ABSTRACT
Background: This is a case in which we explore The presentation and management of a 62-year-old gentleman, who attended a UK based Surgical unit with appendicitis and a positive COVID-19 on admission. Following an urgent appendicectomy, he suffered a morbid and protracted postoperative period, complicated by an Upper Gastrointestinal bleed and prolonged ileus. The virus has been recognised to increase The risk of micro-thromboembolic events and Gastrointestinal complications. We discuss The possibility of COVID-19 causing The patient's presentation and his post-Surgical recovery. We aim to demonstrate our experience of The relationship between acute appendicitis and The morbidity associated with COVID-19. Discussion(s): The case demonstrates a unique sequela following an otherwise routine Emergency appendicectomy. In concurrence with a radiologically and microbiologically evident COVID-19 infection, it raises The question of whether The appendicitis was caused or at lEast complicated by The virus. This hypothesis is supported by a similar discovery in a case series carried out in Wuhan, in which a paediatric patient acutely presented with a perforated appendix in parallel with a SARSCoV-2 infection, which required urgent surgery. Contrastingly, a case which involved a COVID-19 positive adult male with a non-perforated and non-suppurative appendix demonstrated no complications post-operatively. Conclusion(s): It is possible to postulate that The severe presentation outlined in our case could also have been caused by a delayed COVID-19 presentation. However, there is currently no formal Research to support this and The approach has not been exemplified in a complex case such as ours.
ABSTRACT
The global pandemic is yet to see any break through in the specific management of Covid-19. Remdesiver was initially given emergency use authorization (EUA) by FDA for severe Covid-19 infection. Recently it use was extended to every hospitalized patient. Little is known about cardiac adverse effects of drug. We report a case of severe symptomatic bradycardia associated with remdesiver use which was managed by close cardiac observation and withdrawal of the drug. © 2022 JK Practitioner. All rights reserved.
ABSTRACT
Introduction: Outcomes and characteristics of patients with severe aortic stenosis (AS) treated during the COVID-19 pandemic is unknown. Methods: This was a single-centre observational study of patients undergoing AS treatment with transcatheter (TAVI) or surgical (SAVR) therapy during the first-wave of the UK COVID-19 pandemic compared to a control cohort undergoing treatment in 2019. Demographics, baseline echocardiogram, CT, procedural characteristics and outcome data were collated. The primary outcome was 30-day allcause mortality. The secondary endpoint was duration of post-procedural hospitalisation. Results: 319 patients were recruited - 122 underwent intervention during the pandemic [73 TAVI;49 SAVR] and 197 in 2019 [127 TAVI;70 SAVR]. In 2020, TAVI patients had a higher Euroscore II (p<0.001) but there were no differences in procedural complications or mortality [p=0.16] compared to TAVI 2019 cases. Duration from TAVI to discharge was shorter in 2020 (p<0.001). SAVR 2020 patients had similar baseline profile [p=0.48], surgical characteristics, mortality (p=0.68) and duration from SAVR to discharge compared to those in 2019. During the pandemic, TAVI patients were older (p<0.001) and had a higher Euroscore II (p<0.001) than SAVR counterparts. TAVI patients had reduced 30-day mortality [0 (0%) vs 3 (6%);p=0.06] and were discharged more rapidly post-intervention than SAVR patients [median 1 [1] vs 7 [4] days;p<0.001) translating into shorter hospitalization (p<0.001). Conclusions: TAVI and SAVR can be safely delivered with predictable resource utilisation during a pandemic. Despite the TAVI cohort incorporating higher risk, older patients, outcomes were at least as good as SAVR with a shorter length of post-procedural hospitalisation.