Diagnosis of COVID-19 in a geriatric patient hospitalised for fall with initial misinterpreted aspiration pneumonia

Background. SARS-CoV-2 is a virus which is more aggressive in aged patients with associated chronic age-related diseases. Although it is known that clinical picture of COVID-19 is already multifaceted, very little is still known about the infectious syndrome in aged patients. We present a case of an aged patient hospitalized for fall affected from COVID-19 pneumonia, initially misinterpreted for an aspiration pneu-monia. Case presentation. We describe the case of a 92 years patient with chronic heart diseases, hospitalized for fall complicated by head trau-ma. She was diagnosed with an aspiration pneumonia due to the fall so that she was put under antibiotics treatment. Despite four days of antibiotics treatment, the patient presented high fever and dry cough motivating in an epidemic period the nasopharyngeal PCR test for the research of SARS-CoV-2 which resulted positive. Discussion and conclusions. Aspiration pneumonia resulting from a fall is a common finding in geriatric patients, that's why the diagnosis of COVID-19 was delayed. The geriatric population often have an altered clinical presentation of diseases, in particular regarding infectious diseases. The correct interpretation of some suspicious findings such as regular blood tests would have led more quickly to a diagnosis of non-aspiration pneumonia. Inflammatory markers and white blood cell count resulted within the normal range. Moreover, lymphopenia, considered as one of the biological1. The presence of confusion as a sign of persisting infection in an older patient should not be under-estimated, expression of a possible involvement of nervous system in SARS-CoV-2 infection2. The common diagnosis of aspiration pneumonia in the geriatric field, the aspecific signs and symptoms of COVID-19 disease, the complex picture of our patient, prove that in geriatrics an apparently simple diagnosis could instead be insidious and complex. Copyright © by Societa Italiana di Gerontologia e Geriatria (SIGG).

Remotely monitoring treatment outcomes in patients with neurogenetic syndromes: A family-centered perspective

Remote assessment has been ongoing for years, however, the integration of remote protocols while considering the unique needs of patients with neurogenetic syndromes (NGS) is lacking. The need for remotely monitoring treatment outcomes has intensified with the ongoing COVID-19 pandemic due to closures, travel mandates, and COVID-19 related health concerns in individuals with NGS. Beyond the COVID-19 pandemic, remote assessment may become the "status quo" and potential benefits and caveats that should be considered. In this review, we first define remote assessment, reasons for conducting remote assessment including enhancing access to research, reducing participant burden, and reducing financial costs and conserving staff. Next, we address reasons to not conduct remote assessment including the digital divide, digital inequities in technology literacy, impact on rapport, trust-building, and community-centered work, particularly for marginalized populations, and task and method constraints. We then describe our remote assessment efforts centered around the caregiver, and future directions and next steps with an emphasis on user experiences (UX), ongoing need to address issues of access and equity and the importance of a whole-family approach given the heterogeneity of experiences in families with NGS.

COVID-19 vaccine and dermatomyositis: Is there an association?

The etiology of dermatomyositis is unknown but immune dysregulation plays a key role. A 68-year-old man presented with a 1-month history of skin rash, myalgia and symmetrical proximal limb weakness. He developed these symptoms about three weeks after the second dose of Vaxzevria. On examination, he showed a diffuse facial, scalp, arm and trunk rash with periorbital edema. No Gottron papules were detected. Creatine kinase levels were markedly increased. Electromyography was normal, whereas muscle biopsy revealed a perivascular mixed cell infiltrate. Based on clinical features, elevated muscle enzymes and muscle biopsy, a diagnosis of dermatomyositis was established. A full-body CT scan, performed in order to exclude a connection with malignancies, appeared unremarkable. The patient showed a gradual improvement of symptoms after treatment with intravenous methylprednisolone 80 mg for three days, then transitioned to oral prednisolone 50 mg. To the best of our knowledge, this is the first case of new-onset dermatomyositis after COVID-19 vaccination. Dermatomyositis occurring after vaccination is a well-recognized phenomenon and may be attributable to homology between vaccine components and muscle antigens, triggering an autoimmune response. Moreover, dermatomyositis has been recognized as a manifestation of COVID-19-induced muscle disease. It has been hypothesized that SARSCoV- 2 may transfer its genetic material into the muscle fibers, thus triggering a T cell-mediated viral response leading to muscle damage. In addition, three different T cell receptor epitopes highly specific” for SARS-CoV-2 have been detected in dermatomyositis patients, reinforcing the hypothesis of molecular mimicry.