Case Report: Cerebral Venous Sinus Thrombosis and COVID-19 Infection.

Coronavirus disease-2019 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus). Coronavirus disease-2019 (COVID-19) was declared a pandemic in March 2020 and has changed our lives in many ways. This infection induces a hypercoagulable state leading to arterial and venous thrombosis, but the exact pathophysiology of thrombosis is unknown. However, various theories have been postulated including excessive cytokine release, endothelial activation, and disseminated intravascular coagulation (DIC). We present a patient diagnosed with cerebral venous sinus thrombosis (CVST) with COVID-19 infection. A 66-year-old man presented to a hospital for evaluation of persistent headaches. He tested positive for COVID-19, and MRI of the brain and CT venogram revealed CVST. He was started on heparin drip in the hospital and transitioned to oral anticoagulants at the time of discharge. His headaches improved with treatment. Even though headache is the most frequent and initial symptom of cerebral venous thrombosis, it is rarely the only symptom. A high index of suspicion is therefore required to diagnose CVST especially if the patient presents with a simple complaint like a headache. Common complaints can delay the diagnosis leading to disease progression. Considering the high mortality rates in patients diagnosed with CVST, we suggest the importance of knowing the association between COVID-19 infection and CVST, especially in susceptible patients.

Loneliness among older adults in the community during COVID-19

ObjectivePhysical distancing and stay-at-home measures implemented to slow transmission of novel coronavirus disease (COVID-19) may intensify feelings of loneliness in older adults, especially those living alone. Our aim was to characterize the extent of loneliness in a sample of older adults living in the community and assess characteristics associated with loneliness. DesignOnline cross-sectional survey between May 6 and May 19, 2020 SettingOntario, Canada ParticipantsConvenience sample of the members of a national retired educators organization. Primary outcome measuresSelf-reported loneliness, including differences between women and men. Results4879 respondents (71.0% women; 67.4% 65-79 years) reported that in the preceding week, 43.1% felt lonely at least some of the time, including 8.3% that felt lonely always or often. Women had increased odds of loneliness compared to men, whether living alone (adjusted Odds Ratio (aOR) 1.52 [95% Confidence Interval (CI) 1.13-2.04]) or with others (2.44 [95% CI 2.04-2.92]). Increasing age group decreased the odds of loneliness (aOR 0.69 [95% CI 0.59-0.81] 65-79 years and 0.50 [95% CI 0.39-0.65] 80+ years compared to <65 years). Living alone was associated with loneliness, with a greater association in men (aOR 4.26 [95% CI 3.15-5.76]) than women (aOR 2.65 [95% CI 2.26-3.11]). Other factors associated with loneliness included: fair or poor health (aOR 1.93 [95% CI 1.54-2.41]), being a caregiver (aOR 1.18 [95% CI 1.02-1.37]), receiving care (aOR 1.47 [95% CI 1.19-1.81]), high concern for the pandemic (aOR 1.55 [95% CI 1.31-1.84]), not experiencing positive effects of pandemic distancing measures (aOR 1.94 [95% CI 1.62-2.32]), and changes to daily routine (aOR 2.81 [95% CI 1.96-4.03]). ConclusionsWhile many older adults reported feeling lonely during COVID-19, several characteristics - such as being female and living alone - increased the odds of loneliness. These characteristics may help identify priorities for targeting interventions to reduce loneliness. Strengths and limitations of this studyO_LIThis survey study leveraged a strong community-based partnership to obtain timely data from a large sample of older Canadians on the impacts of COVID-19. C_LIO_LIThis study identified several characteristics that increased the odds of loneliness, which may help to identify priorities for targeted interventions to reduce loneliness. C_LIO_LIThe data were based on a convenience sample of retired, educational staff, who are not fully representative of the Canadian population. The perspectives of vulnerable groups who may be at greater risk for loneliness (e.g. those with severe mental health illness, low income, no home internet access, etc.) are likely underrepresented in this sample. C_LI