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Introduction: The new pandemic of coronavirus disease 2019 (COVID-19) has evolved certain neurologic syndromes as a presentation of this disease that should be integrated into the whole disease process. Case Presentations: We present cases of neurologic involvement in adult patients with documented bronchopulmonary COVID-19. Certain signs and symptoms are introduced, including new onset seizures, ischemic stroke, and altered mental status in otherwise minimal clinical signs and symptoms of COVID-19. Conclusions: Many neurologic presentations are diagnosed in resolving COVID respiratory infections or in an otherwise asymptomatic individual.
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Introduction: The new pandemic of coronavirus disease 2019 (COVID-19) has evolved certain neurologic syndromes as a presenta-tion of this disease that should be integrated into the whole disease process. Case Presentations: We present cases of neurologic involvement in adult patients with documented bronchopulmonary COVID-19. Certain signs and symptoms are introduced, including new onset seizures, ischemic stroke, and altered mental status in otherwise minimal clinical signs and symptoms of COVID-19. Conclusion(s): Many neurologic presentations are diagnosed in resolving COVID respiratory infections or in an otherwise asymp-tomatic individual. Copyright © 2022, Author(s).
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Background: Few studies have reported the association of Guillain-Barre syndrome (GBS) and coronavirus disease-2019 (COVID-19) infection. In this study, we reported GBS in six patients infected with COVID-19 and reviewed all existing literature about GBS in association with COVID-19. Method(s): This study was performed in three referral centers of COVID-19 in Iran, and six patients with the diagnosis of GBS were enrolled. Patients enrolled in the study with acute progressive weakness according to the demyelinating or axonal variant of GBS, according to Uncini's criteria. Result(s): Four of our patients had axonal polyneuropathy, two patients had demyelinating polyneuropathy, and one patient required mechanical ventilation. All our patients had a favorable response to treatment. In one patient, the GBS symptoms recurred four months after the first episode. Conclusion(s): Limited case reports suggest a possible association between GBS and COVID-19. Such associations may be an incidental concurrence or a real cause-and-effect linkage;however, more patients with epidemiological studies are necessary to support a causal relationship. Copyright © 2020 Iranian Neurological Association, and Tehran University of Medical Sciences.
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Background: Patients with a prolonged corrected QT (QTc) interval are at risk of arrhythmias, including Torsade de pointes (TdP). This interval could be affected by demographic characteristics, ischemia, and most importantly drugs. Furthermore, hospitalized patients tend to experience arrhythmias, accompanied by electrolyte abnormalities and the inflammatory status of diseases. Methods: The present retrospective study recruited 135 patients with COVID-19. We observed the QTc interval on the third post-administration day and laboratory findings for possible risk factors for QTc-interval prolongation. Results: Ischemic heart disease was markedly more common among patients with prolonged and severely prolonged QTc intervals. Laboratory findings showed a significantly higher neutrophil-to-lymphocyte ratio (NLR) in patients with prolonged or severely prolonged QTc intervals compared with those with normal QTc intervals and QTc intervals exceeding 500 milliseconds (P<0.001) on admission and the third day. Ribavirin caused the most elevation in the QTc interval after 3 days of hospitalization compared with other drugs. Forty percent of the patients who took ribavirin experienced a QTc interval exceeding 500 milliseconds, which was significant compared with other therapeutic regimens. Conclusions: In addition to the well-known predisposing factors for the prolongation of QTc interval, we suggest focusing on the history of ischemic heart disease and inflammatory status (eg, by NLR) in patients with COVID-19 before making decisions to commence drugs that greatly affect QTc intervals. Further studies are required to shed light on the cardiac side effects of medications applied for COVID-19, particularly ribavirin.
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COVID-19 is a multisystemic infectious disease that primarily affects the respiratory system. However, the involvement of extra-pulmonary systems has also been reported. We report a 25-year-old female patient who visited the emergency department with a four-day history of severe burning epigastric pain associated with vomiting. The patient was later diagnosed with severe acute pancreatitis with concomitant severe COVID-19 based on clinical, biochemical, and imaging findings. The patient was managed with antibiotics, anticoagula-tion, and ventilatory support. Despite aggressive treatment efforts, the patient sustained cardiac arrest in the setting of refractory hypoxemia and passed away on day three of her hospitalization. © 2022 Tehran University of Medical Sciences.
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Background: The coronavirus disease 2019 (COVID-19) pandemic imposed the most devastating challenge on healthcare systems worldwide. Iran was among the first countries that had to confront serious shortages in reverse-transcriptase-polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and ventilators availabilities throughout the COVID-19 outbreak. Objectives: This study aimed to investigate the clinical course of hospitalized COVID-19 patients with different real-time RT-PCR test results during the first three weeks of the outbreak in Qazvin province, Iran. Methods: In this retrospective cohort study, patients with a positive chest computed tomography (CT) scan for COVID-19 who were admitted to all 12 hospitals across Qazvin province, Iran, between February 20 and March 11, 2020, were included and followed up until March 27, 2020. A multivariate logistic regression model was applied to compare the independent associates of death among COVID-19 patients. Then, patients were categorized into six groups based on admission to the intensive care unit (ICU) and rRT-PCR test status (positive, negative, or no test). Also, multilevel logistic regression was used to compare the odds of surviving in each group against the reference group (PCR negative patients not-received ICU) to show if the rational allocation of ICU occurred while its capacity is limited. Results: In this study, we included 998 patients (57% male;median age: 54 years) with positive chest CT scan changes. Among them, 558 patients were examined with rRT-PCR test and 73.8% tested positive. Case fatality rate (CFR) was 20.68 and 7.53% among hospitalized patients with positive and negative tests, respectively. While only 5.2% of patients were admitted to the ICU, CFR outside ICU was 17.70 and 4.65% in patients with positive and negative results not admitted to the ICU, respectively. Conclusions: Total CFR in all hospitalized COVID-19 patients in Qazvin province during the first three weeks of the pandemic was 11.7%. Also, according to the results, the main risk factors included a positive rRT-PCR test, age more than 70 years, and having two or more comorbidities or just immunodeficiency disorders. Hence, the ICU admission criteria or prioritized ICU beds allocation should be considered with more emphasis on rRT-PCR results when the capacity of ICU beds is low.
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Background and aim The severity of Coronavirus Disease 2019 (COVID-19) is a multifactorial condition. Cardiac and acute kidney injury (AKI) are two complications commonly reported in severe forms of COVID-19. We aimed to investigate the effect of these tow complications on the COVID-19 in-hospital mortality. Materials and methods This is a prospective study, including 120 severe cases of COVID-19, admitted at the university hospital of Blida. Troponin was assessed by an immuno-fluoroassay method. AKI was defined according to the KDIGO-2012 guidelines. The association with in-hospital mortality was assessed using the Kaplan–Meier survival curve, proportional Cox regression analyses and the receiver operating characteristic curve. Results Cardiac and acute kidney injury were very common, occurring in 19% and 25% of patients. When analyzing survival, both were significantly associated with in-hospital mortality (pLogRank<0.0001). A cutoff value of 9.6ng/mL for troponin and 13.9mg/L for creatinine could predict poor prognosis with a sensitivity of 73% and 67%, and a specificity of 62% and 64%, respectively. Hazard ratios were (HR=3.5, 95% CI [1.7–7.3], P=0.001 and HR=3.14, 95% CI [1.6–6.1], P=0.001) for troponin cutoff and AKI respectively. Conclusion This study demonstrates the high frequency of cardiac and acute kidney injury in severe COVID-19 patients and provides further evidence of their potential link to poor short-term prognosis.
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Introduction/Background*Same-day discharge (SDD) has been found to be safe and attainable following minimally invasive surgery (MIS) for gynaecological cancer.1 We audited the compliance to SDD, opposed to 24 hours discharge, at the Royal London Hospital.MethodologyWe performed a retrospective audit of all minimally invasive hysterectomies performed at the Royal London Hospital in 2019 and 2020. All patients were identified for SDD at pre-op clinic and were followed up until 30 days post discharge.Data was collected from electronic patient to record demographic, operating time & outcome, postoperative recovery (+/- complication and readmission) and time of discharge.Following the first audit cycle in 2019, interventions were performed comprising of staff education to highlight the human factors that led to failed SDD (including delayed prescriptions, discharge summaries and removal of catheters).Result(s)*A total of 12 patients were selected for SDD in 2020 compared to 22 in 2019 with 30 day follow up for all patients. Numbers of patient in 2020 was reduced due to covid. Successful SDD was achieved in 42% of cases in 2020 compared to 56% in 2019. Of those planned for SDD, 50% of those that failed were due to unavoidable intraoperative complications. No SDD discharges in 2020 failed due to pharmacy, transport or discharge documentation delays (7 failed SDD in 2019 due to these factors). No re-admissions or complications were recorded.Conclusion*Same day discharge continues to be safe and achievable following minimally invasive surgery for gynecological cancer, despite disruption from the Covid-19 pandemic. Auditing and implementation of interventions helps improve this pathway.ReferenceKorsholm M, Mogensen O, Jeppesen MM, Lysdal VK, Traen K, Jensen PT. Systematic review of same-day discharge after minimally invasive hysterectomy. Int J Gynaecol Obstet 2017 Feb;136(2):128–137. doi: 10.1002/ijgo.12023. Epub 2016 Nov 11. PMID: 28099736.
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Background and Objectives: Several studies have focused on the alterations of hematological parameters for a better un-derstanding of the COVID-19 pathogenesis and also their potential for predicting disease prognosis and severity. Although some evidence has indicated the prognostic values of thrombocytopenia, neutrophilia, and lymphopenia, there are conflicting results concerning the leukocyte and monocyte count. Materials and Methods: In this retrospective Double Centre study, we reviewed the results of WBC and monocyte counts of 1320 COVID-19 patients (243 of whom (18.4%) had severe disease) both on admission and within a 7-day follow-up. Results: We found that both the number of monocytes and the percentage of monocytosis were higher in the severe group;however, it was not statistically significant. On the other hand, we found that not only the mean number of WBCs was significantly higher in the severe cases also leukocytosis was a common finding in this group;indicating that an increased number of WBC may probably predict a poor prognosis. Also, the monocyte count was not affected by age;however, univariate analysis showed that the percentage of leukocytosis was significantly greater in the older group (>50) with an odds ratio of 1.71 (P: 0.003). Conclusion: Alteration of monocytes either on admission or within hospitalization would not provide valuable data about the prediction of COVID-19 prognosis. Although the rapidly evolving nature of COVID-19 is the major limitation of the present study, further investigations in the field of laboratory biomarkers will pave the way to manage patients with severe disease better.