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1.
Folia Morphol (Warsz) ; 80(3): 714-717, 2021.
Article in English | MEDLINE | ID: covidwho-1399547

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a condition caused by a novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease's course ranges from entirely asymptomatic to severely ill patients. Hypercoagulation is often a complication of this disease, worsening the prognosis, which is extremely important in patients at higher risk of thromboembolic events, such as atrial fibrillation (AF), where thrombus formation in the left atrial appendage (LAA) is frequent. LAA could be of various sizes, volumes, and shapes, distinguish several morphologies, from which the WindSock LAA is the most frequent. In contrast, thromboembolic complications occur most frequently in patients with AF and the Cactus LAA. We present a clinical case of a 70-year-old woman with an initial negative real-time polymerase chain reaction (RT-PCR) test for SARS-CoV-2, suspicion of device-related infection after dual pacemaker implantation, AF, and LAA without thrombus in the initial transoesophageal echocardiography (TEE). Despite apixaban treatment, spontaneous restoration of sinus rhythm, and WindSock LAA morphology, the sludge in LAA was diagnosed in control TEE. The patient did not present any typical clinical COVID-19 symptoms but re-checked the RT-PCR test for SARS-CoV-2 infection was positive. The described case presents echocardiographic evidence of hypercoagulation as the first and only feature of SARS-CoV-2 condition besides the usual morphological presentation of the WindSock LAA.


Subject(s)
Atrial Appendage , Atrial Fibrillation , COVID-19 , Echocardiography , Thrombophilia , Aged , Atrial Appendage/diagnostic imaging , COVID-19/diagnosis , Female , Humans , SARS-CoV-2 , Thrombophilia/etiology
2.
Case Rep Otolaryngol ; 2021: 6618191, 2021.
Article in English | MEDLINE | ID: covidwho-1201166

ABSTRACT

BACKGROUND: One of the most rare but deadly types of infectious fungal infection is Mucormycosis. All the cases reported with this type of infection are immunocompromised individuals. The challenge of early detection and intervention makes it one of the high mortality rates among other infectious diseases. Case Report. We report an 18-month-old girl with undiagnosed diabetes presented with a very aggressive form of necrotic infection of the ear auricle with facial nerve palsy. Using a series of magnetic resonance imaging, antibiotics, and high clinical suspicion, a diagnosis was established, and the patient was sent to the operation theatre for surgical debridement. Monthly follow-ups showed improvement of the facial palsy, and a plan for artificial auricle is set to occur in the following months before the age of five. Discussion. Mucormycosis is considered a very fatal and aggressive infection that has a very high mortality rate in immunocompromised patients. Early detection of such cases with an array of magnetic resonance imaging (MRI) and computed tomography (CT) is crucial in early treatment. Early aggressive surgical debridement and empirical coverage of bacterial, viral, and fungal infections can also alleviate the chances of preventing any secondary infection to develop in such cases. CONCLUSION: A combination of antifungal, antibiotic, and antiviral with timely surgical intervention improved the patient with complete resolution of the facial nerve palsy and no further recurrence of the infection.

3.
Pan Afr Med J ; 38: 30, 2021.
Article in English | MEDLINE | ID: covidwho-1110741

ABSTRACT

SARS-CoV-2 is an infection due to a novel virus belonging to the coronavirus family. Since December 2019, first human cases of COVID-19 have been identified in Wuhan (China) and rapidly has been progressed to a global pandemic declared by the world health organization (WHO) on March 11th 2020. The major complication of COVID-19, is pneumonia, but other presentations like cardiovascular and neurological complications have been reported. Herein, we report a first case of pregnant women presented with bifacial weakness and paraesthesia (BFP) associated to a vestibulocochlear neuritis as post-COVID-19 manifestation. This is a 36-year-old Moroccan female patient with a history of SARS-CoV-2 positive 6 weeks before admission. She presented to the emergency department with rapid bifacial paralysis, bilateral lower extremity paresthesia, vertigo, nausea, vomiting and right auricular pain. An acute stroke was ruled out after neurological examination and brain MRI. Clinical presentation, neurophysiological, audiometry and videonystagmography workup additionally to CSF findings were suggestive of a variant of Guillain Barré Syndrome (GBS), which is BFP associated to right vestibulocochlear neuritis. The patient was treated with Intravenous immunoglobulins (IVIG) therapy associated with intravenous steroids. The patient made a complete recovery of the right facial palsy and the sensorineural hearing loss but still have tingling in lower limbs and left facial palsy at 2 weeks´ follow-up. BFP can be induced by COVID-19 as a postinfectious immune-mediated complication. Regarding the pathophysiology of vestibular neuritis, is probably similar to other viral infection causing nerve damage. Clinicians should consider the association of vestibulocochlear neuritis and BFP as a post SARS-CoV-2 manifestation.


Subject(s)
COVID-19/complications , Guillain-Barre Syndrome/virology , Pregnancy Complications, Infectious/virology , Vestibular Neuronitis/virology , Adult , Facial Paralysis/diagnosis , Facial Paralysis/virology , Female , Follow-Up Studies , Guillain-Barre Syndrome/diagnosis , Humans , Immunoglobulins, Intravenous/administration & dosage , Paresthesia/virology , Pregnancy , Vestibular Neuronitis/diagnosis
4.
3D Print Med ; 6(1): 27, 2020 Sep 29.
Article in English | MEDLINE | ID: covidwho-802427

ABSTRACT

PURPOSE: Many commonly used mask designs are secured by elastic straps looping around the posterior auricular region. This constant pressure and friction against the skin may contribute to increased wearer pain, irritation, and discomfort. The purpose of this work is to report a modified 3D printed mask extender to alleviate discomfort and increase mask wearability by relieving posterior auricular pressure from isolation masks. METHODS: Our institutional review board designated this project as non-human research and exempt. As part of resourcing 3D printing laboratories along with individual 3D printers to provide resources to healthcare workers, mask extenders were printed to relieve posterior auricular pressure from individuals wearing isolation masks. The authors modifed an existing mask extender, increasing its length with accompanying peripheral rungs for isolation mask securement. 3D printing was performed with Ultimaker S5 (Ultimaker B.V.; Geldermalsen, Netherlands) and CR-10 (Creality3D; Shenzhen, China) 3D printers using polylactic acid filaments. The author's modified extended mask extenders were printed and freely delivered to healthcare workers (physicians, nurses, technologists, and other personnel) at the authors' institution. RESULTS: The final mask extender design was printed with the two 3D printers with a maximum 7 straps printed simultaneously on each 3D printer. Mean print times ranges from 105 min for the Ultimaker S5 printer and 150 min for the CR-10. Four hundred seventy-five mask extenders were delivered to healthcare workers at the authors' institution, with the demand far exceeding the available supply. CONCLUSION: We offer a modification of a 3D printed mask extender design that decreases discomfort and increases the wearability of isolation mask designs with ear loops thought to relieve posterior auricular skin pressure and ability to control strap tension. The design is simple, produced with inexpensive material (polylactic acid), and have been well-received by healthcare providers at our institution.

5.
Int J Cardiol ; 322: 170-174, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-799320

ABSTRACT

BACKGROUND: Catheter ablation for complex left-atrial arrhythmia is increasing worldwide with many centres admitting patients overnight. Same-day procedures using conscious sedation carry significant benefits to patients/healthcare providers but data are limited. We evaluated the safety and cost-effectiveness of same-day complex left-atrial arrhythmia ablation. METHOD: Multi-centre retrospective cohort study of all consecutive complex elective left-atrial ablation procedures performed between January 2011 and December 2019. Data were collected on planned same-day discharge versus overnight stay, baseline parameters, procedure details/success, ablation technology, post-operative complications, unplanned overnight admissions/outcomes at 4-months and mortality up to April 2020. A cost analysis of potential savings was also performed. RESULTS: A total of 967 consecutive patients underwent complex left-ablation using radiofrequency (point-by-point ablation aided by 3D-mapping or PVAC catheter ablation with fluoroscopic screening) or cryoballoon-ablation (mean age: 60.9 ± 11.6 years, range 23-83 yrs., 572 [59%] females). The majority of patients had isolation of pulmonary veins alone (n = 846, 87%) and most using conscious-sedation alone (n = 921, 95%). Of the total cohort, 414 (43%) had planned same-day procedure with 35 (8%) admitted overnight due to major (n = 5) or minor (n = 30) complications. Overall acute procedural success-rate was 96% (n = 932). Complications in planned overnight-stay/same-day cohorts were low. At 4-month follow-up there were 62 (6.4%) readmissions (femoral haematomas, palpitation, other reasons); there were 3 deaths at mean follow-up of 42.0 ± 27.6 months, none related to the procedure. Overnight stay costs £350; the same-day ablation policy over this period would have saved £310,450. CONCLUSIONS: Same-day complex left-atrial catheter ablation using conscious sedation is safe and cost-effective with significant benefits for patients and healthcare providers. This is especially important in the current financial climate and Covid-19 pandemic.


Subject(s)
Ambulatory Surgical Procedures/economics , Arrhythmias, Cardiac/surgery , Catheter Ablation/economics , Cost-Benefit Analysis , Adult , Aged , Aged, 80 and over , Ambulatory Surgical Procedures/adverse effects , Catheter Ablation/adverse effects , Cohort Studies , Female , Heart Atria/surgery , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
6.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137(4): 251-256, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-612302

ABSTRACT

OBJECTIVE: To analyze the impact of the first month of lockdown related to the 2020 SARS-Cov-2 epidemic on the consulting activity of private ENT physicians in Réunion Island. MATERIAL AND METHODS: A multicenter prospective study analyzed the consulting activity of 12 ENT physicians in full-time private practice. The main endpoints were the number, characteristics and conditions of consultations. Secondary endpoints comprised presenting symptoms, diagnosis, prescriptions, adverse effects, and progression of monthly consulting turnover. RESULTS: Six hundred and ninety three consultations were performed during the study period (Appendix 1), with 50% emergency consultations. In 57.9% were face-to-face, 28.4% by phone and 13.7% video. In face-to-face consultation, the physician wore gloves in 53.8% of cases and a mask in 92.2%: surgical mask in 71.6% of cases and FFP2 in 28.4%. The three most frequent symptoms (48.5% of cases) were otalgia, hearing impairment, and vertigo. The three most frequent diagnoses (60.6% of cases) were otitis, intra-auricular foreign body (including wax), and pharyngeal infection. The three most frequently prescribed complementary exams (74.3% of cases) were imaging, hearing work-up, and specialist opinion. The three most frequently prescribed treatments (52.7% of cases) were intra-auricular drops, oral antibiotics, and nasal spray. The incidence of adverse effects was 0.001%. None of the physicians or patients seemed to have been infected by Covid-19 during the study period. There was a 47.3-91% (median, 75.6%) drop in monthly consultation turnover. CONCLUSION: The present study underscored the availability and adaptability of ENT physicians in the Réunion Island in an epidemic context, although economic impact was detrimental.


Subject(s)
Coronavirus Infections/epidemiology , Otolaryngology , Otorhinolaryngologic Diseases , Pneumonia, Viral/epidemiology , Private Practice/statistics & numerical data , Quarantine/statistics & numerical data , COVID-19 , Child , Child, Preschool , Female , Humans , Infant , Male , Otorhinolaryngologic Diseases/diagnosis , Otorhinolaryngologic Diseases/therapy , Pandemics , Prospective Studies , Reunion , Time Factors
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