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1.
Akademik Acil Tip Olgu Sunumlari Dergisi ; 12(3):91-93, 2021.
Article in English | EMBASE | ID: covidwho-1822752

ABSTRACT

Introduction: Many studies have shown that coagulation disorders and increased risk of thrombosis may occur during coronavirus disease 2019 (COVID-19) infection. Although cardiac or pulmonary vascular pathologies has been detected in most cases, cerebral sinus thrombosis are rare. During COVID-19 infection patients rarely present with neurological symptoms. Case Report: A 19-year-old man was admitted to our emergency department with neurological symptoms. Cerebral venous sinus thrombosis (CVST) was detected in Brain Computerized Tomography and Magnetic Resonance Imaging examinations. Our patient was hospitalized in the neurology department of our hospital for medical treatment and was discharged after clinical recovery. Discussion: In this case report we wanted to draw attention to cerebral venous sinus thrombosis which is a rare but treatable complication of COVID-19 infection in a young patient. We examined our patient in the light of literature. Conclusion: Clinicians should keep in mind the diagnosis of CVST that may occur due to infection associated thrombosis in COVID-19 patients presenting with neurological symptoms and consider adding anticoagulants to the treatment if necessary.

2.
ACG Case Reports Journal ; 9(3), 2022.
Article in English | EMBASE | ID: covidwho-1822626

ABSTRACT

Liver injury is a common manifestation of coronavirus disease 2019 (COVID-19), with most injuries manifesting as transient mild hepatocellular injury. Cholestatic injury occurs less commonly and is typically mild. Severe cholestatic injury is rare, with only 4 cases reported in the literature. We present a 70-year-old woman with no known liver disease who presented with severe COVID-19 and developed severe cholestatic hepatitis. A liver biopsy was performed demonstrating bile duct injury, uncommonly reported in patients with COVID-19. This complication needs greater awareness because it has been known to cause progressive liver disease requiring transplantation.

3.
Pakistan Journal of Medical Sciences ; 38(5), 2022.
Article in English | EMBASE | ID: covidwho-1822610

ABSTRACT

Objectives: To determine the association between the laboratory biomarkers (C-reactive protein (CRP), Ferritin, lactate dehydrogenase (LDH), Procalcitonin, and D-dimer) with complications and in-hospital mortality in COVID-19 patients. Methods: This single-center, cross-sectional study was conducted at the Department of Emergency Medicine of Aga Khan University Hospital from April 01, 2020, to July 31, 2020. Descriptive statistics were presented as Mean±SD and Median along with Range. The frequencies and percentages were calculated for all categorical variables. Univariate and multivariate analysis was carried out to evaluate the significant association between the laboratory biomarkers and in-hospital mortality. Results: A total of 310 adult COVID positive patients were included. The most common complication was acute respiratory distress syndrome (ARDS) (37.1%), followed by myocardial injury (MI) (10.7%), deep vein thrombosis (DVT) (0.6%), and pulmonary embolism (PE) (0.3%). In-hospital mortality was 15.2%. In univariate analysis, it was observed that increased values of all biomarkers were significantly associated with the prediction of in-hospital mortality using binary logistic regression analysis (OR > 1.0, P <0.05). In multivariate analysis, increased levels of LDH and D-dimer at admission were significantly associated with increased odds of mortality (P <0.05). Conclusion: Serum CRP, ferritin, Procalcitonin, LDH, and D-dimer levels at the time of admission can predict complications like ARDS and MI and also predict mortality in COVID-19 infection. Serum LDH and D-dimer are the best amongst them for predicting mortality.

5.
Journal of Babol University of Medical Sciences ; 24(1):70-75, 2022.
Article in English | EMBASE | ID: covidwho-1820637

ABSTRACT

Background and Objective: Intussusception is one of the most common causes of intestinal obstruction in children 5 months to 3 years, which is the most common cause of acute abdominal pain and its prevalence increases as a result of viral infection. In this report, were present a case of intussusception in a 17-years-old boy following COVID-19. Case Report: A 17-year-old adolescent boy with a known case of steroid-dependent nephrotic syndrome from the age of two has been referred to the emergency department with severe abdominal pain and vomiting. On ultrasound, renal mass and free fluids were shown. Ileocecal intussusception was observed and was repaired without any complications. Conclusion: Based on the results of this study, intussusception should be considered in every patient with nephrotic syndrome with COVID-19 infection.

6.
Andes Pediatrica ; 93(2):167-173, 2022.
Article in Spanish | EMBASE | ID: covidwho-1819097

ABSTRACT

During the SARS-CoV-2 pandemic, efforts have focused on trying to identify the routes of transmission of the virus, characterize its symptoms and signs, and investigate the best diagnostic and therapeutic methods. There are fewer published data and series in the pediatric population than in adults. Objective: To analyze the clinical and epidemiological characteristics in children under 16 years of age diagnosed with SARS-CoV-2. Patients and Method: Descriptive study carried out on children who underwent SARS-CoV-2 RNA testing due to compatible symptoms, close contact, or requiring hospitalization or surgery, in the Emergency Department of a hospital in Madrid, Spain. 30 variables were collected including epidemiological data, symptoms, and signs of infection. Results: Out of 1378 patients, 12% were positive (165). There was a higher proportion of patients of North African origin in the positive group than in the negative one (p < 0.01). Of all patients, 35.6% reported close contact with a confirmed case, which was more frequent in the positive group. 75.8% of the positive patients had some symptoms, most frequently fever, runny nose, and cough, followed by digestive symptoms. There was one case of COVID-19 pneumonia and two patients with MIS-C, one of which had SARS-CoV-2 infection. Eight of the positive patients (4.8%) required hospitalization due to SARS-CoV-2 infection. Conclusion: Although SARS-CoV-2 infection is milder in the pediatric population, almost 5% will require hospitalization. No close contact was identified in a high percentage of patients (61%). Further studies are needed at all levels of care to characterize the infection in children and adolescents.

7.
Journal of Clinical Medicine ; 11(9), 2022.
Article in English | EMBASE | ID: covidwho-1818162

ABSTRACT

We performed an updated meta-analysis to robustly quantify admission trends of patients with ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI) during the first wave of the pandemic and to characterize on a large basis the risk profile and early prognosis. Studies having the same observation period for the comparison between SARS-CoV-2 outbreak in 2020 versus control period in 2019 were included. Primary endpoints were the relative variation of hospital admissions, the difference of in-hospital mortality for STEMI and NSTEMI. Secondary were: mortality according to countries, income levels and data quality;cardiogenic shock, mechanical complications, door-to-balloon time, time from symptom onset to first medical contact, left ventricular ejection fraction (LVEF) and troponin. In total, 61 observational studies with 125,346 patients were included. Compared with 2019, during the pandemic for STEMI were observed: a 24% reduction of hospitalizations with an impact on early survival (OR = 1.33 in-hospital mortality);the time from symptom onset to first medical contact was 91.31 min longer, whereas door-to-balloon time was increased (+5.44 min);after STEMI, the rate of cardiogenic shock was 33% higher;LVEF at discharge was decreased (−3.46);elevated high-sensitivity troponin levels (1.52) on admission. For NSTEMI, in the COVID-19 period, we observed a 31% reduction of hospitalizations and higher in-hospital deaths (OR = 1.34). The highest mortality rates among countries were: Italy OR = 3.71 (high income), Serbia OR = 2.15 (upper middle) and Pakistan OR = 1.69 (lower middle). Later hospital presentation was associated with larger infarctions, as well as with increased cardiogenic shock and in-hospital mortality.

8.
Clinical Neurosurgery ; 67(SUPPL 1):46-47, 2020.
Article in English | EMBASE | ID: covidwho-1816180

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has caused unprecedented social, geopolitical, and health systems factors that may affect types of patients presenting for essential, non-ambulatory care. Social distancing and lockdowns may reduce the incidence of trauma;however, a significant decline in presentations of acute medical conditions such as stroke and ACS have been reported. Furthermore, health system capacities are substantially altered, with elective surgeries postponed to devote resources to COVID-related illness and high acuity non-COVID illness. METHODS: We reviewed all emergency department and inpatient consultations to the neurosurgical service at a Level 1 Trauma Center during an 8-week post-lockdown period (3/15-5/4), quantifying overall volume, as well the distribution of problem types and management endpoints. RESULTS: Pandemic period consult volumes were significantly lower than those of parallel periods in 2016-2019 (388 vs. a 4-year average of 576, P < .001, Pearson's chi-squared test). Compared to 2016-2019, 2020 consult volume was decreased by 37% during the first four weeks following lockdown (204 vs. 280, P = .01), and by 48% during the latter four weeks (184 vs. 296, P < .001). Pandemic period consults required acute surgery in 21% of cases, non-acute or non-surgical management in 75%, and palliative management (CMO, hospice, death) in 4%. During the prior year (2019), these proportions were 15%, 80% and 5%, respectively (P = .06). The distribution of consult problem types was not statistically different between periods. Among cranial consults, trauma comprised 45% during the pandemic compared to 41% in the analogous 2019 period;tumor 20% vs 18%;vascular 16%;and ICH/stroke 8%. Among spinal consults, trauma comprised 47% vs 43%, tumor 6% vs 3%, and degenerative disc disease 29% vs 36%. CONCLUSION: Neurosurgical consult volume increasingly declined throughout the post-lockdown COVID-19 pandemic period, which was unprecedented over the 5 years studied. A higher proportion of consults resulted in acute care surgery, approaching statistical significance. Surprisingly, problem types did not differ in the pandemic period despite vastly different social circumstances. Further study will employ time series analysis to contextualize these changes within local COVID-19 surge data.

9.
Age and Ageing ; 51(SUPPL 1):i10, 2022.
Article in English | EMBASE | ID: covidwho-1815968

ABSTRACT

Introduction: Evaluation of Wythenshawe Hospital's Acute Frailty Service in January- June 2019 demonstrated slow referrals times and poor identification of frail patients due to inaccurate Clinical Frailty Scoring (CFS) at emergency department triage. This project presents the Results: of ongoing quality assessment of our service between June 2019- January 2021, following two quality improvement (QI) interventions. Aims: To evaluate our service's ability to deliver early identification and intervention for complex frail patients via Complex Geriatric Assessment (CGA), as set out in National and Regional Frailty standards.(1,2). -To improve and maintain better outcomes for patients accessing our frailty service. Method: Intervention1 (July'19): Specialist frailty nurses relocated to ED. Dedicated frailty clinical fellows and Consultant geriatrician input 0900-1700 weekdays. Intervention2 (Sep'20): Short-stay frailty unit opened. Junior clinical fellow cover increased (0900-1900 weekdays and 0900-1700 weekends). 299 patients seen at intervals between Jun'19-Jan'21 analysed using electronic records and completed CGA proformas. Results: Pre-intervention Intervention1 Intervention2 June'19(n = 22) July'19(n = 198) Nov'19(n = 25) Sep'20(n = 26) Jan'21(n = 28) Time from triage-to-CGA (mins) (CI 95%)∗ 372.0±178.2 56.0 83.4±31.0 72.9±35.7 48.4±20.0 Discharge(%): Same day 22.7 39.4 21.7 36.0 25.0<72 hr(cumulative) 72.7 63.6 47.8 68.0 57.1 Ave. length of stay(days)(CI95%) 10.4±5.9 20.6 20.0±8.7 7.1±3.4 5.4±2.1 Readmission <30 days(%) 30.0 9.0 17.4 12.5 25.0 CGA Quality(%) CFS completion 100 96.0100 89.3 ReSPECT discussion 29.3 64.0 61.5 67.9 Full medication review 46.5 96.0 80.8 89.3 Therapy assessment 85.5 92.0 92.3 89.3 ∗patients triaged between 0800-1700. Conclusion: Since Intervention1,Wythenshawe frailty service has sustained a reduction in triage-to-CGA time, maintained high percentages of same-day and<72 hr discharges, and sustained high rates of CFS completion and therapy assessments. Following intervention2, average length of stay reduced. Increased readmission rates in Jan'21 were impacted by COVID-19. Additional interventions targeted at reducing readmission rates and increasing ReSPECT discussions should be implemented. 1. GreaterManchester Frailty Collaborative and Network, 2019. 2. Same-day acute frailty service, NHS improvement, 2019.

10.
Brain Injury ; 36(SUPPL 1):116, 2022.
Article in English | EMBASE | ID: covidwho-1815753

ABSTRACT

Background: One in three women experience intimate partner violence (IPV) in their lifetime and both the rates and severity of IPV have increased during the COVID-19 pandemic. The majority of injuries to women experiencing IPV are to the head, face, and neck, leaving survivors at high risk for traumatic brain injury (TBI);however, the intersection of IPV and TBI (IPV/TBI) remains largely unrecognized. Here we report on the COVID-19 related impacts, barriers, needs, and priorities to healthcare and support services for women survivors of IPV/TBI. Methods: A pan-Canadian group of 30 stakeholders was engaged in a two-day virtual summit using a participatory research model. Stakeholders were drawn from an IPV/TBI knowledge-to-practice (K2P) Network comprising women survivors, service providers, researchers, and decision makers. Semi-structured discussion guides were used by the research team to facilitate small group break-out sessions which were recorded and transcribed verbatim. Thematic analysis techniques were used to analyze transcripts and develop themes. Stakeholders were given the opportunity to contribute to the analysis and KT through member checking activities. Ethics approval was obtained through the University of Toronto. Results: COVID-19 has increased rates and severity of IPV and resulted in barriers to help-seeking and accessing services. The impacts of the pandemic have been exacerbated by pre-existing infrastructure and resource limitations in rural and remote areas, including limited access to services. Stakeholders called for increased awareness across a number of groups. Survivors and the public need greater awareness of the resources available for survivors of IPV/TBI, particularly how access to or availability of resources and services have changed during the pandemic. Healthcare providers ranging from emergency departments to rehabilitation professionals need greater awareness of the intersection of IPV/TBI and how to appropriately manage these survivors' unique needs, particularly considering the impact of COVID on the accessibility of that care. Requests from survivors for peer support have increased significantly during the pandemic, highlighting the need for more formalized and better supported peer roles for IPV/TBI survivors. Stakeholders also noted the implications of virtual care, for example, safety, privacy, and usability, require careful consideration. Conclusions: The COVID-19 pandemic has intensified IPV/ TBI, increased challenges for women survivors, and accentuated the continued lack of IPV/TBI awareness. Key recommendations for healthcare and rehabilitation and a national strategy to address this priority are discussed.

11.
Journal of Neurological Surgery, Part B Skull Base ; 83(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1815666

ABSTRACT

Introduction: There have been multiple reports of acute invasive fungal rhinosinusitis (AIFRS) in patients with COVID-19 infection. Most cases were associated with high dose steroid therapy in diabetic patients. We report a case of a patient with COVID-19 infection and AIFRS. We will discuss management with the unique risks to the care team. Case: A 61-year-old diabetic woman was admitted to another facility with COVID-19 pneumonia and treated with oral dexamethasone. Three days later, she developed sharp stabbing pain in the right eye with ptosis and blurry vision. She was treated with analgesics and discharged. She returned with persistent pain and increasing right-sided hypesthesia. A CT scan did not show an acute orbital or sinus infection. She was discharged with outpatient ophthalmology follow-up. She presented to our emergency department 3 days later with 48 hours of right vision loss. Physical exam also showed disconjugate gaze and right V1/V2 hypesthesia. Nasal endoscopy showed necrotic tissue within the right nasal cavity. She was immediately started on IV amphotericin and taken to the operating room for biopsy and debridement. Pathology results were consistent with necrosis and invasive fungal hyphae. She was treated with liposomal amphotericin and was eventually discharged with permanent loss of right vision. Discussion: Management of COVID-19-associated acute invasive fungal sinusitis (CA-AIFRS) presents challenges for safety of the health care team. Diabetic COVID-19 patients' new sinonasal complaints or cranial nerve deficits must be immediately evaluated for AIFRS. The CT scan changes associated with AIFRS are nonspecific early in the disease process, therefore nasal endoscopy and biopsy are critical. This requires appropriate PPEnasal endoscopy should be performed with N95 respirator, eye protection, gloves, and a disposable gown. In patients with suspicious nasal endoscopy, immediate initiation of IV antifungals is critical. The next step is biopsy and surgical debridement. This should not be delayed in COVID-19 patients. At our institution, several steps are taken to protect the healthcare team. During intubation, only necessary anesthesia staff are in the roomwith properly worn powered air purifying respirator (PAPR). A viral filter is placed on the ET tube and the room doors are closed for 20 minutes after intubation to allow for air exchange. After 20 minutes, surgical staff may enter the room. The surgical team is outfitted with PAPRs. Powered instruments associated with aerosol generation such as high-speed drills are avoided. The surgical specimens are considered contaminated with COVID19. Therefore, frozen analysis is not used. Margins are sent for permanent analysis. Cultures are sent with appropriate labeling for laboratory precautions. The tissue is debrided to healthy tissue or natural barriers such as the skull base. Conclusion: Management of COVID-19 must include an awareness of CA-AIFRS. Diabetic patients on steroids appear to be more susceptible to CA-AIFRS. Nasal endoscopy is important for evaluation. Avoiding delays in starting antifungals and operative biopsy and debridement is critical. Safety considerations need to be prepared in advance for safe surgical debridement of these patients.

12.
Allergy, Asthma and Clinical Immunology ; 18(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1817263

ABSTRACT

Background: With increasing uptake of COVID-19 vaccines and media focus on adverse reactions, questions and anxiety surrounding vaccinations intensified. The potential relationship between patient anxiety and adverse reactions risks vaccine hesitancy and the possibility of increased COVID-19 infections. The need for allergy consultation for adverse reactions to COVID-19 vaccines is essential in ensuring completion of vaccination protocols, especially in patients identified as having adverse reactions from first vaccinations. Methods: Two patients with reactions to their first dose of the Pfizer- BioNTech COVID-19 vaccine were assessed for potential allergy. Symptoms included throat tightness, dyspnea, tingling, and dizziness immediately after vaccination. One of the patients required treatment with epinephrine with subsequent need for emergency room visit. A two-step approach was taken to assess these patients for a potential allergic cause and exclude anxiety-induced reactions. Patients were blinded and initially skin tested to saline, observed for 15 minutes, and then assessed prior to skin testing to polyethylene glycol (PEG) as a suspected IgE mediated allergic trigger in the Pfizer-BioNTech vaccine. Results: Both patients tested negative to saline. However, both experienced similar or worse symptoms as their initial reaction to Pfizer-BioNTech vaccination with dyspnea, pruritus, coughing, chest tightness, and dizziness during their allergy assessment. Notably, urticaria was absent. One of the patients then went on to receive skin testing to PEG and tested negative. Both patients later received their second vaccination without issue. Conclusions: Two patients experienced “allergic-type” reactions after their first COVID-19 vaccine, not felt to be IgE mediated. Testing to saline elicited similar allergic-type symptoms, likely due to anxiety presenting as pseudo allergic reactions. Benefits of allergy consult and blinded testing to saline facilitated completion of vaccination.

13.
Allergy, Asthma and Clinical Immunology ; 18(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1817248

ABSTRACT

Background: Anaphylaxis is a systemic and life-threatening allergic reaction. Data are sparse regarding variations in anaphylaxis rates on a year-by-year basis. We aimed to assess changes in yearly rates of anaphylaxis in a pediatric Emergency Department (ED) in Montreal, Canada. Methods: Cases of anaphylaxis presenting to the Montreal Children's Hospital between April 2011 and May 2021 were recruited prospectively and retrospectively. Data were obtained via a standardized recruitment form. Descriptive analysis was used to assess the trend of anaphylaxis in relation to clinical triggers. Statistical significance was calculated using Pearson's chi-squared test. Results: Among 760,079 ED visits between April 2011 and May 2021, 2573 (34.95% of whom recruited prospectively) presented with anaphylaxis, The median age was 5.70 years (IQR: 2.20, 11.70), and 58.66% were males. The relative frequency of anaphylaxis cases with respect to ED visits doubled between 2011-2015, from 0.22 (95% CI, 0.19, 0.26) to 0.42% (95% CI, 0.38, 0.46). From 2015 to 2020 the rate was stable. Importantly, during the COVID-19 pandemic, beginning March 2020, the total absolute number of anaphylaxis and emergency cases declined, leading to a significant decrease in anaphylaxis cases by 24 cases per month(p < 0.05) and by 0.5% among ED visits (p < 0.05). Foods, (85.75%),drugs (2.81%) and venom (1.60%). Peanut (19.08%) and tree nuts (14.36%) were the major triggers of food-induced anaphylaxis. Most anaphylactic reactions were moderate (71.81%), defined as crampy abdominal pain, diarrhea, recurrent vomiting, hoarseness, “barky” cough, difficulty swallowing, dyspnea, moderate wheezing, and lightheadedness. Conclusions: The rate of anaphylaxis has plateaued over the last six years, representing increased awareness, modifications in food introduction strategies or lifestyle changes. The observed decrease in anaphylaxis during COVID-19 may reflect hesitancy in arrival for management in a hospital setting, given the similar decrease in ER visits.

14.
Journal of the International Association of Providers of AIDS Care ; 21:3, 2022.
Article in English | EMBASE | ID: covidwho-1817138

ABSTRACT

Introduction: After the first diagnosis of COVID-19 on March 9, 2020, New Orleans, Louisiana had an early, rapid increase in cases, distinguished as the fastest-growing COVID outbreak worldwide. The University Medical Center-New Orleans (UMCNO), a safety net hospital in New Orleans, provided 24-hour access to routine HIV screening throughout the pandemic when many organizations halted screening services. Description: UMCNO implemented the Frontlines of Communities in the U.S. (FOCUS) grant funded HIV testing program in 2013, which integrated automated electronic medical record (EMR) driven routine HIV testing into normal hospital workflow, with system-wide policy changes to support sustainability. Two full-time navigator positions facilitate linkage to care for patients living with HIV identified through testing. Lessons Learned: Over 100,000 HIV tests were conducted at UMCNO between 2013 and 2020, with a HIV-seropositivity rate of approximately 0.9%. With implementation of stay-at-home orders, monthly average Emergency Department (ED) visits from April to June 2020 decreased to 65% of the November 2019 - January 2020 pre-pandemic levels, with monthly averages for HIV tests decreasing to 57% compared to the same pre-COVID quarter. Average monthly ED visits later increased, but remained lower than pre-pandemic levels (e.g., 7539 in the November 2019-January 2020 pre-COVID quarter compared to 6264 in the July - September 2020 quarter). Linkage to care rates remained consistently high (Table 1), proportional to identified positive diagnoses throughout 2020. Recommendations: UMCNO's FOCUS program integrated HIV screening into hospital workflow. As such, our hospitalmaintained testing, albeit at a reduced rate, during the months the stay-at-home orders were in place in New Orleans. The program maintained routine HIV testing and linkage services through EMR automation (best practice advisories) to ensure all eligible patients are offered testing when appropriate.

15.
Israel Medical Association Journal ; 24(1):5-8, 2022.
Article in English | EMBASE | ID: covidwho-1813102

ABSTRACT

Background: In response to the coronavirus disease-2019 (COVID-19) pandemic, routine clinical visits to the ophthalmic emergency department (OED) were deferred, while emergency cases continued to be seen. Objectives: To assess the consequences of the COVID-19 pandemic for ophthalmic emergencies. Methods: A retrospective chart analysis of patients who presented to the OED during the peak of the COVID-19 pandemic was conducted. The proportions of traumatic, non-traumatic-urgent, and non-traumatic-non-urgent presentations in 2020 were compared to those of the same time period in 2019. Duration of chief complains and best-corrected visual acuity were also assessed. Results: There were 144 OED visits in 2020 compared to 327 OED visits during the same 3-week-period in 2019. Lower mean age of OED patients was present in 2020. Logarithmic expression (LogMAR) best corrected visual acuity (BVCA) was similar in both years. In 2020 there was a reduction in traumatic, non-traumatic-urgent, and non-traumatic-non-urgent cases compared to 2019 (15.4% reduction, P= 0.038;57.6% reduction, P= 0.002;74.6% reduction, P= 0.005, respectively). There was a higher proportion of same-day presentations at commencement of symptoms in 2020 compared with 2019 (52.8% vs. 38.8%, respectively P= 0.006). Conclusions: During the COVID-19 pandemic, the number of OED visits at a tertiary hospital dropped by more than half. Although the drop in visits was mostly due to decrease in non-traumatic-non-urgent cases, there was also decrease in non-traumatic-urgent presentations with possible important visual consequences. Additional studies should elucidate what happened to these patients.

16.
Neuroepidemiology ; 56(SUPPL 1):69, 2022.
Article in English | EMBASE | ID: covidwho-1812949

ABSTRACT

Background: Severe Acute Respiratory Syndrome Corona Virus 2(SARS-Cov2) is well known to cause a multitude of neurologic conditions out of which remains the rather rare condition of Acute Necrotizing Encephalopathy. It's a devastating condition with early immunotherapy bringing a more favorable outcome. Pathophysiology suggests the dysregulation of the blood brain barrier secondary to the cytokine storm. Pituitary apoplexy is an unrelated acute condition in which there is either hemorrhagic or non- hemorrhagic necrosis of the pituitary gland. It again has multiple predisposing factors including changes in intracranial pressure and underlying coagulation disorders. Case Presentation: A thirty-five-year-old male patient with poorly controlled diabetes presented to our emergency department with fever, cough and progressive respiratory distress for three days. He was drowsy with clinical features of bronchopneumonia and his COVID PCR was positive (He had taken only the first dose of Sinopharm nearly a month before). Within twenty-four hours, he was sent to the ICU for ventilatory support mainly due to low GCS. His HRCT Chest revealed severe COVID pneumonia. MRI brain revealed high signal intensities involving cerebellum, brainstem, bilateral thalami and mesial temporal lobes compatible with acute necrotizing encephalopathy with a pituitary macroadenoma and bleeding into it. He received high dose steroids followed by plasma exchange leading to resolution of the above changes within a month but passed away at the end of six weeks due to secondary bacterial sepsis. Discussion: Here the pituitary macroadema was an incidental finding and the bleeding was postulated to be secondary to changes in intra cranial pressure. Both the Necrotizing encephalopathy and the pituitary apoplexy might have resulted in the reduced conscious level in the above patient in the background of severe COVID pneumonia. The immunotherapy was successful in resolution of the radiologic changes though the patient deteriorated clinically following a transient improvement due to bacterial sepsis.

17.
Neuroepidemiology ; 56(SUPPL 1):43, 2022.
Article in English | EMBASE | ID: covidwho-1812821

ABSTRACT

Objectives: The Auckland Regional Community Stroke Studies (ARCOS) are population-based studies conducted in Auckland, New Zealand in adults (<15 yrs). In 2020, the SARS-CoV-2 pandemic disrupted the health system and potentially affected the presentation and care of stroke patients. We aimed to utilise this opportunity to study the impact of the pandemic on stroke incidence, and hospitalisation during this extended phase of the ARCOS V study. Methods: Between 1st March and 31st August 2020, stroke cases were identified through multiple case ascertainment methods, including public hospitals and emergency departments;CT/MRI records;hospital discharge registers;private hospitals, rest homes, and community health services. During this time, the Auckland (population 1,257,690) was in various phases of lockdown, including Level 4 during which everything except essential services was shut down. Completion of case ascertainment from the death registry is currently underway, hence preliminary findings are presented. Results: Of the 1198 registered stroke cases, 50.8% were women, 29.4% were aged between 15-64 years 84.1% were first-ever strokes. The age standardised attack rate of stroke in the 6-month period was 72 [95% CI 72 to 80] per 100,000 and the incidence of first ever stroke was 64 [95% CI 60 to 68] per 100,000. The majority (81%) presented to hospital via ambulance, and 96.1% received brain imaging within 24 hours of admission. While the majority sought attention within minutes or hours of symptom onset, 22% delayed seeking attention by a day or more. Conclusions: Robust and well-established online data collection protocols allowed the continuation of the ARCOS V study during the peak of the SARS-CoV-2 pandemic. The number of people presenting to hospital with stroke was close to expected levels. However, a significant number of people delayed seeking medical attention. Learnings from this study will be important to plan for stroke services during future pandemics.

18.
Dubai Medical Journal ; 2022.
Article in English | EMBASE | ID: covidwho-1799161

ABSTRACT

Myxomas are very rare intracardiac benign tumors. They can arise in any of the cardiac chambers, although 75% occur in the left atrium. Atrial myxomas (AMs) show a female predominance with a sex ratio of 3:1. There is a diversity in the clinical presentation;it may resemble many cardiovascular or systemic diseases. Furthermore, it is possible to present as an acute upper or lower limb ischemia or organ infarction due to systemic emboli. Hereby, we report a previously healthy 38-year-old male, who presented to the emergency department with acute pain of both lower limbs, unilateral upper limb, and acute abdomen. A bedside transthoracic echocardiogram was done which showed a mass that was confirmed to be an AM. The patient underwent surgical embolectomy and tumor resection. As this tumor is rare, the duration between the onset of symptoms to finally reaching the correct diagnosis is usually prolonged, and meanwhile, the patient can experience irreversible neurological damage or even death. Hence, we would like to highlight the role of echocardiogram in detecting AMs. In addition, excluding the primary cause of the thrombi, the patient's ischemic pain has a spectrum of differential diagnosis ranging from peripheral vascular disease to COVID-19. We would also like to emphasize the importance of a high index of suspicion by emergency physicians when such cases present.

19.
Journal of Heart and Lung Transplantation ; 41(4):S295, 2022.
Article in English | EMBASE | ID: covidwho-1796810

ABSTRACT

Introduction: Acute pericarditis is frequently encountered in the immediate post-operative period following lung transplant, however when seen following recovery it is often in the context of infection. We present a case of a patient 12 years out from lung transplant who presented with findings compatible with acute pericarditis, ultimately diagnosed with acute cellular rejection (ACR). Case Report: A 60 year old man 12 years post bilateral lung transplant for smoking related COPD with CLAD, stage I, BOS phenotype and prior history of probable antibody-mediated rejection (AMR), presented to the emergency department with acute onset dyspnea (<24h), pleurisy, and a leukocytosis. CT angiogram of his chest revealed no evidence of pulmonary embolism, but new bilateral ground glass and consolidative opacities. Infectious studies, including COVID-19, were negative. Multiple EKGs demonstrated diffuse ST elevations without reciprocal changes. Serial high sensitivity troponin assays were negative, and transthoracic echocardiogram did not reveal any findings compatible with myocardial injury. Once ischemia was excluded he underwent bronchoscopy with biopsies, which demonstrated A2 ACR. Screening for donor specific antibodies indicated new C1q-binding class II HLA antibodies. He was treated for acute pericarditis with colchicine and prednisone. He also received high dose methylprednisolone for ACR, as well as IVIG and rituximab for possible AMR. His chest pain and pleurisy dramatically improved after the first dose of methylprednisolone. The initial insult was thought to be an interruption of immunosuppression coupled with cigarette use. This case represents a novel presentation of ACR with concurrent findings of acute pericarditis. Symptoms of pericarditis and rejection can overlap and this case highlights that the two entities can present simultaneously.

20.
Journal of the American College of Cardiology ; 79(15):S64-S66, 2022.
Article in English | EMBASE | ID: covidwho-1796605

ABSTRACT

Clinical Information Patient Initials or Identifier Number: R Relevant Clinical History and Physical Exam: A 64-year-old lady with underlying dyslipidemia presented to our emergency department with typical chest pain. Immediate electrocardiogram was performed which showed sinus rhythm, ST elevation at lead 1, aVL and V1, hyperacute T wave at V2 till V3 with ST depression at leads II, III and aVF. Hence a diagnosis of acute anterolateral myocardial infarction, Killip 1 was given and urgent referral to cardiologist was made. Subsequently, she was subjected for primary angioplasty. Relevant Test Results Prior to Catheterization: Blood results showed sodium of 134 mmol/L, potassium of 3.5 mmol/L, urea of 3.2 mmol/L and creatinine of 67 mmol/L. Liver enzymes were within normal limits with aspartate transaminase of 38 U/L and alkaline phosphatase of 91 U/L. Creatinine kinase was 330 U/L but increased to 2861 U/L during subsequent day. In addition, COVID-19 RTK antigen was negative. Relevant Catheterization Findings: Coronary angiogram revealed mild disease at proximal right coronary artery and proximal left circumflex. Minimal disease was noted at distal left main stem, but severe disease was observed from proximal left anterior descending till mid left anterior descending. Heterogenous plague suggesting thrombus was seen at ostial first diagonal as well. [Formula presented] [Formula presented] Interventional Management Procedural Step: Right femoral assess was obtained with 7Fr sheath, and SL 3.5 7Fr guiding catheter was engaged to left coronary artery. Intracoronary heparin and tirofiban were given prior to wiring. First diagonal was wired with Sion Blue while left anterior descending was wired with Runthrough Floppy. Post-wiring both vessels, coronary flow remained TIMI 3 and hence we decided to proceed with IVUS. From IVUS, noted fibrous elastic plague with heavy thrombus burden. Intracoronary streptokinase was given and noted improvement of thrombus from IVUS. BMW wired to left circumflex. Lesion predilated with scoring balloon and associated with no reflow events, resolved post vasodilators. Left main stem was stented with Onyx 3.5 x 26 mm and deployed at 16 atm. Both side branches wires were rewired into same branches via Crusade microcatheter. LMS stent was post dilated with NC Euphora 4.5 mm at nominal pressure. Noted impingement of both ostium diagonal and circumflex branches. Balloon kissing inflation was performed for both LAD/Diagonal bifurcation and LMS/LAD/circumflex bifurcation. POT was performed post balloon kissing inflation with NC Euphora 3.5 mm and 4.5 mm for both LAD and LMS respectively. Next, IVUS was repeated for mid LAD stent length and Onyx 3.0 mm X 15 mm was deployed at nominal pressure. IVUS repeated and noted under-expansion of overlapped segments and post dilated with NC Euphora 3.0 mm at high pressure. [Formula presented] [Formula presented] [Formula presented] [Formula presented] Conclusions: Our clinical vignette demonstrated few learning points including utilization of IVUS during primary angioplasty. Understanding of plague characteristic ensures adequate stents expansion especially with fibro elastic plague. In addition, we also demonstrated several precautions in dealing with bifurcation lesions including usage of double lumen microcatheter for wiring the side branches. Even though we opted for provisional stenting, balloon kissing inflation played pivotal role in preserving flow into side branches.

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