ABSTRACT
Background: COVID-19 is the new version of the old coronavirus known since 1960, which caused the Middle East respiratory syndrome (MERS-CoV) in 2012 and the severe acute respiratory syndrome (SARS) in 2003. Symptoms included fever and cough, diarrhea and vomiting, and neurological symptoms like anosmia. Method(s): One hundred twenty-eight patients diagnosed as COVID-19 with audio-vestibular complaints were subjected to audio-vestibular assessment and were included in the study. Result(s): In our study on COVID-19 patients who reported audio-vestibular complaints, hearing loss was found in 43.8% of patients in comparison to vertigo that represented 40.6% of cases. The most common type was sensorineural hearing loss representing 29.7% of patients and which was unilateral and sudden in 35.7% of them. Less commonly conductive hearing loss (CHL) was found in 14.1% of cases the most common form was bilateral mild to moderate CHL (83.3%) due to bilateral middle ear effusion. Among cases with vertigo, the most common etiology was benign paroxysmal positional vertigo (BPPV) (42.5%) then uncompensated vestibular neuritis (VN) (31.5%), and lastly, combined BPPV with VN (25%) of cases. Less frequently we found tinnitus in (13.3%) which was bilateral in (64.7%), labyrinthitis (5.5%), and acute VN 5.5%). The significant increase in the number of audiovestibular complaining cases that were observed in the course of the recurrent waves' peaks pushed us to study the relationship between the pandemic and the audiovestibular system. The effect of COVID on AV systems is well noticed and management would be mandatory.Copyright © 2022, The Author(s).
ABSTRACT
Background: Cirrhosis is a state of immune dysfunction and is associated with a higher susceptibility to infection Cytopaenias in this group of patients is not uncommon As such, given the current coronavirus pandemic, we sought to determine the impact of SARS-Cov2 on mortality in patients with cirrhosis and whether popular risk assessment tools such as the CALL (Co-morbidities, older age, higher lactate dehydrogenase and lower lymphocyte count) model, could be applied to this cohort Methods: A retrospective study was conducted between 1st January 2020 and June 2020 at St George's University Hospital NHS foundation trust Demographic and clinical information was retrieved from the electronic patient record Laboratory parameters (including lymphocyte count), and MELD-Na were assessed on admission and day 3 for the non-Covid group and the day of positive nasopharyngeal swab and day 3 for the Covid group The primary outcome was all-cause mortality, defined by the death recorded at data-lock (11th June 2020) The secondary outcomes were to compare the length of hospital stay and to assess whether baseline predictors were reliable diagnostic and prognostic markers for patients with SARS-Cov2 Results: 85 patients included were dichotomised to Covid negative (n=75) and Covid positive (n=10) groups according to polymerase chain reaction results Characteristics were similar between the two groups with males representing 69% (n=52) in the Covid negative and 60% (n=6) in the Covid positive groups Mean age was 60 8 and 61 05 respectively SARS-Cov-2 in the context of cirrhosis was found to be associated with longer hospital stay with a median of 11 5 days (Q1-Q3: 8 25 -15 8, p=0 047, Mann Whitney) 30% (n=3) of patients in the Covid positive group died within 30 days compared to 9 3% (n=7) in the Covid negative group Primary cause of death for the Covid positive patients was respiratory failure MELD-Na score ≥15 was found to be a statistically significant predictor for mortality in the Covid negative group alone [RR 8 37 (95%CI 1.10-63.15, p=0.015]. There was no statistically significant difference between the lymphocyte counts of the two groups at the time of diagnosis (p=0 561) Conclusion: In patients with underlying cirrhosis, SARS-Cov-2 infection is associated with a longer hospital stay As lymphopenia is not uncommon in patients with underlying cirrhosis, the lymphocyte count should not be used as an early assessment tool in this group to triage patients to suspected COVID wards and all patients should be tested for SARS-Cov-2 Risk assessment models such as CALL should be currently avoided in patients with cirrhosis.