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Cureus ; 14(3), 2022.
Article in English | EuropePMC | ID: covidwho-1781884


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the etiologic agent of coronavirus disease 2019 (COVID-19), causes an excessive inflammatory response and hemostatic abnormalities in the lungs, kidney, and skin. Four patients with COVID-19 admitted to an acute care community hospital developed nonblanchable purpuric macules, patches, and retiform purpura-like lesions at the sacrum, buttocks, lower extremities, and upper back. These lesions can be misdiagnosed as deep tissue pressure injuries. One patient also developed a vesicular-like rash at the upper back and another one developed pernio (chilblains)-like lesions to the third toe of the left foot. Previous studies suggest that the vascular hyperinflammation status and microthrombosis may be responsible for the cutaneous manifestations in patients with SARS-CoV-2. These cutaneous manifestations observed in patients with SARS-CoV-2 may be related to progression of the disease.

J Nerv Ment Dis ; 209(8): 543-546, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1234178


ABSTRACT: Social distancing due to COVID-19 may adversely impact treatment of adults with serious mental illness, especially those receiving intensive forms of community-based care, in part through weakening of the therapeutic alliance. Veterans and staff at a Veterans Affair (VA) medical center were surveyed 3 months after social distancing disrupted usual service delivery in intensive community-based treatment programs. Veterans (n = 105) and staff (n = 112) gave similar multi-item ratings of service delivery after social distancing, which involved far less face-to-face contact and more telephone contact than usual and rated their therapeutic alliances and clinical status similarly as "not as good" on average than before social distancing. Self-reported decline in therapeutic alliance was associated with parallel decline in clinical status indicators. Both veterans and staff indicated clear preference for return to face-to-face service delivery after the pandemic with some telehealth included.

Attitude of Health Personnel , COVID-19 , Case Management/standards , Community Mental Health Services/standards , Delivery of Health Care/standards , Patient Preference , Physical Distancing , Telemedicine/standards , Therapeutic Alliance , Adult , COVID-19/prevention & control , Female , Humans , Male , Middle Aged , United States , United States Department of Veterans Affairs , Veterans
Int J Gen Med ; 14: 267-271, 2021.
Article in English | MEDLINE | ID: covidwho-1060965


We sought to examine the trend (April-July) in the treatment patterns among hospitalized COVID-19 patients using the Premier Healthcare Database (PHD). In the analysis, we identified 53,264 patients from 302 hospitalsthat continuously provided inpatient data from April 1, 2020 to July 31, 2020 to the PHD, a nationwide, population-based multihospital research database in the US. We used generalized estimating equations (GEE) models to assess changes in the proportion of therapies used during the study period. After adjusting for patient and provider factors, a decline in hydroxychloroquine and an increase in azithromycin and dexamethasone were observed among COVID-19 patients during the 4-month study period.