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1.
J Ayurveda Integr Med ; 13(1): 100420, 2022.
Article in English | MEDLINE | ID: covidwho-1838954

ABSTRACT

In ongoing viral pandemic named as COVID-19 also Severe Acute Respiratory illness (SARI) or Flue Like illness (FLI) reported surging in many cities of India and many of the patients opted for traditional medicine, in spite of they have been given a option of contemporary line of treatment instructed by health authorities, they opted to take traditional indian medicine that is Ayurvedic medicine. Present case series is a same novel experience of early diagnosing and treating mid aged, morbid individuals who took only Ayurvedic treatment and could get out of the disease without any complications. This case series had 10 mid aged, morbid patients with maximum symptoms of COVID-19 disease and their hemogram and CRP was suggestive of moderate to severe type COVID-19/FLI/SARI. They were diagnosed by contemporary methods of pathology and treated with Ayurvedic classical medicines Tamra Sinduradi Yoga and Bhunimbadi Kwath for 20 days along with continuing the medicines for their ongoing morbidities. All 10 patients showed recoveries without any complications, they reduced their all symptoms, drastic reduction in their CRP and corrections in their hemograms were observed and also they showed any complications neither physically nor in their pathological tests. Hence it can be concluded that early diagnosis and treating it with Ayurvedic medicine can manage viral pandemic issue in a very successful way.

2.
Journal of Advances in Medical and Biomedical Research ; 30(140):215-222, 2022.
Article in English | EMBASE | ID: covidwho-1822724

ABSTRACT

Background & Objective: Measurement of inflammatory markers and lactate dehydrogenase (LDH) may contribute to the evaluation of lung involvement severity. This study aimed to evaluate relationship between severity of primary lung involvement with highest level of erythrocyte sedimentation rate (ESR) and LDH in patients with COVID-19. Materials & Methods: This descriptive-analytical study was conducted on 123 patients with COVID-19 in Shahid Sadoughi Hospital. Data including age, gender, ESR (mm/h), LDH (U/L), and high-resolution Computed Tomography scan (HRCT) findings and hospitalization ward were extracted from medical records. The regression model was used to determine the relation between HRCT findings with LDH and ESR. Results: Mean LDH, ESR, and HRCT findings were 508.41±224.65, 52.23±29.56, and 37.17± 22.18 respectively. A significant relation was seen between HRCT findings with highest level of LDH and ESR (P=0.001). A significant relation was observed between the highest levels of ESR and HRCT findings, regarding age, gender, and hospitalization wards (P<0.01). There was a significant relation between the highest level of LDH and HRCT findings regarding age group and hospitalization wards (P<0.01). Conclusion: A significant relation was seen between HRCT findings and highest levels of ESR and LDH in patients with COVID-19. Therefore, it seems that assessment of laboratory findings such as LDH and ESR can be helpful as cost-effective markers instead of chest CT scan for predicting the severity of lung injury when the CT scan report is controversial. The relation between HRCT findings with LDH and ESR were affected by age and hospitalization ward. However, more studies should be conducted in this regard.

3.
Surgical Neurology International ; 13, 2022.
Article in English | EMBASE | ID: covidwho-1822704

ABSTRACT

Background: Spondylodiscitis could be considered one of the most disturbing challenges that face neurosurgeons due to variety of management strategies. The lumbar region was highly affected then dorsal region with higher percentage for lesion in L4/5 (25%) followed by T11/12 and L5/S1 (15%). In our study, we discuss the efficacy of debridement and fixation in cases of spontaneous thoracic and lumbar spondylodiscitis. Methods: This retrospective study included 40 patients with spontaneous thoracic or lumbar spondylodiscitis indicated for surgical intervention in the period from March 2019 to February 2021. All patients were subjected to thorough history taking, neurological examination, and investigations. The patients were operated on through posterior approach by debridement and posterior transpedicular screws fixation and fusion. Results: Clinical assessment early postoperative revealed 75% of cases showed full motor power and 20% showed improvement in motor power, for sensory assessment, 85% showed improvement, the mean visual analog scale (VAS) score was of 3.65 ± 0.87. After 3 months postoperatively, 95% of cases were full motor power with sensory and autonomic (sphincteric) improvement. The mean VAS score was 2.5 ± 0.68. After 6 months postoperative, the clinical assessment revealed that 95% of cases were full motor power with sensory manifestation improvement, and 95% of them were continent. The mean VAS score was 1±0.85. Culture results showed that 65% of samples were negative culture, 15% had methicillin-resistant Staphylococcus aureus, and 10% had Escherichia coli with a single case of Pseudomonas and another one of fungal (Candida albicans). Postoperative 90% of cases showed improvement in erythrocyte sedimentation rate results and 95% of cases showed improvement in C-reactive protein results. Conclusion: Management of spontaneous thoracic and lumbar spondylodiscitis by surgical debridement and posterolateral open transpedicular fixation seems to be effective and safe method despite the presence of infection. We found that the clinical condition of our patients showed significant improvement with this addressed approach.

4.
Journal of Clinical and Diagnostic Research ; 16(4):OC24-OC27, 2022.
Article in English | EMBASE | ID: covidwho-1818677

ABSTRACT

Introduction: The portable Chest Radiograph (CXR) has an indispensable role in large scale screening and diagnosis of Coronavirus Disease 2019 (COVID-19), especially in developing countries with limited resources. It can help in predicting the severity of lung involvement in the patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, especially in areas where the Computed Tomography (CT) is unavailable. Aim: To determine the prognostic value of CXR at clinical presentation in assessing the disease severity and its correlation with inflammatory markers in COVID-19 hospitalised patients. Materials and Methods: This was a single-centre retrospective study, conducted at Sri Ramachandra Institute of Higher Education and Research, from October 2020 to December 2020, on hospitalised COVID-19 patients. Clinically, the patients were categorised as mild, moderate and severe, based on their peripheral oxygen saturation- more than 94%, between 90-93%, and less than or equal to 89%, respectively. Blood samples, drawn at presentation to the hospital tested for various inflammatory markers proven to be predictive of disease severity, were documented for the analysis purpose. The CXRs, done at the presentation, were scored based on the number of zones involved and type of abnormality present (ground glassing, consolidation and septal thickening). The CXRs were scored a minimum '0' to a maximum of '9'. Correlation between the radiograph score and inflammatory markers was further analysed. Results: Among the 456 study patients, 71% had mild, 15% had moderate and 14% had severe COVID-19 infection. The mean CXR score in each category was 1, 3 and 4, respectively (p-value <0.001). The study groups were grouped as mild and non mild (included the moderate and severe categories). A criterion CXR score of 2 was able to differentiate mild and non mild cases (sensitivity was 78.29%, specificity was 77.98%, positive predictive values was 58.38%, negative predictive values was 90.11%), with an accuracy of 78.1%. The inflammatory markers like Neutrophil Lymphocyte Ratio (NLR), Absolute Lymphocyte Counts (ALC), eosinophil%, D-dimer, Lactate Dehydrogenas (LDH), Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), and ferritin showed statistically significant difference between the two groups (p-value<0.001). Conclusion: The CXR can be used as a screening and predictive tool for disease severity in developing countries where access to Computed Tomography (CT) is limited. Given the possibility of subsequent waves of the COVID-19 pandemic and the risk of excessive radiation exposure from CT, CXR may be used as a reliable alternative.

5.
Infection and Drug Resistance ; 15:1121-1126, 2022.
Article in English | EMBASE | ID: covidwho-1817636

ABSTRACT

Background: Mucormycosis is a fulminant and rapidly progressing fungal infection associated with a high mortality rate. Mucormycosis is primarily seen in immunocompromised patients, especially those with uncontrolled diabetes mellitus (DM), and recently in coronavirus disease 2019 (COVID-19) patients. Case Presentation: In this case report, we present a rare case of fatal mucormycosis in Palestine. A 34-year-old Palestinian female patient presented to the emergency department one-month post-COVID-19 infection with left facial pain. During her hospital stay, she deteriorated, with a random blood sugar level of 400 mg/dl and a hemoglobin A1c of 18% with metabolic acidosis and the appearance of swelling and black eschar on her left side of her face. Finally, she was diagnosed with mucormycosis and expired two days later. Conclusion: In this unfortunate case report of mucormycosis, severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection, delayed diagnosis, misuse of corticosteroids, inappropriate use of antibiotics, and uncontrolled diabetes with ketoacidosis contributed to patient mortality and fatality. Therefore, appropriate patient assessment, rapid diagnosis, and selection of appropriate treatment are important and lifesaving.

6.
Journal of Investigative Medicine High Impact Case Reports ; 10, 2022.
Article in English | EMBASE | ID: covidwho-1817132

ABSTRACT

Coccidioidomycosis (CM) is a fungal disease that results from inhalation of spores of Coccidioides immitis and C posadasii. If symptomatic, disease primarily manifests as community-acquired pneumonia;however, additional pulmonary manifestations such as pleural effusion, empyema, and cavitation may occur. Diabetic patients have an increased risk of severe and cavitary CM. Cavitary disease may erode vasculature and pulmonary parenchyma leading to further complications. Furthermore, chronic cavities can become colonized as well and develop superimposed infections. This is a case of cavitary CM in uncontrolled diabetic nonadherent to treatment presenting with hemoptysis and mycetoma.

7.
Clinical Neurosurgery ; 67(SUPPL 1):131, 2020.
Article in English | EMBASE | ID: covidwho-1816190

ABSTRACT

INTRODUCTION: Covid 19 infections has been shown to be associated with a range of thromboembolic disease that has implications for the neuro-endovascular management of large vessel occlusions. METHODS: Five consecutive Covid-19 positive patients presented with large vessel occlusions to our institution. Covid-19 testing was performed using nasal swab. All thrombectomy cases was performed under general endotracheal anesthesia using a stent-aspiration combination as primary thrombectomy technique. The technical details of each case and the angiographic outcome are described. Routine labs including D-dimer, platelet count, coagulation panel (aPTT, INR), Interleukin 6 (IL-6), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) were evaluated in all patients. Rotational thrombelastography (ROTEM) was performed on the patients' blood samples to assess real-time clot formation/dissolution properties. RESULTS: Four patients had anterior circulation large vessel occlusions and one patient had both anterior and posterior circulation occlusions. Mean age was 52.8 years and 80% were males. TICI 3 revascularization was achieved in one patient, TICI 2B achieved in two patients and TICI 2A in two patients. In our cohort, patients were on average 52.8 years old and presented with a median NIHSS of 27. All our patients had very proximal occlusions. Three patients presented with intra-cranial ICA occlusions. Two patients presented with a tandem carotid bulb thrombus in conjunction with an intracranial vessel occlusion. One patient had an ICA terminus occlusion with a concomitant basilar occlusion. Second, the intravascular clots in all our patients were prone to fragment and migrate into both new vascular territories and into distal downstream vasculature. Distal emboli into a different territory (anterior cerebral artery occlusion) was seen in two two of our five patients (40%) and distal emboli into a downstream territory was seen in all five patients (100%). An average of 2.7 pstent-retriever passes was needed to achieve a final TICI revascularization of IIb or better. CONCLUSION: Covid-19 patients are predisposed to a hypercoagulable state. When presenting with large vessel occlusions, these patients present unique challenges that make successful revascularization difficult.

8.
Journal of Child and Adolescent Psychopharmacology ; 32(3):194-198, 2022.
Article in English | ProQuest Central | ID: covidwho-1806217

ABSTRACT

Chief Complaint and Presenting Problem K. was a 17-year-old adolescent boy referred to the emergency department of an inner-city teaching hospital for admission to a child and adolescent psychiatry inpatient service for extreme change in behavior that included assuming an almost nonverbal status, extended periods of time in bathroom for no apparent reason, and poor hygiene/grooming. Educational History At the time of referral, K. was enrolled in special education in a public school system with an Individualized Education Plan (IEP) since the second grade for language and speech delays. Routine admission laboratory screening, including basic metabolic panel, complete blood count with differential, thyroid stimulating hormone, hepatic panel, salicylate level, alcohol level, acetaminophen level, vitamin B12, folate, C-reactive protein, erythrocyte sedimentation rate, antinuclear antibodies, and serum ammonia level, were all unremarkable. Medication Administration Schedule Hospital day Mirtazapine (mg) Lorazepam (mg) Other 1 None None None 2 7.5 0.5 3 1 Polyethylene glycol 17 g 4 None None 5 15 6 7 22.5 Polyethylene glycol 17 g 8 30 None 9 2 Artificial tears ophthalmic solution 1 drop 10 1 None As mirtazapine was gradually increased from 7.5 to 30 mg, he began to reveal brighter affect and engaged more in the unit milieu, including participating in group therapy sessions and art sessions unprompted.

9.
American Journal of Blood Research ; 12(1):43-53, 2022.
Article in English | EMBASE | ID: covidwho-1798258

ABSTRACT

Coronavirus disease 2019 (COVID-19) is caused by pathogenic and highly transmissible Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is a single stranded RNA virus. It rapidly emerged from an epidemic to a global pandemic form spreading in alarming levels. The pathogenesis involving spike protein which is present on the viral surface, plays a key role in host attachment and penetration. SARS-CoV-2 infection significantly affects respiratory system, but may involve other systems including haematopoietic system and homeostasis. Aim of the review article is to discuss spectrum of haematological changes in the blood counts, coagulation, peripheral blood and bone marrow in COVID-19 for complete understanding the disease process, the knowledge of which is helpful in early diagnosis and management of these patients. An extensive immune profiling of B and T cell population with analysis of spectrum of immune changes during the period of infection were also discussed. In COVID-19, changes in laboratory parameters and hematologic abnormalities have been reported and its association with early diagnosis, disease prognosis and severity has been repeatedly discussed in the literature. Changes in laboratory investigations help in risk stratification and early intervention. The most common laboratory finding in COVID-19 is lymphopenia. COVID-19 patients presented with coagulopathy is at high risk of morbidity and mortality. In severe COVID-19 patients, bone marrow aspirate shows histiocytic proliferation with hemophagocytosis. To understand the correlations between immune responses and severity of COVID-19, immune profiling of B and T cell population was compared with extensive clinical data. A deep understanding of the laboratory findings and haematological abnormalities associated with SARS-CoV-2 infection would help to raise disease suspicion in absence of Real time polymerase chain reaction or antibody results. Also the blood counts along with the morphological changes in peripheral blood would be helpful in prompt screening, diagnosis, prognosis and management of COVID-19 patients.

10.
Clin Epidemiol Glob Health ; 14: 100966, 2022.
Article in English | MEDLINE | ID: covidwho-1797102

ABSTRACT

The COVID-19 outbreak sparked by SARS-CoV-2, begat significant rates of malady worldwide, where children with an abnormal post-COVID ailment called the Multisystem Inflammatory Syndrome (MIS-C), were reported by April 2020. Here we have reviewed the clinical characteristics of the pediatric patients and the prognosis currently being utilized. A vivid comparison of MIS-C with other clinical conditions has been done. We have addressed the probable etiology and fundamental machinery of the inflammatory reactions, which drive organ failure. The involvement of androgen receptors portrays the likelihood of asymptomatic illness in children below adolescence, contributing to the concept of antibody-dependent enhancement.

11.
Journal of the American College of Cardiology ; 79(9):2324, 2022.
Article in English | EMBASE | ID: covidwho-1768641

ABSTRACT

Background: Although rare, there is increasing incidence of myocarditis in young adult males who receive the second dose of the COVID-19 mRNA vaccine. We present a rare case of myocarditis in a young female following the initial dose. Case: A 20-year-old female presented with progressive pleuritic chest pain and fever. Past medical history was significant for depression and COVID-19 infection 5 months prior to admission. She received the first dose of the Moderna mRNA vaccine one week prior to admission. She had elevated D-dimer, erythrocyte sedimentation rate (ESR), and troponin levels. Electrocardiogram showed PR depression. Echocardiogram, respiratory viral panels, and cultures were normal. Decision-making: Due to persistent worsening chest pain, she underwent cardiac magnetic resonance imaging (CMRI), which was consistent with myocarditis. She was treated with supportive care and her condition improved. Given the temporal relationship between vaccine administration and symptom onset, as well as negative viral testing, it was determined that the Moderna vaccine was likely the culprit. Conclusion: COVID-19 vaccine-induced myocarditis is becoming a more recognized entity, however other more common etiologies should be first ruled out. Nonetheless, the benefits of immunization against COVID-19 outweigh the risks of vaccine-induced myocarditis. [Formula presented]

12.
Embase; 2021.
Preprint in English | EMBASE | ID: ppcovidwho-331157

ABSTRACT

Background: The unpredictability of the progression of coronavirus disease 2019 (COVID-19) may be attributed to the low precision of the tools used to predict the prognosis of this disease. Objective: To identify the predictors associated with poor clinical outcomes in patients with COVID-19. Methods: Relevant articles from PubMed, Embase, Cochrane, andWeb of Science were searched as of April 5, 2020. The quality of the included papers was appraised using the Newcastle-Ottawa scale (NOS). Data of interest were collected and evaluated for their compatibility for the meta-analysis. Cumulative calculations to determine the correlation and effect estimates were performed using the Z test. Results: In total, 19 papers recording 1,934 mild and 1,644 severe cases of COVID-19 were included. Based on the initial evaluation, 62 potential risk factors were identified for the meta-analysis. Several comorbidities, including chronic respiratory disease, cardiovascular disease, diabetes mellitus, and hypertension were observed more frequent among patients with severe COVID-19 than with the mild ones. Compared to the mild form, severe COVID-19 was associated with symptoms such as dyspnea, anorexia, fatigue, increased respiratory rate, and high systolic blood pressure. Lower levels of lymphocytes and hemoglobin;elevated levels of leukocytes, aspartate aminotransferase, alanine aminotransferase, blood creatinine, blood urea nitrogen, high-sensitivity troponin, creatine kinase, highsensitivity C-reactive protein, interleukin 6, D-dimer, ferritin, lactate dehydrogenase, and procalcitonin;and a high erythrocyte sedimentation rate were also associated with severe COVID-19. Conclusion: More than 30 risk factors are associated with a higher risk of severe COVID-19. These may serve as useful baseline parameters in the development of prediction tools for COVID-19 prognosis.

13.
Open Forum Infectious Diseases ; 8(SUPPL 1):S243, 2021.
Article in English | EMBASE | ID: covidwho-1746718

ABSTRACT

Background. Although SARS-CoV-2 predominantly targets the respiratory system, it has also been associated with vascular complications including stroke. Identifying COVID-19 patients at elevated risk for stroke can help inform target anticoagulation strategies. We sought to understand how symptoms and laboratory markers at presentation with COVID-19 relate to stroke risk. Methods. We enrolled a cohort of 1324 subjects who were hospitalized with COVID-19 across six PennMedicine hospitals between April and August 2020 and performed retrospective, manual chart review to measure exposures including presenting symptoms and admission inflammatory markers. Data were organized with a REDCap database, and analyses were performed using R statistical software, with Bayesian binomial regression models fit using Stan Hamiltonian Monte Carlo via the "brms" package. Results. Among 1324 subjects, 19 stroke events were observed within 30 days of COVID-19 diagnosis. Admission inflammatory markers, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), ferritin, and D-dimer, were poor predictors of stroke risk. Among presenting symptoms, including respiratory, gastrointestinal, dermatologic, and neurologic features of COVID-19 disease, only altered mental status documented on presentation (in 529 subjects) was significantly associated with stroke risk (odds ratio 6.06, 95% credible interval 2.16 - 18.7). Conclusion. Inflammatory markers associated with COVID-19 disease severity did not discriminate patients at high versus low risk of stroke in this cohort. Altered mental status documented on presentation was significantly associated with incident stroke during COVID-19 disease.

14.
Journal of Pharmacy and Bioallied Sciences ; 13(6):S1333-S1337, 2021.
Article in English | EMBASE | ID: covidwho-1744793

ABSTRACT

Introduction: The viral infection COVID-19 is highly infectious and has claimed many lives till date and is still continuing to consume lives. In the COVID-19, along with pulmonary symptoms, cardiovascular (CV) events were also recorded that have known to significantly contribute to the mortality. In our study, we designed and validated a new risk score that can predict CV events, and also evaluated the effect of these complications on the prognosis in COVID-19 patients. Materials and Methods: A retrospective, multicenter, observational study was done among 1000 laboratory-confirmed COVID-19 patients between June 2020 and December 2020. All the data of the clinical and laboratory parameters were collected. Patients were randomly divided into two groups for testing and validating the hypothesis. The identification of the independent risk factors was done by the logistic regression analysis method. Results: Of all the types of the clinical and laboratory parameters, ten 'independent risk factors' were identified associated with CV events in Group A: male gender, older age, chronic heart disease, cough, lymphocyte count <1.1 × 10 9 /L at admission, blood urea nitrogen >7 mmol/L at admission, estimated glomerular filtration rate <90 ml/min/1.73 m 2 at admission, activated partial thromboplastin time >37 S, D-dimer, and procalcitonin >0.5 mg/L. In our study, we found that CV events were significantly related with inferior prognosis (P < 0.001). Conclusions: A new risk scoring system was designed in our study, which may be used as a predictive tool for CV complications among the patients with COVID-19 infection.

15.
Iraqi Journal of Hematology ; 10(2):152-157, 2021.
Article in English | Web of Science | ID: covidwho-1715906

ABSTRACT

BACKGROUND: Corona virus disease 2019 (COVID-19) is a coronavirus that can produce a variety of symptoms, ranging from asymptomatic carrier status to severe respiratory failure, multiple organ dysfunction, and death, it might be associated with hypercoagulability as increase in coagulation factor 8 (FVIII). OBJECTIVES: This study was carried out to investigate markers of hypercoaguablility (factor VIII activity, D-Dimer) in hospitalized adult patients with COVID-19, evaluation of certain markers of inflammation (S. ferritin, lactate dehydrogenase [LDH], C-reactive protein [CRP], and erythrocyte sedimentation rate [ESR]) and correlate those markers with each other. PATIENTS AND METHODS: This cross-sectional study included 70 adult hospitalized patients with COVID-19. Blood samples were obtained for FVIII, D. dimer, and ESR. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23 and Microsoft Office Excel 2010. RESULTS: The mean age of enrolled 70 patients was 60.22 +/- 14.43 years. 44 (62.9%) of patients had neutrophilia and lymphopenia was seen in 41 (58.6%). High ratio of N/L was seen in 66 (94.3%). Low count of eosinophil was seen in 44 (62.9%), high LDH level was seen at 57 (81.4%). Regarding serum ferritin, high level was seen 64 (91.4%) and high level of CRP was seen in 56 (80%). High level of ESR was seen in 64 (91.4%) and high level of D. dimer was seen in 55 (78.6%), while the high level of FVIII was seen in 30 (42.9%) and low FVIII level was seen in 4 (5.7%). CONCLUSIONS: The majority of patients had neutrophilia, lymphopenia, high N/L ratio, and eosinopenia. Markers of inflammation (S. ferritin, LDH, CRP, and ESR), which were elevated. FVIII level and D. dimer were elevated in the majority of patients with COVID-19. Few of the patients were had a low level of FVIII, which might be related to abnormal function of the liver or might be attributed to autoantibodies directed against FVIII.

16.
Journal of Investigative Medicine ; 70(2):595-596, 2022.
Article in English | EMBASE | ID: covidwho-1705497

ABSTRACT

Case Report A 7-year-old healthy boy with a history of COVID-19 infection 10 months ago and history of recent tick exposure presented with 6 days of intermittent fevers up to 40C and right sided axillary lymphadenopathy. During his first emergency room visit, labs were reportedly normal and the patient was discharged home. The next day, his fevers continued and he developed generalized abdominal pain and emesis. At his pediatrician's office, labs were significant for a leukocytosis. He then developed conjunctivitis and was admitted to an outside hospital for worsening fever and emesis. There, labs were significant for a C reactive protein (CRP) of 7.9 mg/dL and erythrocyte sedimentation rate (ESR) of 51 mm/hr. Urinalysis had no pyuria. Tick titers were also obtained. He was transferred to our facility for additional treatment with concern for Kawasaki disease due persistent fevers, cervical lymphadenopathy, lip redness, and a generalized rash. Upon arrival to our facility, he was well-appearing. Besides an intermittent rash with fevers, review of systems was otherwise negative. Our initial differential diagnosis included Kawasaki Disease, Multisystem inflammatory syndrome due to COVID-19 (MIS-C), tick-borne illness, or a systemic viral infection such as adenovirus. Examination was significant for conjunctivitis and small mobile right axillary adenopathy. Laboratory studies were significant for leukocytosis (15,000/mm3), elevated CRP (10.1 mg/dL), and elevated ESR (85 mm/hr). A respiratory viral panel and COVID-19 serology were both negative. D-dimer was elevated at 295 ng/mL. The rest of his labs including chemistries were normal. An echocardiogram was obtained, which was normal, and infectious disease was consulted. He was started on empiric doxycycline due to the history of tick exposure. He was observed overnight and developed no further fevers. However, due to his continued abnormal laboratory studies and in the setting of an otherwise negative workup for other diagnoses, we treated him for KD. He was started on high dose aspirin and given 2 g/kg of IVIG. 24 hours after completing IVIG, he had a fever of 38C, so he was observed an additional 24 hours. He was discharged home to complete a 7-day course of doxycycline and on low dose aspirin with plans to follow up with cardiology clinic. Our case makes many illustrative points for the clinician. Our patient had four of the five findings involving bilateral conjunctivitis, oral changes (strawberry tongue/injected pharynx/ fissured lips), peripheral extremity changes, polymorphous rash, and cervical lymphadenopathy. However, many of these symptoms were absent upon arrival to our facility and his fevers had subsided. There were also other factors such as his age that were unusual for typical KD along with his recent tick exposure and past COVID-19 infection that made his diagnosis more difficult to determine. This case highlights the importance of remebering that common conditions may have unusual presentations.

17.
American Journal of Translational Research ; 14(1):501-510, 2022.
Article in English | EMBASE | ID: covidwho-1688163

ABSTRACT

Objectives: Traditional Chinese medicine has been reported to be effective in the treatment of epidemic diseases. Here, we aimed to investigate the effects of combined therapy of Chinese and western medicine on coronavirus disease 2019 (COVID-19). Methods: A total of 60 patients diagnosed with COVID-19 were enrolled. Both the ordinary and severely affected patients were randomly divided into Groups A-C each with 10 cases each. The patients in Group A-C received Western medicine, Western medicine + traditional Chinese medicine, and Western medicine + traditional Chinese medicine + high dose of vitamin C, respectively. The time of disease recovery, symptoms disappearance, chest CT improvement, and tongue amelioration was recorded. Leukocyte, neutrophil and lymphocyte were monitored, as well as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalitonin (PCT), inflammatory factors, partial pressure of oxygen and carbon dioxide (PaCO2) and oxygenation index (PaO2). Urinary tract stones, liver function, and other side-effects such as gastrointestinal dysfunction were also investigated. Results: Traditional Chinese medicine enhanced the effect of Western medicine, including the reduction of CRP, ESR, PCT, and inflammatory factors, and the increase of leukocyte, neutrophil, and lymphocyte counts, and the improvement of respiratory rate, PaO2, PaCO2, and oxygenation index. Traditional Chinese medicine combined with high-dose Vitamin C therapy more effectively shortened the time of disease recovery, symptom disappearance, chest CT improvement, and tongue amelioration. Conclusions: a combined therapy of Western medicine, traditional Chinese medicine, and high dose of Vitamin C results in a most effective outcome in the treatment of COVID-19.

18.
Iranian Heart Journal ; 23(1):223-227, 2022.
Article in English | EMBASE | ID: covidwho-1647695

ABSTRACT

There is ample evidence that the coronavirus can cause fatal blood clots. Angiotensin-converting enzyme 2 (ACE2) receptors act as a gateway for the coronavirus to enter the body and facilitate infection. ACE2 receptors are scientifically linked to disease severity in smokers because nicotine is thought to affect ACE2 expression in different ways. Patients admitted with severe COVID-19 infection with high levels of factor V Leiden are prone to serious damage from blood clots such as deep vein thrombosis or pulmonary embolism. Damage to the vascular endothelium is a complication that can be caused by the coronavirus. It can cause vascular clots, in the formation of which factors such as age, sex, blood type, and underlying diseases are effective. Thrombotic events, especially venous thrombosis, following COVID-19 infection have already been described;nonetheless, data are scarce on arterial thrombosis. Herein we report 4 cases of COVID-19 infection complicated by arterial thrombosis. (Iranian Heart Journal 2022;23(1): 223-227).

19.
Iranian Heart Journal ; 23(1):129-139, 2022.
Article in English | EMBASE | ID: covidwho-1647545

ABSTRACT

Background: Hypertension is a critical risk factor in increasing the mortality rate of COVID-19 inpatients. This association can be confounded by a history of consuming some angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs). Objective: This study aimed to assess the COVID-19 prognosis in patients with/without a history of taking ACEIs and ARBs. Methods: This single-center, prospective, observational study was performed on 345 patients with COVID-19 hospitalized in Baqiyatallah Hospital. The patients were categorized into 2 groups: with a history of ACEI/ARB consumption (the case group, n=115) and without such a history (the control group, n=230). Results: After the exclusion of some patients, the COVID-19 prognosis of 294 patients (ncontrol =184, ncase=110, 53% female) at a mean age of 64±9.7 years was evaluated. Unequal variables were adjusted between the case and control groups, and the results showed no significant differences in oxygen saturation, the computed tomography scan score, the erythrocyte sedimentation rate, C-reactive protein, lactate dehydrogenase, D-dimer, the white blood cell count, lymphocytes, hemoglobin, platelets, and mortality between the 2 groups. However, a significant difference in the average length of hospital stay was found between the control (6.55±0.56 d) and case (8.53±0.55 d) groups (P=0.013). Conclusions: The dosage adjustments and changes of ACEIs and ARBs are not recommended due to increased referrals to health centers involved with the COVID-19 risk. The prognosis, safety, and efficacy of ACEI/ARB consumption should be assessed further in larger studies on middle-aged to old patients with COVID-19. (Iranian Heart Journal 2022;23(1): 129-139).

20.
Chest ; 161(1):A98, 2022.
Article in English | EMBASE | ID: covidwho-1637206

ABSTRACT

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: Blastomycosis is endemic to the midwest, south-central and southeast regions of North America. It should thus be suspected in the differential of patients presenting with atypical symptoms, as extrapulmonary manifestations can be seen. We present a case of disseminated blastomycosis to the spine prior to development of significant pulmonary symptoms. CASE PRESENTATION: 38 year old male presents to a tertiary center in Southern Indiana with back pain of 8 months, fever and dyspnea. Magnetic resonance imaging was significant for L1 osteitis and chest x-ray showed diffuse interstitial markings. Lab work showed leukocytosis with erythrocyte sedimentation rate of 91, and C-reactive protein of 45. He was initiated on broad spectrum antibiotics without any improvement. Due to worsening respiratory failure requiring supplemental oxygen, infectious disease and pulmonology specialists ruled out Legionella, Aspergillosis, COVID-19, HIV, Histoplasmosis, Mycoplasma, Hantavirus and Tuberculosis. Blood cultures and respiratory panel were negative. Urinary blastomycosis antigen was positive. Patient completed 14 days of amphotericin B and was discharged on itraconazole for at least 1 year. DISCUSSION: Blastomycosis can have a broad spectrum of manifestations with pulmonary infection in more than 79% of patients. Extrapulmonary dissemination is less common though can occur in approximately 25-40% of symptomatic patients. Osseous blastomycosis is the second most common dissemination site following the skin and is seen in approximately 5-25% of patients. CONCLUSIONS: We recommend early consideration of blastomycosis in patients with atypical infectious symptoms who reside in Blastomyces endemic regions. Early diagnosis is key in initiating appropriate treatment and preventing severe complications of disseminated disease. DISCLOSURE: Nothing to declare. KEYWORD: blastomycosis

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