Unvaccinated COVID-19 Pneumonia- a family affair.

The authors present the case of a 15-year-old boy who was infected with COVID-19 by his family and developed pneumonia severe enough to require hospitalization. He was one of several children who required hospitalization, and vaccination was considered by the parent to be "risky" despite this. This case illustrates the complexities of vaccine hesitancy and societal misinformation.

Telehealth in Response to the Rural Health Disparity.

The COVID-19 pandemic introduced lockdown and social distancing measures that made new methods of healthcare essential. Telehealth was introduced as a temporary measure but is being considered as a more permanent form of healthcare, particularly in rural areas, to provide more equitable healthcare. A survey was conducted on 200 rural dwellers (residents) regarding their experience with rural healthcare, any barriers to adequate healthcare, and openness to telehealth. The results demonstrated interest in telehealth and predominately positive experiences with telehealth in the areas where there was need and lack of access to healthcare, more commonly expressed in the younger age group. Quality healthcare should be equitable and available for every individual irrespective of zip code or the county they live. Telehealth is capable of bridging the gap of lack of access and transportation for individuals in rural areas to meet their healthcare needs in a timely fashion in the coming years.

COVID-19 Vaccine Hesitancy Among Healthcare Providers.

Objective: Vaccine hesitancy among healthcare providers can compromise public confidence in vaccination during the ongoing COVID-19 global epidemic and increase susceptibility to life-threatening disease. We sought to investigate predictors of openness to vaccination among healthcare workers who choose not to be vaccinated against COVID-19 in order to explore potential solutions. Methods: Physicians, physician assistants, and nurses who chose not to be vaccinated were surveyed to decipher reasons for vaccine refusal and personal loss due to the virus along with demographic variables. Multivariate logistic regression analysis evaluated whether provider role, parenthood, and death of family or friends were associated with strong versus relative vaccine refusal. Results: The predominant reasons for vaccine hesitancy in this cohort of health care workers who had access to, but chose not to be vaccinated (n=500) were a concern for vaccine side effects (69.6%) and the belief that the vaccines are inadequately studied (61.6%). Being a physician, a parent, and having no experience of death in the family or friends had 2.64 times (95% CI: 1.65-4.23, p < 0.001), 1.72 times (95% CI: 1.05-2.81, p = 0.032), and 1.70 times (95% CI: 1.06-2.72, p = 0.028) the odds of strong vaccine refusal, respectively. Older age (35 and up) respondents were 1.83 times (95% CI: 1.24-2.68, p = 0.002) more likely to be open to vaccination.

Use of Casirivimab and Imdevimab for the Treatment of COVID-19.

The authors present three cases of unvaccinated coronavirus disease 2019 (COVID-19) patients who exhibited symptoms of fever, sore throat, nausea, diarrhea, congestion, and headache. Although they refused COVID-19 vaccination, they presented for the casirivimab and imdevimab monoclonal antibody cocktail, which resulted in the resolution of all symptoms. The authors describe the mechanisms and importance of monoclonal antibody treatment for high-risk and unvaccinated patients infected with SARS-CoV-2.

Threatened Miscarriage in a COVID-19 Patient.

The authors present the case of a 30-year-old female who was pregnant and contracted COVID-19. She presented with vaginal bleeding and eventually went on to miscarry. Here, we discuss the risk factor of COVID-19 for threatened miscarriage and spontaneous abortion as well as pregnancy being a risk factor for increased COVID-19 disease severity. The patient received casirivimab and imdevimab per emergency department protocol due to this increased risk.

Severe COVID-19 Pneumonia in an Unvaccinated Female Treated With Remdesivir.

Though recent developments in the management of the coronavirus disease 2019 (COVID-19) pandemic have resulted in significant progress, its continued persistence demands continued consideration both of larger scale public health factors as well as individual patient management. We present a case that provides a broad perspective across several issues within both categories, of a morbidly obese 34-year-old unvaccinated female presenting with respiratory distress secondary to COVID-19 pneumonia, managed through remdesivir therapy. Though this case presents an example of successful management, it nonetheless emphasizes the demand for a renewed focus on vaccine hesitancy and obesity as public health issues, particularly within the context of the pandemic.

The History and Evolution of the Stethoscope.

This paper is a summary of the evolution of the stethoscope. It goes through the major stages of stethoscope evolution, starting with the first recorded breath sounds and going all the way to the most recent, entirely automated stethoscope pads. The iconic stethoscope has undergone many changes and evolved with the times to earn its place slung around the neck of a physician. This review traces its journey.

The Burden of Hypercoagulability in COVID-19.

The novel coronavirus disease 2019 (COVID-19) infection has widespread impact on multiple organ systems, including damage to endothelial cells. Various studies have found evidence for direct mechanisms by which interaction between severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and endothelial cells lead to extensive damage to the latter, and indirect mechanisms, such as excessively elevated cytokines, can also result in the same outcome. Damage to the endothelium results in release of thrombotic factors and inhibition of fibrinolysis. This confers a significant hypercoagulability burden on patients infected or recovering from COVID-19 infection. In this case report, the authors report the case of a gentleman presenting with extensive deep vein thrombosis and pulmonary embolism, in the context of recent COVID-19 infection. The postulated mechanisms and management are discussed.

Prevalence of hepatopancreatic injury and clinical outcomes in patients with COVID-19 in USA.

BACKGROUND: (1) To determine the prevalence of hepatopancreatic injury in coronavirus disease 2019 (COVID-19) patients. (2) To correlate hepatopancreatic injury in COVID-19 with mortality, disease severity, and length of stay in this cohort. RESULTS: Forty-five thousand three hundred sixty patients were included in the analysis, 62.82% of which had either hepatic or pancreatic injury. There was a significant upward trend in transaminases, alkaline phosphatase, prothrombin time, bilirubin, lactate dehydrogenase, and lipase and a downward trend in albumin with an increase in disease severity. COVID-19-positive patients with hepato-pancreatic injury have a significantly higher mortality (OR 3.39, 95%CI 3.15-3.65) after controlling for the differences in age, sex, race/ethnicity, liver cirrhosis, and medication exposures. They also have increased disease severity (OR 2.7, 95%CI 2.5-2.9 critical vs mild/moderate; OR 1.4, 95% CI 1.3-1.5 severe vs mild/moderate) and longer hospital length of stay (2 days). CONCLUSION: COVID-19 can cause liver injury. Mortality, disease severity, and hospital length of stay are increased in COVID-19 patients with hepatopancreatic injury.

Anaphylaxis after Moderna COVID-19 vaccine.

The authors of this article report on a case of a patient who presented to the emergency department (ED) in anaphylaxis after receiving the Moderna® COVID-19 vaccine. The patient was hypoxic, with diffuse wheezing bilaterally to auscultation, flush skin, swollen face, and the feeling of her throat closing. Anaphylaxis can have wide range of presentation, the key is recognizing the symptoms and treating early. The incidence of anaphylaxis from COVID-19 vaccine is not well documented to date.

Impact of COVID-19 on the mental health of US college students.

BACKGROUND/AIM: In the beginning of 2020, the novel Coronavirus disease (COVID-19) caused by the SARS-CoV-2 virus, became a public health emergency in the U.S. and rapidly escalated into a global pandemic. Because the SARS-CoV-2 virus is highly contagious, physical distancing was enforced and indoor public spaces, including schools and educational institutions, were abruptly closed and evacuated to ensure civilian safety. Accordingly, educational institutions rapidly transitioned to remote learning. We investigated the impacts of the COVID-19 pandemic on domestic U.S. college students, ages 18-24 years. METHODS: Through Pollfish®'s survey research platform, we collected data from 200 domestic U.S. college students in this age range (N = 200) regarding the physical, emotional, and social impacts of COVID-19 as well as key background information (e.g. whether or not they are first-generation or if they identify with the LGBTQIA+ community). RESULTS: Our results indicate that students closer to graduating faced increases in anxiety (60.8%), feeling of loneliness (54.1%), and depression (59.8%). Many reported worries for the health of loved ones most impacted their mental health status (20.0%), and the need to take care of family most affected current and future plans (31.8%). Almost one-half of students took to exercising and physical activity to take care of their mental health (46.7%). While a third did not have strained familial relationships (36.5%), almost one half did (45.7%). A majority found it harder to complete the semester at home (60.9%), especially among those who had strained relationships with family (34.1%). Seventy percent spent time during the pandemic watching television shows or movies. Significantly more men, first-generation, and low-income students gained beneficial opportunities in light of the pandemic, whereas their counterparts reported no impact. First-generation students were more likely to take a gap year or time off from school. CONCLUSIONS: Although students found ways to take care of themselves and spent more time at home, the clear negative mental health impacts call for schools and federal regulations to accommodate, support, and make mental health care accessible to all students.

Cerebrospinal fluid findings and hypernatremia in COVID-19 patients with altered mental status.

BACKGROUND: The objective of the study was to assess the cerebrospinal fluid (CSF) findings in COVID-19 patients. AIMS: This was an observational retrospective cohort from electronic medical records of hospitalized patients (n = 2655) with confirmed COVID-19 between February 15, 2020, and April 15, 2020, in 182 hospitals from a large health system in the USA. The review of data yielded to a total of 79 patients in 20 hospitals who had CSF analysis. METHODS: Outcomes during hospitalization, including hospital length of stay, disease severity, ventilator time, and in-hospital death were recorded. Independent variables collected included patient demographics, diagnoses, laboratory values, and procedures. RESULTS: A total of 79 patients underwent CSF analysis. Of these, antigen testing was performed in 73 patients. Ten patients had CSF analysis for general markers such as total protein, cell count, glucose, clarity, and color. Seven of the 10 cases (70%) had normal total cell count and normal white blood cell count in CSF. Sixty-three percent (5/8) had elevated total protein. Two patients had normal levels of lactate dehydrogenase (LDH) and 1 patient had significantly elevated (fourfold) neuron-specific enolase (NSE) level in CSF. CONCLUSION: Unlike bacterial infections, viral infections are less likely to cause remarkable changes in CSF glucose, cell count, or protein. Our observations showed no pleocytosis, but mild increase in protein in the CSF of the COVID-19 patients. The fourfold elevation of NSE may have diagnostic/prognostic value as a biomarker in CSF for COVID-19 patients who have altered mental status.

Acute Myopericarditis in the Post COVID-19 Recovery Phase.

The COVID-19 viral infection, caused by the novel coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a currently ongoing global pandemic that, as of mid-October, 2020, has resulted in more than 38.7 million confirmed cases globally and has caused more than 1.1 million fatalities. COVID-19 infection is associated with severe life threatening respiratory and cardiac complications such as acute respiratory distress syndrome (ARDS), pneumonia, shock, cardiac arrhythmias, myocardial infarction and heart failure, particularly in the acute infectious stage. Acute myopericarditis is another reported cardiac complication of COVID-19. Case reports have been limited in reporting the effects of COVID-19 in the post-symptomatic period. In this article, we present a case of acute myopericarditis resulting 6 to 8 weeks after testing positive for COVID-19. Here we will breakdown the initial emergency department (ED) presentation, with particular attention to the electrocardiogram (ECG) findings of acute myopericarditis. This case, to the our best knowledge and after an extensive literature review, depicts the first case of myopericarditis in the post COVID-19 infection recovery phase.

Can Neuron Specific Enolase Be a Diagnostic Biomarker for Neuronal Injury in COVID-19?

Neuron specific enolase (NSE) is a biomarker for neuronal injury. However, increased levels in cerebrospinal fluid (CSF) and serum is associated with the clinical outcome in patients with head injury, ischemic stroke, intracerebral hemorrhage, cardiac arrest, anoxic encephalopathy, encephalitis, brain metastasis, and status epilepticus. Recently, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which started in China, rapidly evolved into the coronavirus disease 2019 (COVID-19) pandemic. Patients with COVID-19 have a wide range of symptoms varying from mild upper respiratory symptoms to severe illness requiring mechanical ventilation. While coronaviruses primarily target the human respiratory system, neurological symptoms are also observed in some patients. These include symptoms such as loss of taste and olfaction and diseases like cerebrovascular disorders including ischemic stroke and hemorrhages, encephalopathies, Guillain-Barré syndrome and acute disseminated encephalomyelitis. Here we report an observation from a patient whose NSE levels increased approximately four-fold in CSF. This finding was accompanied by increased white blood cell count and elevated protein in CSF indicating neuroinflammation. Thus, we suggest that NSE may be used as a CSF biomarker in COVID-19 patients with encephalopathy.

Knowledge and attitudes of us adults regarding COVID-19.

This was a survey of the general non-healthcare-worker USA population regarding their knowledge and attitudes toward the COVID-19 pandemic. Almost everyone practiced social distancing. Women were significantly more likely to be worried about contracting the virus than men (65% vs. 43%, p = 0.0272). There was also a linear trend with age, with older Americans being more worried about contracting the virus. Women were also significantly likely to have received the influenza vaccine this past season compared to men (60% vs. 37%, p = .0167). Similarly, women were significantly more likely to get the influenza vaccine next season than men (77% vs. 46%, p = .0014.). Overall, across every age group, geographic part of the USA and gender, more (or the same) Americans plan on getting the influenza vaccine next season compared to last, but not fewer. This may reflect more awareness of preventative health brought on by the COVID-19 pandemic.

A Less Virulent COVID-19 Pneumonia.

Since its initial outbreak, COVID-19 saw a high death rate with those infected typically presenting with severe respiratory distress along with multi-organ involvement. However, over the course of the pandemic, particularly due to the lower age of those diagnosed with the disease and a greater understanding of the risk posed to certain at-risk populations, a new disease course seems to be more prominent with an overall lower mortality among those diagnosed. We present a typical example of such a case here, showing a less lethal course of COVID-19 occurring in late June amidst the resurgence of new daily cases in the United States.

Hypercoagulable State in COVID-19: A Case Series of Three Patients.

The novel coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that originated in China in late 2019, has caused significant morbidity and mortality worldwide. Although fever, cough, and shortness of breath have been recognized as hallmark symptoms, other lesser known complications continue to be described. We report a series of three patients who presented to the emergency department, who tested positive for COVID-19, and were found to have or subsequently developed thromboembolic complications.

Hospital Course of a Man With Viral Pneumonia Caused by COVID-19.

The authors present a case of a man with pneumonia caused by COVID-19. There is currently no FDA-approved medical treatment or vaccine for COVID-19, so a variety of drugs and medicinal therapies have been repurposed for use in hospital settings and clinical studies while the medical community waits for a medication to be approved and standardized. Pneumonia is a common outcome of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), so cases of it are rapidly spreading around the world as the novel coronavirus continues to spread.

Elastomeric respirators are safer and more sustainable alternatives to disposable N95 masks during the coronavirus outbreak.

BACKGROUND: In this paper, the authors review the safety and practicality of elastomeric respirators for protecting themselves and others from the novel coronavirus or COVID-19. They also describe the safe donning and doffing procedures for this protective gear. MAIN TEXT: Due to the shortage of personal protective equipment (PPE), the CDC has recommended ways to conserve disposable N95 masks, including re-use and extended use, and reserving N95 masks for aerosol-generating procedures. However, these were never made to be re-used. Although the modes of transmission of COVID-19 are not fully understood, based on what we know about severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), droplets and aerosolized droplets contribute to the spread of this virus. More evidence from Wuhan, China, has demonstrated that COVID-19 viral particles are aerosolized and found in higher concentrations in rooms where PPE is being removed. Thus, it is best for all healthcare providers to have full aerosol protection. CONCLUSION: Given the shortage of PPE for aerosols, it is logical to utilize reusable elastomeric respirators with filter efficiency of 95% or higher. A single elastomeric respirator may replace hundreds to thousands of new disposable N95 masks.