Volume 4, Issue 2, Summer 2022


Association between Negatively Impacted Wellbeing and Alcohol Consumption during the COVID-19 Pandemic

Jiyeon Park; Peter Anto Johnson; John Johnson; Austin Albert Mardon

Canadian Journal of Medicine, 2022, Volume 4, Issue 2, Pages 38-41
DOI: 10.33844/cjm.2022.6020

Uncertainty about the future, fear of losing a loved one, and countless lockdowns and social distancing restrictions have created great stress for almost everyone during the COVID-19 pandemic. As a result, the wellbeing of individuals has been negatively impacted. Maintaining stable wellbeing is important as is an avoidance of excessive alcohol use, as both factors can potentially harm individual health and lead to death. However, an increase in alcohol purchases and alcohol consumption has been noted globally during the COVID-19 pandemic. Thus, this article explores the possible connections between affected wellbeing and alcohol usage during the COVID-19 pandemic.  

An Investigation into the Association of COVID-19 and Viral Myocarditis: A Literature Review

Zara Hasan; Parmin Rahimpoor-Marnani; Vivek Kannan; Shruti Misra; Austin Albert Mardon

Canadian Journal of Medicine, 2022, Volume 4, Issue 2, Pages 42-50
DOI: 10.33844/cjm.2022.6021

Myocarditis, or inflammation of the muscle layer in the heart wall, is caused by several factors including viral infection. Although the literature briefly alludes to a method of viral entry into cardiomyocytes, this work provides further detail into subsequent novel mechanisms leading to the development of myocarditis following infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The keywords "COVID-19”, “SARS-CoV-2”, “Myocarditis”, “viruses”, and “human” were used to run searches on OVID Medline, as well as Google Scholar. Resulting papers were subject to further analysis. SARS-CoV-2 binds to the angiotensin-converting enzyme 2 (ACE2) receptor which is found on type 2 pneumocytes and cardiomyocytes. Infection of cardiomyocytes can overregulate the immune response resulting in a cytokine storm: an uncontrolled increase of proinflammatory cytokines, as is commonly seen in respiratory infections. Cytokines can enter established biological pathways, creating positive feedback, which causes increased inflammation leading to myocarditis. SARS-CoV-2 viral envelope (E) proteins present an alternate association with myocarditis. Less severe myocarditis manifests common symptoms, and detecting it before it worsens may be difficult. Understanding the pathogenesis of myocarditis in COVID-19 could help find and implement preventative measures during future treatment.

Importance of Music Participation on Mental Health and Wellbeing Among Senior Citizens during the COVID-19 Pandemic

Jiyeon Park; Peter Anto Johnson; John Johnson; Austin Albert Mardon

Canadian Journal of Medicine, 2022, Volume 4, Issue 2, Pages 51-54
DOI: 10.33844/cjm.2022.6022

As life expectancy continues to increase, it is critical to investigate ways to age successfully physically, mentally, and socially. Senior citizens (65 years and older) tend to struggle with lower mental health and wellbeing and suffer higher incidences of loneliness compared to the younger population. As a result, the COVID-19 pandemic has put them at higher risk, not only of contracting the virus, but also of experiencing feelings of loneliness and depression. Music participation, specifically music therapy, has been known to be an effective tool to promote wellbeing and mental health, especially among the elderly. Thus, this article investigates the changes in mental health and wellbeing among elderly people when participating in music to explore the importance of conducting virtual music participation programs during the COVID-19 pandemic.   

Thyrotoxic Periodic Paralysis in the Post-COVID Era: A Case Report with Literature Review

Chaitanya Gandhi; Mahua Ghosh

Canadian Journal of Medicine, 2022, Volume 4, Issue 2, Pages 55-62
DOI: 10.33844/cjm.2022.6023

Thyrotoxic Periodic Paralysis (TPP) is an acute potentially lethal emergency in patients with hyperthyroidism who present with sudden muscle weakness and hypokalemia. It is commonly precipitated by high carbohydrate or high salt content meals, strenuous exercise, stress, trauma, glucocorticoids, epinephrine, alcohol, or respiratory infections. COVID-19 infection or vaccination may represent a novel trigger for TPP. Furthermore, COVID-19 infection or vaccination may incite inflammatory processes leading to thyrotoxicosis, which can manifest as TPP. While COVID-19 causing subacute thyroiditis, euthyroid sick syndrome, Hashimoto’s disease, or Graves’ disease have been well documented in the literature; there have only been six case reports of post-COVID-19 TPP. Notably, all cases thus far have been restricted to male patients, and there is paucity of literature from North America. The purpose of this paper is to outline the first case of post-COVID-19 TPP in a female patient, who presented to the emergency department with acute paralysis and severe hypokalemia (2.2 mmol/L) three months after COVID-19 infection. Investigations in the emergency department showed thyrotoxicosis. She was treated with potassium replacement, which improved her paralysis. Subsequent investigations revealed severe hyperthyroidism from Graves’ disease, which is currently managed with metoprolol and methimazole. Her hyperthyroidism improved without recurrent hypokalemia or paralysis. In addition, we outline the epidemiology, pathophysiology, precipitants, and management of TPP, with a particular focus on COVID-19 infection or vaccination precipitating TPP. We discuss post-COVID-19 TPP cases thus far described in the literature. Knowing that North American COVID-19 infection waves lagged Asia, we could anticipate additional future TPP cases.

A Case Study of Administering Lithium to a Senior Who is Bipolar and Who Also has Chronic Kidney Disease Using an Innovative Treatment Method

Richard Burns

Canadian Journal of Medicine, 2022, Volume 4, Issue 2, Pages 63-68
DOI: 10.33844/cjm.2022.6024

The case follows the treatment of a woman from age 73 to age 83 who was bipolar and who also had Chronic Kidney Disease (CKD). During the study, the eGFR dropped from 43 to below 20. Initially the treatment was fairly standard but highlighted the difficulty of knowing when to reduce the lithium dose before undesired mood changes occurred. In phase 2 of the treatment, the usual monthly blood serum test is combined with a new concept of a monthly running average eGFR to decide when to reduce the lithium dose. A new way of administering lithium was created which was used when the patient’s daily dose of lithium reached 300mg a day.  In place of a fixed daily dose of lithium, a fixed average daily dose of lithium over a short cyclic pattern was used. The daily dose varies within the repeatable cycle but is smoothed out by the long half-life of lithium. The new method allows for the reduction of the lithium dose by small amounts, less than the minimum strength 150mg capsule used in North America or the 100mg tablet used in Europe.  The method has been successfully used for several years with the patient’s moods stable and lithium toxicity avoided. The patient is currently on an average daily dose of 187mg a day with an eGFR less than 20.

Understanding and Using the Variable Therapeutic Region of Lithium for Bipolar Patients During Aging

Richard Burns

Canadian Journal of Medicine, 2022, Volume 4, Issue 2, Pages 69-74
DOI: 10.33844/cjm.2022.6025

In 2019, Shulman et al. [1] summarized the known lithium therapeutic ranges for Old Age Bipolar Patients (OABP).  For patients over 60, the range is 0.4-0.8 mmol/L, and for those over 80, 0.4-0.7 mmol/L. For younger patients, the standard region is 0.6-1.2 mmol/L. The current research leaves three disconnected therapeutic ranges. A unifying theory is developed explaining the therapeutic range of lithium for all ages. It explains why the changes in the therapeutic range happen and exactly how the upper limits change on a year by year basis instead of by decades.  It also explains why and when the standard therapeutic range should be abandoned.   In developing the theory, only information about the changes with age in the eGFR is used; when applied to lithium, the theory explains why the therapeutic regions for over sixty and over eighty exist. The known ranges were discovered using empirical evidence. The theory gives a more precise start for those regions as well as how to move smoothly through them.  It applies for bipolar patients who do not have chronic kidney disease and shows that a new therapeutic region for those over 90 needs to be created. Table 1 is developed using the new theory to give the upper limit, the midpoint, and the twenty-fifth percentile up from the minimum level of the therapeutic range for each year from age fifty to one hundred.  This table enables doctors to keep the patient’s serum level where they want it as the patient ages.