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Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV 2) has become a global threat that has led to tremendous societal instability. The SARS-CoV-2 can exhibit a drastic variation in terms of the signs and symptoms in the patient's body. This virus manifests its existence through cough, fever, sore throat, body aches, chest pain, headaches, and dyspnoea. These can lead to life-threatening respiratory insufficiency, thereby affecting several other organs such as the kid-ney, heart, lungs, liver, and nervous system. The lungs are the primary target site for SARS-CoV-2 and several diagnoses are being deployed in real time for treatment purposes. Although chest CT is the standard method for early diagnosis and management of Coronavirus Disease (COVID-19), lung ultrasound (US) has some merits over chest CT and may be used in addition to it in the workup of COVID-19. The goal of our review is to look at the observations of the reports on lung ultrasound in COVID-19 patients and the current advances.Copyright © 2023 Bentham Science Publishers.
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Introduction: India has recorded over 4.23 Crores of COVID -19 cases and 5.04 lakh deaths till now. Available literature shows mortality in Covid ICU of 30-35%. Aim(s): To study mortality and comorbidities in Covid Pandemic First & Second wave. Methodology: In this retrospective study conducted at Covid ICU in Mumbai, all patients needing ICU admission were enrolled. We studied 214 Covid patients in first wave and 97 patients in second wave. Covid patients (pts) with breathlessness, fever, sore throat were included. Patients with underlying chronic respiratory lung diseases were also treated as per standard Covid protocol. Result(s): Of the 214 patients in first Covid wave, 210 patients needed high flow oxygen (92.51%);180 pts needed NIV (82.94%);30 pts needed Mechanical Ventilation (MV);28 pts expired (13.33%). Most patients belonged to sixth decade. The major co morbidities in dead pts were diabetes (33.33%) followed by hypertension (24.20%). Comorbidities of chronic respiratory diseases were COPD (12.1%), post TB sequelae (3%) and tuberculosis (3%) In 2nd covid wave(n=97), 95 needed oxygen. 67 needed NIV (69.07%) and 28 needed MV (28.86%). Of these, 25 pts expired (28.86%). The major comorbidities in dead pts were hypertension (38.3%), followed by diabetes(25.5%). In chronic respiratory diseases, COPD (4.3%) was the most common comorbidity. Conclusion(s): The COVID-ICU mortality was high at 13.33% (first wave) and 28.86%(second wave). Pt's mean age was 56.0 yrs and 63.5 yrs in first and second wave respectively. Respiratory failure with high oxygen requirement and ARDS were leading causes of deaths. Comorbidities like diabetes and COPD had high mortality.
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Case Report: As COVID-19 infections became more common, children began presenting with multisystem inflammatory syndrome (MIS-C). It can be difficult to distinguish rare presentations of common diseases from MIS-C, especially when there has been a close contact with COVID-19. Epstein-Barr virus (EBV) is a universally common infection with 90% of individuals showing serological signs of past infection. Both MIS-C and EBV can present with similar signs and symptoms. Our case aims to remind the reader to keep in mind uncommon presentations of common viral infections which may mimic MIS-C. Case Presentation: A previously healthy 5-year-old girl presented with persistent fevers for 12 days, associated with stomatitis, vomiting, and diarrhea. Physical exam was significant for a moderately ill-appearance, small (<1 cm) left posterior cervical lymphadenopathy, and soft palate and buccal oral ulcers. Initial labs (see Table) revealed leukocytosis with reactive lymphocytes and cholestatic hepatitis with mild coagulopathy. Although she had no respiratory symptoms, CT chest revealed left upper lobe pneumonia. Abdominal ultrasound showed diffuse hepatosplenomegaly, gallbladder wall thickening, and enlarged epigastric lymph nodes. Echocardiogram showed normal systolic function and coronary arteries without dilation. Extensive viral and bacterial nasal swab and serologic testing, including for SARS-CoV-2 antibodies, was negative. On Day 2, her Monospot was positive, along with EBV viral capsid antigen IgM and IgG with the absence of EBV nuclear antigen IgG. In addition, serum PCR was positive for EBV. Management and Outcome: Due to persistent fevers on Day 3 of broad-spectrum antibiotics, coupled with a close contact with active COVID infection, she was treated with the MIS-C protocol of intravenous immunoglobulin G (IVIG), prednisone, and aspirin. Within a day of IVIG, she improved clinically and fever resolved. By discharge on Day 8, her lab values had begun to normalize. Discussion(s): EBV is known to present in children with typical infective mononucleosis symptoms such as fever, sore throat, and lymphadenopathy. However, these can be lacking which makes the diagnosis challenging. Although hepatitis is a common sequalae of EBV, EBV induced pneumonitis and stomatitis are rare, especially in immunocompetent individuals. While our patient improved after treatment with IVIG, suggesting MIS-C, we still attribute her illness to EBV, as IVIG has been shown to provide antiviral and anti-inflammatory benefit in EBV infections. This case highlights the challenge of recognizing and overtreating rare presentations of common viral infections in the face of an emerging disease such as MIS-C. Significant Laboratory Values [Table presented] Copyright © 2023 Southern Society for Clinical Investigation.
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Background: Coronavirus disease 2019 (Covid-19) is caused by a novel coronavirus (SARS-CoV-2) infection, while influenza viruses cause the flu. SARS-CoV-2 and influenza virus co-infection seems to be a real and serious concern. Objective(s): This study aims to evaluate the clinical features, laboratory investigations, computed tomography scans, and interventions of Covid-19 patients during seasonal influenza. Method(s): This was a multi-center prospective cohort study that collected data from hospitals, clinics, and laboratories on measurements, treatments, and outcomes from Covid-19 patients admitted to temporary Covid-19 care centers. Result(s): A total of 480 individuals (female, 231 [48.12%];male, 249 [51.88%]) were recruited from March 31st to May 14th, 2021 at five hospitals/clinics in Uttar Pradesh, North India. The patients were divided into six groups based on their age (65+ years [25.41% of cases] being the most affected age) and five groups based on their conditions (asymptomatic 65 [13.54%], mild 94 [19.58%], moderate 206 [42.91%], severe 84 [17.50%] and critical 31 [6.45%]). Patients' outcomes were documented as death (19 [3.95%]), recovery (421 [87.71%]) and under-treatment (40 [8.34%]). Conclusion(s): The most common clinical symptoms reported were fever, sore throat, and dyspnea. The severity was linked to hypoxemia, lymphocytopenia, thrombocytopenia, elevated erythrocyte sedimentation rate (ESR), and high blood urea nitrogen (BUN). The vast majority of patients were given symptomatic treatment. Any onset of fever should be suspected and examined for the viral strain to distinguish between Covid-19 and the seasonal flu. Copyright © 2022 Bentham Science Publishers.
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SESSION TITLE: Systemic Diseases with Deceptive Pulmonary Manifestations SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Pulmonary cavitary lesions can have varying etiologies. Among these, Lemierre syndrome is an uncommon disease which usually presents with symptoms of upper respiratory tract infection with unilateral neck pain, tenderness or swelling. In recent years, antibiotic stewardship for upper respiratory illnesses has led to its delayed diagnosis resulting in possible increased morbidity and mortality. There have been few reported cases of pulmonary cavitary lesions as the initial presentation of Lemierre syndrome. Our patient presented with incidental bilateral pulmonary cavitary lesions, which led to a diagnosis of Lemierre syndrome. CASE PRESENTATION: A 30-year-old gentleman with no significant past medical history visited urgent care for reproducible chest pain following motor vehicle accident. Chest x ray obtained for suspected rib fracture showed bilateral patchy and rounded opacities, confirmed by CT as bilateral cavitary nodules and consolidation. He was referred to our hospital for further care. Two weeks prior, following administration of COVID booster vaccine, he had developed fever, sore throat, tender lump behind left ear, left jaw and anterior left neck. Most symptoms self resolved in 3-5 days except persistent fever. On arrival, patient was febrile to 102F and hemodynamically stable. Physical examination revealed dry mucous membranes and erythematous pharynx. Labs were significant for leukocytosis of 24.5uL with bandemia and elevated inflammatory markers. Three sets of blood cultures were drawn and empirically started on vancomycin and piperacillin/tazobactam. Echocardiogram ruled out heart valve vegetations. CT angiography of neck showed intraluminal thrombi in left internal jugular vein. Blood cultures finalized to Fusobacterium nucleatum and antibiotics were tapered to metronidazole. Due to persistent fever, anticoagulation was initiated with apixaban 5mg twice daily. Pan CT showed improvement in size of many pulmonary septic emboli. After 48 hours of patient being afebrile, he was discharged on antibiotics and apixaban for at least 4 weeks until surveillance CT angiography showed non progression of thrombus. DISCUSSION: Lemierre syndrome is septic thrombophlebitis of internal jugular vein which presents within 1-3 weeks following upper respiratory tract infections with multi-system complications. Management involves prolonged antibiotic course with use of anticoagulation and vein stripping still being debated. Our patient came to the hospital with an incidental finding of bilateral cavitary pulmonary lesions which went on to be diagnosed as Lemierre syndrome from positive blood cultures and CT angiography findings. CONCLUSIONS: Lemierre syndrome is an uncommon disease with mortality up to 18%. A call out to health care providers to keep a low threshold for its diagnosis in patients with initial presentation of bilateral pulmonary cavitary lesions, warranting prompt management. Reference #1: Sinave CP, Hardy GJ, Fardy PW. The Lemierre syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection. Medicine (Baltimore). 1989 Mar;68(2):85-94. PMID: 2646510. Reference #2: Golpe R, Marín B, Alonso M. Lemierre's syndrome (necrobacillosis). Postgrad Med J. 1999 Mar;75(881):141-4. doi: 10.1136/pgmj.75.881.141. PMID: 10448489;PMCID: PMC1741175. Reference #3: Lee WS, Jean SS, Chen FL, Hsieh SM, Hsueh PR. Lemierre's syndrome: A forgotten and re-emerging infection. J Microbiol Immunol Infect. 2020 Aug;53(4):513-517. doi: 10.1016/j.jmii.2020.03.027. Epub 2020 Apr 4. PMID: 32303484. DISCLOSURES: No relevant relationships by Sumukh Arun Kumar No relevant relationships by Megna Machado No relevant relationships by Sushmita Prabhu No relevant relationships by PAWINA SUBEDI No relevant relationships by Mithil Gowda Suresh No relevant relationships by Bradley Switzer
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INTRODUCTION: Patients Infected with CORONA VIRUS- 2019 (COVID-19) showed changes in their platelet counts and Mean platelet volume (MPV). The present study was aimed to observe any association between lowered platelet counts with mean platelet volume (MPV) from the corana positive individuals. METHOD(S): It is a prospective study from 1-8-2020 to 30-9-2020 .Patients who presented with complaints of Fever, sore throat, body pains, cough, breathlessness, diarrhoea were evaluated at the triage area of the Hospital. Throat swab was taken and RT-PCR was done and only 200 confirmed cases were included in the study. Patient blood samples were collected and processed in SYSMAX 5 -part Haematology analyser in the Hospital Central Laboratory. The patients CBP, Platelet count and MPV were tabulated. RESULT(S): Out of 200 COVID-19 confirmed cases, the numbers of males were 145 (72.5%) and females 55 (27.5%). Most of the patients belonged to age group 50 years (25.5%), 60yrs age group (21%). The Maximum age in our study group was 80 years, minimum age was 19 years and mean age was 50 years. In our study it was noticed that Severe thrombocytopenia was seen in one patient with platelet count 38,000/muL,(0.5%), Moderate thrombocytopenia was seen in two patients(1%) and mild thrombocytopenia was seen in 12 (6%) cases. In our study only fifteen cases (7.5%) showed thrombocytopenia. The MPV for all fifteen cases were studied and MPV was in Range of 9.6- 11.8 fl. CONCLUSION(S): Low platelet count and high MPV are associated with disease severity. Platelet count is one of easy cheap method for the assessing the disease severity along with other parameters Copyright © 2022 Ubiquity Press. All rights reserved.
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Introduction/ Background: Most reports are silent on the burden of COVID-19 in paediatric population. Is the incidence and severity of COVID-19 truly low as reported? The objective of this study was to describe the prevalence and clinical features of coronavirus disease among children at a COVID-19 testing centre in Lagos, Nigeria. Methods: This is a retrospective study describing the prevalence and pattern of symptoms of COVID-19 among children at a testing centre in Lagos, Nigeria. Data was collected from the electronic records of individuals (< 18 years) visiting the SARS-CoV-2 testing centre from March 1, 2020, to June 30, 2020. The sociodemographic data, travel history, preexisting comorbidities, clinical symptoms, and outcomes of the qualitative (SARS-CoV-2) RT-PCR results were extracted and analyzed using SPSS software, version 22.0. Results: Three hundred and seven children were screened for SARS-CoV-2 infection and fifty children were found to be positive, giving a prevalence of 16.3%. The median age (interquartile range (IQR)) was 9 (4- 14) years. Seventeen (34.0%) of the SARS-CoV-2- positive children presented with symptoms while the rest were asymptomatic. The common presenting symptoms among those positive for SARS-CoV-2 infection were fever (40.0%), cough (32.9%), sore throat (17.1%), and runny nose (15.7%). Fever and sore throat occurring together was the symptom combination most predictive of SARS-CoV- 2 infection among the population (OR 0.49,95% CI: 0.12-1.98 and OR 4.59 95% CI 0.93-22.73). Impact: This is the first study to describe the epidemiological and clinical characteristics of children screened for SARS-CoV-2 infection in sub-Saharan Africa. The pattern of symptoms seen in SARS-CoV-2 infections among children is similar to common childhood infections (malaria, acute diarrhea diseases, and respiratory tract infection). Conclusion: Prevalence of paediatric SARS-CoV-2 infection was 16.3%, but majorly of mild disease and was commonly predicated by fever and sore throat symptom combination. There is a need for a high level of suspicion in the management of common febrile diseases in paediatric settings especially in presence of sore throat.
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Common causes of viral exanthems in Australia include herpesviruses, enteroviruses, parvovirus B19, varicella, measles and rubella viruses and mosquito-borne alphaviruses. The cause can often be diagnosed clinically from the rash distribution and morphology, confirmed only when necessary with serological or PCR tests. Most viral exanthems are self-limiting, requiring supportive care alone.
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Aim and objective: To present a rare case of abdominal wall fungal coinfection with Mucormycosis in a patient of COVID-19. Materials and methods: A 33-year-old female operated case of laparoscopic ectopic pregnancy removal with salpingectomy and tubectomy, at postoperative day 5 had redness and pus discharge from the operative site and was diagnosed with abdominal wall cellulitis. She underwent local exploration and wound wash. On postoperative day 21, the patient came to the emergency room with cellulitis, and pain at the port insertion site. On examination, we highlight BP 90/50 mm Hg and blood test analysis with HB-8.3, leucocyte count 29.91 × 109/L, CRP 333 mg/L. Results: CT scan revealed necrotizing fasciitis. She underwent wide local excision and debridement. Post debridement the next day during dressing, the wound showed a cotton fluffy appearance at the edges and part of the base with black necrotic areas. A wound swab was sent for fungal culture, KOH mount, pus culture, and tissue for histopathology. In the meantime, she was started on empirical antifungal amphotericin B, meropenem, and minocycline antibiotics. On history, the patient remarked that she did have fever, sore throat, and cough for 5 days, 4 weeks before laparoscopic ectopic pregnancy removal. Also one of her family members had tested positive for COVID-19. COVID antibodies test was done which were reactive: 1.96. Tissue histopathology revealed mucormycosis. MRI abdomen findings showed a 15 cm large defect involving the entire thickness of subcutaneous fat. A high degree of suspicion and promptness in starting antifungal treatment prevented the fatal outcome. Conclusion: COVID-19 is associated with immune dysregulation and consequently life-threatening infections. The prolonged and indiscriminate use of steroids for the treatment of COVID-19 could contribute to this problem of fungal superinfection of mucormycosis. It seems prudent to have a very high suspicion supplemented with thorough clinical examination and low threshold for imaging in order to diagnose secondary fungal infections, such as mucormycosis. Early so that the treatment can be instituted as soon as possible.
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The aim is to determine oral manifestations in patients with COVID-19 disease and in the postcovid period. Methods: A special survey (questionnaire) was made in 424 people who had COVID-19 confirmed by RT-PCR, ELISA for specific IgM and IgG antibodies and Chest CT scan (168 people). 123 people had complaints and clinical symptoms in the oral cavity 2-6 months after the illness and they came to the University dental clinic. Laboratory tests have been performed (clinical blood test, blood immunogram, virus and fungal identification). Results: Survey results showed that 16,0% participants had asymptomatic COVID-19, 23,6% - mild and 48,1% moderate disease. 12,3% with severe COVID-19 were treated in a hospital with oxygen support. In the first 2 weeks 44,3% indicated xerostomia, dysgeusia (21,7%), muscle pain during chewing (11,3%), pain during swallowing (30,2%), burning and painful tongue (1,9%), tongue swelling (30,2%), catharal stomatitis (16,0%), gingival bleeding (22,6%), painful ulcers (aphthae) (8,5%) and signs of candidiasis - white plaque in the tongue (12,3%). After illness (3-6 months), patients indicated dry mouth (12,3%), progressing of gingivitis (20,7%) and periodontitis (11,3%). In patients who applied to the clinic we identified such diagnoses: desquamative glossitis - 16 cases, glossodynia (11), herpes labialis and recurrent herpetic gingivostomatitis (27), hairy leukoplakia (1), recurrent aphthous stomatitis (22), aphthosis Sutton (4), necrotising ulcerative gingivitis (13), oral candidiasis (14), erythema multiforme (8), Stevens-Johnson syndrome (2), oral squamous cell papillomas on the gingiva (4) and the lower lip (1). According to laboratory studies, virus reactivation (HSV, VZV, EBV, CMV, Papilloma viruces) was noted in 52 patients (42,3%), immunodeficiency in 96 people (78,0%), immunoregulation disorders (allergic and autoimmune reactions) in 24 people (19,5%). Conclusions: Lack of oral hygiene, hyposalivation, vascular compromise, stress, immunodeficiency and reactivation of persistent viral and fungal infections in patients with COVID-19 disease are risk factors for progression of periodontal and oral mucosal diseases.
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Background: Paediatric Cov-2 infections have been less severe than in adults, however some have developed a newly defined syndrome, Paediatric Inflammatory Multisystem Syndrome associated with CoV-2 (PIMS -TS). Its presentation is variable and can cause multi-system involvement. It belongs to the common spectrum of pathogen-triggered hyperinflammatory states, including atypical Kawasaki disease. Case summary: 17 year old male of Ghanaian origin, with no significant past medical history, presented with a one-week history of general malaise, fevers and sore throat. He developed severe chest pain and cardiogenic shock, with a CRP of 200, raised troponin and global hypokinesia on echocardiogram with an ejection fraction of 20%. He was positive for SARS-CoV-2 antibodies (though PCR-antigen negative at admission) and fit the criteria for myocarditis secondary to PIMS-TS. He was treated for sepsis, commenced on IV methylprednisolone and needed intubation, sedation and cardiothoracic ICU level care. On weaning sedation after 3 days, he was found to have left middle cerebral artery syndrome with NIHSS 16. CT head and CT angiogram showed a left MCA ischaemic stroke, and a thrombus in the Sylvian MCA branch. This was treated with antiplatelets. His disease markers and motor deficits improved significantly, however he has cognitive impairment and low mood. Conclusion: PIMS-TS related LVO anterior circulation infarct is rare. It necessitates urgent recognition and multi-specialty involvement as currently management is not standardised. Axial DWI (A), ADC (B) MRI demonstrate large left MCA territory infarct. Axial MRA (C) shows occlusion of the left M2 branches, signal drop-out on SWI (D).
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Objectives: We aimed to reveal the skin, mucous membrane, hair and nail findings of children who meet the multisystem inflammatory syndrome in children (MIS-C) criteria. Method: A prospective case series consisting of 43 children who applied to Karadeniz Technical University Faculty of Medicine Farabi Hospital between January 2020 and January 2022 and met the criteria for MIS-C according to the diagnostic criteria of the Centers for Disease Control and Prevention was conducted. Results: Of 43 patients diagnosed with MIS-C, 18 (%41,9) were female and 25 (%58,1) were male. The mean age of the patients is 7.63, the age range is between 7 months and 15 years. The results of polymerase chain reaction tests for SARS-CoV-2 were positive for 4 (%9,3) patients, and the results of SARS-CoV-2 immunoglobulin G tests were positive for 39 (%90,7) patients. No mucocutaneous involvement was observed in 3 (%6,9) of the patients. Nonpurulent conjunctivitis was observed in 25 (%58,1) patients, and periorbital edema was observed in 4 (%9,3) patients. 4 (%9,3) patients had symmetrical edema of the hands and feet, and 2 (%4,6) patients had periungual desquamation. While no oral mucosal findings were observed in 15 (%34,9) patients;12 (%27,9) patients had fissured lips, 10 (% 23,3) had cheilitis, 8 (%18,6) had diffuse hyperemia of the oral mucosa, 6 (%13,9) had strawberry tongue, and 3 (%6,9) had herpes labialis. 21 (%48,8) of the patients had urticarial, 12 (%27,9) of them maculopapular, 5 (%11,6) patients livedoid and 1 (%2,3) patient had a skin rash compatible with pseudopernio. No hair or nail changes were observed in the patients while they were hospitalized. Discussion: In this case series of hospitalized children with definitive MIS-C during the COVID-19 pandemic, a wide spectrum of mucocutaneous findings was identified.
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Thyroid dysfunction has been reported following COVID-19 infection in the recent past. A 50 year old hypertensive female with no previous thyroid illness, developed features of thyrotoxicosis two weeks after a COVID-19 infection. There was no thyromegaly, neck pain or fever and her ESR was 15 mm/hour. She was initiated on propranolol and methimazole in an outside hospital. Ten days later, she presented to our hospital with fever, sore throat, cough and breathing difficulty. On evaluation she was found to be in neutropenic sepsis (WBC -820 cells/mm3, ANC-6 cells/mm3). Evaluation of thyroid functions showed: TSH- <0.00025 IU/ml, free T3 - 4.17 pg/ml, free T4- 3.59 ng/ml and Thyroid Receptor Antibody Levels (TRAb)- 2.53 IU/L. Following treatment with colony stimulating factors and antibiotics she recovered. The patient was commenced on lithium bicarbonate and cholestyramine, along with propranolol. On follow up in the OPD she is euthyroid with free T4 1.43 ng/ml (normal) levels. Post COVID-19 thyrotoxicosis in this case is likely due to Graves' disease. Thyrotoxicosis following COVID-19 is now being recognised and is possibly due to infection induced molecular mimicry with activation of immune pathways causing autoimmune disorders.
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OBJECTIVE: This project sought to uncover genetic explanations as to why certain men face increased susceptibility to developing COVID orchitis. Our goal was to identify genetic variants associated with COVID orchitis in a group of patients, aided by whole-exome sequencing and protein phenotyping of affected patients. MATERIALS AND METHODS:We identified and examined six COVID- 19 patients who all were confirmed with polymerase chain reaction (PCR), including three COVID-19 (+) men without orchitis (controls) and three COVID (+) men with orchitis (bilateral testicular pain for at least 5 days around the time of testing PCR positive). Of note, among the three men with COVID-19 who had orchitis, two of them were siblings.DNA extraction and whole exome sequencing were performed on blood using the QIAmp blood maxi kit on five of the six patients. Variants were prioritized by being shared between the three patients affected with orchitis, absent in controls, and introducing nonsense, frameshift, splicing or non-synonymous amino acid changes and less than 10% in population prevalence. Based on WES findings, DuoSet® Human ACE2 reagent kit 2 (catalog number: DY933- 05) was purchased from R&D Systems, USA, and used to measure the level of soluble ACE2 in the plasma samples. RESULTS: The average age of the men in the study was 25 years old. The average duration of COVID symptoms (fever, sore throat, cough, body aches) were 7 days. Among the men who developed bilateral testis pain, the symptoms lasted for an average of 22 days. The median sperm concentration and sperm motility was 19 million/cc and 60% around 3 months after original infection. A list of 16 variants was generated that found to be shared between the two siblings with COVID orchitis along with the unrelated subject with COVID orchitis, and not present in the two controls. Among the 16 variants, a nonsynonymous non-frameshit deletion in NACAD variant on chromosome 7 with a frequency of 3.9% prevalence in ExAC was prioritized based on known involvement in the ACE2 pathway, read depth, and genotype quality. Phenotypically, we found that circulating levels of solubleACE2 was 3.72 ng/ml among men who had COVID orchitis and was lower than men who developed COVID without orchitis. CONCLUSIONS: We observed a stop mutation in NACAD in 2 brothers and 1 unrelated man who developed COVID orchitis. Interestingly, we found lower circulating ACE2 serum levels in both brothers with orchitis and the one nonrelated orchitis subject but normal serum levels in all controls. NACAD when involved with cellular ability to shuttle out ACE2 becomes critical for COVID symptomatology. With decreased transcellular and extracellular transport of ACE2 being possible in subjects with the gene mutation, it can be postulated more ACE2 will be found intracellularly leading to increased cellular entry of SARS CoV-2 and possibility of orchitis sequelae. IMPACT STATEMENT: These findings provide an explanation as to why genetic variations can lead to some patients developing comorbidities such as orchitis from COVID-19.
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All over the world, there is a new target of public health emergency looming the world along with an appearance and distribution of the novel coronavirus disease (2019-nCoV) also known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). This Virus was initially generated in bats and then transferred to a human being over an unknown animal playing the role of a mediator in Wuhan, China, in December 2019. This virus is transmitted by breathing or coming in contact with an infected person’s droplets. The Incubation period is between 2 to 14 days for COVID-19, that is the time between exposure of the virus (person becoming infected) and symptom appearance in that person, averaging 5-6 days. However, it can go up to 14 days. Throughout this period, which can be also known as a “pre-symptomatic” period, some of the infected patients or persons can be contagious. That is why;transferal from a pre-symptomatic case can happen before the onset of the symptoms. There are a few number of case studies and reports, pre-symptomatic transferal has been documented via contact with someone who is diagnosed with virus and increased investigation of that particular clusters of total confirmed cases. The main problem is that the symptoms are just like the regular flu that are cough, fever, sore throat, fatigue and breathlessness. This virus is moderate or mild in most of the people, but in elder ones, it may proceed to pneumonia, multi-organ dysfunction and Acute Respiratory Distress Syndrome (ARDS). Coronavirus has significant consequences on the Health system, mainly on cardiovascular diseases and on the environment.
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Background: The COVID 19 pandemic caused by the betacoronavirus SARS-CoV-2 with its virulence and contagiousness is a public health emergency. The prefferred method of diagnosis is the FDA aprroved RT-PCR testing of nasopharyngeal swabs with 65% sensitivity, with false negative rates of <5% to 40%. Clinical diagnosis should supplant when there is high suspicion with labs and imaging consistent with COVID'19 and negative RT-PCR does not rule out the disease. Here we report one such case. Case Report: 45-year-old female with nil comorbidities presented with fever and breathlessnesss since 7 days with tachypnoea (46 breaths/min), hypoxia (spo2 75% room air) and bilateral coarse crepitations on auscultation. ABG & CXR suggested severe ARDS. CT Thorax revealed CTSI 21/25.CORADS 5.Two nasopharyngeal swabs 24 hours apart tested negative for COVID'19. Lab investigations suggested deranged inflammatory markers (ferritin 910ng/mL;CRP 121.2ng/L ;D-dimer 660ng/mL). Presumed diagnosis of COVID 19 was established based on early CT findings and lab parameters consistent with COVID'19 Pneumonitis,the patient was immediately isolated and received treatment as per COVID'19 treatment protocols (steroids,LMWH,Remdesivir). After 6th week patient showed clinical and radiological improvement.Subsequently she also developed postcovid fibrosis and discharged on pirfenidone and home based low-flow o2. Discussion and Conclusion: Fever, sore throat and breathlessness are common symptoms of Covid'19, most of which are virtually present in any viral LRTI, however in the setting of current pandemic maintain high index of suspicion for Covid'19 especially in the presence of radiological evidence even with negative RT-PCR.
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Background: We prospectively studied 160 patients of asymptomatic covid 19 infection for their clinical course and outcome. Methods: Demographic and clinical characteristics from the 160 asymptomatic SARS-CoV-2 positive patients were obtained over a period of 3 months. Results: Overall, mean age of the patients was 35.66 years. HYPERTENSION was the commonest comorbidity. However, 142 patients (88.75%) were found to be without any co-morbidities.17 patients (10.6%) developed symptoms on 3rd day whereas 7.5%, 6.8%, 3.7% and 1.2% became symptomatic on 2nd, 4th, 1st and 5th day respectively. Conclusion: Cough was the most common symptom seen followed by fever, sore throat, generalized weakness and dyspnea. Asymptomatic patients were mostly without any comorbidities and hence remained asymptomatic and overall outcome was better.
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Background: A 19-year-old gentleman, with past history of sinusitis, aseptic meningitis upon birth & subsequent epilepsy, came back from the UK presenting with fever, sore throat, chills with myalgia, as well as pleuritic chest pain. Case: COVID-19 was ruled out. Despite appropriate medications, his chest pain worsened together with epigastric pain. Fever persisted. Urgent CT was arranged for him showing findings suspicious of pericarditis. Serial ECG after admission revealed the classical findings compatible with pericarditis. He was taken over to CCU with treatment for pericarditis started. Unfortunately, despite empirical broad spectrum antibiotics & anti-inflammatories, his symptoms worsened with borderline blood pressure, increasing tachypnoea & persistent fever. Blood tests showed sky high white cell count up to 50 with neutrophil predominance. Serial echocardiograms showed a gradual increase in posteriorly-loculated pericardial effusion with fibrin, with striking findings of constriction physiology. Significant respirophasic changes in mitral & tricuspid inflow were demonstrated. Right-sided cardiac chambers were not collapsed, rather, the RA & the IVC were dilated. CT was repeated for deteriorating hemodynamics showing a rim-enhancing pericardial effuision. Decision making: In view of the constrictive physiology demonstrated in echocardiograms, surgical intervention was deemed necessary for the patient & he was sent immediately to Queen Elizabeth Hospital Cardiothoracic Surgery team for emergency surgery. Conclusion: The classical teaching of constrictive pericarditis describes patients with prior insult to the pericardium such as surgery, previous tuberculosis infection, prior radiotherapy exposure, etc, such that the pericardium is calcified as a cage hindering the expansion of the heart. However, with the presence of purulent and fibrin-rich effusion, constrictive physiology can become evident and life-thereatening (Effusive-constrictive pericarditis) as well.
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Objective: To study the Feto maternal outcome of Covid-19 in Pregnancy. Methodology: This is a retrospective study done on 53 pregnant patients who tested positive for SARS-CoV-2 and were delivered in D. Y. Patil Hospital, Kolhapur from April 2020 to July 2020. Maternal and fetal characteristics and the outcome of Covid-19 infection in pregnancy was studied. Results: Among the 53 patients, 49 patients (92%) were asymptomatic. Remaining presented with fever, sore throat, cough. 69% were primigravida and 30% were multigravida. 66% underwent LSCS while 28% were delivered normally. In majority, LSCS was done for oligohydramnios and fetal distress. All the patients were discharged after negative swab report and no maternal death was reported. About 32% of neonates required NICU admission for hyperbilirubinemia, pneumonia and sepsis. There was no neonatal death and none of the neonates turned out to be positive for covid-19. Conclusion: The severity of SARS-CoV-2 was seen to be mild to moderate in pregnant women. Majority of the women infected with coronavirus disease were asymptomatic. The risk of vertical transmission to the neonate was also found to be low. Oligohydramnios and fetal distress were commonly seen in the patients, pointing towards the lack of antenatal follow up visits due to restricted mobility in the covid era.
ABSTRACT
The recent scenario with an outbreak of novel coronavirus has led to dramatic upsurge in mortality and morbidity rates all around the globe. The objective of consolidated article is to provide an updated insight on coronavirus disease (COVID-19) based on the current literature, and it is anticipated that it may serve as a perspective reference in future studies. Scopus, Science Direct, MEDLINE, PubMed, and Google Scholar databases were used to search the literature. For the current review, both research and review articles issued in the English language were considered. The mode of Corona virus disease transmission is through direct contact or inhalation of infected respiratory droplets. The length of period of incubation varies from 2 to 14 days with maximum patients presenting mild symptoms and sign, that is, cough, fatigue, fever, and sore throat. The infection could be worst and life threatening in elderly and immuno-compromised patients. Special diagnostic molecular tests are available for detection and identification of virus. Till date, no cure is available and treatment of patients is only supportive therapy. Preventive measures such as physical isolation, hand washing, and wearing of mask should be followed. Even though, strict measures are taken into account, prevalence of COVID-19 continues to escalate worldwide and coming course of this novel virus is still not known.