ABSTRACT
Introduction/Objective Recent reports suggest that though COVID-19 is predominantly a respiratory pathogen, one of its presenting features can be gastrointestinal symptoms. We hereby present a case of a female with COVID-19 infection whose hospital course was complicated by colonic pseudo-obstruction caused by pseudomembranous colitis resulting in an emergent hemicolectomy. Methods A 59-Year-old female with history of hypertension, diabetes, and breast cancer post mastectomy presented with pneumonia and was confirmed to be COVID-19 positive. She was admitted to the hospital and was treated with Azithromycin for 6 days. Patient developed constipation on day six of hospitalization and started having abdominal pain on day eight with elevated WBC count. Imaging showed distension of cecum and proximal colon. She underwent exploratory laparotomy which revealed a necrotic appearing cecum that was massively dilated and had a serosal tear. These findings prompted emergent hemicolectomy with loop ileostomy. Grossly cecum was black/green, dilated, thin walled with a 5 x 5 cm yellow green raised plaques. Microscopy of the plaques revealed focal erosion of colonic mucosa with overlying acute inflammatory cells, fibrin deposits, mucus, and necrotic epithelial cells consistent with pseudomembranous colitis. Conclusion Review of literature shows no reported cases of intestinal pseudo-obstruction due to pseudomembranous colitis in a COVID-19 patient. Not only this, but there are also only a limited number of case studies of pseudomembranous colitis presenting as intestinal pseudo-obstruction without diarrhea. Though this patient's presentation could be from Clostridium difficile infection secondary to Azithromycin, it is not a common antibiotic to cause this. Also, one of the known causes of pseudomembranous colitis is ischemia. Given that COVID-19 infection is a pro-thrombotic condition, possible ischemia secondary to COVID-19 infection related coagulopathy should also be a consideration.
ABSTRACT
Background: COVID-19 infection is associated with worse outcomes in kidney transplant recipients (KTRs). Despite wide availability of safe and effective vaccines, transplant recipients are disproportionately affected. We aim to investigate our center's experience with COVID-19 hospitalization in KTRs and measure their clinical outcomes. Method(s): In this retrospective observational cohort study, we identified KTRs who developed COVID-19 infection between March 2020 and January 2022 within our integrated health network. Through chart review, patient characteristics and outcomes were collected. Result(s): Among 186 patients who tested positive for COVID-19, 114 (61%) required hospitalization out of which 53 received at least one dose of vaccine and 61 were unvaccinated. Among the unvaccinated, 26 (43%) patients were admitted prior to January 2021 when vaccines were not yet widely available. Vaccination rate among patients admitted after January 2021 was 53/88 (60%). Baseline characterisitcs between vaccinated and unvaccinated patients were similar. There were 24 deaths during admission and another 7 deaths within 90 days, for a total of 31/114 (27%). There was a trend towards lower mortality in vaccinated patients (10/53 (19%) vs. 21/61 (34%), p=0.06). The need for dialysis was significantly lower in vaccinated patients (9/53 (17%) vs. 21/61 (34%), p=0.03) (Table). Conclusion(s): COVID-19 infection is associated with higher mortality in KTRs with a mitigating effect from vaccination. Decreased dialysis requirement in vaccinated but hospitalized KTRs with COVID-19 infection likely reflects less severe infection, indicating that vaccination confers allograft protection. Every effort should be made to encourage and educate KTRs regarding COVID-19 vaccination including booster doses in order to reduce morbidity and mortality. (Figure Presented).
ABSTRACT
Background: Mortality rates for COVID-19 infection vary widely. Immunocompromised patients in general have worse outcomes. We aimed to evaluate kidney transplant recipients (KTRs) who were admitted for COVID-19 infection and investigate patient specific factors or comorbidities that may have influenced mortality rates. Method(s): In this retrospective study, we identified KTRs who developed COVID-19 infection between March 2020 and January 2022 within our integrated health network. Through chart review, patient characteristics were collected and stratified by 90-day mortality. Result(s): Out of 114 KTRs hospitalized with COVID-19 infection, 24 (21.0%) died during admission, and another 7 died within 90 days of admission bringing total 90-day mortality to 31/114 (27.2%). Among the114 hospitalized patients, 53 (46.5%) had received at least one prior COVID-19 vaccine dose including 35 who received two doses and 9 who received >=3 doses. KTRs who survived following COVID-19 hospitalizations were significantly younger and were more likely to be vaccinated (Table). Conclusion(s): Approximately 1 out of 4 KTRs admitted for COVID-19 infection died within 90-days. Older age was a mortality risk factor and vaccination conferred protection against mortality in these immunocompromised patients. Our study highlights the importance of vaccination in these patients. Relatively small sample size likely limited identification of other potential risk factors for mortality in our analysis.
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Background: Studies have shown suboptimal immunological response to COVID-19 vaccination in kidney transplant recipients (KTRs). We aimed to describe specific characteristics of vaccinated KTRs who required hospitalization for COVID-19 infection. Method(s): In this descriptive study utilizing chart review, we identified KTRs who were hospitalized for COVID-19 infection between March 2020 and January 2022 within our integrated health network. Demographic characteristics were identified for KTRs who received >=2 COVID-19 vaccine doses prior to hospitalization. Result(s): Among 114 KTRs admitted to the hospital with COVID-19 infection, 44 (39%) had received 2 or more vaccine doses prior to hospitalization including 35 patients who received 2 vaccines and 9 who received >2 vaccines. Vaccinated patients requiring hospitalization were generally older with male predominance. Prevalent comorbidities included overweight/obesity, hypertension, and diabetes. Among these patients, 18% required dialysis and 90-day mortality was 20% (Table). Conclusion(s): Despite receiving at least 2 doses of preventative vaccination, many KTRs developed COVID-19 infection requiring hospitalization. Our findings are consistent with studies showing reduced antibody and cell mediated response to vaccination in KTRs. Every effort should be made to educate and encourage this vulnerable population about measures to prevent infection, especially vaccination with subsequent booster doses.
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Introduction: Dialysis access surgery, in the UK, is almost always performed in NHS healthboard-run hospitals. During the height of the COVID-19 pandemic, in which access to elective operating theatres became limited, arrangements were made in our vascular access service, to perform some dialysis access surgery in a local private hospital. Patients were selected such that those deemed suitable as day-case and unlikely to require in-patient stay were chosen. A scoring system, 'Medically Necessary Time-Sensitive' (MeNTS) criteria, was proposed recently to assist in such decision-making processes by considering procedural, disease, and patient factors (Prachand et al, J Am Coll Surg.2020). The cumulative MeNTS score ranges from 21 to 105, with a score >65 signifying a 'too high risk to be justified' procedure. The aim of this study was to use MeNTS scores retrospectively to determine whether correct decisions were made in performing dialysis-access operations in the usual NHS university healthboard (UHB) setting vs local private hospital (Spire). Method(s): MeNTS scores were calculated for all patients who underwent dialysis access surgery at both sites between March 2020 - March 2021. Outcomes assessed included patient survival and COVID-19 infection Results: 213 Patients underwent dialysis access surgery at UHB and 76 at Spire. Mean cumulative MeNTS scores were 40.03(+/-0.30) and 39.97(+/-0.46) for the UHB and Spire groups, respectively (P=.922). COVID-19 infection occurred in four patients at UHB, and none in Spire (P=.576). Successful dialysis access was achieved in 76.06% and 69.74% in UHB and Spire patients, respectively (P=.287). At 30 days, one UHB patient had died whilst all Spire patients were alive (P>.999). Discussion and conclusion: Dialysis access surgery can take place safely during the COVID-19 pandemic, with necessary precautions. A modified version of the MeNTS score to make it more renal-specific would allow maximum benefit to be achieved from it in this field.
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Telemedicine is the utilization of electronic facts to correspond expertise for sustaining healthcare when physical distance part the users. Within the same time frame, patient-related data can be simultaneously get collected for large number of people using remote monitoring. However, there is always a disadvantage if any issue arises due to software and hardware. Thus, computer-based patient monitoring can be problematic at sometimes if we exclusively depend on computer system. There should always be a balance between computer dependency and human intelligence use. Each and every one's life difference can be made by maintaining the balance between the two. Here, in this review article, we discussed the historical perspectives, telemedicine system concepts, telemedicine centers infrastructure, role in diverse spheres, types of telemedicine technology, applications in public health, current initiatives, and finally the success and popularity of telemedicine during COVID-19 pandemic.
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Background: mRNA vaccines have been instrumental in fighting the Covid- 19 pandemic. Due to waning immunity, booster doses have received emergency use authorization.1 While awaiting FDA approval, physicians should continue to report adverse effects. Here, we present a 90 year old incidentally found to have bilateral pulmonary emboli 6 days after receiving a Covid-19 booster vaccine. Case: WR is a 90 year old male with HTN, HLD, T2DM, CKD, CVA, osteoporosis, and prostate cancer in remission who presented to the ED after falling. He complained only of left hip pain. He denied chest pain, cough, or shortness of breath. X-ray revealed left hip fracture. CTA head and neck demonstrated concern for acute PE. Follow-up CTA chest showed large central pulmonary emboli extending into every lobe bilaterally and right heart strain. Notably, he received a mRNA Covid-19 booster vaccine 6 days prior. His first 2 vaccinations were uncomplicated. He had no personal or family history of blood clots. Vitals in ED: temp 36.8°C, HR 87, RR 24, BP 126/61, SaO2 87% on room air with improvement to 91% on 4L via nasal cannula. Physical exam was unremarkable except for tenderness and deformity of the left leg. Labs were significant for Cr 2.18 (baseline 1.7), troponin-HS 1990, and CPK 1514. Heparin was started, and he was admitted to the hospital. Discussion: We report the case of a nonagenarian incidentally found after a fall to have severe, yet asymptomatic, thromboembolism in the setting of a recent mRNA Covid-19 booster vaccine. The CDC recommends booster doses for people older than 50 and for those living in long-term care2, which is common among the elderly. Although there is evidence that some Covid-19 vaccines are associated with higher risk of blood clots than placebo, the absolute risk is substantially smaller compared to a similar event occurring after Covid-19 infection.3 There is not enough data right now to determine if booster doses affect these risks. However, it is reasonable to closely monitor those at higher risk for blood clots, such as geriatric patients who are prone to falling or prolonged periods of limited mobility.