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Objective: This study aims to systematically review the literature on using electroconvulsive therapy (ECT) in patients with dementia/major NCD (Neuro cognitive disorder) presenting with behavioral symptoms. Design: We conducted a PRISMA-guided systematic review of the literature. We searched five major databases, including PubMed, Medline, Embase, Cochrane, and registry (ClinicalTrials.gov), collaborating with “ECT” and “dementia/major NCD” as our search terms. Measurements: Out of 445 published papers and four clinical trials, only 43 papers and three clinical trials met the criteria. There were 22 case reports, 14 case series, 4 retrospective chart reviews, 1 retrospective case–control study, 1 randomized controlled trial, and 2 ongoing trials. We evaluated existing evidence for using ECT in dementia/major NCD patients with depressive symptoms, agitation and aggression, psychotic symptoms, catatonia, Lewy body dementia/major NCD, manic symptoms, and a combination of these symptoms. Settings: The studies were conducted in the in-patient setting. Participants: Seven hundred and ninety total patients over the age of 60 years were added. Results: All reviewed studies reported symptomatic benefits in treating behavioral symptoms in individuals with dementia/major NCD. While transient confusion, short-term memory loss, and cognitive impairment were common side effects, most studies found no serious side effects from ECT use. Conclusion: Current evidence from a systematic review of 46 studies indicates that ECT benefits specific individuals with dementia/major NCD and behavioral symptoms, but sometimes adverse events may limit its use in these vulnerable individuals.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel strain of coronavirus that has spread throughout the globe causing coronavirus disease 2019 (COVID-19). As the number of cases rises in the United States (US), it has become more imperative to detect COVID-19 at its earliest radiologic stage to decrease community transmission. In this case series, we discuss five patients who presented with non-respiratory-related symptoms and underwent non-chest CT imaging, such as abdominal and neck CT, with a portion of the lungs visualized in each respective study. Imaging findings of COVID-19 include basilar and peripherally predominant pulmonary parenchymal ground-glass opacities. All five of our patients had findings suggestive of COVID-19 that prompted the radiologist to suggest testing for the disease. Subsequently, four of the five patients tested positive for COVID-19, and one of them was presumed to have the diagnosis based on clinical and imaging findings.

One of the most dreaded complications of fracture management is a nonunion. Nonunions are usually difficult to manage and can be a source of significant mental, physical, and financial distress to the patient. The incidence of nonunion is dependent on multiple factors including degree of comminution, open versus closed, concomitant infection, and vascular status, and therefore the management of such nonunions continues to be an often debated topic. Currently, there is no clear consensus on the role of reamed exchange nailing for tibial shaft nonunions. While reamed exchange nailing for aseptic tibial shaft nonunions has shown promising results, with very high union rates, many surgeons prefer newer novel techniques such as plating along with osteoperiosteal decortication or the use of more conventional compressive plating with bone grafts. The aim of this article is to critically review and understand the available evidence base on reamed exchange nailing in nonunion of tibial shaft fractures and to explore the other options available and their indications.

Coronavirus disease 2019 (COVID-19) is currently the causative agent for a global health emergency and is predominantly associated with respiratory symptoms. In this case, a patient presented to the emergency department with gastrointestinal symptomatology without associated respiratory findings and was subsequently diagnosed with COVID-19 based on incidental findings from an abdominal computed tomography (CT) study. Given the patient's lack of respiratory symptoms, diagnosis and treatment were ultimately delayed. During this global health crisis, an improved understanding of the various presentations of COVID-19 is paramount in an effort to initiate immediate treatment and prevent further transmission.