If the Test Fits: Diagnosis to Aid in the Treatment of Influenza.

Influenza is a significant cause of morbidity and mortality worldwide, presenting with lethal complications such as acute respiratory distress syndrome (ARDS). Multiple ways to diagnose influenza include rapid antigen tests, flu polymerase chain reaction (PCR), and respiratory viral panels or multiplex PCR. However, they have different sensitivities and specificities. We present a case of a 70-year-old female who was admitted to the ICU for ARDS and had a high pretest probability of influenza. She had an initial rapid flu antigen test that was negative and a negative flu PCR. However, she tested positive for influenza A (H1N1) with a respiratory viral panel. We as physicians should take into consideration the different sensitivities and specificities diagnostic tests have and consider retesting patients who have a negative test in the context of a high pretest probability. We should also remember to begin antiviral therapy early in a patient with high suspicion of influenza with a severe clinical presentation despite not having a confirmed diagnosis.

COVID-19 infection characteristics and outcomes in a predominantly Latino community hospital.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has rapidly spread worldwide and claimed millions of lives. Several studies have attempted to understand the relationship between COVID-19 infection and health disparities. The aim of the current work was to evaluate the pre-admission health characteristics, symptomatology, diagnostic abnormalities, treatment measures and clinical outcomes of the community served by our institution, with a sub-analysis of our Hispanic community. Methods: This is a single-center, cross-sectional cohort study of patients with COVID-19 admitted from 15 March 2020 to 30 April 2020 to MacNeal Hospital. A retrospective chart review was performed including patients >18 years and a positive nasopharyngeal SARS-CoV-2 PCR. Demographical data, comorbidities, clinical data, treatment regimen, and patient outcomes were collected. Results: A total of 257 patients were included in the study of which 60.4% were identified as Hispanic. The median age at admission of Hispanic patients was significantly lower compared to non-Hispanic patients (56.6 vs. 65.7 years, p<0.01). Non-Hispanic patients had lower prevalence of hypertension, coronary artery disease, and chronic lung disease. Most common at presentation were shortness of breath (69.6%), cough (69.2%), and fever (64%). Hypertension was the most common comorbidity (53.6%). Approximately 89% of the patients received antibiotics, 40.4% hydroxy-chloroquine, 13.2% steroids, and 6% tocilizumab. Twenty six percent required mechanical ventilation (MV), and over half of them (56.7%) were Hispanic. The strongest factors associated with MV were smoking (OR 2.97, 95%CI 1.01-8.69), CRP >10 mg/dL (OR 4.53, 95%CI 1.49-13.38) and D-dimer >1.5 mcg/mL (OR 3.63, 95%CI 1.31-10.05). An oxygen saturation of >90% on room air on presentation was a protective factor when predicting intubation (OR 0.11, 95%CI 0.03-0.33). The overall 30-day mortality rate was 17.1% (n=44); 11.9% in the Hispanic group vs 26.3% in the non-Hispanic group (p<0.003). Conclusions: Our review of consecutive patients admitted with COVID-19 demonstrated that over half of patients were of Hispanic descent. Interestingly enough, despite being significantly younger and healthier, the need for mechanical ventilation in the Hispanic group was not significantly different compared to the non-Hispanic group. However, the Hispanic group had a lower mortality rate.

The Young Heart Tears Easily Apart: A Case Report of Spontaneous Coronary Artery Dissection.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), seen mostly in young females. The rarity and limited knowledge of the disease make its management challenging. Prompt diagnosis of the condition is extremely important to decrease both long- and short-term complications. Treatment options depend on hemodynamic stability and the location of the dissection- with more distal lesions treated more conservatively as opposed to proximal lesions which are treated with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The following are the two cases with different presentation, management and outcomes. Our first patient was a 35-year-old woman with no medical history who presented with acute, anginal pain, diaphoresis and palpitations. She was hemodynamically stable on presentation, with work-up significant for electrocardiogram (ECG) with sinus bradycardia, ST elevation in leads V1-V6, and elevated troponin level of 4 ng/ml. There was no evidence of a pulmonary embolism on computed tomography (CT) of the chest. A coronary angiogram showed 100% dissection of the proximal to mid-left anterior descending (LAD) artery. Attempts to place a stent in the proximal to mid LAD were unsuccessful as the true lumen of the LAD was not accessible. The patient became hemodynamically unstable, and an emergent CABG was done, restoring blood flow. The patient recovered during her hospital stay and was discharged with dual antiplatelet therapy (DAPT), beta-blockers, and atorvastatin. The second patient was a 28-year-old woman, with a history of hypertension who presented with anginal chest pain. Workup showed ECG with minimal ST elevations in anteroseptal leads, with elevated troponin level to 0.71 ng/ml. Coronary angiogram showed 40-50% stenosis of the mid LAD with an aneurysmal segment. An echocardiogram showed no evidence of wall motion abnormalities, and she had a normal left ventricular ejection fraction (LVEF). She was discharged home the next day, on medical management. After two days, she returned to the hospital with similar complaints, with work-up significant for ECG with non-specific ST-T abnormality, and troponin level which peaked at 2.22 ng/ml. She was started on a heparin drip, and a repeat left heart catheterization revealed type 2 dissection of the mid to distal LAD, with intravascular ultrasound showing a fractional flow reserve of 0.76. She was discharged home on DAPT, beta-blocker, calcium channel blocker (CCB), and atorvastatin, with close cardiology follow up. These two cases highlight the importance of keeping in mind the possibility of SCAD, especially when relatively healthy young women present with anginal symptoms. Early diagnosis of the condition and prompt management are extremely important to ensure favourable outcomes. The two cases also describe the coronary angiogram findings in SCAD, and the different strategies employed in the management of this condition.

Cardiovascular Disease Risk and Outcomes in Patients Infected With SARS-CoV-2.

Cardiovascular involvement is one of the end-organ complications commonly reported in coronavirus disease 2019 (COVID-19). It has also been postulated to be an independent risk factor for increased mortality in COVID-19-infected patients. With such a significant effect of COVID-19 on the cardiovascular system and vice versa, it is pivotal for physicians to observe this association closely for improving management and understanding prognosis in these patients. Here, we present three patients and describe their baseline cardiac risk factors, the cardiac complications they developed in association with COVID-19 infection, and their varying outcomes.

Diabetes Mellitus: An Unrecognized Complication in the Management of Patients With Mental Illness.

Psychiatric patients can have undiagnosed illness due to difficulties accessing the health care system and the lack of guidelines regarding screening recommendations for them. The following case describes a 36-year-old male who presented with a hyperglycemic emergency in the setting of undiagnosed diabetes mellitus.

The Necessity of a Colonoscopy after an Acute Diverticulitis Event in Adults Less Than 50 Years Old.

Introduction Acute diverticulitis is defined as a macroscopic inflammation of a diverticulum or diverticula. Approximately, 4.0% of patients with diverticulosis present with an acute diverticulitis event: with the incidence increasing in the younger patient population. According to the American Gastrointestinal Association, a colonoscopy should be performed six to eight weeks after resolution of acute diverticulitis. The purpose of this study is to determine if there is malignancy after an acute diverticulitis event in adults less than 50 years old. Methods  A retrospective chart review study was performed at Loyola MacNeal Hospital in Berwyn, Illinois. Patients between the ages of 18 and49 years with acute diverticulitis were identified. Of the identified patients, those who underwent colonoscopy after a computed tomography (CT)-verified acute diverticulitis event were recorded. Colonoscopy findings, as well as pathology results, were recorded. Results  A total of 295 patient presented with diverticulitis. Of these 295 patients, 111 patients underwent colonoscopy post diverticulitis event. Of the 111 patients, 86 were after uncomplicated event and 25 were after a complicated diverticulitis event. Pre-malignant tubular adenomas were found in 12.8% (11/86) of patients with acute uncomplicated diverticulitis and 24.0% (6/25) of the patients with complicated diverticulitis. No cases of neoplasm were found. Conclusion  Of the 111 patients who underwent colonoscopy after an acute diverticulitis event, no malignancy was found in patients less than 50 years of age.