ABSTRACT
Introduction: SARS-Co-V2 neuroinvasive ability might be the basis for the onset of delirium and neuropsychiatric outcomes. Objective(s): We hypothesized that some infected patients with preexisting cognitive dysfunction may present delirium as unique manifestation of COVID-19 infection or as a prodrome of a new episode consistent with the psychiatric history. Method(s): We conducted a PubMed literature search to verify whether cognitive impairment might predispose to COVID-19. We included three patients with mild cognitive impairment and delirium at admission for SARS-Co-V2 suspected infection. Delirium was diagnosed according to DSM-5 criteria, Cognitive Assessment Method and Coma Glasgow Scale. Result(s): Literature analysis evidenced patients presenting delirium or delirium-like symptoms as clinical manifestation of COVID-19, plus a cognitive impairment, from mild to severe, which preexisted or was evidenced during the acute phase or after the infection. Most studies described delirium in patients with a past neurological/ psychiatric history. Contrasting data emerged on the potential link between COVID-19 and delirium in patients with cognitive impairment and without a past neuropsychiatric history. Our patients had no history of other medical complications. Our first patient had no psychiatric history, the second reported only a depressive episode, and the third had story of bipolar disorder. Delirium resolved completely after 2 days in the first patient. The other patients required 4 and 14 days to resolve: delirium appeared as the prodrome of a new psychiatric episode in line with their past history. Conclusion(s): Clinicians should acknowledge the possibility that COVID-19 infection may appear as delirium and acute psychiatric sequelae as unique manifestation.
ABSTRACT
Introduction & Objective: Urologic-related visits to the emergency department (ED) are variable in their acuity, ranging from non-emergent to life-threatening. We sought to evaluate trends in urologic presentations to the ED during the COVID-19 pandemic at a tertiary academic institution in the United States to determine the differences in frequency between urgent and nonurgent visits and further elucidate delayed access to urologic care. Methods: A retrospective analysis was performed comparing the frequency and type of urologic-related ED visits at our institution in January-April 2019 to those in January-April 2020 during the initial pandemic phase. 1,838 urologic presentations between the two-time intervals were organized by diagnosis and divided by acuity into urgent and non-urgent categories. Interrupted time series regression models were used to determine how urologicrelated ED visits changed due to the COVID-19 pandemic. Results: The total number of urologic related ED visits by type for each time interval is demonstrated in Table 1. There was a statistically significant drop in total urologic-related ED visits after the COVID-19 pandemic began, with a drop in total visits of approximately 76 per month (p = 0.002). There was no difference in the number of urgent ED visits due to the COVID-19 pandemic (p = 0.13). However, there was a statistically significant decrease in non-urgent ED visits, with a decrease of 68 visits per month (p = 0.002). When examining the individual visit types, there were no differences in visit volume except for hematuria and nephrolithiasis/ureterolithiasis visits. There was a statistically significant reduction in hematuria-related ED visits, with a reduction in visits of approximately 11 per month (p = 0.03). Similarly, there was a statistically significant decline in nephrolithiasis/ ureterolithiasis-related ED visits, with a decline of approximately 28 visits per month (p = 0.04). Conclusions: The COVID-19 pandemic coincided with a significant decrease in the number of non-urgent urologic presentations to our institution's ED. Specifically, there was a significant decrease in the number of patients presenting with hematuria and nephrolithiasis-related issues. There was no significant decrease in the number of urgent urologic consults. Follow up study is indicated to investigate the effect of delayed evaluation for these non-urgent urologic diagnoses. (Table Presented).