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1.
BMJ Case Rep ; 14(10)2021 Oct 19.
Article in English | MEDLINE | ID: covidwho-1476414

ABSTRACT

Herpes zoster reactivation is a frequently encountered condition that can result in several uncommon complications. This case report highlights one such frequently overlooked complication, segmental zoster paresis. We discuss a case of prolonged fever and lower limb weakness in an immunocompromised patient with breast cancer on active chemotherapy after resolution of a herpetiform rash in the L2, L3 and L4 dermatomes. Early investigation with lumbar puncture, looking for cerebrospinal fluid pleocytosis, varicella zoster virus detection by PCR or molecular testing and immunoglobulins against varicella zoster virus, should be undertaken to support the diagnosis. Nerve conduction studies, electromyography and MRI of the spine can sometimes help with neurolocalisation. Intravenous acyclovir and a tapering course of steroids can help with resolution of symptoms. The variegate presentation can make diagnosis challenging. Awareness and a high index of suspicion can prevent delays in diagnosis and treatment and improve patient outcomes.


Subject(s)
Herpes Zoster , Acyclovir/therapeutic use , Herpes Zoster/complications , Herpes Zoster/diagnosis , Herpes Zoster/drug therapy , Herpesvirus 3, Human , Humans , Immunocompromised Host , Paresis/etiology
2.
Neurol Sci ; 42(5): 1653-1659, 2021 May.
Article in English | MEDLINE | ID: covidwho-1056019

ABSTRACT

OBJECTIVE: To explore the activity changes in neurology clinical practice that have occurred in tertiary public hospitals during the COVID-19 pandemic. METHODS: Outpatient and inpatient data from the neurology department were extracted from the electronic medical record system of three tertiary Grade A hospitals in Wenzhou. Data were analyzed across 5 months following the beginning of the pandemic (from January 13 to May 17) and compared with the same period in 2019. Data on reperfusion therapy for acute infarction stroke were extracted monthly from January to April. RESULTS: The number of outpatients declined from 102,300 in 2019 to 75,154 in 2020 (26.54%), while the number of inpatients in the three tertiary Grade A hospitals decreased from 4641 to 3437 (25.94%). The latter trend showed a significant drop from the 3rd week to the 7th week. The number of patients in these hospitals decreased significantly, and a significant drop was seen in the neurology department. As usual, stroke was the most common disease observed; however, anxiety/depression and insomnia increased dramatically in the outpatient consultation department. CONCLUSIONS: The results of our study revealed the effects of the COVID-19 pandemic in the clinical practice of neurology in Wenzhou during the outbreak. Understanding the pandemic's trends and impact on neurological patients and health systems will allow for better preparation of neurologists in the future.


Subject(s)
COVID-19 , Neurology , Humans , Neurologists , Pandemics , SARS-CoV-2
3.
J Hepatol ; 73(4): 807-816, 2020 10.
Article in English | MEDLINE | ID: covidwho-345685

ABSTRACT

Background & Aims: Liver enzyme abnormalities are common in patients with coronavirus disease 2019 (COVID-19). Whether or not severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to liver damage per se remains unknown. Herein, we reported the clinical characteristics and liver pathological manifestations of COVID-19 patients with liver enzyme abnormalities. Methods: We analyzed 156 patients diagnosed with COVID-19 from 2 designated centers in China and compared clinical features between patients with or without elevated aminotransferases. Postmortem liver biopsies were obtained from 2 cases who had elevated aminotransferases. We investigated the patterns of liver impairment by electron microscopy, immunohistochemistry, TUNEL assay and pathological studies. Results: Sixty-four out of 156 (41.0%) patients with COVID-19 had elevated aminotransferases. The median levels of alanine aminotransferase were 50 U/L vs. 19 U/L, respectively, aspartate aminotransferase were 45.5 U/L vs. 24 U/L, respectively in abnormal and normal aminotransferase groups. Liver enzyme abnormalities were associated with disease severity, as well as a series of laboratory tests including higher alveolar-arterial oxygen partial pressure difference, higher gamma-glutamyltransferase, lower albumin, decreased CD4+ T cells and B lymphocytes. Ultrastructural examination identified typical coronavirus particles, characterized by spike structures, in the cytoplasm of hepatocytes in 2 COVID-19 cases. SARS-CoV-2-infected hepatocytes displayed conspicuous mitochondrial swelling, endoplasmic reticulum dilatation and glycogen granule decrease. Histologically, massive hepatic apoptosis and some binuclear hepatocytes were observed. Taken together, both ultrastructural and histological evidence indicated a typical lesion of viral infection. Immunohistochemical results showed scarce CD4+ and CD8+ lymphocytes. No obvious eosinophil infiltration, cholestasis, fibrin deposition, granuloma, massive central necrosis, or interface hepatitis were observed. Conclusions: SARS-CoV-2 infection in the liver directly contributes to hepatic impairment in patients with COVID-19. Hence, a surveillance of viral clearance in liver and long-term outcome of COVID-19 is required. Lay summary: Liver enzyme abnormalities are common in patients with coronavirus disease 2019 (COVID-19). We reported the clinical characteristics and liver pathological manifestations of COVID-19 patients with elevated liver enzymes. Our findings suggested that SARS-CoV-2 infection of the liver is a crucial factor contributing to hepatic impairment in patients with COVID-19.


Subject(s)
Alanine Transaminase/blood , Aspartate Aminotransferases/blood , Coronavirus Infections , Liver Diseases , Liver , Pandemics , Pneumonia, Viral , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/blood , Coronavirus Infections/complications , Coronavirus Infections/mortality , Coronavirus Infections/pathology , Correlation of Data , Humans , Immunohistochemistry , Liver/metabolism , Liver/pathology , Liver/virology , Liver Diseases/blood , Liver Diseases/diagnosis , Liver Diseases/etiology , Liver Function Tests/methods , Male , Microscopy, Electron , Middle Aged , Pneumonia, Viral/blood , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Pneumonia, Viral/pathology , SARS-CoV-2 , Severity of Illness Index
4.
Int J Gynaecol Obstet ; 149(2): 130-136, 2020 05.
Article in English | MEDLINE | ID: covidwho-11527

ABSTRACT

OBJECTIVE: To provide clinical management guidelines for novel coronavirus (COVID-19) in pregnancy. METHODS: On February 5, 2020, a multidisciplinary teleconference comprising Chinese physicians and researchers was held and medical management strategies of COVID-19 infection in pregnancy were discussed. RESULTS: Ten key recommendations were provided for the management of COVID-19 infections in pregnancy. CONCLUSION: Currently, there is no clear evidence regarding optimal delivery timing, the safety of vaginal delivery, or whether cesarean delivery prevents vertical transmission at the time of delivery; therefore, route of delivery and delivery timing should be individualized based on obstetrical indications and maternal-fetal status.


Subject(s)
Coronavirus Infections/therapy , Infectious Disease Transmission, Vertical/prevention & control , Pneumonia, Viral/therapy , Pregnancy Complications, Infectious/therapy , Betacoronavirus , COVID-19 , China , Consensus , Coronavirus Infections/virology , Delivery, Obstetric/methods , Female , Humans , Infant, Newborn , Infection Control/methods , Pandemics , Pneumonia, Viral/virology , Pregnancy , Pregnancy Complications, Infectious/virology , Risk Factors , SARS-CoV-2
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