Post-COVID Wernicke's presenting as bilateral vision loss.

PURPOSE: This case report represents poor nutritional intake and vomiting secondary to COVID-19 resulting in Wernicke's syndrome and blindness. OBSERVATIONS: We report the case of a 36 year old with a post-COVID episode of acute-subacute onset bilateral blindness ultimately diagnosed as Wernicke's syndrome based on MRI findings and clinical response to high dose IV thiamine supplementation. CONCLUSIONS AND IMPORTANCE: Given this patient's dramatic presentation of no light perception vision in both eyes and resolution of symptoms with treatment, it is reasonable to consider thiamine deficiency in any individual who presents with acute-subacute onset vision loss, particularly when the history is suggestive of potential nutritional deficiency.

The environmental impact of personal protective equipment in a pre and post COVID era in the ENT clinic.

PURPOSE: The use of single use plastic items and plastic wrapping has increased over the last number of decades. Outside of the medical field there has been a conscious drive to reduce single use plastic and reuse items to reduce the amount of waste we produce. We undertook this investigation to quantify our plastic waste production and generate ideas to reduce this volume. METHODOLOGY: Data was collected from a University Hospital ENT outpatient department via real-time recording methods using standard data collection forms. We measured plastic unit usage pre and post COVID restrictions and compared this to our number of patient encounters. Projections of plastic usage were determined via a hypothetical resumption of patient services model. RESULTS: In total there were 440 patients included. In period one the mean units of plastic used per day was 65.1 (median 67; range 27-84). In the second period, the mean number of plastic units was 23.4 (median 22; range 1-7). Blue nitrile gloves and masks were the most commonly used single use items. The hypothetical projection model predicted a 147.6% increase in single use items following the introduction of COVID precautions. CONCLUSION: We have a duty of care not only to our patients but future generations of patients and the environment which we share. Single use items and excessive plastic wrapping have benefits in terms of convenience and sterility, but these conveniences can be easily extended to reusable types to limit our volume of waste, reduce our waste management costs and protect our environment.

The Science Underlying COVID-19: Implications for the Cardiovascular System.

The coronavirus disease 2019 (COVID-19) pandemic has affected health and economy worldwide on an unprecedented scale. Patients have diverse clinical outcomes, but those with preexisting cardiovascular disease, hypertension, and related conditions incur disproportionately worse outcome. The high infectivity of severe acute respiratory syndrome coronavirus 2 is in part related to new mutations in the receptor binding domain, and acquisition of a furin cleavage site in the S-spike protein. The continued viral shedding in the asymptomatic and presymptomatic individuals enhances its community transmission. The virus uses the angiotensin converting enzyme 2 receptor for internalization, aided by transmembrane protease serine 2 protease. The tissue localization of the receptors correlates with COVID-19 presenting symptoms and organ dysfunction. Virus-induced angiotensin converting enzyme 2 downregulation may attenuate its function, diminish its anti-inflammatory role, and heighten angiotensin II effects in the predisposed patients. Lymphopenia occurs early and is prognostic, potentially associated with reduction of the CD4+ and some CD8+ T cells. This leads to imbalance of the innate/acquired immune response, delayed viral clearance, and hyperstimulated macrophages and neutrophils. Appropriate type I interferon pathway activation is critical for virus attenuation and balanced immune response. Persistent immune activation in predisposed patients, such as elderly adults and those with cardiovascular risk, can lead to hemophagocytosis-like syndrome, with uncontrolled amplification of cytokine production, leading to multiorgan failure and death. In addition to the airways and lungs, the cardiovascular system is often involved in COVID-19 early, reflected in the release of highly sensitive troponin and natriuretic peptides, which are all extremely prognostic, in particular, in those showing continued rise, along with cytokines such as interleukin-6. Inflammation in the vascular system can result in diffuse microangiopathy with thrombosis. Inflammation in the myocardium can result in myocarditis, heart failure, cardiac arrhythmias, acute coronary syndrome, rapid deterioration, and sudden death. Aggressive support based on early prognostic indicators with expectant management can potentially improve recovery. Appropriate treatment for heart failure, arrhythmias, acute coronary syndrome, and thrombosis remain important. Specific evidence-based treatment strategies for COVID-19 will emerge with ongoing global collaboration on multiple approaches being evaluated. To protect the wider population, antibody testing and effective vaccine will be needed to make COVID-19 history.