a multidisciplinary shared decision-making approach, disentangling informed consent and assent from chronological age, developing a consistent approach to the assessment of decisional capacity, and developing age-appropriate informational materials.

Cannabis (marijuana) has been known to humans for thousands of years but its neurophysiological effects were sparsely understood until recently. Preclinical and clinical studies in the past two decades have indisputably supported the clinical proposition that the endocannabinoid system plays an important role in the etiopathogeneses of many neuropsychiatric disorders, including mood and addictive disorders. In this review, we discuss the existing knowledge of exo- and endo-cannabinoids, and role of the endocannabinoid system in depressive and suicidal behavior. A dysfunction in this system, located in brain regions such as prefrontal cortex and limbic structures is implicated in mood regulation, impulsivity and decision-making, may increase the risk of negative mood and cognition as well as suicidality. The literature discussed here also suggests that the endocannabinoid system may be a viable target for treatments of these neuropsychiatric conditions.