ABSTRACT
Objective: NA Background: The etiology of MOGAD post-COVID-19 infection is not well understood and there are limited publications describing cases in pediatric patients. Here we report a case of a 14-year-old male with MOG antibody positive ADEM (Acute Disseminated Encephalomyelitis) and positive COVID-19 PCR. Design/Methods: NA Results: The patient presented to our hospital in December of 2020 with acute onset of ataxia and lower extremity weakness. His exam was pertinent for mild and symmetric weakness in bilateral hip flexors, dysmetria with ataxic gait, as well as bilateral patellar and ankle hyporeflexia. MRI brain showed symmetric areas of T2 signal hyperintensity, predominantly adjacent to the fourth ventricle as well as the peri-insular and frontal regions. MRI of the lumbosacral spine demonstrated T2 signal hyperintensity within the conus medullaris without enhancement. CSF studies revealed an increased white blood cell count of 74 (90% lymphocyte), elevated protein of 51, elevated kappa free light chain (0.12) and positive oligoclonal bands (3). He was also found to be serum anti-MOG antibody positive (1:100) and COVID-19 positive (PCR). He received 1000 mg of intravenous methylprednisolone daily for 5 days and 2 g/kg IVIG. He was subsequently placed on a 6 week taper of oral prednisone. 2 months after his initial presentation, his neurologic symptoms have completely resolved, and he has been asymptomatic since. Repeat MRI brain 4 months later showed improvement in his multifocal supratentorial FLAIR signal abnormalities. Conclusions: Here we describe a case of a 14-year-old male with MOGAD post-COVID-19, with complete resolution of his symptoms after high dose corticosteroid and IVIG treatment.
ABSTRACT
Study Objectives: Violence in the emergency department (ED) is a common and longstanding threat to staff. The COVID-19 pandemic brought unique challenges;however, it remains unclear what effect the pandemic had on violence in health care. The objective of this study was to identify the impact of the pandemic on workplace violence at an academic emergency department in the Midwest. Methods: The hospital referral region (HRR) COVID-19 case rate per 100,000 people was obtained from March through December 2020. Monthly incidents of ED violence were obtained from the Office of Security and included both physical assault and verbal threats where security officers were notified to respond. These incidents were combined with monthly reports of violent flags added to patient charts within the electronic medical record. Overlapping data from both sources were counted only once. Monthly ED patient volume was obtained to calculate a rate of violent incidents per 1,000 ED visits. Two anonymous surveys were sent to all multidisciplinary ED staff both pre/early-pandemic (April 2020) and mid/late-pandemic (December 2020) and surveyed respondents regarding the incidence of verbal abuse and physical assault experienced over the prior 6-months (November 2019-April 2020 and July 2020-December 2020). Chi-squared tests and Fisher’s exact tests were used for comparison. The study was deemed exempt by the Mayo Clinic Institutional Review Board. Results: There was a positive association between the HRR rate and rate of violent ED incidents (r = 0.24;Figure 1). There was also an increase in overall violent workplace incidents per ED volume during the pandemic compared to the months leading up to it. A total of 259 responses were received for the initial pre/early-pandemic survey and 259 responses received for the mid/late-pandemic survey. The reported level of safety perceived by staff remained the same, as did the overall percentage of respondents indicating any verbal abuse or physical assault in the prior 6-months. The frequency of verbal abuse experienced by staff did increase during the pandemic, with 6.2% of respondents pre/early-pandemic indicating verbal abuse by patients or their visitors every day or two, compared to 10.8% mid/late-pandemic (p =.029). Conclusion: Despite our findings of a positive association between the COVID-19 case rate and rate of violent ED incidents, the percentage of our survey respondents indicating verbal abuse or physical assault experienced in a 6-month time period remained unchanged between the pre/early-pandemic and mid/late-pandemic periods, as did staff perception of workplace safety. This difference in documented and self-reported/perceived violence may be attributable to staff prioritizing other personal safety concerns throughout the pandemic. This positive association could be due to significant fear and stress experienced by the general public, or worsening substance abuse or mental health state during the pandemic. [Formula presented]