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  interstitial thickening Figures 5 6 Despite the typical imaging features and the onset of mild symptoms


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  Cureus DOI 10 7759 cureus 9840 sha cba50e6ab6f7bc3255e1c34d60a8e87973733384 doc_id 255752 cord_uid ofph98ac Infection associated with the novel severe acute respiratory syndrome coronavirus 2 SARS CoV 2


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  Johns Hopkins Coronavirus COVID 19 Resource Center Chinese Pediatric Novel Coronavirus Study Team SARS CoV


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  enoxaprin 4 41 9 8 or heparin plus tissue plasminogen activator TPA 2 41 4 9 and was unknown for one patient 1 41 2 4 As expected use of vasopressor support and invasive mechanical ventilation were associated with a decreased likelihood of survival p 0 001 p 0 001 Figure 3 Median OS for was shorter for patients with atrial fibrillation versus those with renal failure median OS 9 days vs 11 days respectively Figure 4 Complications PE pulmonary embolism DVT deep vein thrombosis We then investigated the impact of healthcare insurance status of the patient on overall survival Patients were divided by insurance of whom 83 81 4 were on either Medicare or Medicaid which is consistent with our standard patient population Further stratification showed 59 patients receiving Medicare 59 102 57 8 compared to 24 receiving Medicaid 24 102 23 5 Statistical analysis showed no significant difference in survival based on insurance status p 0 38 Figure 5 with median overall survival of 10 19 12 and 15 days for Medicare Medicaid self pay and private insurance respectively We quantified prevalence of specific comorbidities including obesity diabetes hypertension asthma vascular events chronic kidney disease gastroesophageal reflux disease and human immunodeficiency virus


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  human coronavirus NL63 HCoV NL63 and beta coronaviruses human coronavirus HKU1 HCoV HKU1 human coronavirus OC43 HCoV OC43


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  structural proteins spike S protein membrane M protein nucleocapsid N protein haemagglutinin esterase fusion glycoprotein HEF


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  protein creatinine kinase and d dimer 1 However there are other newly emerging initial presenting symptoms that were absent in the Chinese patients as COVID 19 spreads quickly across the globe They include asymptomatic carriers and other nonspecific symptoms that do not generally arouse suspicion of a possible COVID 19 infection Most hospitals in the United States utilize COVID 19 screening criteria that include cough fever and or respiratory distress Unfortunately these screening criteria may miss out on silent carriers and those with atypical presentations Furthermore Italy and France surprisingly 2020 reported a large population of patients with symptoms of anosmia


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  fever sore throat rhinorrhea cough myalgia vomiting dysphagia neck pain chest pain shortness of breath weakness


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  atrial fibrillation cardioembolic stroke parkinson disease chronic obstructive pulmonary disease COPD


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  Successful Treatment of Legionnaires Disease with Tigecycline in an Immunocompromised Man with a Legion of Antibiotic Allergies


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  interleukins IL 1 6 8 12 15 18 tumor necrosis factors TNF granulocytemacrophage GM granulocyte G macrophage colony stimulating factors M CSF


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  interleukins IL 1 6 8 12 15 18 tumor necrosis factors TNF granulocytemacrophage GM granulocyte G macrophage


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  1 spike S glycoprotein 2 nucleocapsid N protein 3 matrix protein and 4 envelope E protein 8 9 10 SARS CoV


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  angiotensin converting enzyme inhibitors ARBS angiotensin receptor blockers CRP C reactive protein References 1


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  metapneumovirus adenovirus parainfluenza respiratory syncytial virus and coronaviruses HKU1 NL63 229E


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  The Milestones Guidebook ACGME Core Entrustable Professional Activities for Entering Residency Toolkits for the 13


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  N De Oliveira Souza Ricardo Gorgulho Alessandra De Salles Antonio title Upholding Scientific Duty Amidst


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  Adult Critically Ill COVID 19 Patient COVID 19 Guidance Independent Health Facilities Using Personal Protective Equipment PPE Rational use of personal protective equipment PPE


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  the Emergency Department A Case of Klebsiella Infective Endocarditis Presenting With Splenic Abscess date 2020


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  splenic abscess embolic phenomenon focal neurologic deficit mycotic aneurysm decompensated heart failure


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  PPE 4 5 6 7 8 9 10 11 12 While there is also conflicting evidence regarding the impact of ultrasound on intravenous IV


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  Disease Site Specific Guidelines for Curative Radiation Treatment During Limited Surgery and Hospital Avoidance A Radiation Oncology Perspective


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  Cureus DOI 10 7759 cureus 8685 sha c549002e80ba06bcb7dea7305903f16d5eaef420 doc_id 324644 cord_uid sz5n7a5z We present a case of a 39 year old male who presented with chest pain without fever or respiratory symptoms Troponins were elevated and electrocardiogram ECG


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  Cureus DOI 10 7759 cureus 9816 sha 5a7ba300d2e669e38410abb2171b5e18c3ebf63f doc_id 327224 cord_uid e4rlbfin Race and class are major predictors of health outcomes in the United States Health disparities among racial and low income minorities often have environmental etiologies Using Rhode Island as a case study we geocoded and visualized several environmental determinants of health via Geographic Information Systems GIS


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  Cureus DOI 10 7759 cureus 10156 sha 7a91947a93f84055b9768eeedf13913283e3059c doc_id 333808 cord_uid deifddar Cancer patients frequently develop tumor and treatment related complications leading to diminished quality of life shortened survival and overutilization of emergency department and hospital services Outpatient oncology treatment has potential to leave cancer patients unmonitored for long periods while at risk of clinical deterioration which has been exaggerated during the


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  interleukin IL 2 IL 6 IL 7 tumor necrosis factor granulocyte colony stimulating factor interferon gamma


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  Cureus DOI 10 7759 cureus 9846 sha 05abb647162d84b09391a09f2bf24db60348b312 doc_id 352580 cord_uid l6vkzja0 Background Coronavirus disease 2019 COVID 19 caused


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  Cureus DOI 10 7759 cureus 10270 sha 79a5db217a0377f624a1cc77f270106d00cfd4ba doc_id 351267 cord_uid itdorszt The recent Lebanese port explosion came as a continuation of a series of socioeconomic disasters the country has been facing during the past year In addition the massive impact of the coronavirus


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  the Institutional Ethics Committee Human Research IEC HR University College of Medical Sciences University


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  Institutional Ethics Committee Human Research IEC HR University College of Medical Sciences University


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  Cureus DOI 10 7759 cureus 9725 sha dae1345c0f14ce2d06147f78edfd9298ecebf938 doc_id 356332 cord_uid t0ahmh0h Ventricular septal defect VSD


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  Cureus DOI 10 7759 cureus 10310 sha d5f6a88712a8e8b616f9d745cdb4a67026f0ebbe doc_id 353824 cord_uid 0oyvia6d Coronavirus disease 2019 COVID 19


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# bib

id: cord-253355-dii5zszf
title: Awake Proning: A Necessary Evil During the COVID-19 Pandemic
author: Khan, Sheharyar
date: 2020-07-03
txt: ./txt/cord-253355-dii5zszf.txt
cache: ./cache/cord-253355-dii5zszf.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32775071/
doi: 10.7759/cureus.8989
summary:
  Patients presenting with ARDS need mechanical ventilation, as their lungs are unable to oxygenate blood on their own due to fluid accumulation. One way to manage this excess pressure of fluid build-up around the lung tissues is to relieve the dorsal alveoli by prompting the patient to lie face down on the stomach; this is called awake proning. Awake proning delays the use of mechanical ventilation and facilitates the patients with severe ARDS or severe pneumonia in maintaining the supply of oxygen to the body tissues. As it progresses, the disease presents with more severe symptoms like viral pneumonia, which causes acute respiratory distress syndrome (ARDS). The blood oxygen levels also improved after the cycles of prone positioning, and endotracheal intubation was avoided in patients with ARDS, which would have been the only option to opt from if awake proning was not administered [17] . A COVID-19 patient presenting with severe pneumonia or ARDS can be managed with awake proning as a supportive treatment to relieve symptoms.

abstract:
  The spread of COVID-19 has been exponential throughout the globe. Though only a small percentage of infected individuals reach the critical stage of the disease, i.e., acute respiratory distress syndrome (ARDS), this percentage represents a significant number of patients that can overwhelm the healthcare system. Patients presenting with ARDS need mechanical ventilation, as their lungs are unable to oxygenate blood on their own due to fluid accumulation. One way to manage this excess pressure of fluid build-up around the lung tissues is to relieve the dorsal alveoli by prompting the patient to lie face down on the stomach; this is called awake proning. It is a procedure that is directed towards the recruitment of lung parenchyma when infected with pneumonia or when the condition has worsened into ARDS. This helps in relieving the pressure from the dorsal lung surface that has markedly higher perfusion than the ventral surface. Awake proning delays the use of mechanical ventilation and facilitates the patients with severe ARDS or severe pneumonia in maintaining the supply of oxygen to the body tissues. Since medical institutes are overburdened and limited ventilators are available, awake proning can reduce not only the burden on hospitals but also decrease the need for ventilators.


id: cord-253580-q13qndic
title: The Unaddressed Behavioral Health Aspect During the Coronavirus Pandemic
author: Onyeaka, Henry K
date: 2020-03-21
txt: ./txt/cord-253580-q13qndic.txt
cache: ./cache/cord-253580-q13qndic.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32328363/
doi: 10.7759/cureus.7351
summary:
  Public health emergencies have been demonstrated to have an impact on the behavioral health of the affected population as they may experience fear, anxiety, anger and post-traumatic stress disorder as consequences of their experiences. Although the Centers for Disease Control and Prevention (CDC) has outlined some behavioral health guide for affected individuals, how best to respond to psychological challenges during the crisis is not known. On March 11, the World Health Organization (WHO) declared 2019-nCoV a pandemic, citing more than 118,000 cases of the coronavirus illness in more than 110 countries and territories around the world and the sustained risk of further global spread. Furthermore, contact tracing and the mandatory quarantine isolation for two weeks, which is a crucial part of the public health responses to the 2019-nCoV pneumonia outbreak, could be a precursor for increased psychological distress such as posttraumatic stress disorder, anxiety and anger among suspected or confirmed cases [3, 4] .

abstract:
  The 2019 novel coronavirus (2019-nCoV) pneumonia has been declared a pandemic, citing more than 118,000 cases of the coronavirus illness in more than 110 countries and territories around the world. Public health emergencies have been demonstrated to have an impact on the behavioral health of the affected population as they may experience fear, anxiety, anger and post-traumatic stress disorder as consequences of their experiences. These effects may persist among affected individuals long after the outbreak has been controlled. To date, data on the behavioral distress and psychiatric morbidity of those suspected or diagnosed with the 2019-nCoV and their treating health professionals are lacking. Although the Centers for Disease Control and Prevention (CDC) has outlined some behavioral health guide for affected individuals, how best to respond to psychological challenges during the crisis is not known. There is an urgent need to provide robust and timely psychosocial support in the face of such an outbreak.


id: cord-253704-y0t30xw3
title: COVID-19 Pandemic: A Neurological Perspective
author: Lahiri, Durjoy
date: 2020-04-29
txt: ./txt/cord-253704-y0t30xw3.txt
cache: ./cache/cord-253704-y0t30xw3.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.7889
doi: 10.7759/cureus.7889
summary:
  Even though severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been observed to principally affect the respiratory system, neurological involvements have already been reported in some published work. Neurological manifestations can further be subdivided into the central nervous system (headache, dizziness, alteration of the sensorium, ataxia encephalitis, stroke, and seizures) and peripheral nervous system (skeletal muscle injury and peripheral nerve involvement including hyposmia and hypogeusia) symptomatology. Even though severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been observed to mainly affect the respiratory system, neurological involvements have already been reported in some published work. In the present paper, we have reviewed the recently published or pre-print original articles, case reports, and existing open-source data-sets in order to delineate the spectrum of neurological disorders in SARS-CoV-2 positive cases. Another report from China describes a case of acute myelitis, possibly affecting the cervical spinal cord, as evidenced by the clinical features, in a known patient of SARS-CoV-2 infection [22] .

abstract:
  Even though severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been observed to principally affect the respiratory system, neurological involvements have already been reported in some published work. We have reviewed original articles, case reports, and existing open-source data-sets to delineate the spectrum of neurological disorders potentially observed in SARS-CoV-2 positive cases. Neurological involvement in coronavirus disease 2019 (COVID-19) corresponds to three situations: (a) neurological manifestations of viral infection, (b) post-infective neurological complications, and (c) infection in patients with neurological co-morbidity. Neurological manifestations can further be subdivided into the central nervous system (headache, dizziness, alteration of the sensorium, ataxia encephalitis, stroke, and seizures) and peripheral nervous system (skeletal muscle injury and peripheral nerve involvement including hyposmia and hypogeusia) symptomatology. Post-infective neurological complications include demyelinating conditions. Reduced mobility and dementia as co-morbidities may predispose a patient to have a viral infection. It is concluded that the pandemic of COVID-19 presents for a neurologist some unique challenges. We observe that SARS-CoV-2 may have various neurological manifestations and in many cases, neurological features may precede typical respiratory symptoms.


id: cord-255240-ltatgq3e
author: Kesserwani, Hassan
date: 2020-09-20
txt: ./txt/cord-255240-ltatgq3e.txt
cache: ./cache/cord-255240-ltatgq3e.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33101796/
doi: 10.7759/cureus.10548
summary:
  We present the case of an 86-year-old woman who has a vascular dementia, Binswanger''s syndrome, and coronary artery disease, who presented with more than five CMBs. We present this case in order to highlight the dilemma of anti-platelet therapy in this group of patients and we demonstrate the cardinal radiologic features of CMBs. We then segue into the pathologic correlates of CMBs and associated risk factors. If the magnetic resonance imaging (MRI) scanner software is endowed with a left-handed reference frame such as Siemens, the CMBs appear hyperintense on the phase map. Hence one faces a therapeutic dilemma; with such extensive cerebral white matter disease and stable coronary artery disease, is anti-platelet therapy warranted in the presence of more than five CMBs? [ In the study by Lau et al., in 1811 patients who were prescribed anti-platelet therapy, the five-year risk of recurrent ischemic stroke and hemorrhagic stroke both increased with the number of CMBs [6] .

title:
  Cerebral Microbleeds - To Treat or Not to Treat, That Is the Question: A Case Report With a Note on Its Radiologic Deconstruction and Therapeutic Nuances

abstract:
  With the ubiquity of susceptibility weighted imaging (SWI), cerebral microbleeds (CMBs) are fast becoming a prevalent phenomenon. They are tightly associated with age, neurodegeneration and diverse vascular etiologies. CMBs have a unique radiological signature. Their morphology, number and topology are quite informative. They also pose a therapeutic conundrum, as they are associated with the risk of cerebral hemorrhage. We present the case of an 86-year-old woman who has a vascular dementia, Binswanger's syndrome, and coronary artery disease, who presented with more than five CMBs. We present this case in order to highlight the dilemma of anti-platelet therapy in this group of patients and we demonstrate the cardinal radiologic features of CMBs. We then segue into the pathologic correlates of CMBs and associated risk factors. We finally analyze the risk of anti-platelet therapy in the presence of CMBs, and we unfold the latest data on CMB number and anti-platelet therapy.


id: cord-255752-ofph98ac
title: Coronavirus Disease 2019 (COVID-19) Associated With Febrile Status Epilepticus in a Child
author: Chegondi, Madhuradhar
date: 2020-08-18
txt: ./txt/cord-255752-ofph98ac.txt
cache: ./cache/cord-255752-ofph98ac.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32953347/
doi: 10.7759/cureus.9840
summary:
  Infection associated with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been named coronavirus disease 2019 (COVID-19). We report the case of a two-year-old child who presented to our pediatric intensive care unit with febrile status epilepticus and was diagnosed to have COVID-19 infection. The emerging literature suggests that the SARS-CoV-2 infection can affect children, including all age groups, predominantly males, and cause milder disease compared to adult patients [2, 3] . We report the case of a two-year-old child who presented to our pediatric intensive care unit (PICU) with febrile status epilepticus and was diagnosed to have COVID-19 infection. A retrospective study from China reported that common neurological symptoms in adult patients with COVID-19 include headache, dizziness, and rarely seizures [12] . Our index case illustrates that SARS-CoV-2 associated COVID-19 can present with febrile seizure and febrile status epilepticus in children.

abstract:
  Infection associated with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been named coronavirus disease 2019 (COVID-19). The emerging literature suggests that SARS-CoV-2 infection affects children of all age groups. COVID-19 as a cause of febrile seizures and status epilepticus is not yet reported in children. We report the case of a two-year-old child who presented to our pediatric intensive care unit with febrile status epilepticus and was diagnosed to have COVID-19 infection. The child recovered fully and was discharged home after three days.


id: cord-258484-jwgtjisx
author: Mehrabi, Sara
date: 2020-05-16
txt: ./txt/cord-258484-jwgtjisx.txt
cache: ./cache/cord-258484-jwgtjisx.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32550070/
doi: 10.7759/cureus.8151
summary:
  Aim To study ground-glass opacities (GGO) not only from the coronavirus 2019 (COVID-19) pneumonia" perspective but also as a radiological presentation of other pathologies with comparable features. In the presence of typical imaging features (e.g. GGO and consolidation), the radiologist should focus on the pandemic and manage a suspect patient as COVID-19 positive until proven to be negative. Even if chest CT can detect lung anomalies before symptom onset, the findings follow a temporal pattern and are consistent with clinicopathological development: the first and most common feature is ground-glass opacity (GGO), which represents early alveolar damage, with bilateral subpleural distribution in the lower lobes; then, areas of consolidation appear and tend to coalesce on the underlying GGOs. Later, in this background, the "crazy paving" pattern can be seen, with thickened interlobular septa and intralobular lines. COVID-19 pneumonia was suspected because of the CT report and clinical presentation so an RT-PCR assay by nasopharyngeal swab was performed; interestingly, the virus was not detected in any patient.

title:
  Pitfalls of Computed Tomography in the Coronavirus 2019 (COVID-19) Era: A New Perspective on Ground-Glass Opacities

abstract:
  Aim To study ground-glass opacities (GGO) not only from the coronavirus 2019 (COVID-19) pneumonia” perspective but also as a radiological presentation of other pathologies with comparable features. Methods We enrolled 33 patients admitted to Policlinico Universitario G. B. Rossi who underwent non-contrast-enhanced (NCE) or contrast-enhanced (CE) chest computed tomography (CT) between March 12 and April 12. All patients with CT-detected ground-glass opacity (GGO) were included. All patients resulted as COVID-19 negative at the reverse transcription-polymerase chain reaction (RT-PCR) assay. We studied the different pathologies underlying GGO features: neoplastic diseases and non-neoplastic diseases (viral pneumonias, interstitial pneumonias, and cardiopulmonary diseases) in order to avoid pitfalls and to reach the correct diagnosis. Results All CT scans detected GGOs. Symptomatic patients were 25/33 (75.7%). At the clinical presentation, they reported fever and dry cough; in six out of 25 cases, dyspnea was also reported (24%). Thirty-three (33; 100%) showed GGO at CT: 15/33 (45.45%) presented pure GGO, and 18/33 (54.54%) showed GGO with consolidation. The RT-PCR assay was negative in 100%. We investigated other potential underlying diseases to explain imaging features: neoplastic causes (8/33, 24.24%) and non-neoplastic causes, in particular, infectious pneumonias (16/33, 48,48 %, viral and fungal), interstitial pneumonias (4/33, 12,12%), and cardio-pulmonary disease (5/33, 15,15%). Conclusions GGO remains a diagnostic challenge. Although CT represents a fundamental diagnostic tool because of its sensitivity, it still needs to be integrated with clinical data to achieve the best clinical management. In the presence of typical imaging features (e.g. GGO and consolidation), the radiologist should focus on the pandemic and manage a suspect patient as COVID-19 positive until proven to be negative.


id: cord-259660-x9sobzyw
author: Mohakud, Nirmal K
date: 2020-09-26
txt: ./txt/cord-259660-x9sobzyw.txt
cache: ./cache/cord-259660-x9sobzyw.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10659
doi: 10.7759/cureus.10659
summary:
  In the present report, we describe a premature newborn, who was born to a primigravida mother with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome and moderate COVID-19 pneumonia. The newborn tested positive at 12 hours of life for COVID-19 by real-time polymerase chain reaction (RT-PCR) of the tracheal aspirate sample [9] . The authors in one review reported 179 cases of newborns tested positive at birth, whose mothers were infected in the third trimester of pregnancy [5] . The authors of one study described that three newborns born to mothers with COVID-19 infection had positive antibodies (IgM and IgG) at birth [7, 8] . In the present report, the index newborn was tested positive at 12 hours of life without any features of symptomatic COVID-19 infection [9] . Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn A neonate born to mother with COVID-19 during pregnancy & HELLP syndrome: a possible vertical transmission

title:
  An Assumed Vertical Transmission of SARS-CoV-2 During Pregnancy: A Case Report and Review of Literature

abstract:
  The ongoing coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected persons of all ages, including the newborns. Few published case reports and case series have described the possibility of vertical transmission of COVID-19. In the present report, we describe a young primigravida at 33 weeks of gestation, who presented with a four-day history of low-grade fever, malaise, and breathing difficulty. She underwent testing of nasopharyngeal swab sample by real-time polymerase chain reaction (RT-PCR), which was positive for COVID-19. Cesarean section was done, and a preterm low birthweight baby was delivered. The baby required resuscitation at birth and was mechanically ventilated for a shorter duration. A tracheal aspirate that was taken at 12 hours of life tested positive for COVID-19. The course and outcome of the newborn are described here along with the possibility of vertical transmission.


id: cord-260224-1aeqe7fh
author: Passerini, Matteo
date: 2020-05-23
txt: ./txt/cord-260224-1aeqe7fh.txt
cache: ./cache/cord-260224-1aeqe7fh.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32596073/
doi: 10.7759/cureus.8254
summary:
  A 61-year-old male patient affected by stage IV prostate cancer with bone metastasis at diagnosis presented to our Wound Care Clinic complaining of ulcers on the right forearm that appeared two weeks prior following a referred domestic trauma. He presented no signs and symptoms of recrudescence of cutaneous and neurological cryptococcosis, but the cryptococcal antigen was still positive. There is no typical cutaneous lesion of cryptococcosis, but skin involvement is typically characterized by various non-specific presentations (e.g., papules, pustules, nodules, abscesses, edema, panniculitis, and ulcers) and can be due to a primary infection or due to a secondary systemic hematogenous spread [8] [9] [10] . Our patient presented with two large and necrotic ulcers on his right forearm and was treated with broad-spectrum antibiotics. The studies cited above and the clinical course of our patient showed that cutaneous symptoms in an immunocompromised patient should always alert about the possibility of an opportunistic infection such as cryptococcosis.

title:
  Disseminated Cryptococcosis in a Patient With Metastatic Prostate Cancer Who Died in the Coronavirus Disease 2019 (COVID-19) Outbreak

abstract:
  We report the case of a 61-year-old patient with a history of prostate cancer affected by bone metastasis. He presented to our attention for ulcerous and necrotic cutaneous lesions unresponsive to antibiotics. The spread of cutaneous lesions and the onset of neurological symptoms suggested a cryptococcal disease, which was confirmed by lumbar puncture and cutaneous biopsy. We present the diagnostic and therapeutic approach to this case.


id: cord-261938-ls363vud
author: Khan, Farah
date: 2020-08-22
txt: ./txt/cord-261938-ls363vud.txt
cache: ./cache/cord-261938-ls363vud.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32968603/
doi: 10.7759/cureus.9944
summary:
  In assessing medical fitness and healthcare mediations for refugees and migrant children, special consideration should be given to certain areas such as their distinct history, whether they are with their family or separated or unaccompanied, and whether they have been peddled or have been left behind. Children''s right to medical care is guaranteed by all the world leaders and Member States of the WHO European Region and is compiled in the Convention on the Rights of the Child (CRC), a convention guaranteeing the highest attainable standard of healthcare and treatment of illness and rehabilitation of the refugee, migrant, and asylum-seeking children similar to the children native to the host country [3] . A study reports of unaccompanied refugee and migrant children who were arriving in Germany with multidrug-resistant bacteria colonization at higher rates, and other records of a surge of measles, which is vaccine-preventable, have also been seen in asylum-seeking juveniles [14, 15] .

title:
  Refugee and Migrant Children’s Mental Healthcare: Serving the Voiceless, Invisible, and the Vulnerable Global Citizens

abstract:
  Millions of children are on the run worldwide, with many unaccompanied children and adolescents undertaking risky journeys to flee war, adverse circumstances, and political persecution. The grueling journey and multiple stressors faced by the refugee children, both accompanied and unaccompanied during the pre-migration, migration, and in the country of destination, increase their risk for psychiatric disorders and other medical conditions. Unaccompanied refugee migrant children have higher prevalence of mental health disorders than accompanied refugee peers. Long after reaching the host country, the refugee, migrant, and asylum-seeking juveniles continue to face adversities in the form of acculturation. In assessing medical fitness and healthcare mediations for refugees and migrant children, special consideration should be given to certain areas such as their distinct history, whether they are with their family or separated or unaccompanied, and whether they have been peddled or have been left behind.


id: cord-262236-1lilrqts
title: Characterization of Critically Ill COVID-19 Patients at a Brooklyn Safety-Net Hospital
author: Capone, Stephen
date: 2020-08-17
txt: ./txt/cord-262236-1lilrqts.txt
cache: ./cache/cord-262236-1lilrqts.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32850261/
doi: 10.7759/cureus.9809
summary:
  There was no statistically significant difference in overall survival based on ethnicity, healthcare status, or individual medical comorbidities, although a negative trend exists for diabetes. There was no statistically significant difference in overall survival based on ethnicity, healthcare status, or individual medical comorbidities, although a negative trend exists for diabetes. The purpose of this study was to explore the disease characteristics in a Brooklyn safety-net hospital affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the clinical course and outcomes of this uniquely diverse population. Deceased patients were then isolated and a multiple linear regression analysis was performed to compare each comorbidity to the overall days to death which yielded no statistically significant results. We do note a trend towards decreased survival in patients with diabetes (p=0.12), but no individual factor showed a statistically significant impact on overall mortality or median OS.

abstract:
  Background The novel coronavirus disease 2019 (COVID-19) pandemic continues to spread across the country with over 3 million cases and 150,000 deaths in the United States as of July 2020. Outcomes have been poor, with reported admission rates to the intensive care team of 5% in China and mortality among critically ill patients of 50% in Seattle. Here we explore the disease characteristics in a Brooklyn safety-net hospital affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods A retrospective chart review of COVID-19 positive patients at The Brooklyn Hospital Center who were treated by the intensive care team prior to April 20, 2020. Data was extracted from the electronic health record, analyzed and correlated for outcome. Results Impact of various clinical treatments was assessed, showing no change in median overall survival (OS) of both hydroxychloroquine with azithromycin or vitamin C with zinc. Supplemental therapies were used in selected patients, and some were shown to increase median OS and patients requiring vasopressor support or invasive mechanical ventilation showed decreased OS. There was no statistically significant difference in overall survival based on ethnicity, healthcare status, or individual medical comorbidities, although a negative trend exists for diabetes. Despite this, there is a trend towards increasingly poor prognosis based on the number of comorbidities and Class 3 obesity. Conclusions Despite the fact that we show no significant differences in mortality based on ethnicity, insurance status, or individual medical comorbidities, we show a high overall mortality. There is also a trend towards increased overall mortality in Class 3 obesity, which should be further investigated. We suggest that these findings may be attributed to both socioeconomic factors and an increased incidence of total medical comorbidities in our patient population.


id: cord-262886-irmwqjfh
title: Frequent Hand Washing for COVID-19 Prevention Can Cause Hand Dermatitis: Management Tips
author: Beiu, Cristina
date: 2020-04-02
txt: ./txt/cord-262886-irmwqjfh.txt
cache: ./cache/cord-262886-irmwqjfh.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.7506
doi: 10.7759/cureus.7506
summary:
  Frequent hand washing implies a prolonged exposure to water and other chemical or physical agents and may induce several pathophysiologic changes, such as epidermal barrier disruption, impairment of keratinocytes, the subsequent release of proinflammatory cytokines, activation of the skin immune system, and delayed-type hypersensitivity reactions. This article aims to review the potential dermatological adverse effects that may arise due to frequent hand washing, as well as practical tips for preventing these uncomfortable skin reactions. Frequent hygienization of hands may generate various changes in skin texture, ranging from the development of cutaneous xerosis (dryness of the skin) up to irritant contact dermatitis (ICD) or, rarely, even allergic contact dermatitis (ACD). In these times, it is very important to adapt our hand washing habits to ensure efficient protection against the spread of COVID-19 while lowering the risk of skin adverse reactions. Regular skin hydration is a key component in preventing hand dermatitis as a consequence of frequent washing.

abstract:
  Coronavirus disease 2019 (COVID-19) continues to spread globally, outpacing the capacity and resources of health systems worldwide. A therapeutic vaccine is not yet on the rise, and preventive measures are the current approach to restraint the transmission of cases. As the virus is highly contagious via respiratory route (droplets from infected persons, widely spread by coughing or sneezing) and via contact with contaminated surfaces, community transmission and spread can be decreased through the practice of regular and diligent hand hygiene. Frequent hand washing implies a prolonged exposure to water and other chemical or physical agents and may induce several pathophysiologic changes, such as epidermal barrier disruption, impairment of keratinocytes, the subsequent release of proinflammatory cytokines, activation of the skin immune system, and delayed-type hypersensitivity reactions. Adverse dermatologic effects, such as excessive skin dryness or even contact dermatitis (particularly the irritant subtype and, to a lesser extent, the allergic subtype), can occur, especially in individuals with a history of atopic dermatitis. These skin conditions are perfectly manageable, and applying a moisturizer immediately after washing hands or after using a portable hand sanitizer is the cornerstone in preventing the development of eczematous changes in the hands. In the current global context, the potential occurrence of these dermatological adverse events should in no way cause people to deviate from strict hand hygiene rules.


id: cord-263064-n4c0m5hn
author: Choudhury, Ivana
date: 2020-07-04
txt: ./txt/cord-263064-n4c0m5hn.txt
cache: ./cache/cord-263064-n4c0m5hn.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.9000
doi: 10.7759/cureus.9000
summary:
  We report a case of a 73-year-old male with a history of diabetes mellitus, osteomyelitis, methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia who recently completed an extended intravenous course of cefazolin eight days back, and presented with MSSA bacteremia complicated by epidural abscess, endocarditis, and aortic root abscess. A 73-year-old male recently treated for methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia secondary to presumed source of non-healing diabetic foot ulcer (completed a six weeks course of intravenous (IV) cefazolin eight days ago, negative transesophageal echocardiogram (TEE)) presented to our emergency department with lower back pain with extension to the left flank region, urinary incontinence, and an altered mental status. For a patient with MSSA bacteremia and COVID-19, such as ours, CD4 and CD8 Tcell functional exhaustion may be why our patient required an extended course of IV antibiotic therapy. Our patient presented with a recurrent and persistent MSSA bacteremia and osteomyelitis, complicated by a spinal epidural abscess, bioprosthetic valve endocarditis and aortic root abscess despite appropriate antibiotic therapy.

title:
  COVID-19 as a Possible Cause of Functional Exhaustion of CD4 and CD8 T-cells and Persistent Cause of Methicillin-Sensitive Staphylococcus aureus Bacteremia

abstract:
  We report a case of a 73-year-old male with a history of diabetes mellitus, osteomyelitis, methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia who recently completed an extended intravenous course of cefazolin eight days back, and presented with MSSA bacteremia complicated by epidural abscess, endocarditis, and aortic root abscess. Meanwhile, the patient was tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription-polymerase chain reaction (RT-PCR). Even with aggressive antibiotic treatment, the patient remained bacteremic and developed endocarditis with a worsening aortic root abscess. We suspect coronavirus disease 2019 (COVID-19) as a cause for the infectious paradox and will discuss the possible mechanisms in this case report.


id: cord-263179-uvq3hzga
title: A Case of a COVID-19-positive Patient
author: Malik, Zohra R
date: 2020-04-09
txt: ./txt/cord-263179-uvq3hzga.txt
cache: ./cache/cord-263179-uvq3hzga.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32399342/
doi: 10.7759/cureus.7608
summary:
  Virus SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) or the 2019 novel coronavirus (2019-nCoV) belong to the broad family of coronaviruses (subgenus Sarbecovirus). The HCoV (human coronavirus) is responsible for up to 10% -30% of the upper respiratory tract infections globally [2] . Historically, HCoV''s were only responsible for mild infections until 2002, with the emergence of the severe acute respiratory syndrome (SARS) that started in the Guangdong province of China. Based on available data of SARS and MERS, the Centers for Disease Control and Prevention (CDC) has estimated an incubation period for the COVID-19 to be between two and 14 days [6] . There have been reported cases involving large populations showing people with varying incubation periods and the severity of symptoms based on age and immune status. The patient was placed on airborne, droplet, and contact isolation because of the high suspicion of coronavirus infection. Middle East respiratory syndrome coronavirus: another zoonotic betacoronavirus causing SARS-like disease

abstract:
  The coronavirus (COVID-19), discovered in 2019, has been creating havoc since it first emerged in China and is now spreading worldwide. Its presentation is somewhat similar to influenza. We hereby discuss the salient features of the coronavirus and present the case of a 33-year-old male who was tested positive for COVID-19.


id: cord-263901-hmqq9w1a
title: Effectiveness of Computed Tomography in the Diagnosis of Novel Coronavirus-2019
author: Yurdaisik, Isil
date: 2020-05-15
txt: ./txt/cord-263901-hmqq9w1a.txt
cache: ./cache/cord-263901-hmqq9w1a.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32550054/
doi: 10.7759/cureus.8134
summary:
  Correct diagnosis of viral pneumonia based on chest CT indicates isolation and plays an important role in the management of patients suspected to have an infection, especially in the absence of scientifically proven treatment methods. Radiologists to have sufficient knowledge about the clinic and chest CT imaging of COVID-19 will help early detection of the infection and evaluation of the disease course. In a study from Wuhan, China, it was reported that COVID-19 had abnormal findings on chest CT even in asymptomatic patients [26] . In a study by radiologists from Wuhan, China, it was found that chest CT had a low misdiagnosis rate in COVID-19 and this method can help standardization of imaging and a rapid diagnosis [10] . Liu: Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: a multicenter study Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases

abstract:
  Coronaviruses (CoV) belong to the coronavirus genus of the coronaviridae family. All CoVs are pleomorphic RNA viruses containing crown-like peplomers of 80-160 nm in size. This virus is a zoonotic pathogen seen with a wide range of clinical features from asymptomatic state to intensive care in humans. So far, seven human coronaviruses have been identified with the last one being Coronavirus-2019 (COVID-19). These pathogens typically lead to mild disease, but SARS and MERS type coronaviruses have caused severe respiratory disease and even mortality within the last 20 years. COVID-19 virus has rapidly spread worldwide after China and is continuing to cause huge economical and social impacts. Given the scarcity of resources including healthcare staff, hospital capacities, test kits, etc., timely diagnosis and treatment of this virus are of paramount importance. However, there is no vaccination or drug developed for the treatment of this disease up to today. Because the spreading rate of the virus is very high worldwide and there is no definitive treatment, diagnosis becomes even more important. The objective of this review is to evaluate the use of chest computed tomography, one of the commonly used radiologic imaging modalities, in the diagnosis of COVID-19 in light with the current literatüre.


id: cord-264122-n64tm6qr
author: Gaballa, Salem
date: 2020-06-24
txt: ./txt/cord-264122-n64tm6qr.txt
cache: ./cache/cord-264122-n64tm6qr.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8809
doi: 10.7759/cureus.8809
summary:
  title: COVID-19 Fears May Be Worse Than the Virus: A Case of Cardiogenic Shock Secondary to Post-Myocardial Infarction Ventricular Septum Rupture We report a sad and unfortunate case of an 87-year-old female who was experiencing pressure-like chest pain but presented to the emergency room five days later out of fear of catching COVID-19 from the hospital. Ventricular septal rupture (VSR) is an uncommon but fatal mechanical complication of myocardial infarction (MI). Ventricular septal rupture following acute myocardial infarction Post-infarction ventricular septal defect: risk factors and early outcomes Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry Ventricular septal rupture after acute myocardial infarction Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database

title:
  COVID-19 Fears May Be Worse Than the Virus: A Case of Cardiogenic Shock Secondary to Post-Myocardial Infarction Ventricular Septum Rupture

abstract:
  Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there has been a growing and justifiable fear of catching the virus from the emergency rooms, thus decreasing the hospital visits. With Virginia State slowly reopening and HCA local hospitals resuming elective procedures, the number of emergency room visits, are recovering and increasing. We report a sad and unfortunate case of an 87-year-old female who was experiencing pressure-like chest pain but presented to the emergency room five days later out of fear of catching COVID-19 from the hospital. On presentation to the ED, she was found to have an non-ST-elevation myocardial infarction, which required urgent stenting of the left anterior descending artery. Unfortunately, several hours later, she developed fatal cardiogenic shock due to ventricular septal rupture. We are reporting this case to highlight one of the many potential bad outcomes as a result of a delay in seeking necessary medical attention due to the fear of contracting the virus.


id: cord-264180-0vd3tr9j
title: Is It Safe to Perform Lung Surgery During the Coronavirus Pandemic?
author: Gupta, Anupam K
date: 2020-08-14
txt: ./txt/cord-264180-0vd3tr9j.txt
cache: ./cache/cord-264180-0vd3tr9j.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32944464/
doi: 10.7759/cureus.9749
summary:
  All patients who remained for at least one-day inpatient post-lung surgery were assessed to see if they had an increased incidence of coronavirus infection during the hospital stay or at the follow-up office visit. As of April 20, 2020, we have reported 55 cases requiring intensive care unit (ICU) care at our tertiary medical center Boca Raton Regional Hospital (400 bedded hospital) in Florida and over 250 coronavirus positive patients. From February 1, 2020, to April 14, 2020, the patients who underwent lung surgery were evaluated for the incidence of coronavirus infection during the hospital stay and on postoperative follow-up. Patients underwent surgery after triage and if they fulfilled guidelines set by the American College of Surgeons and hospital review board, so that hospital resources were not exhausted during an increasing number of COVID cases in our community.

abstract:
  Background: Coronavirus disease (COVID-19) patients are rapidly growing in our community. Patients with compromised lungs and older age are supposedly at high risk of poor outcomes with COVID-19. We aimed to evaluate the COVID-19 impact on lung surgery during this pandemic at our hospital. Methodology: This is a retrospective study of all lung surgery patients at our hospital in Boca Raton over three months (February to April 2020). All patients who remained for at least one-day inpatient post-lung surgery were assessed to see if they had an increased incidence of coronavirus infection during the hospital stay or at the follow-up office visit. Results: A total of 44 patients underwent thoracic surgery. It was found that there was no incidence of coronavirus infection in these patients. Conclusion: With adequate precautions, older patients can undergo lung surgery during this pandemic. There was no incidence of COVID-19 found among the patients during the hospital stay or at the first follow-up in the office. Also, the postoperative course was not adversely affected.


id: cord-265197-kxfj3ziu
title: Cognitive Bias in the COVID-19 Pandemic
author: DiMaria, Christina N
date: 2020-07-06
txt: ./txt/cord-265197-kxfj3ziu.txt
cache: ./cache/cord-265197-kxfj3ziu.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.9019
doi: 10.7759/cureus.9019
summary:
  In the pandemic of corona virus disease-19 (COVID-19), recognizing and creating strategies to minimize these biases is crucial to optimize medical care for our patients. We describe a case of a 68-year-old male with decreased appetite, subjective fears, dry cough, and confusion presenting during the corona virus disease-19 (COVID-19) pandemic. This case brings into question how we approach medical decision making during the COVID-19 pandemic. On review of the case, the presenting symptoms were vague, yet we focused on dry cough and fever to lead us to a diagnosis of COVID-19. Recognition and strategies to prevent cognitive biases, especially during a pandemic, are crucial to optimize medical care for our patients. Although cognitive biases are known contributors to cognitive errors, we still are not sure of all the ways they play into medical decision making during this COVID-19 pandemic.

abstract:
  Cognitive bias plays a significant role in medical errors. In the pandemic of corona virus disease-19 (COVID-19), recognizing and creating strategies to minimize these biases is crucial to optimize medical care for our patients. In this article we present a case of a 68-year-old male with decreased appetite, subjective fears, dry cough, and confusion. The report illustrates the concept of cognitive bias during a pandemic and discusses strategies to ameliorate them.


id: cord-266466-5sgfx7oq
title: First Case of an Infant with COVID-19 in the Middle East
author: Mansour, Amani
date: 2020-04-03
txt: ./txt/cord-266466-5sgfx7oq.txt
cache: ./cache/cord-266466-5sgfx7oq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32377468/
doi: 10.7759/cureus.7520
summary:
  Here, we report the case of a 16-month-old female infant from Lebanon who presented with fever and severe diarrhea and tested positive for COVID-19. Her RT-PCR test was negative after five days of treatment, suggesting that children can clear the virus faster than adults. Most severe illness occurs in older adults but comparison with the pediatric population can be challenging as documented cases in infants and children have been scarce [3, 4] . On day 5, the RT-PCR test of the infant was negative, and the patient''s symptoms had resolved. Uniquely, our patient presented with fever and diarrhea; cough and other respiratory symptoms were not reported. Similarly, previous research in children indicates that the RT-PCR test becomes negative within 12 days (range: 6-22) after the presentation of symptoms [6] . This is the first case reported from the Middle East on an infant presenting with fever and diarrhea that tested positive for COVID-19.

abstract:
  The novel coronavirus (COVID-19) has been declared a worldwide pandemic. It was initially thought to spare children and adolescents as significantly smaller number of cases have been reported in the pediatric population in comparison to adults. Here, we report the case of a 16-month-old female infant from Lebanon who presented with fever and severe diarrhea and tested positive for COVID-19. Her symptoms started six days prior to presentation with no cough, rhinorrhea, or other respiratory manifestations reported. Chest radiography showed lobar consolidation and bronchial infiltrates. Blood culture was positive for Streptococcus pneumoniae. Stool and urine cultures were negative. She was treated with ceftriaxone and metronidazole. Her RT-PCR test was negative after five days of treatment, suggesting that children can clear the virus faster than adults. The patient likely contracted the virus from her parents, who because of the fear of social stigma hide recent history of respiratory illness. These findings serve as a practical reference for the clinical diagnosis and medical treatment of children with COVID-19.


id: cord-266478-642m488a
author: Gino, Bruno
date: 2020-07-11
txt: ./txt/cord-266478-642m488a.txt
cache: ./cache/cord-266478-642m488a.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32789074/
doi: 10.7759/cureus.9134
summary:
  title: Automated Inflating Resuscitator (AIR): Design and Development of a 3D-Printed Ventilator Prototype and Corresponding Simulation Scenario Based on the Management of a Critical COVID-19 Patient The aim of this technical report is twofold: first, to describe the design and manufacturing process of the automated inflating resuscitator (AIR), a 3D-printed ventilator training device which operates on the principle of pushing a bag valve mask; second, to present a simulation scenario that can be used for training health professionals how to use this and similar, low-cost, 3D-printed ventilators in the context of ventilator shortages caused by COVID-19. In addition to the description of the ventilator, we also present a simulation case using AIR to train safety, operational ability, crisis resource management, and communication skills. If there is a limited supply of participants, the paramedics team can only be reported by the facilitators, as the main objective of this simulation is training with the use of AIR and care involving a patient with COVID-19.

title:
  Automated Inflating Resuscitator (AIR): Design and Development of a 3D-Printed Ventilator Prototype and Corresponding Simulation Scenario Based on the Management of a Critical COVID-19 Patient

abstract:
  Recent surges in COVID-19 cases have generated an urgent global demand for ventilators. This demand has led to the development of numerous low-cost ventilation devices, but there has been less emphasis on training health professionals to use these new devices safely. The aim of this technical report is twofold: first, to describe the design and manufacturing process of the automated inflating resuscitator (AIR), a 3D-printed ventilator training device which operates on the principle of pushing a bag valve mask; second, to present a simulation scenario that can be used for training health professionals how to use this and similar, low-cost, 3D-printed ventilators in the context of ventilator shortages caused by COVID-19. To this end, the AIR was designed in an expedient manner in accordance with basic functionality established by the Medicines and Healthcare Products Regulatory Agency (United Kingdom) for provisional clinical use in light of COVID-19.


id: cord-266916-flskltdf
title: Paying in Blood: A Case of Thrombocytopenia in Covid-19
author: Malik, Jahanzeb
date: 2020-08-16
txt: ./txt/cord-266916-flskltdf.txt
cache: ./cache/cord-266916-flskltdf.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32953307/
doi: 10.7759/cureus.9791
summary:
  Infection with COVID-19 typically presents with fever and upper respiratory symptoms like cough and dyspnea. A small proportion of mildly symptomatic patients present with atypical symptoms like diarrhea, thrombocytopenia, or bleeding tendencies [4] . We present a case of COVID-19, diagnosed with an isolated thrombocytopenia. Such studies state that decreasing trend of platelets confer a grave prognosis of COVID-19 infection and lead to a severe disease [8] . There is only one case report published recently on idiopathic COVID-19 associated thrombocytopenia [11] . Our patient was also mildly symptomatic and after ruling out all major causes of decreased platelets, it was postulated to be associated with the virus. Mechanism of thrombocytopenia in COVID-19 patients Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis Thrombocytopenia is independently associated with poor outcome in patients hospitalized for COVID-19 Isolated severe thrombocytopenia in a patient with COVID-19: a case report

abstract:
  Novel coronavirus disease 2019 (COVID-19) primarily involves the respiratory system. Consumptive coagulopathy is seen in acute respiratory distress syndrome (ARDS) and multi-organ failure (MOF). Usually, only severely sick patients develop mild thrombocytopenia. We present a case of mildly symptomatic young adult, presenting with severe thrombocytopenia. She responded well to corticosteroids.


id: cord-267006-gsevwptc
title: Improving CT-Derived Fractional Flow Reserve Analysis: A Quality Improvement Initiative
author: Waltz, Jeffrey
date: 2020-10-07
txt: ./txt/cord-267006-gsevwptc.txt
cache: ./cache/cord-267006-gsevwptc.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10835
doi: 10.7759/cureus.10835
summary:
  Objectives The aim of this study was to identify factors and quality improvement strategies to improve coronary computed tomography angiography (CCTA) studies referred for fractional flow reserve derived from CT angiography (FFRCT) analysis. To evaluate potential issues, a question and answer session with a brief didactic lecture was given by an expert cardiovascular radiologist to the CT technologists and the nursing staff, including an overview of coronary artery imaging and the purpose of performing CCTA and FFRCT at our institution. To evaluate the effect of pre-scan medication use on overall CCTA image quality at our institution, the radiology nurses were instructed to give every patient nitroglycerine and a beta-blocker, if required and not contraindicated, to achieve a heart rate of <70 and preferably <60. A second random sample of 30 CCTA cases performed during the month of November 2019 was reviewed by the same expert cardiovascular radiologist to assess for early post-intervention changes following the initial medication changes to confirm that improvement could be seen in the visual quality score.

abstract:
  Objectives The aim of this study was to identify factors and quality improvement strategies to improve coronary computed tomography angiography (CCTA) studies referred for fractional flow reserve derived from CT angiography (FFRCT) analysis. Methods Thirty randomly selected CCTAs were analyzed for quality control. A uniform CCTA protocol was implemented by an in-house steering committee, emphasizing the importance of adequate heart rate control and nitroglycerine usage. Sixty additional randomly selected CCTAs were evaluated for quality at multiple time points during intervention, and FFRCT acceptance rate was analyzed at the conclusion. Results Prior to the implementation of this quality improvement program, our overall institution-specific percent acceptance rate was 76.1% for FFRCT compared to the national average of >95%. Post-intervention, this was improved to an average acceptance rate of 90% for FFRCT analysis. Conclusions Establishment and strict adherence to CCTA imaging protocols with appropriate training and adequate buy-in of CT technologists and nurses is a viable way of improving the quality of imaging and subsequent patient care.


id: cord-267300-zbipv9er
title: A Hemodialysis Patient with Severe COVID-19 Pneumonia
author: Alalwan, Adel A
date: 2020-05-06
txt: ./txt/cord-267300-zbipv9er.txt
cache: ./cache/cord-267300-zbipv9er.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32391234/
doi: 10.7759/cureus.7995
summary:
  Even though end-stage renal disease (ESRD) patients are particularly susceptible to COVID-19 infection and can develop severe to critical disease, there are limited studies and case reports about COVID-19 in ESRD patients. Even though ESRD patients are particularly susceptible to COVID-19 infection and can develop severe to critical disease, there are limited studies and case reports about COVID-19 in ESRD patients. We report a case of an ESRD patient on regular hemodialysis with severe COVID-19 pneumonia. This report describes the clinical presentation of this disease in a hemodialysis patient, the diagnostic process, the laboratory and imaging investigations, as well as the course of treatment. reported five cases of COVID-19 disease in hemodialysis patients in Zhongnan Hospital of Wuhan University. Lopinavir-ritonavir and Ribavirin have been used successfully as monotherapies in the treatment of mild COVID-19 pneumonia in hemodialysis patients [8, 10] . COVID-19 in hemodialysis patients: a report of 5 cases

abstract:
  Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a novel coronavirus that has spread rapidly, resulting in a worldwide pandemic. Even though end-stage renal disease (ESRD) patients are particularly susceptible to COVID-19 infection and can develop severe to critical disease, there are limited studies and case reports about COVID-19 in ESRD patients. We report a case of a 63-year-old gentleman with ESRD on regular hemodialysis. We describe the clinical presentation of this patient, the diagnostic process, the laboratory and imaging investigations, as well as the course of treatment. He positively responded to a 14-day course of Lopinavir-Ritonavir, Ribavirin, Azithromycin, and Hydroxychloroquine.


id: cord-268085-vpzrk8u7
title: Gastrointestinal Manifestations in COVID-19 Infection and Its Practical Applications
author: Mandal, Amrendra
date: 2020-06-21
txt: ./txt/cord-268085-vpzrk8u7.txt
cache: ./cache/cord-268085-vpzrk8u7.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32714688/
doi: 10.7759/cureus.8750
summary:
  This outbreak is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is also commonly known as COVID-19. We reviewed the mechanisms, clinical manifestation, impact on pre-existing liver diseases, and recommendations endorsed by the several GI societies for the management and prevention of its transmission. This article aims to review the mechanisms, clinical manifestation, impact on pre-existing digestive diseases, and recommendations endorsed by the several GI societies for the management and prevention of its transmission. Clinical characteristics of hospitalized patients with SARS-CoV-2 and hepatitis B virus co-infection Exploring the mechanism of liver enzyme Abnormalities in patients with novel coronavirus-infected pneumonia Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.

abstract:
  The latest novel coronavirus (COVID-19) outbreak, which emerged in December 2019 in Wuhan, Hubei, China, is a significant cause of the pandemic. This outbreak is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is also commonly known as COVID-19. A typical symptom includes cough and fever, but a considerable number of patients can manifest gastrointestinal (GI) symptoms, including diarrhea, which can be the initial presentations and may or may not present with respiratory symptoms or fever. COVID-19 virus may be present in stool samples of patients infected with COVID-19, and angiotensin-converting enzyme 2 (ACE2) is a receptor for this virus, which is substantially present in GI epithelial cells. The wide availability of this receptor facilitates COVID-19 infection to be proactive and multiply in the GI tract. Although no antiviral treatments have been approved, several approaches have been proposed, and at present, optimized supportive care remains the mainstay of therapy. Elective endoscopic procedures should be delayed, but the urgent procedures should be performed as indicated. Due to the rapidly evolving data on COVID-19, it is difficult to keep up with the outpouring of information. We reviewed the mechanisms, clinical manifestation, impact on pre-existing liver diseases, and recommendations endorsed by the several GI societies for the management and prevention of its transmission.


id: cord-268760-31i0mpvn
title: Anosmia and Ageusia as the Only Indicators of Coronavirus Disease 2019 (COVID-19)
author: Zhang, Qian
date: 2020-05-01
txt: ./txt/cord-268760-31i0mpvn.txt
cache: ./cache/cord-268760-31i0mpvn.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32494532/
doi: 10.7759/cureus.7918
summary:
  There is currently a lack of published case reports describing COVID-19 patients with the sole symptoms of anosmia and ageusia in the United States of America. This case report details a 60year-old woman with the chief complaint of right-sided headache along with anosmia and ageusia but was eventually found to be SARS-COV-2 positive. The most common COVID-19 symptoms include fever (43.8% on initial presentation and 88.7% during hospitalization), cough (67.8%), nasal congestion (4.8%), nausea or vomiting (5.0%), and diarrhea (3.8%) based on a research study of 1099 patients from China. Our patient had a very low clinical suspicion of COVID-19 infection, as she was afebrile along with no respiratory symptoms despite having anosmia and ageusia in the setting of headache caused by trigeminal neuralgia. Awareness of a possible COVID-19 infection should be raised in patients with the sole presentation of anosmia and ageusia despite the lack of published case reports or research findings on its exact mechanisms of action.

abstract:
  The patient is a 60-year-old woman with a history of vertigo and seasonal allergies who presented to the hospital with the chief complaint of headache. Radiological findings were negative for intracranial abnormalities. The headache was due to trigeminal neuralgia. She had concurrent complaints of anosmia and ageusia without fever, respiratory symptoms, or obvious risk factors. However, it was determined to test the patient for coronavirus disease 2019 (COVID-19) infection despite extremely low clinical suspicion. Unfortunately, she was found to be COVID-19 positive after she was discharged from the hospital while she remained asymptomatic. There is currently a lack of published case reports describing COVID-19 patients with the sole symptoms of anosmia and ageusia in the United States of America.


id: cord-269216-7ejmefxv
author: Zhang, Xiao Chi
date: 2020-08-30
txt: ./txt/cord-269216-7ejmefxv.txt
cache: ./cache/cord-269216-7ejmefxv.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33005544/
doi: 10.7759/cureus.10130
summary:
  As a result, the Council of Residency Directors (CORD) Advising Students Committee in EM (ASC-EM) created a dedicated IMG Advising Team to create a set of evidence-based advising recommendations based on longitudinal data from the National Residency Match Program (NRMP) and information collected from EM program directors and clerkship directors. Investigators from the CORD ASC-EM identified best-practice advising information through the collation of available literature, existing advising resources, members'' opinions, and the National Resident Matching Program (NRMP) data collected from 2009 to 2018, specifically focusing on the admission patterns for IMG applicants in comparison to U.S. senior applicants. Based on CORD survey results and available NRMP data (as of 2018), the CORD ASC-EM created a list of evidence-based recommendations for IMG applicants applying to ACGME EM residency programs to maximize their chance of matching.

title:
  International Medical Graduate Advising Recommendations From the Council of Residency Directors in Emergency Medicine Advising Student Committee

abstract:
  International Medical Graduate (IMG) physicians applying to residency training programs in a country different from where they completed medical school, bring beneficial diversity to a training program, but also face significant challenges matching into an Accreditation Council for Graduate Medical Education (ACGME)-accredited residency program. Despite the growing number of IMG applications in Emergency Medicine (EM), there is a paucity of targeted recommendations for IMG applicants. As a result, the Council of Residency Directors (CORD) Advising Students Committee in EM (ASC-EM) created a dedicated IMG Advising Team to create a set of evidence-based advising recommendations based on longitudinal data from the National Residency Match Program (NRMP) and information collected from EM program directors and clerkship directors. IMG applicants should obtain at least two EM standardized letters of evaluation (SLOEs), review IMG matched percentages for programs-of-interest, analyze their objective scores with the previous matched cohorts, and rank at least 12 programs to maximize their chances of matching into EM.


id: cord-269503-ij4u980v
title: Bradycardia in Patients With COVID-19: A Calm Before the Storm?
author: Amaratunga, Eluwana A
date: 2020-06-13
txt: ./txt/cord-269503-ij4u980v.txt
cache: ./cache/cord-269503-ij4u980v.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32550090/
doi: 10.7759/cureus.8599
summary:
  This is a retrospective case series of four patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, admitted to St. Luke''s University Health Network ICU between 24 March 2020 and 5 April 2020. A study involving 138 patients infected with COVID-19 in Wuhan, China, demonstrated cardiogenic shock, arrhythmia, and acute cardiac injury to be among common complications; 8.7%, 16.7%, 7.2% respectively [1] . Patient demographics, comorbidities, presenting day of illness since symptom onset, admission heart rate, duration of illness at intubation, duration of illness at onset of bradycardia, vital signs [blood pressure, mean arterial pressure (MAP), oxygen saturation, respiratory rate, temperature], laboratory studies (including cTnI, ferritin, C-reactive protein, D-dimer, fibrinogen), as well as medications and dose adjustments were investigated and compared against episodes of bradycardia. As previously described, acute myocardial injury was thought to be the most common cardiac manifestation in COVID-19 patients and potential for developing cardiac arrhythmias has been noted in a few studies.

abstract:
  Cardiac manifestations of coronavirus disease 19 (COVID-19), including arrhythmia, have been described in the literature. However, to our knowledge, association of COVID-19 with bradycardia has not been reported. This case study describes sinus bradycardia as a potential manifestation of COVID-19. This is a retrospective case series of four patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, admitted to St. Luke’s University Health Network ICU between 24 March 2020 and 5 April 2020. Medical records of these patients were reviewed using the EPIC electronic health record system. Demographic, clinical, laboratory, and treatment data were reviewed against periods of bradycardia in each patient. The patient group comprised two males and two females. Two patients had pre-existing cardiovascular (CV) comorbidities but no history of arrythmias. Heart rates ranged between 66 and 88 beats/min on admission. The lowest rates during bradycardia were between 42 and 49 beats/min. The onset of sinus bradycardia in patients 1, 2, and 3 were day nine, 15, and five of illness, respectively. Patient 4 had three episodes of bradycardia, starting on day 10 of illness. Patients’ bradycardia episodes lasted one to 14 days. During bradycardia, maximum body temperatures ranged between 99.9 and 100.2 degree Fahrenheit. Patients 2, 3, and 4 required vasopressors to maintain mean arterial pressure > 65 mmHg during episodes. All four patients were on propofol at some point during bradycardia with patients 1, 2, and 3 also receiving dexmedetomidine. There was no consistent correlation of these medications with bradycardia. Electrocardiogram (ECG) findings included sinus bradycardia. Prolonged QTc interval observed in patient 2 on admission improved during bradycardia. Transient sinus bradycardia is a possible manifestation of COVID-19 and is important for close CV surveillance. Etiology can be multifactorial, but severe hypoxia, inflammatory damage of cardiac pacemaker cells, and exaggerated response to medications are possible triggers. High levels of pro-inflammatory cytokines may act directly on the sinoatrial (SA) node contributing to the development of bradycardia. This may be a warning sign of the onset of a serious cytokine storm. An increased awareness of possible exaggerated bradycardia response is important to consider with the use of empiric medications which have arrhythmogenic effects.


id: cord-270336-x1up9nvp
title: Neurological Complications of Coronavirus Disease (COVID-19): Encephalopathy
author: Filatov, Asia
date: 2020-03-21
txt: ./txt/cord-270336-x1up9nvp.txt
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extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.7352
doi: 10.7759/cureus.7352
summary:
  We report a case of a 74-year-old patient who traveled from Europe to the United States and presented with encephalopathy and COVID-19. Since elderly patients with chronic medical conditions are at an increased risk of altered mental status in the setting of acute infections, patients with COVID-19 infection can also present with acute encephalopathy and changes in their level of consciousness. Here we report a case of a patient who presented with encephalopathy and was found to be infected with COVID-19. Elderly patients with chronic conditions are at an increased risk of altered mental status in the setting of acute infections. Since COVID-19 affects more the elderly and those with preexisting conditions, patients with prior neurological conditions and acute respiratory symptoms are at an increased risk of encephalopathy on initial presentation. Health care providers should be aware that patients with COVID-19 can present with encephalopathy in the acute setting and during hospitalization.

abstract:
  Coronavirus disease 2019 (COVID-19) is a pandemic. Neurological complications of COVID-19 have not been reported. Encephalopathy has not been described as a presenting symptom or complication of COVID-19. We report a case of a 74-year-old patient who traveled from Europe to the United States and presented with encephalopathy and COVID-19.


id: cord-270391-703js942
title: Atypical Presentation of Panhypopituitarism
author: Rai, Harpreet K
date: 2020-07-09
url: https://doi.org/10.7759/cureus.9102
doi: 10.7759/cureus.9102
abstract:
  Hypopituitarism is a rare disorder. Hypopituitarism can present as a deficiency of individual anterior pituitary hormones (e.g., adrenocorticotropic hormone, thyroid-stimulating hormone, luteinizing hormone, follicle-stimulating hormone, prolactin, growth hormone) or posterior pituitary hormones (e.g., oxytocin, vasopressin) or as the deficiency of all these pituitary hormones, also known as panhypopituitarism. Here, we discuss a 59-year-old man who presented with two episodes of unwitnessed syncope after an episode of vomiting. On admission, the patient was hypotensive to 88/54 mmHg, afebrile, and with a leukocyte count of 21.43 K/µL (reference range: 3.80 to 10.50 K/µL). CT scan of the head revealed a hyperdensity in the left intracranial internal carotid artery just proximal to the bifurcation, suggesting an artifact or presence of an embolus. Additional findings included a sellar mass with calcifications and suprasellar extensions. The patient was admitted for further workup of syncope. Other differential diagnoses included sepsis, stroke, cardiac arrhythmias, and pulmonary embolism. Sepsis, stroke, and cardiac workup were negative for significant findings. The patient remained persistently hypotensive despite aggressive intravenous hydration, raising suspicion for an underlying endocrine disorder. MRI of the brain was negative for stroke but again was significant for a sellar mass. Additional workup showed a deficiency of all the anterior pituitary hormones likely secondary to mass effect. The patient was diagnosed with panhypopituitarism due to pituitary macroadenoma.


id: cord-271062-ev2efm10
title: COVID-19 Presenting as Acute Bilateral Submassive Pulmonary Embolism in a Young Healthy Female
author: Fransawy Alkomos, Mina
date: 2020-07-19
txt: ./txt/cord-271062-ev2efm10.txt
cache: ./cache/cord-271062-ev2efm10.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.9266
doi: 10.7759/cureus.9266
summary:
  Similar symptoms, signs, and laboratory abnormalities between coronavirus disease 2019 (COVID-19) and pulmonary embolism (PE) creates a diagnostic challenge to every physician, and emerging data show an association between COVID-19, hypercoagulable state, and venous thromboembolism. Since EKG finding of S(I) Q(III) T(III) pattern and right ventricular strain, and ECHO finding of right ventricular dysfunction are well described in PE but not in COVID-19, these bedside diagnostic tools can help identify COVID-19 patients with underlining PEs. Coronavirus disease 2019 (COVID-19) (caused by the SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2] virus) was first reported in China in December of 2019 [1, 2] . Fever, dry cough, fatigue, shortness of breath, pleuritic chest pain, and elevated D-dimer were some of the commonly reported symptoms in two retrospective studies in China; these data overlap with pulmonary embolism (PE) clinical presentation and laboratory tests [1] [2] [3] .

abstract:
  Similar symptoms, signs, and laboratory abnormalities between coronavirus disease 2019 (COVID-19) and pulmonary embolism (PE) creates a diagnostic challenge to every physician, and emerging data show an association between COVID-19, hypercoagulable state, and venous thromboembolism. We present a rare case of COVID-19 presented as bilateral sub-massive PE. A 28-year-old COVID-19 positive female with no significant past medical history presented with a dry cough and shortness of breath for three days. Initial laboratory test showed elevated D-dimer, electrocardiogram (EKG) showed right axis deviation, right ventricular strain pattern, and S(I) Q(III) T(III) pattern, and echocardiogram (ECHO) showed right ventricular dysfunction. Those two bedside tests directed the urgency of chest CT angiography that showed bilateral sub-massive PE. Since EKG finding of S(I) Q(III) T(III) pattern and right ventricular strain, and ECHO finding of right ventricular dysfunction are well described in PE but not in COVID-19, these bedside diagnostic tools can help identify COVID-19 patients with underlining PEs.


id: cord-271308-nypkr537
author: Drexler, Richard
date: 2020-08-30
txt: ./txt/cord-271308-nypkr537.txt
cache: ./cache/cord-271308-nypkr537.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10147
doi: 10.7759/cureus.10147
summary:
  Background: The coronavirus disease 2019 (COVID-19) pandemic affects the education of medical students around the world and countries have had differing responses in dealing with this dynamic situation. Final year students had already been working in hospitals since before the outbreak, with 35.0% of them assisting doctors in the treatment of COVID-19 positive patients during their placements. The final year students were asked about the changing workload since the beginning of the COVID-19 pandemic, contact to COVID-19 positive patients, possible infection, and the impact on future residencies. To evaluate the usefulness and gratitude of the voluntary work during COVID-19 pandemic, the 17 volunteering students were confronted with several statements that were answered using a 5-Point Likert Scale (Figure 1) . In addition, volunteers'' work was appreciated and valued more by the medical staff in comparison to final year students conducting their clinical placements (p<0.01).

title:
  Involvement of Medical Students During the Coronavirus Disease 2019 Pandemic: A Cross-Sectional Survey Study

abstract:
  Background: The coronavirus disease 2019 (COVID-19) pandemic affects the education of medical students around the world and countries have had differing responses in dealing with this dynamic situation. The role of medical students in fighting this pandemic is controversial and it is yet to be elucidated how they can best be of service. The aim of this study is to evaluate the working fields of volunteering students and the impact of the pandemic on final year students from a student's perspective. Methods: An anonymous online survey was conducted amongst 219 medical students from Hamburg (Germany), using an institutional online data collection program. Results: A total of 137 questionnaires (63.5%) were completed. Of these, 97 participants were students from academic year three to five (70.8%) and 40 students were in the final year of medical school (29.2%). Of the 97 students from academic year three to five, 68 students (70.1%) signed up for voluntary duties during the pandemic. Interestingly, only 25.0% of the students were called for voluntary work in hospitals or health authorities. Final year students had already been working in hospitals since before the outbreak, with 35.0% of them assisting doctors in the treatment of COVID-19 positive patients during their placements. Using a 5-Point Likert Scale, the students who volunteered self-assessed their work as more useful and received more gratitude than final year students (p<0.01). Conclusions: The majority of medical students are willing to make a significant contribution in the response to COVID-19 and do not wish to be overlooked. Furthermore, the current pandemic offers novel educational opportunities for medical students.


id: cord-271404-tu8u1b1d
title: COVID-19 in Smokeless Tobacco Habitués: Increased Susceptibility and Transmission
author: Gaunkar, Ridhima B
date: 2020-06-25
txt: ./txt/cord-271404-tu8u1b1d.txt
cache: ./cache/cord-271404-tu8u1b1d.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8824
doi: 10.7759/cureus.8824
summary:
  Smokeless tobacco (SLT) consumption is of particular concern in countries in South Asia with high population densities, as it facilitates exposure to SARS-CoV-2 within or between communities by the act of public spitting. SLT-induced higher expression of angiotensin-converting enzyme 2 receptors along with the presence of furin in the oral mucosa and dysfunctional immune responses among SLT habitués increase viral dissemination and an individual''s susceptibility to COVID-19. There has not been much research on the increased risk of contracting COVID-19 for smokeless tobacco (SLT) users, although the use of these products is widely prevalent in South Asia and the Western Pacific region. The known action of the enzyme furin and the nicotine-induced increased expression of the ACE2 receptor result in COVID-19 viral tropism to the oral mucosal tissues in smokeless tobacco habitués [11] [12] [13] [14] [15] [16] [17] [18] [19] .

abstract:
  As the coronavirus disease (COVID-19) pandemic continues to sweep across the globe, the world is responding by implementing public awareness campaigns, social distancing measures, and other preventive strategies to arrest the spread of this lethal disease. Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exacts a heavy toll on patients with existing comorbidities. Smokeless tobacco (SLT) consumption is of particular concern in countries in South Asia with high population densities, as it facilitates exposure to SARS-CoV-2 within or between communities by the act of public spitting. Salivary droplets generated in this act are a potential threat because they can transmit this airborne infection. Moreover, large gatherings at tobacco retail outlets, frequent hand-to-mouth contact, and sharing of apparatus by SLT habitués could also aid in increasing the spread of SARS-CoV-2. SLT-induced higher expression of angiotensin-converting enzyme 2 receptors along with the presence of furin in the oral mucosa and dysfunctional immune responses among SLT habitués increase viral dissemination and an individual’s susceptibility to COVID-19. Issuing rigorous regulations to restrict the use of various forms of SLT products and the obnoxious act of spitting in public can assist in arresting the spread of COVID-19. Widespread education campaigns enlightening the community regarding the adverse effects of SLT consumption and its relationship with COVID-19, along with providing effective assistance to quit for those who are addicted, would decrease the spread of COVID-19.


id: cord-272300-ck301hcu
title: A Bibliometric Analysis of COVID-19 Research Activity: A Call for Increased Output
author: Chahrour, Mohamad
date: 2020-03-21
txt: ./txt/cord-272300-ck301hcu.txt
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extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.7357
doi: 10.7759/cureus.7357
summary:
  Background: The novel coronavirus disease 2019 (COVID-19) has impacted many countries across all inhabited continents, and is now considered a global pandemic, due to its high rate of infectivity. Methods: We explored the PubMed database and the World Health Organization (WHO) database for publications pertaining to COVID-19 since December 2019 up until March 18, 2020. Observational studies and therapeutic trials pertaining to COVID-19 are essential for assessing pathogenic characteristics and developing novel treatment options. Reports from countries with big numbers of confirmed cases would delineate risk factors, clinical features as well as treatment strategies for patients with COVID-19 [12] . The publication type was identified and only original articles and case reports were included in our study. This information begins with early-outbreak case reports and observational studies, where the basic characteristics of the novel disease are documented, and hence, awareness can be raised [23] .

abstract:
  Background: The novel coronavirus disease 2019 (COVID-19) has impacted many countries across all inhabited continents, and is now considered a global pandemic, due to its high rate of infectivity. Research related to this disease is pivotal for assessing pathogenic characteristics and formulating therapeutic strategies. The aim of this paper is to explore the activity and trends of COVID-19 research since its outbreak in December 2019. Methods: We explored the PubMed database and the World Health Organization (WHO) database for publications pertaining to COVID-19 since December 2019 up until March 18, 2020. Only relevant observational and interventional studies were included in our study. Data on COVID-19 incidence were extracted from the WHO situation reports. Research output was assessed with respect to gross domestic product (GDP) and population of each country. Results: Only 564 publications met our inclusion criteria. These articles came from 39 different countries, constituting 24% of all affected countries. China produced the greatest number of publications with 377 publications (67%). With respect to continental research activity, Asian countries had the highest research activity with 434 original publications (77%). In terms of publications per million persons (PPMPs), Singapore had the highest number of publications with 1.069 PPMPs. In terms of publications per billion-dollar GDP, Mauritius ranked first with 0.075. Conclusion: COVID-19 is a major disease that has impacted international public health on a global level. Observational studies and therapeutic trials pertaining to COVID-19 are essential for assessing pathogenic characteristics and developing novel treatment options.


id: cord-273044-ikk9d6wz
author: Knio, Ziyad O
date: 2020-05-16
txt: ./txt/cord-273044-ikk9d6wz.txt
cache: ./cache/cord-273044-ikk9d6wz.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32550078/
doi: 10.7759/cureus.8162
summary:
  title: Heated Air Delivery by Micro-Sauna: An Experimental Treatment Prototype Concept for Coronavirus Disease 2019 The present report describes the engineering of a micro-sauna prototype for the delivery of heated air. The present report describes the engineering of a micro-sauna prototype for the 1 2 1 delivery of heated air in a safe and tolerable manner. The present report demonstrates the feasibility of engineering a micro-sauna prototype for heated air delivery. The micro-sauna prototype, with its delivery of air heated to 80-90 degrees C, is more likely to be successful. Heated air delivery by a micro-sauna treatment prototype may prove beneficial in treating viral pathogens. A micro-sauna delivering air heated to 80-90 degrees C can be feasibly engineered from an electric heater, EMT conduit connector, anesthesia mask, and PID controller with thermocouple.

title:
  Heated Air Delivery by Micro-Sauna: An Experimental Treatment Prototype Concept for Coronavirus Disease 2019

abstract:
  Coronavirus disease 2019 (COVID-19) has gained international attention as it poses a significant threat to global health. Currently, medical researchers are working to exhaust all strategies that may prove beneficial in combating this disease. Heat has been shown to destabilize other coronavirus strains in testing environments, and it has been hypothesized that heated air may destabilize viral pathogens in vivo as well. The present report describes the engineering of a micro-sauna prototype for the delivery of heated air. Concept formulation, process highlights, and the final prototype are all discussed. The prototype can deliver air heated to 80-90 degrees Celsius in a safe and tolerable manner. The goal of this technical report is to further encourage the study of heated air as a potential COVID-19 treatment.


id: cord-273614-qmp2tqtb
title: Cardiac Manifestations of Coronavirus Disease 2019 (COVID-19): A Comprehensive Review
author: Tahir, Faryal
date: 2020-05-08
url: https://www.ncbi.nlm.nih.gov/pubmed/32528760/
doi: 10.7759/cureus.8021
abstract:
  Since its origin in China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has become a pandemic and spread to 209 countries. As coronavirus disease 2019 (COVID-19) is a very rapidly emerging disease, organ-specific studies related to it have been reported. Apart from respiratory findings, some studies have highlighted inflammatory consequences in the heart, kidney, and/or liver as well. Cardiac involvement in COVID-19 seems to be a result of an inflammatory storm in response to the infection. Moreover, direct viral invasion of cardiomyocytes, as well as a myocardial injury due to oxidative stress, may account for acute cardiac injury in COVID-19. Nevertheless, the mechanism of heart injury in COVID-19 is not clear yet. However, multiple studies that highlight the clinical features, laboratory findings, and prognosis of acute myocardial injury (AMI) in COVID-19-affected individuals have been published. In this review, we have summarized the findings of all those studies as well as the clinical features and management of cardiac injury discussed by some case reports.


id: cord-273741-ipnt6g0i
title: Fluid Replacement Versus Fluid Restriction in COVID-19 Associated Hyponatremia
author: Khan, Adeel A
date: 2020-07-08
txt: ./txt/cord-273741-ipnt6g0i.txt
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extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32782878/
doi: 10.7759/cureus.9059
summary:
  Literature describes syndrome of inappropriate anti diuretic hormone (SIADH) as the mechanism of hyponatremia in COVID-19 requiring fluid restriction for management. We present a case of hypovolemic hyponatremia in a patient with COVID-19, which unlike SIADH, required fluid replacement early in the disease course for its correction. Hypovolemic hyponatremia should be distinguished from SIADH as these conditions employ different management strategies, and early diagnosis and management of hypovolemic hyponatremia affects morbidity and mortality. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been recently reported to manifest as hyponatremia secondary to syndrome of inappropriate anti diuretic hormone (SIADH ) [2] [3] [4] [5] [6] . With the prevalence of gastrointestinal (GI) symptoms in coronavirus disease 2019 (COVID-19), there is a possibility of hypovolemic hyponatremia secondary to GI loss [7] . An early clinical judgement should consider the volume status of the COVID-19 patients with hyponatremia to decide between fluid restriction and isotonic fluid replacement.

abstract:
  Hyponatremia is one of the most frequently observed electrolyte abnormalities in coronavirus disease 2019 (COVID-19). Literature describes syndrome of inappropriate anti diuretic hormone (SIADH) as the mechanism of hyponatremia in COVID-19 requiring fluid restriction for management. However, it is important to rule out other etiologies of hyponatremia in such cases keeping in mind the effect of an alternate etiology on patient management and outcome. We present a case of hypovolemic hyponatremia in a patient with COVID-19, which unlike SIADH, required fluid replacement early in the disease course for its correction. A 52-year-old Filipino gentleman presented with a three-week history of diarrhea and symptomatic hyponatremia. There was no history of fever or respiratory symptoms. Physical examination revealed a dehydrated and confused middle-aged gentleman. Labs revealed lymphopenia, thrombocytopenia, and severe hyponatremia (108 mmol/L). Blood cultures and stool workup were negative. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nasopharyngeal swab was positive. Hyponatremia workup excluded SIADH. The patient had hypovolemic hyponatremia due to gastrointestinal (GI) losses and was managed with saline infusion for correction of hyponatremia with improvement in his clinical status. Hyponatremia in COVID-19 is not only secondary to SIADH but can also be due to other etiologies. Hypovolemic hyponatremia should be distinguished from SIADH as these conditions employ different management strategies, and early diagnosis and management of hypovolemic hyponatremia affects morbidity and mortality.


id: cord-274182-7z2tb0ll
author: Veerabathini, Bala C
date: 2020-08-31
txt: ./txt/cord-274182-7z2tb0ll.txt
cache: ./cache/cord-274182-7z2tb0ll.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10154
doi: 10.7759/cureus.10154
summary:
  title: An Unusual Case of Moraxella osleonsis Bacteremia in an Immunocompetent Patient With SARS-CoV-2 Infection We report a case of an immunocompetent 59-year-old male with a recent SARS-CoV-2 infection that developed M.osleonsis bacteremia. While the specific mechanisms are not fully understood, it is becoming more evident that a SARS-CoV-2 infection may be making humans more susceptible to various systemic diseases, including the possibility of causing rare bacteremia. CD4+ and CD8+ T cell functional exhaustion may explain the reason why the patient in that case report presented with recurrent bacteremia and multi-organ infection. According to current literature, the level of peripheral Tregs is significantly reduced in severely affected COVID-19 patients compared to mild disease. Based on the currently published data, this is the first reported case of M.osleonsis bacteremia in a COVID-19 positive patient. This raises the question of whether the presence of a recent SARS-CoV-2 infection (or the presence of current COVID-19 antigen positivity) creates an immunocompromised state that predisposes patients to bacteremia.

title:
  An Unusual Case of Moraxella osleonsis Bacteremia in an Immunocompetent Patient With SARS-CoV-2 Infection

abstract:
  Moraxella osleonsis (M.osleonsis ) is an organism that rarely presents with bacteremia in immunocompetent patients. We report a case of an immunocompetent 59-year-old male with a recent SARS-CoV-2 infection that developed M.osleonsis bacteremia. We believe that SARS-CoV-2 infection may have played a role in developing M.osleonsis bacteremia in this patient and may be one of the first reported cases of such bacteremia in a COVID-19 patient.


id: cord-274632-d9z0m2l8
title: Coronavirus Disease 2019 (COVID-19) in a Renal Transplant Patient
author: Chenna, Avantika
date: 2020-05-09
txt: ./txt/cord-274632-d9z0m2l8.txt
cache: ./cache/cord-274632-d9z0m2l8.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32528774/
doi: 10.7759/cureus.8038
summary:
  Transplant patients are particularly at a higher risk of contracting COVID-19 because of their immunosuppressed state, and they have the propensity to develop opportunistic infections [1] . Transplant patients are particularly at a higher risk of contracting COVID-19 because of their immunosuppressed state, and they have the propensity to develop opportunistic infections [1] . Here, we describe a case of a renal transplant patient who developed COVID-19 and, unfortunately, died from the infection despite all medical management. The illness from COVID-19 in renal transplant recipients ranged from mild to severe, and few patients presented with atypical symptoms [1, 3] . Transplant patients constitute a population more vulnerable to develop COVID-19 because of their immunosuppressed state and higher risk for opportunistic infections. Case report of COVID-19 in a kidney transplant recipient: does immunosuppression alter the clinical presentation? Threatening drug-drug interaction in a kidney transplant patient with coronavirus disease 2019 (COVID-19)

abstract:
  Coronavirus disease 2019 (COVID-19) has resulted in significant morbidity and mortality worldwide. Transplant patients are particularly at a higher risk of contracting COVID-19 because of their immunosuppressed state, and they have the propensity to develop opportunistic infections. The pre-immunosuppressed state, along with other existing comorbidities, can influence the outcomes of COVID-19 in transplant patients. We describe a case of a renal transplant patient who developed COVID-19. Real-time nucleic acid testing (NAT) should be done in deceased and living donors. The most common management strategy is the modification of immunosuppression along with current experimental strategies for COVID-19.


id: cord-276150-hp174yft
title: COVID-19 Containment Efforts of a Low-Resource Nation: The First Four Months in Nepal
author: Basnet, Sangita
date: 2020-07-01
txt: ./txt/cord-276150-hp174yft.txt
cache: ./cache/cord-276150-hp174yft.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8946
doi: 10.7759/cureus.8946
summary:
  In our review, we determined that the key steps taken by Nepal included border control to prevent the importation of cases, strict quarantine in facilities for anyone entering the country, early case detection, and isolation of all infected cases irrespective of symptoms. Towards the end of March, there were five cases that had arrived from China, Europe, and Dubai that tested positive and were placed in isolation in COVID-19-designated hospitals in Kathmandu. On May 7, in order to increase the rate of testing in the limited number of facilities, PCR of pooled samples of individuals in quarantine and low risk for COVID-19 was started at a ratio of 1:5. After the initial cases introduced into Kathmandu by flight in early March as detailed above, there was a cohort of a few dozen Indian nationals adjacent to the border entering Nepal from India by land that tested positive.

abstract:
  A novel coronavirus (severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2) was identified in hospitalized patients in Wuhan, China, in December 2019. It rapidly spread across the globe within the span of a few months. Nepal is a low-resource country with limited critical care delivery infrastructure. Coronavirus 2019 (COVID-19), the disease caused by the virus, could potentially cause a medical catastrophe in Nepal. We reviewed all pertinent documents published in the public domain by the Ministry of Health and Population of Nepal and other relevant literature. We aimed to describe the key strategies Nepal embraced in the first four months in its attempt to curtail the disease immediately following the identification of its first case and the challenges it faced. In our review, we determined that the key steps taken by Nepal included border control to prevent the importation of cases, strict quarantine in facilities for anyone entering the country, early case detection, and isolation of all infected cases irrespective of symptoms. Testing capabilities, quarantine facilities, and isolation beds were also rapidly increased. We discuss how Nepal achieved some success in the first four months between January 13, 2020, when the first case was identified, to May 13, 2020. However, it faced several challenges that ultimately led to an exponential rise in cases thereafter.


id: cord-278106-ev1nx60h
title: Coronavirus Disease 2019 (COVID-19) in Cancer Patients
author: Cancarevic, Ivan
date: 2020-04-26
txt: ./txt/cord-278106-ev1nx60h.txt
cache: ./cache/cord-278106-ev1nx60h.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.7835
doi: 10.7759/cureus.7835
summary:
  The Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become the most talked-about clinical entity in early 2020. Management presents its own set of challenges, including but not limited to, deciding whether postponing cancer treatment until the infection resolves is going to benefit the patient and how to organize all aspects of patient care when social contact is as limited as it is for patients newly diagnosed with COVID-19. found that the prevalence of cancer among patients infected with SARS-CoV-2 (COVID-19) was higher than in the general population [12] . We would strongly encourage clinicians to keep reporting any cases of cancer patients infected with SARS-CoV-2, their management, and the outcome in order to further our understanding of this complex issue. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges The treatment and outcome of a lung cancer patient infected with SARS-CoV-2

abstract:
  The Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become the most talked-about clinical entity in early 2020. As an infection that spreads easily and has a significant mortality rate, it has caused global panic rarely seen before. Many of the measures taken by governments worldwide will have long-lasting impacts on the wellbeing of the population at large. It has been widely reported that the most vulnerable patients have been most negatively affected by SARS-CoV-2 (COVID-19). In this study, we have tried to search the currently available data on the outcomes of infected cancer patients. Most of the data points to the very challenging nature of treating such patients. Their overall outcomes seem to be worse than in the general population, and it may be difficult to differentiate which potential complications are a result of the primary oncologic disease versus the infection. Management presents its own set of challenges, including but not limited to, deciding whether postponing cancer treatment until the infection resolves is going to benefit the patient and how to organize all aspects of patient care when social contact is as limited as it is for patients newly diagnosed with COVID-19. We believe that as more data becomes available, it is going to be necessary to publish detailed guidelines on how to approach this unique clinical challenge.


id: cord-278246-mnj0zmkn
title: A Meta-Analysis on the Effects of Hydroxychloroquine on COVID-19
author: Hussain, Nowair
date: 2020-08-24
txt: ./txt/cord-278246-mnj0zmkn.txt
cache: ./cache/cord-278246-mnj0zmkn.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32983702/
doi: 10.7759/cureus.10005
summary:
  HCQ treated patients had higher rates of adverse clinical outcomes and side effects compared with the control populations. The treatment of COVID-19 positive patients with HCQ has been met with controversy, as there have been no large multicenter randomized control trials to support its use. Studies 1 and 2 both do not cross the effect line at 0, indicating that they are not in agreement with the mortality rate of HCQ treated COVID-19 positive patients. All studies, except Study 6, are in agreement with the results of a disease progression rate of HCQ treatment in patients with COVID [19] . These results seem to be in line with the meta-analysis'' of a slight disease improvement in COVID-19 patients treated with HCQ as compared with the controls. Our study looks at three disease outcome measures of treatment with HCQ in patients with COVID-19: mortality rates, progression rates, and severity rates.

abstract:
  Introduction Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread throughout the world with a large medical and economic impact. On March 12, 2020, the World Health Organization (WHO) classified SARS-CoV-2 as a pandemic. As a result of this worldwide public health crisis, politicians, elected officials, and healthcare professionals emergently began trialing hydroxychloroquine (HCQ) in efforts to treat and prevent the transmission of the virus. This meta-analysis was performed to assess the effects of HCQ on patients with COVID-19. Methods This meta-analysis adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMA) guidelines. Selected articles published between December 2019 and July 2020 were found utilizing the following search engines: PubMed, Google Scholar, Cochrane Library, DisasterLit, Clinicaltrials.gov, Medrxiv, and Embase. Two independent physician reviewers screened eligible articles that met the inclusion and exclusion criteria of the analysis. The outcome measures analyzed were mortality rate, rate of disease progression/improvement, rate of disease severity, and adverse effects of treatment. Six out of 14 studies that met the study’s eligibility criteria were selected and further analyzed, with a total of 381 participants (n= 381). Conclusion From the studies analyzed, it was found that groups treated with HCQ had an overall mortality rate that was 2.5 times greater than that of the control group. HCQ treated patients had higher rates of adverse clinical outcomes and side effects compared with the control populations. Lastly, there was a 1.2 times higher rate of improvement in the group of HCQ treated patients with mild to moderate symptoms as compared to the control group.


id: cord-278722-hox9m5mv
title: Learning Communities Engage Medical Students: A COVID-19 Virtual Conversation Series
author: Anderi, Emilyn
date: 2020-08-06
txt: ./txt/cord-278722-hox9m5mv.txt
cache: ./cache/cord-278722-hox9m5mv.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32923199/
doi: 10.7759/cureus.9593
summary:
  Conclusion The Virtual Conversation series emphasizing different medical aspects of COVID-19 provided a unique benefit to medical students'' understanding of the current landscape of healthcare, the anticipation of their future roles as physicians, connectedness with their community, and opportunity to practice flexibility as they begin to apply online learning with real-world situations in the health system. The Virtual Conversation series emphasizing different medical aspects of COVID-19 provided a unique benefit to medical students'' understanding of the current landscape of healthcare, the anticipation of their future roles as physicians, connectedness with their community, and opportunity to practice flexibility as they begin to apply online learning with real-world situations in the health system. As the COVID-19 pandemic evolved and social distancing measures were put into place, medical students faced numerous obstacles relating to their education such as the inability to gather with peers, lost sense of community, inadequate opportunities to practice crucial clinical skills, uncertainties of their roles in rotations, as well as individually grappling with virtual delivery of rigorous and difficult academic content while in quarantine [2, 3] .

abstract:
  Context Challenges to medical education have been pervasive during the COVID-19 pandemic, and medical students, in particular, have faced numerous obstacles as a result. One of the greatest losses for medical students was the inability to gather with their peers and a lost sense of community. The Learning Community (LC) program at Wayne State University School of Medicine (WSU SoM) expanded our offerings through the use of the Zoom platform to increase a sense of connectedness among medical students. The first initiative of its kind at WSU SoM, the Virtual Conversation series enabled students to share their pandemic challenges while also connecting with physicians on the COVID-19 frontlines. Students were offered eight online sessions with physicians and residents who were able to share insight regarding (1) how to succeed as a medical student on rotation during COVID-19, (2) potential implications of the pandemic on residency applications, (3) the utility of telemedicine, (4) tips for patient encounters, and (5) realities of serving as a physician during a global health crisis. Methods Residents and clinical physicians on the COVID-19 frontlines participated in 40-minute discussions with WSU SoM students through Zoom. Electronic Qualtrics surveys were distributed to medical student attendees of the Virtual Conversation series and responses were received via Likert scale, open text, and ranking questions. Results Qualtrics results demonstrated 55% of medical students (n=55) reported they learned new information about the COVID-19 pandemic from the perspective of physicians. Additionally, 62% of medical students described the Virtual Conversation series as ‘extremely useful’. Conclusion The Virtual Conversation series emphasizing different medical aspects of COVID-19 provided a unique benefit to medical students’ understanding of the current landscape of healthcare, the anticipation of their future roles as physicians, connectedness with their community, and opportunity to practice flexibility as they begin to apply online learning with real-world situations in the health system.


id: cord-279435-ffgd2ets
title: COVID-19: Precautionary Guidelines for Ophthalmologists
author: ALBalawi, Hani B
date: 2020-06-25
txt: ./txt/cord-279435-ffgd2ets.txt
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url: https://doi.org/10.7759/cureus.8815
doi: 10.7759/cureus.8815
summary:
  Healthcare providers, particularly ophthalmologists, are at high risk of a COVID-19 infection through unprotected contact with eye secretions during routine ophthalmic examinations that involve the use of direct ophthalmoscopy and slit-lamp examinations, which are usually performed in a setting that allows for close doctor-patient contact. In fact, ophthalmologists are at high risk of contracting the COVID-19 virus through unprotected eye contact with secretions during routine ophthalmic examinations with direct ophthalmoscopy and slit-lamp examinations, which are usually performed in a setting that has close doctor-patient contact. A three-stage control measure to reduce the transmission of the virus in the ophthalmology department in Hong Kong was based on text messaging to reschedule refill visits [6] ; a triage to identify patients with fever, conjunctivitis, and respiratory symptoms; asking those who recently traveled to areas infected with the virus to postpone their ophthalmology visits for 14 days; and the avoidance of micro-aerosol generating procedures, nasal endoscopy, and operations under general anesthesia.

abstract:
  Several coronaviruses can infect humans, and the globally endemic human coronaviruses, HCoV-229E (human coronavirus 229E), HCoV-NL63 (human coronavirus NL63), and others, tend to cause mild respiratory diseases. The zoonotic Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus type1 (SARS-CoV-1) have high fatality rates. In December 2019, the World Health Organization (WHO) was notified by Chinese authorities about an outbreak of pneumonia before the causative organism was identified in January 2020 as a novel coronavirus family. The WHO refers to the virus as coronavirus disease 2019 (COVID-19). Within several weeks, the outbreak has become an emergency, and many countries have since been affected. The method of transmission is not yet fully known but is thought to be mainly respiratory. Healthcare providers, particularly ophthalmologists, are at high risk of a COVID-19 infection through unprotected contact with eye secretions during routine ophthalmic examinations that involve the use of direct ophthalmoscopy and slit-lamp examinations, which are usually performed in a setting that allows for close doctor-patient contact. In light of these, specific measures are needed from an ophthalmic point of view to control the COVID-19 outbreak and to protect health care providers.


id: cord-279737-b4c3txut
author: Neeki, Michael M
date: 2020-08-16
txt: ./txt/cord-279737-b4c3txut.txt
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extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.9781
doi: 10.7759/cureus.9781
summary:
  SBCYOR is a coalition of professionals in healthcare, behavioral health, public education, law enforcement, emergency medical services (EMS) agencies, and juvenile detention centers throughout San Bernardino County, California. The San Bernardino County Youth Opioid Response (SBCYOR) program was formed to help mitigate the spread of OUD, increase access to MAT and reduce the risk of overdose for the youth populations. Its goal is to integrate the county''s available resources into a continuum of care to enable the youths of the community to grow into productive members of society, free of the burden of opioid use exposure, disorder and associated risks. The X waivered providers received extensive training and education in key aspects of MAT including identification of individuals who may benefit from treatment, safe and appropriate use of Federal Drug Administration-approved medications, strategies for communicating and educating patients and their families, and coordinating care with other community infrastructure.

title:
  San Bernardino County Youth Opioid Response: Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder

abstract:
  Opioid use disorder (OUD) and related overdose deaths have become a crisis of epidemic proportions in the United States. In 2018, over 10 million people age 12 years or older misused opioids.Substance use is also correlated with increased physical and mental health disorders, and developmental challenges among youths. Medication-assisted treatment (MAT) has been reported to reduce mortality, opioid use, and human immunodeficiency virus and hepatitis C virus transmission while increasing treatment retention in adults. The San Bernardino County Youth Opioid Response (SBCYOR) program was formed to explore best practices for youths at risk of opioid use disorders and/or overdose. SBCYOR is a coalition of professionals in healthcare, behavioral health, public education, law enforcement, emergency medical services (EMS) agencies, and juvenile detention centers throughout San Bernardino County, California. SBCYOR focuses on high-risk and addicted individuals between the ages of 12 to 24 years in San Bernardino County’s correctional system. It utilizes a strategy of collaboration, prevention, risk mitigation, medication, psychological treatment, and community outreach. This study aimed to evaluate the implementation and progress of SBCYOR.


id: cord-279846-g0ro8pbb
title: Right Atrial Thrombus in a Patient With COVID-19
author: Terrigno, Vittorio R
date: 2020-07-28
txt: ./txt/cord-279846-g0ro8pbb.txt
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url: https://www.ncbi.nlm.nih.gov/pubmed/32864265/
doi: 10.7759/cureus.9441
summary:
  We highlight the successful use of half-dose anticoagulation in the treatment of right atrial thrombus in a patient with COVID-19. To our knowledge, this is a first reported case of right atrial thrombus in a COVID-19 patient who was treated successfully with half-dose anticoagulation. In another three-center retrospective study of 184 COVID-19 ICU patients from the Netherlands, the authors reported 31% incidence of thrombotic complications. Therefore, the true incidence is likely higher.Our case supports the need to think of initiating therapeutic anticoagulation early in the course of critically ill patients with COVID-19. In addition to this, our case also highlights the use of half-dose anticoagulation therapy to treat a right atrial thrombus. To our knowledge, this is the first reported case of right atrial thrombus in a COVID-19 patient that resolved with a half dose of thrombolytic therapy. We highlight the ability to treat a right atrial thrombus in a patient with COVID-19 with half-dose anticoagulation.

abstract:
  Coronavirus disease 2019 (COVID-19) is a worldwide pandemic. Evidence suggests a strong association between COVID-19 and pro-thrombotic states. We report our experience in managing a patient with COVID-19 complicated by a right atrial thrombus. We highlight the successful use of half-dose anticoagulation in the treatment of right atrial thrombus in a patient with COVID-19. To our knowledge, this is a first reported case of right atrial thrombus in a COVID-19 patient who was treated successfully with half-dose anticoagulation.


id: cord-280050-fktc778q
author: Tahir, Shumaila
date: 2020-06-17
txt: ./txt/cord-280050-fktc778q.txt
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url: https://www.ncbi.nlm.nih.gov/pubmed/32699679/
doi: 10.7759/cureus.8679
summary:
  Methods We retrospectively analyzed data from 412 patients who were residents of East Karachi and tested positive for SARS-CoV-2 between February 26 to April 24, 2020. The primary aim of this retrospective observational study was to report the epidemiological features and statistics of individuals infected with COVID-19 from February 26 to April 24 from East Karachi, Pakistan, and contribute towards an accurate collection of figures from the country. The suspected or confirmed cases were clinically classified as asymptomatic, mild, moderate, severe, and critical, according to the National Institute of Health, Pakistan guidelines and are defined below in Table 1 [9]. Candidates with fever, symptoms of lower respiratory illness, and a travel history to Wuhan, China or other countries with uncontrolled COVID-19 cases or who have been in contact with an individual suspected of COVID-19 or with laboratory-confirmed COVID-19 in the preceding 14 days should be isolated and tested for the infection promptly [19] .

title:
  Epidemiological and Clinical Features of SARS-CoV-2: A Retrospective Study from East Karachi, Pakistan

abstract:
  Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread to almost every country on the globe, and each country is reporting the symptomatic presentation of their patients to give better insight into the various clinical presentations of SARS-CoV-2. However, the epidemiological literature from Pakistan is scanty. Methods We retrospectively analyzed data from 412 patients who were residents of East Karachi and tested positive for SARS-CoV-2 between February 26 to April 24, 2020. Patients' demographics, symptoms, travel and contact history, and outcomes were recorded. All statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 22 (IBM SPSS Statistics for Windows, IBM Corp, Armonk, NY). Results Most of the patients were male (64.6%), the majority (43.3%) belonging to the 21- to 40-year age group. Most of the patients (65.5%) were residents of Gulshan Iqbal. A total of 15.8% of the patients were admitted to the hospital, and 3.9% of patients expired. The three most common presenting symptoms were fever (74.8%), cough (60.4%), and flu (35.5%). The majority of patients (89.3%) gave a history of contact with SARS-CoV-2 patients. Conclusion The number of SARS-CoV-2 cases is rapidly increasing in Karachi, Pakistan. There is a need to educate the population about the most common sign and symptoms of the virus so that individuals can identify these symptoms and get themselves tested. The concerned authorities should devise an adequate and effective plan to flatten the infectivity curve.


id: cord-280835-i28azljq
title: A Case of Adult-Onset Still''s Disease with Positive Antinuclear Antibodies
author: Lakshman, Harini
date: 2020-10-01
txt: ./txt/cord-280835-i28azljq.txt
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url: https://doi.org/10.7759/cureus.10761
doi: 10.7759/cureus.10761
summary:
  We report the case of a 30-year-old female who presented with persistent rash, joint pain, and fever, along with positive antinuclear antibodies (ANA), diagnosed with this condition. We report a case of AOSD diagnosed on the basis of the Yamaguchi criterion and weakly positive antinuclear antibodies (ANA). Meanwhile, suspecting a broad differential of autoimmune etiology, workup was done, including complete blood count, basic metabolic profile, liver function test, urine analysis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ANA, complements, rheumatoid factor, hepatitis panel, human acquired immunodeficiency virus (HIV) rapid antigen test, and blood cultures. With the clinical findings, four major criteria, and one minor Yamaguchi criteria along with the ferritin value, she was diagnosed to have adult-onset Still''s disease and started on high-dose steroids when her rashes and joint pains decreased. Patients with AOSD typically present with fever, rash, arthralgia, fever exceeding 102.2 F, and sore throat, as seen in this case, though sore throat was absent.

abstract:
  Adult-onset Still's disease (AOSD) is a rare inflammatory disorder involving multiple systems. It can present a wide range of symptoms like maculopapular rash, fever, and arthralgia, which may overlap with many other disorders, making it difficult to diagnose. Unknown etiology and no diagnostic tests further make it complex to establish the diagnosis of AOSD. We report the case of a 30-year-old female who presented with persistent rash, joint pain, and fever, along with positive antinuclear antibodies (ANA), diagnosed with this condition. The patient improved with corticosteroids and the plan is to start disease-modifying antirheumatic drugs (DMARDs) after tapering off steroids.


id: cord-280935-ur9x4fsa
title: The Dilemma of Renal Involvement in COVID-19: A Systematic Review
author: Bajwa, Hamza
date: 2020-06-15
url: https://doi.org/10.7759/cureus.8632
doi: 10.7759/cureus.8632
abstract:
  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), now known as coronavirus disease 2019 (COVID-19), has posed a serious threat to global health since December 2019. It has spread worldwide and is consuming healthcare resources rapidly. Published literature suggests that people with advanced age and comorbidities are affected more severely. It is crucial to uncover the underlying pathogenesis of acute kidney insufficiency in COVID-19 patients to understand better the reasoning behind the grave outcomes in these patients. In this review, we have included articles stating the prevalence and specific mortality rates of COVID-19 patients with acute kidney insufficiency. Our study included 1098 COVID-19 positive patients, of whom 66 (6%) developed acute kidney insufficiency and 62 patients died, showing a mortality rate of 94%. Patients with acute kidney insufficiency showed a more severe disease course, and these patients ended up more in intensive care units. Particular attention should be paid to those with already established kidney disease, such as chronic kidney disease, or renal transplant recipients, as these patients are already on immunosuppressive therapy. Our review focuses on the prevalence of acute kidney insufficiency in COVID-19 patients and mortality rates in this subset of patients.


id: cord-285732-xew5ar1e
title: Spontaneous Pneumomediastinum/Pneumothorax in Patients With COVID-19
author: Eperjesiova, Bianka
date: 2020-07-03
txt: ./txt/cord-285732-xew5ar1e.txt
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mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32642391/
doi: 10.7759/cureus.8996
summary:
  No spontaneous air leak case series have been described in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patient population thus far. We described seven spontaneous air leak cases we found in our coronavirus disease 2019 (COVID-19) positive 976-patient cohort. Air leak in hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients has been sparsely published as case reports, however, the presence of non-invasive ventilation and positive airway pressure were reported prior to this finding [3] [4] . Studies of a severe acute respiratory syndrome with SARS did identify air leak as a frequent complication, often with no relation to intubation or positive pressure ventilation [1] [2] [3] [4] [5] . Of these, we found 20 cases of air leak; three traumatic/post-procedure, 10 post-intubation/mechanical ventilation, and seven spontaneous (five cases of pneumomediastinum and two isolated pneumothorax). One out of seven spontaneous air leak patients expired. Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome

abstract:
  No spontaneous air leak case series have been described in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patient population thus far. We described seven spontaneous air leak cases we found in our coronavirus disease 2019 (COVID-19) positive 976-patient cohort. Five out of seven patients eventually required mechanical ventilation, and one of these patients died. All of our patients who demonstrated radiological air leaks after intubation died. No other precipitating factors offered in the literature thus far played a role in our patient population. We presume that acute lung injury leading to SARS-CoV-2 with associated acute respiratory distress syndrome (ARDS) predisposes patients to this rare complication.


id: cord-287544-n32iscmr
author: Solaimanzadeh, Isaac
date: 2020-05-12
txt: ./txt/cord-287544-n32iscmr.txt
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url: https://www.ncbi.nlm.nih.gov/pubmed/32411566/
doi: 10.7759/cureus.8069
summary:
  title: Nifedipine and Amlodipine Are Associated With Improved Mortality and Decreased Risk for Intubation and Mechanical Ventilation in Elderly Patients Hospitalized for COVID-19 A retrospective review was conducted on CCB use in hospitalized patients in search of any difference in outcomes related to specific endpoints: survival to discharge and progression of disease leading to intubation and mechanical ventilation. Nifedipine and amlodipine were found to be associated with significantly improved mortality and a decreased risk for intubation and mechanical ventilation in elderly patients hospitalized with COVID-19. Nifedipine and amlodipine were found to be associated with significantly improved mortality and a decreased risk for intubation and mechanical ventilation in elderly patients hospitalized with COVID-19. A retrospective review of patients on either nifedipine or amlodipine was conducted in search of any difference in outcomes, including survival to discharge and progression of disease leading to intubation and mechanical ventilation.

title:
  Nifedipine and Amlodipine Are Associated With Improved Mortality and Decreased Risk for Intubation and Mechanical Ventilation in Elderly Patients Hospitalized for COVID-19

abstract:
  Dihydropyridine calcium channel blockers (CCB) are typically used agents in the clinical management of hypertension. Yet, they have also been utilized in the treatment of various pulmonary disorders with vasoconstriction. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been implicated in the development of vasoconstrictive, proinflammatory, and pro-oxidative effects. A retrospective review was conducted on CCB use in hospitalized patients in search of any difference in outcomes related to specific endpoints: survival to discharge and progression of disease leading to intubation and mechanical ventilation. The electronic medical records for all patients that tested positive for SARS-CoV-2 that were at or above the age of 65 and that expired or survived to discharge from a community hospital in Brooklyn, NY, between the start of the public health crisis due to the viral disease up until April 13, 2020, were included. Of the 77 patients that were identified, 18 survived until discharge and 59 expired. Seven patients from the expired group were excluded since they died within one day of presentation to the hospital. Five patients were excluded from the expired group since their age was above that of the eldest patient in the survival group (89 years old). With 65 patients left, 24 were found to have been administered either amlodipine or nifedipine (CCB group) and 41 were not (No-CCB group). Patients treated with a CCB were significantly more likely to survive than those not treated with a CCB: 12 (50%) survived and 12 expired in the CCB group vs. six (14.6%) that survived and 35 (85.4%) that expired in the No-CCB treatment group (P<.01; p=0.0036). CCB patients were also significantly less likely to undergo intubation and mechanical ventilation. Only one patient (4.2%) was intubated in the CCB group whereas 16 (39.0%) were intubated in the No-CCB treatment group (P<.01; p=0.0026). Nifedipine and amlodipine were found to be associated with significantly improved mortality and a decreased risk for intubation and mechanical ventilation in elderly patients hospitalized with COVID-19. Further clinical studies are warranted. Including either nifedipine or amlodipine in medication regimens for elderly patients with hypertension hospitalized for COVID-19 may be considered.


id: cord-288166-z4r0vnku
title: Closing the Gap in Global Neurosurgical Education via Online Conference: A Pre-Covid Survey
author: Downes, Simon R
date: 2020-05-07
txt: ./txt/cord-288166-z4r0vnku.txt
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mime: text/plain
url: https://doi.org/10.7759/cureus.8015
doi: 10.7759/cureus.8015
summary:
  As opportunities to participate in online continuing medical education (CME) increase, there is a reduction in the worldwide knowledge gap often due to a lack of resources to attend conferences and advanced training in person. Methods A total of 64 participants completed a 10-item anonymous online questionnaire to assess how their knowledge and applied practical skills improved by participating in online conferences, and whether this education modality adequately addresses challenges for countries with limited access to conferences or training. Item six, ''Virtual neurosurgical education can help to unify international neurosurgical knowledge'', had participants consider whether this form of education can fill the global gap in education, particularly for developing countries where there are limited resources and those who cannot attend conferences in person due to cost or logistics ( Figure 5 ). The questionnaire results indicate that respondents generally had a positive attitude toward online conferences and training and found neurosurgical online education to be useful.

abstract:
  Introduction A reliable network for peer review and feedback can lead to an increase in knowledge and improving patient care. As opportunities to participate in online continuing medical education (CME) increase, there is a reduction in the worldwide knowledge gap often due to a lack of resources to attend conferences and advanced training in person. Methods A total of 64 participants completed a 10-item anonymous online questionnaire to assess how their knowledge and applied practical skills improved by participating in online conferences, and whether this education modality adequately addresses challenges for countries with limited access to conferences or training. Results While an overall positive response toward this mode of neurosurgical education was expected, interesting insights were gained from the short-answer section, demonstrating a direct influence on clinical practice through online conference participation. Conclusion While limited in size, the study results support the expectation of a positive attitude toward neurosurgical e-learning, which translates directly to improving patient care and lessening the worldwide gap in neurosurgical education.


id: cord-289854-p8okfa4b
author: Flores, Gabriel
date: 2020-10-05
txt: ./txt/cord-289854-p8okfa4b.txt
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mime: text/plain
url: https://doi.org/10.7759/cureus.10809
doi: 10.7759/cureus.10809
summary:
  In this report, we outline the clinical presentation of a 40-year-old male who developed severe coughing and sneezing before presenting to the emergency department with confusion, somnolence, and respiratory distress. On hospital day four, his neurological examination deteriorated to quadriparesis and only cough and gag reflexes remaining intact after which his family opted for comfort measures only. Since initial reports in December 2019 from Wuhan, China, the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus two (SARS-CoV-2) has become a global pandemic. Our patient is a 40-year-old male with past medical history of obesity, hypertension, and type two diabetes mellitus who developed severe coughing and sneezing before presenting to the emergency department with confusion, somnolence, and respiratory distress. Severe cough was reported to cause cerebral hemorrhage in patients with whooping cough as early as 1885 [8] . Increased risk of intracerebral hemorrhage adds to the complexity of management of patients with COVID-19.

title:
  Spontaneous Brainstem Hemorrhagic Stroke in the Setting of Novel Coronavirus Disease 2019 – A Case Report

abstract:
  Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has become a global pandemic. This disease has been shown to affect various organ systems, including the cerebrovascular system with sequelae still not completely uncovered. We present an unusual case of extensive brainstem intraparenchymal hemorrhage in a patient with COVID-19 to caution readers of this possible complication in patients positive for COVID-19. In this report, we outline the clinical presentation of a 40-year-old male who developed severe coughing and sneezing before presenting to the emergency department with confusion, somnolence, and respiratory distress. CT head without contrast revealed extensive pontine and midbrain hemorrhage with intraventricular extension and early hydrocephalus. Neurological examination revealed pinpoint, minimally reactive pupils, withdrawal to painful stimuli in the right hemibody, left hemibody paresis, and intact left corneal, cough, and gag reflexes. MRI and MRA brain revealed no evidence of an underlying vascular lesion. Over the next two days, the patient had worsening multiorgan failure and hypoxemia without intracranial hypertension. He remained too unstable to undergo cerebral angiogram. On hospital day four, his neurological examination deteriorated to quadriparesis and only cough and gag reflexes remaining intact after which his family opted for comfort measures only. In summary, a potential increased risk of intracerebral hemorrhage adds to the complexity of management of patients with COVID-19. This is especially true in those who have violent sneezing or coughing, or those who are on anticoagulation or antiplatelet therapy.


id: cord-291430-rsu6xviv
title: A Mysterious Paratracheal Mass: Parathyroid Carcinoma
author: Zhang, Qian
date: 2020-07-11
txt: ./txt/cord-291430-rsu6xviv.txt
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extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.9126
doi: 10.7759/cureus.9126
summary:
  He was subsequently found to have parathyroid carcinoma as the cause of the acute encephalopathy with impressive serum calcium and parathyroid hormone levels. According to a systemic review conducted from 1995-2003 by Ruda et al., parathyroid carcinoma accounted for 0.74% of cases out of the total study population of 22,225 patients [3] . On days 4-10 of hospitalization, the patient became more lucid as serum calcium level had normalized to 9.1 mg/dL with treatment. The patient remained to have normal serum calcium levels with elevated PTH levels for the next few days. The primary treatment for parathyroid carcinoma is surgical resection, as it offers the greatest chance for potential cure [11] . However, it is advised that the serum calcium levels should be controlled prior to surgery as our patient''s hypercalcemia was normalized after being treated with intravenous fluids, calcitonin, cinacalcet, and pamidronate. Surgical treatment of parathyroid carcinoma (review)

abstract:
  Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. We detail a 60-years-old gentleman who was otherwise healthy presented to the hospital due to acute encephalopathy. He was subsequently found to have parathyroid carcinoma as the cause of the acute encephalopathy with impressive serum calcium and parathyroid hormone levels. The parathyroid carcinoma was later surgically resected with the diagnosis confirmed via pathology specimen. The patient was safely discharged from the hospital with recommendations of close routine outpatient followup.


id: cord-291581-oyhzot4z
author: Malik, Fazila-Tun-Nesa
date: 2020-08-24
txt: ./txt/cord-291581-oyhzot4z.txt
cache: ./cache/cord-291581-oyhzot4z.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10004
doi: 10.7759/cureus.10004
summary:
  HCP employed in this hospital who experienced fever or respiratory symptoms or came in close contact with COVID-19 patients at home or their workplace were included in this study. Protective measures against SARS-CoV-2 are of particular importance for HCP in direct contact with patients suffering from COVID-19 in the ambulatory as well as hospital setting. The apparent higher rate of infection among HCP may be due to lack of awareness among staff, insufficient protective measures, social gatherings outside the workplace, or contact with known patients with COVID-19 in the community. The aim of this study was to evaluate demographic and clinical characteristics, management, and in-hospital outcome of COVID-19 among HCP with self-reported fever or respiratory symptoms in a tertiary cardiac care hospital. From April 29 to July 20, 2020, HCP with self-reported fever or respiratory symptoms or close contact with the patient at home or at the workplace in the last 10 days were tested for SARS-CoV-2 infection.

title:
  Clinical Presentation, Management and In-Hospital Outcome of Healthcare Personnel With COVID-19 Disease

abstract:
  Objective Healthcare personnel (HCP) are undoubtedly one of the major frontline fighters in the coronavirus disease 2019 (COVID-19) pandemic. Therefore, it comes as no surprise that many HCP have become infected by COVID-19 globally. The infection of HCP has received great attention in social media and is frequently reported from different parts of the world. However, there are few scientific reports addressing this aspect of the COVID-19 pandemic. The aim of this study was to evaluate the characteristics of clinical presentation, treatment, and outcome of COVID-19 infection among the HCP of our setting. Methods This cross-sectional study was performed in the National Heart Foundation Hospital & Research Institute of Bangladesh from April 29 to July 20, 2020. HCP employed in this hospital who experienced fever or respiratory symptoms or came in close contact with COVID-19 patients at home or their workplace were included in this study. The presence of COVID-19 disease was confirmed by real-time reverse transcriptase-polymerase chain reaction on nasopharyngeal samples. A total of 394 HCP were sampled and 139 had a positive corona test. Structured interviews were conducted to document symptoms for all HCP with confirmed COVID-19. Data analysis was performed in July 2020. Results Out of 1,409 HCP, 139 subjects tested positive for COVID-19. Among the HCP, infection rate was 9.86%. The mean age of the study population was 34.08±11.11 years (range: 20-69 yrs), of whom 82 (59%) were female. Most of this cohort were nurses (56 [40.3%]) and physicians (25 [18%]), and the remaining 58 (41.7%) were other staff. The mean duration of onset of symptoms to test was 2.89±2.07 days. The most common symptoms were fever (84.2%), fatigue (56.1%), cough (54%), body ache (39.6%), headache, and anosmia (38.8%). Most subjects had mild disease (125 [93%]), three (2.1%) of the HCP had moderate disease and one (0.7%) had severe disease. Ten of the HCP (7.2%) were asymptomatic. Most of them were treated either by ivermectin plus azithromycin or ivermectin plus doxycycline. Only 20 (14.4%) of the HCP were hospitalized, while others were treated either in home isolation (59.7%) or in institutional isolation (25.9%). Recovery was almost uneventful except one healthcare worker who died. Conclusion Most HCP had mild symptoms and a few of them were asymptomatic also. HCP with mild COVID-19 symptoms may be treated in home or institutional isolation. As they are a vulnerable group for infection, providing adequate protection to HCP is absolutely mandatory to safeguard them from this pandemic.


id: cord-291877-7sgxiilt
author: Cruz Salcedo, Elis M
date: 2020-09-13
txt: ./txt/cord-291877-7sgxiilt.txt
cache: ./cache/cord-291877-7sgxiilt.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10430
doi: 10.7759/cureus.10430
summary:
  Patients who are developing ARDS secondary to COVID-19 pneumonia have been treated with self-proning intervals in combination with supplementation of oxygenation via high-flow nasal cannula (HFNC) or non-invasive positive pressure ventilation (NIPPV); however, a few patients have poor tolerance to the devices, leading to poor compliance and eventual worsening respiratory symptoms leading to intubation. In the current case report, we detail how a patient was able to successfully be self-proned with proper tolerance to HFNC and NIPPV while using dexmedetomidine, leading to discharge without the need for further oxygen supplementation at home. Our case details a patient with COVID-19 pneumonia who was successfully managed with awake self-proning while using dexmedetomidine in combination with HFNC and noninvasive positive pressure ventilation (NIPPV) during the beginning stages of the disease in order to promote increased adherence to proning cycles and oxygen support equipment, to prevent endotracheal intubation.

title:
  Use of Dexmedetomidine in Early Prone Positioning Combined With High-Flow Nasal Cannula and Non-Invasive Positive Pressure Ventilation in a COVID-19 Positive Patient

abstract:
  As the COVID-19 pandemic continues to manifest in our society, we still lack evidence-based treatment guidelines. Current treatment for COVID-19 pneumonia has been modeled from currently established guidelines such as that of acute respiratory distress syndrome (ARDS). COVID-19 pneumonia, also known as SARS-CoV-2, is characterized by severe hypoxia and near-normal respiratory system compliance with a time-related presentation. Dexmedetomidine is a centrally acting alpha-2 receptor agonist that promotes sedative and anxiolytic effects without the risk of respiratory depression and can provide cooperative or semi-rousable sedation. Patients who are developing ARDS secondary to COVID-19 pneumonia have been treated with self-proning intervals in combination with supplementation of oxygenation via high-flow nasal cannula (HFNC) or non-invasive positive pressure ventilation (NIPPV); however, a few patients have poor tolerance to the devices, leading to poor compliance and eventual worsening respiratory symptoms leading to intubation. In the current case report, we detail how a patient was able to successfully be self-proned with proper tolerance to HFNC and NIPPV while using dexmedetomidine, leading to discharge without the need for further oxygen supplementation at home.


id: cord-292976-qctfl6r8
author: Monday, Lea M
date: 2020-06-11
txt: ./txt/cord-292976-qctfl6r8.txt
cache: ./cache/cord-292976-qctfl6r8.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8558
doi: 10.7759/cureus.8558
summary:
  Conclusions An online virtual synchronous boot camp increased students'' confidence in handling common topics encountered during residency and demonstrated an appropriate gain in knowledge using a comprehensive assessment. The goals of this study were to determine the effectiveness of the Internship Boot Camp on three measures: (1) level of confidence about entering their internship, (2) ability to develop a framework for responding to common challenges, and (3) ability to demonstrate an appropriate gain in clinical knowledge using a comprehensive post-course assessment. Fifty-three students from the Wayne State University School of Medicine who matched into a variety of non-surgical residencies were offered an ungraded elective entitled, "Intern Boot Camp." Before developing the boot camp curriculum, a needs assessment (a systematic process for determining and addressing needs or "gaps" existing in the knowledge and skills of medical students) was conducted through a voluntary online survey.

title:
  Outcomes of an Online Virtual Boot Camp to Prepare Fourth-Year Medical Students for a Successful Transition to Internship

abstract:
  Introduction Changes in medical education and health care delivery have limited the ability of fourth-year medical students to perform the role of an intern prior to graduating from medical school. To address this issue, many schools have instituted residency preparation courses (sometimes referred to as boot camps) particularly for students entering surgical fields. Courses for students entering nonprocedural fields are less common and most assess increases in self-reported confidence without providing objective evidence of a gain in knowledge or skills improvement. Materials and Methods We used a Plan, Do, Study, Act (PDSA) model to develop and pilot cycle 1 of a nonprocedural internship preparation elective in 2019. Feedback was used to refine the course and map sessions to core competencies outlined by the Accreditation Council of Graduate Medical Education (ACGME) for PDSA cycle 2. The curriculum was adapted for remote synchronous delivery due to the coronavirus pandemic in spring 2020 using a combination of didactic lectures containing embedded polls and case-based role play responses using a chat box. Students completed anonymous surveys assessing self-perceived levels of confidence, as well as an objective comprehensive assessment after course completion. Results A total of 89 students participated in the course. Pre-session confidence was lowest for transfusion medicine, handling pages from nursing while on call, and knowledge of the role of a chief resident. A statistically significant increase in median scores for self-reported knowledge or confidence was seen in all sessions. The percentage of students reporting that they were either confident or extremely confident also increased significantly after each session (p<0.001 for all). All sessions analyzed were rated as useful or extremely useful by more than half of the students, and 94% of the students scored 70% or higher on the comprehensive course assessment. Conclusions An online virtual synchronous boot camp increased students’ confidence in handling common topics encountered during residency and demonstrated an appropriate gain in knowledge using a comprehensive assessment. We were able to adapt our curriculum to a remote model and will likely keep several sessions in an online format in the future.


id: cord-293475-6ghjewxc
title: Extracorporeal Membrane Oxygenation as Treatment of Severe COVID-19 Infection: A Case Report
author: Douedi, Steven
date: 2020-04-17
url: https://www.ncbi.nlm.nih.gov/pubmed/32431992/
doi: 10.7759/cureus.7714
abstract:
  Novel coronavirus 2019 (COVID-19) is a severe respiratory infection leading to acute respiratory distress syndrome (ARDS) accounting for thousands of cases and deaths across the world. Several alternatives in treatment options have been assessed and used in this patient population. However, when mechanical ventilation and prone positioning are unsuccessful, venovenous extracorporeal membrane oxygenation (VV-ECMO) may be used. We present a case of a 41-year-old female, with no significant medical history and no recent history of exposure to sick contacts, presented to the emergency department (ED) with fever, severe shortness of breath, and flu-like symptoms with a positive COVID-19 test. Ultimately, she worsened on mechanical ventilation and prone positioning and required VV-ECMO. The use of VV-ECMO in COVID-19 infected patients is still controversial. While some studies have shown a high mortality rate despite aggressive treatment, such as in our case, the lack of large sample size studies and treatment alternatives places healthcare providers against a wall without options in patients with severe refractory ARDS due to COVID-19.


id: cord-293622-gdplbrsf
author: Arget, Michael
date: 2019-04-30
txt: ./txt/cord-293622-gdplbrsf.txt
cache: ./cache/cord-293622-gdplbrsf.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/31281760/
doi: 10.7759/cureus.4577
summary:
  We describe an immunocompromised and severely ill patient with Legionnaires'' disease and who also has allergies to both fluoroquinolones and macrolides; he was successfully treated using tigecycline, a third generation glycylcycline, indicating that tigecycline may serve as a safe and effective alternative therapeutic option for treatment of Legionnaires'' disease in select cases. A recently published case series describes eight patients with Legionnaires'' disease who were switched to tigecycline, often due to worsening sepsis and/or respiratory status, following initial exposure to macrolide and/or fluoroquinolone therapy (median of three days) [8] . While the integrated results of these two randomized controlled trials support the early use of tigecycline as empiric treatment of community-acquired pneumonia, one of these trials permitted switching to oral levofloxacin following at least three days of intravenous therapy if evidence of clinical improvement.

title:
  Successful Treatment of Legionnaires’ Disease with Tigecycline in an Immunocompromised Man with a Legion of Antibiotic Allergies

abstract:
  Legionella species are Gram-negative bacilli that are relatively rare causes of community-acquired pneumonia but can be associated with significant morbidity and mortality if unrecognized or improperly treated. Limited data exist regarding the use of tigecycline, a third generation glycylcycline, in the treatment of Legionnaires' disease. We present an immunocompromised patient with Legionnaires' disease and allergies to both fluoroquinolones and macrolides, which are first-line treatment options for Legionnaires' disease. He was successfully treated using tigecycline, a third generation glycylcycline, indicating that tigecycline may serve as a safe and effective alternative therapeuticl option for treatment of Legionnaires’ disease.


id: cord-294422-hsqphc3t
title: Impact of COVID-19 on the Mental Health of Healthcare Professionals in Pakistan
author: Sandesh, Ram
date: 2020-07-02
txt: ./txt/cord-294422-hsqphc3t.txt
cache: ./cache/cord-294422-hsqphc3t.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8974
doi: 10.7759/cureus.8974
summary:
  The psychological response of HCPs to an epidemic could be dependent on many factors which may cause anxiety and stress such as feeling vulnerable to infection, lack of control over the situation, the spread of the virus, health of their family, and being isolated [11] . It can be also seen that many of the factors due to which HCPs suffer from these ill-effects can be potentially modified, for example, such as free provision of PPEs to all healthcare workers, promoting general public awareness about COVID-19, and building better infrastructure to encourage lighter work hours can all be carried out by the government and thus have a positive impact on the mental health of HCPs. In our study, high levels of anxiety, stress and depression among health care professionals were noted, which is a cause for concern. Since there is a high prevalence of anxiety, depression, and stress among HCPs treating COVID-19 patients, it is imperative to invest resources to promote the mental health welfare of frontline professionals.

abstract:
  Introduction As a result of the ongoing COVID-19 pandemic, health care professionals (HDPs) are facing immense strain due to the heavy load of cases. In many cases, they work increasingly long hours, often with limited resources and a dubious infrastructure. Thus, it is important to check on the mental health of caregivers. Methods and materials This cross-sectional study was conducted in May 2020, at various hospitals in Karachi, Pakistan. All HCPs posted in the COVID-19 isolation wards were invited to participate and a total of 112 completed this study. A carefully structured form was created, which included the Depression Anxiety Stress Scale-21 (DASS-21). Results The overall mean score of anxiety was 19.01 ± 9.2, depression was 18.12 ± 10, and stress was 20.12 ± 12.0. There were 81 (72.3%) participants who suffered from moderate to extremely severe depression, 96 ( 85.7%) participants who suffered from moderate to extremely severe anxiety, and 101 (90.1%) participants who reported moderate to extreme stress levels Conclusions It is evident that there are a high number of healthcare workers affected by various psychological ailments such as anxiety, stress, and depression. It is important that the government take steps to ensure that HCPs' mental health is regularly checked and that efforts are made to reduce their burdens.


id: cord-294788-9usyb1nn
title: A Comprehensive Review of Severe Acute Respiratory Syndrome Coronavirus 2
author: Baek, Woong Kee
date: 2020-05-03
txt: ./txt/cord-294788-9usyb1nn.txt
cache: ./cache/cord-294788-9usyb1nn.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.7943
doi: 10.7759/cureus.7943
summary:
  Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), the virus strain that causes coronavirus disease 2019 (COVID-19), was first identified in Wuhan, China in December 2019. It is suspected that the acute respiratory distress syndrome (ARDS)-like picture in SARS-CoV-2-infected patients is precipitated and worsened by the excess monocytes in response to GM-CSF, which is released by rapidly activated CD4+T-cell lineage [17] . have reported that the cytokine profile and the trend of the inflammatory markers of SARS-CoV-2-infected patients present similarly to the secondary hemophagocytic lymphohistiocytosis (sHLH), whose severe clinical presentation is related to the cytokine storm [23] . There is no consensus yet on how to treat SARS-CoV-2-infected patients who present with a wide spectrum of clinical symptoms and severity. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Epub ahead of print)

abstract:
  Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), the virus strain that causes coronavirus disease 2019 (COVID-19), was first identified in Wuhan, China in December 2019. It spread to several countries across continents and infected more than one million people within three months. While there is no consensus on the treatment of the disease yet, understanding the virus and its transmission is a cardinal priority. SARS-CoV-2 can be transmitted through bodily fluid. Upon inoculation, the surface enzyme angiotensin-converting enzyme 2 (ACE2) acts as a receptor protein for viral entry. The mean incubation period is 5.1 days, and infected individuals can exhibit a variety of symptoms from fever, cough, dyspnea, and respiratory failure to even multiorgan failure. Given the current situation, it is of paramount importance to understand the virus as thoroughly as possible. In this review, we discuss the background, epidemiology, possible pathophysiology, clinical presentation, and diagnostic studies related to SARS-CoV-2 infection. We also elaborate on the current research and evidence on treatment options and vaccine development based on the literature.


id: cord-294828-yemg28ds
author: Jameel, Tahir
date: 2020-07-07
txt: ./txt/cord-294828-yemg28ds.txt
cache: ./cache/cord-294828-yemg28ds.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32782867/
doi: 10.7759/cureus.9048
summary:
  title: Persistence of Reverse Transcription-Polymerase Chain Reaction (RT-PCR) Positivity in COVID-19 Recovered Patients: A Call for Revised Hospital Discharge Criteria The hospital discharge criteria for COVID-19 patients upon recovery includes the absence of respiratory symptoms, afebrile for the last three days, radiological improvement of chest exudates (by X-ray or CT scan), and two upper respiratory tract samples negative for viral RNA in RT-PCR assay, collected at the interval of at least 24 hours. WHO, in the latest newsletter "criteria for releasing COVID-19 patients from insolation," advised not to keep on waiting for RT-PCR to become negative; instead, the decision should be based on clinical and essential laboratory investigation like the presence of neutralizing antibodies. When the COVID-19 patient recovers, the discharge criteria from the hospital are meticulous, and the patient may wait a long time to be released from isolation because of the positive RT-PCR assay.

title:
  Persistence of Reverse Transcription-Polymerase Chain Reaction (RT-PCR) Positivity in COVID-19 Recovered Patients: A Call for Revised Hospital Discharge Criteria

abstract:
  In the world scenario, the advent of COVID-19 has halted every aspect of life. It influenced every field of life, including the economy, and revealed the inadequacies in all nations' healthcare systems, from the most developed to the underdeveloped countries. There is a debate about the timing of antibodies production and detection during the disease. What is the significance of reverse transcription-polymerase chain reaction (RT-PCR) viral ribonucleic acid (RNA) in symptom resolving period? In the present manuscript, we have evaluated these points.


id: cord-296739-ujsqshjg
author: Dexter, Franklin
date: 2020-10-08
txt: ./txt/cord-296739-ujsqshjg.txt
cache: ./cache/cord-296739-ujsqshjg.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33178503/
doi: 10.7759/cureus.10847
summary:
  Then, for each category of procedure, and for each of the preceding quarters included for the category, we used the cumulative counts to calculate the asymptotic standard error (SE) for the proportion of cases with LOS of <2 days. Applying our methodology with local LOS data will allow OR managers to estimate the number of patients on the elective OR schedule each day who will be hospitalized for longer than overnight, facilitating communication and decision-making with surgical departments when census considerations constrain the ability to run a full surgical schedule. The first summary measure compared was the percentage of patients previously undergoing the same 1 2 3 category of procedure as that scheduled whose hospital LOS was zero (i.e., ambulatory surgery) or one day (i.e., overnight stay) [1, 2] . In this study, we analyzed five years of data from a large teaching hospital to compare methods of estimating the percentages of cases with LOS of <2 days for each category of procedures.

title:
  Forecasting the Probability That Each Surgical Case Will Either Be Ambulatory or the Patient Will Remain in the Hospital Overnight Versus Having a Length of Stay of Two or More Days

abstract:
  When the hospital census is high, perioperative medical directors or operating room (OR) managers sometimes need to review with surgical departments as to which surgical cases scheduled to be performed within the next three days may need to be postponed. Although distributions of hospital length of stay (LOS) are highly skewed, a surprisingly effective summary measure is the percentage of patients previously undergoing the same category of procedure as that scheduled whose LOS was zero or one day. We evaluated how to forecast each hospital's percentage of cases with LOS of <2 days, segmented by category of surgical procedure. The large teaching hospital studied included several inpatient adult surgical suites, an ambulatory surgery center, and a pediatric surgical suite. We included 98,540 cases in a training dataset to predict 24,338 cases in a test dataset. For each category of procedure, we calculated the cumulative count of cases among quarters, from the most recent quarter, second most recent quarter, and so forth up to the quarter resulting in at least 800 cases. If every quarter combined had fewer than 800 cases for a given category of procedure, we included all cases for that category. For each combination of category and quarter, we used the cumulative counts of cases and cases with LOS of <2 days, excluding the current quarter. Then, for each category of procedure, and for each of the preceding quarters included for the category, we used the cumulative counts to calculate the asymptotic standard error (SE) for the proportion of cases with LOS of <2 days. If all preceding quarters combined provided a sample size such that the estimated SE for the proportion exceeded 1.25%, we included all preceding quarters. The observed absolute percentage error was 0.76% (SE: 0.12%). This error was nearly 100-fold smaller than the percentage of cases to which it would be used (i.e., 0.76% versus 73.1% with LOS of <2 days). The principal weakness of the forecasting methodology was a small bias caused by a progressive reduction in the overall LOS over time. However, this bias is unlikely to be important for predicting cases’ LOS when the hospital census is high. When performing these time series calculations quarterly, a reasonable approach is to perform calculations of both case counts and SEs for each category of procedure. We recommend using the fewest historical quarters, starting with the most recent quarter, either with at least 800 cases or an estimated asymptotic SE for the estimated percentage no greater than 1.25%. Applying our methodology with local LOS data will allow OR managers to estimate the number of patients on the elective OR schedule each day who will be hospitalized for longer than overnight, facilitating communication and decision-making with surgical departments when census considerations constrain the ability to run a full surgical schedule.


id: cord-297222-2danzbqt
title: An Intriguing Presentation of Epstein-Barr Virus-Associated Hemophagocytic Lymphohistiocytosis
author: Quadri, Syed P
date: 2020-08-05
url: https://doi.org/10.7759/cureus.9561
doi: 10.7759/cureus.9561
abstract:
  Hemophagocytic lymphohistiocytosis (HLH) is an immune related clinical syndrome with protean manifestations, varying presentation, clinically complex, with diverse causes, and is an under-recognized entity which carries high morbidity and mortality. It is precipitated by an immunological trigger in a susceptible host resulting in immune activation and dysregulation leading to disruption of immune homeostasis, cytokine storm and multi-organ failure. We describe a case of Epstein-Barr virus (EBV) associated HLH with its typical diagnostic challenges and associated high mortality rate. Certain diagnostic criteria and online tools may help to arrive at an earlier presumptive diagnosis which, in turn, may expedite treatment and lead to better clinical outcomes.


id: cord-297832-picpuzvo
author: Salazar, Rafael
date: 2020-10-06
txt: ./txt/cord-297832-picpuzvo.txt
cache: ./cache/cord-297832-picpuzvo.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33173630/
doi: 10.7759/cureus.10822
summary:
  The number of patients with acute episodes of severe bronchospasm needing intubation and ventilatory support has increased rapidly during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus disease 2019 (COVID-19) pandemic. Anteroposterior chest X-ray at the time of acute bronchospasm with Radiographic Assessment of Lung Edema (RALE) score 2 The initial management comprised placing the patient in the prone position and administering oxygen at high flow through a non-rebreather mask with flow between 10 and 15 liters per minute until reaching 100% FiO 2 . To improve ventilatory mechanics and ultimately postpone the need for IMV due to acute bronchospasm in patients diagnosed with COVID-19, we put in place a therapeutic approach consisting of early respiratory therapy and pharmacological bronchospasm rescue approach. The therapeutic bundle of early respiratory therapy, consisting of deep inspiration with inspiratory hold, and pharmacological bronchospasm rescue decreased the need for invasive mechanical ventilation in patients with bronchospasm associated with SARS-CoV-2 and reduced the mortality rate.

title:
  Decreased Mortality in Patients With Severe Bronchospasm Associated With SARS-CoV-2: An Alternative to Invasive Mechanical Ventilation

abstract:
  The number of patients with acute episodes of severe bronchospasm needing intubation and ventilatory support has increased rapidly during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus disease 2019 (COVID-19) pandemic. Although medical consensus upholds the use of ventilatory support in this pathology, its survival benefits remain unclear. To improve the outcomes and survival rates, a bundle of early respiratory therapy with a pharmacological rescue regimen was provided to four patients with bronchospasm secondary to COVID-19. This therapeutic approach successfully delayed the need for invasive mechanical ventilation for 48 hours and decreased the mortality rate in all cases.


id: cord-297878-c4cq92x8
title: ST-Elevation Myocardial Infarction in a 27-Year-Old Male With COVID-19
author: Ali, Mohammed
date: 2020-09-11
url: https://www.ncbi.nlm.nih.gov/pubmed/33062505/
doi: 10.7759/cureus.10384
abstract:
  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus that led to a global public health emergency causing coronavirus disease 2019 (COVID-19). It was initially identified in Wuhan, China after causing significant respiratory illness. Although respiratory symptoms are the most common presenting symptoms, it is now recognized that COVID-19 encompasses multiple organ systems including the cardiovascular system. Acute myocardial injury and ST-elevation myocardial infarction (STEMI) have now been associated with COVID-19. COVID-19 patients with cardiovascular manifestations are at risk for increased severity of illness. Here we present a case of a very young 27-year-old patient without any past history of hypertension, coronary artery disease, or any risk factors for coronary artery disease except obesity, who developed STEMI while in the hospital.


id: cord-299125-kuvnwdn6
author: Ikegami, Saya
date: 2020-06-22
txt: ./txt/cord-299125-kuvnwdn6.txt
cache: ./cache/cord-299125-kuvnwdn6.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8768
doi: 10.7759/cureus.8768
summary:
  title: Suspected Virus-Inducing Severe Acute Respiratory Distress Syndrome Treated by Multimodal Therapy Including Extracorporeal Membrane Oxygenation and Immune Modulation Therapy We report a case of suspected virus-inducing severe ARDS treated by multimodal therapy including extracorporeal membrane oxygenation (ECMO) and immune modulation therapy that led to a favorable outcome for the patient. The risk factor in the present case was unspecified pneumonia, and an unspecified virus was considered the most likely cause based on the negative results of all cultures, β-D glucan, and rapid test for bacteria and influenza. As the present case also showed marked hypoxia despite mechanical ventilation with a high concentration of oxygen and high PEEP, ECMO was introduced, and the lung rest setting was selected. We presented a case of suspected virus-inducing severe ARDS that was treated by multimodal therapy including ECMO and immune modulation therapy.

title:
  Suspected Virus-Inducing Severe Acute Respiratory Distress Syndrome Treated by Multimodal Therapy Including Extracorporeal Membrane Oxygenation and Immune Modulation Therapy

abstract:
  A 44-year-old man who had been feeling general fatigue was found in an unconscious state on the same day. He had no remarkable medical history. On arrival at the hospital, his Glasgow Coma Scale was E1V2M3; he had tachycardia and hypertension, was afebrile, and in a severe hypoxic state. His PaO(2)/FiO(2) (P/F) was under 100, even with tracheal intubation with 100% oxygen. Chest X-ray and CT revealed a bilateral ground-glass appearance with consolidation. Cardiac echo initially showed hyper-dynamic wall motion. The main results of a blood analysis suggested an acute inflammatory reaction, rhabdomyolysis, and pancreatitis. The microscopic findings of sputum and a rapid test for bacterial and viral infections were all negative. As he showed deterioration of P/F, venovenous extracorporeal membrane oxygenation (ECMO) was started. He also showed hypotension and therefore underwent vasopressor and steroid administration. Due to concerns of pneumonia, he received meropenem and azithromycin in addition to the infusion of γ-globulin and glycyrrhizin. The results of a COVID-19 test, culture of sputum, and collagen disease test were all negative. The serum virus neutralization assay as a serological test for Coxsackievirus B4 showed a four-fold increase in titer. The multimodal therapy mentioned above resulted in the improvement of his general condition, including acute respiratory distress syndrome (ARDS). In this report, we discuss the benefits of ECMO and immune modulation therapy in the treatment of severe ARDS.


id: cord-300216-3mvfiuwc
author: Montenegro-Villalobos, Jiulliana
date: 2020-09-02
txt: ./txt/cord-300216-3mvfiuwc.txt
cache: ./cache/cord-300216-3mvfiuwc.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10212
doi: 10.7759/cureus.10212
summary:
  title: Subconjunctival Acute Bilateral Hemorrhages Due to Kawasaki Disease in a Costa Rican Girl: An Unusual Clinical Manifestation of the Disease Among the ocular manifestations in these patients, bilateral non-suppurative conjunctival injection and uveitis are the most common. We describe a six-year-old Costa Rican girl with acute Kawasaki disease who developed severe bilateral conjunctival injection with subsequent bilateral subconjunctival hemorrhages. To our knowledge, this is the first report from Latin America and among the few in the literature of a child in whom severe bilateral subconjunctival hemorrhages occur as a manifestation of Kawasaki disease. Kawasaki disease (KD) is an acute systemic vasculitis and the leading cause of acquired cardiac disease in children, with approximately 80% of cases occurring in children in the first five years of age. Rare ocular manifestations in an 11-year-old girl with incomplete Kawasaki disease: a case report

title:
  Subconjunctival Acute Bilateral Hemorrhages Due to Kawasaki Disease in a Costa Rican Girl: An Unusual Clinical Manifestation of the Disease

abstract:
  Kawasaki disease is an acute systemic vasculitis and is the leading cause of acquired cardiac disease in children. Among the ocular manifestations in these patients, bilateral non-suppurative conjunctival injection and uveitis are the most common. We describe a six-year-old Costa Rican girl with acute Kawasaki disease who developed severe bilateral conjunctival injection with subsequent bilateral subconjunctival hemorrhages. For her ocular involvement, she was treated expectantly, and after six weeks there was complete resolution. To our knowledge, this is the first report from Latin America and among the few in the literature of a child in whom severe bilateral subconjunctival hemorrhages occur as a manifestation of Kawasaki disease.


id: cord-300333-p73sz5bj
title: Diabetic Ketoacidosis Complicated by a Brain Death
author: Kabashneh, Sohaip
date: 2020-06-29
url: https://www.ncbi.nlm.nih.gov/pubmed/32742870/
doi: 10.7759/cureus.8903
abstract:
  Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM). Cerebral edema (CE) can complicate DKA management. We report a patient with no significant medical history who presented with DKA and a new-onset DM; she received the standard management with regular insulin and IV fluids, the management resulted in a rapid drop in serum osmolality, the patient`s mental status deteriorated and became nonresponsive, brain imaging confirmed CE, a few days later the patient was declared brain dead by neurology. This case highlights the importance of gradual correction of hyperosmolar conditions including hyperglycemia and urges all healthcare providers to closely trend glucose levels in the management of DKA.


id: cord-300508-po2zolo8
author: Inoue, Gen
date: 2020-10-24
txt: ./txt/cord-300508-po2zolo8.txt
cache: ./cache/cord-300508-po2zolo8.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33133795/
doi: 10.7759/cureus.11140
summary:
  With the need to develop an approach to manage orthopaedic surgeries, we aimed to evaluate the most current data on all the surgical cases in our department including the results of the reverse-transcriptase polymerase chain reaction (RT-PCR) assay for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We also examined the results of PT-PCR for SARS-CoV-2, which was principally performed for all the surgical candidates in our department beginning May 13, and investigated their laboratory test results before surgery, their clinical signs and symptoms, which were reported to be related with COVID-19. evaluated 66 orthopaedic healthcare workers exposed to one patient who became positive for SARS-CoV-2 infection one week after admission, and reported that the RT-PCR assays were negative for all 66 healthcare workers, although 14 (21%) manifested clinical signs/symptoms suggestive of COVID-19, including cough (6.1%), sore throat (4.5%), nasal congestion (4.5%), dyspnoea (3.0%), fever (1.5%), headache, and myalgias (1.5%) [19] .

title:
  Experience of an Orthopaedic Surgery Department Early During the COVID-19 Outbreak in Japan Including Real-Time Polymerase Chain Reaction Assay Results for SARS-CoV-2

abstract:
  Introduction The coronavirus disease 2019 (COVID-19) epidemic beginning December 2019 in China has now become a worldwide pandemic. With the need to develop an approach to manage orthopaedic surgeries, we aimed to evaluate the most current data on all the surgical cases in our department including the results of the reverse-transcriptase polymerase chain reaction (RT-PCR) assay for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods The monthly number of surgical cases from 2016 were reviewed, and compared the numbers of surgical cases both in elective and emergency surgery during the pandemic with the pre-pandemic period. The results of RT-PCR for SARS-CoV-2 in 94 orthopaedic surgery cases from May 13 to June 30, 2020, and clinical signs/symptoms, and laboratory data of 48 consecutive cases within a month from May 13 were also evaluated. Results The mean monthly number of surgeries from January to May 2020 was significantly lower than the mean number in 2019 (73.8 vs 121.9, respectively, p=0.01). The proportion of emergency surgeries in all surgeries performed in May 2020 was 35.5%, which is significantly more than the mean rate of 20.4% in 2019 (p=0.04). Hip arthroplasties and spine surgeries showed the greatest reduction, at greater than 80% and 65%, respectively. Although none of the 94 patients were positive for SARS-CoV-2, 66.7% showed signs/symptoms typical of COVID-19. The most frequent signs/symptoms were production of nasal mucus (25.5%), followed by dry cough (19.1%); and fatigue, headache, and dizziness (17.0% each). The incidence of abnormal values, which are commonly noted in COVID-19 patients, were eosinopaenia 37.5%; lymphopaenia 18.8%; thrombocytopaenia 8.3%; and elevated prothrombin time 10.4%. Conclusions Our results show that our RT-PCR negative patients showed signs/symptoms and abnormal laboratory values typical of COVID-19, indicating surgeons should be aware of these abnormalities in patients and the need to rule out COVID-19 before proceeding with surgery.


id: cord-301843-oxe22chd
author: Meza, Jose L
date: 2020-08-25
url: https://www.ncbi.nlm.nih.gov/pubmed/32983724/
doi: 10.7759/cureus.10031
title:
  Diabetic Ketoacidosis Precipitated by COVID-19 in Patients Without Respiratory Symptoms: Case Reports

abstract:
  Worse outcomes of coronavirus disease 2019 (COVID-19) have been documented in older patients with comorbidities, especially in those with diabetes mellitus (DM). However, the clinical picture and risk factors of COVID-19 in DM is still emerging. Here, we report four cases of severe COVID-19 patients with acute diabetic ketoacidosis (DKA) without respiratory symptoms, with viral and bacterial coinfection, and poor clinical outcomes. Higher monitoring of patients with DM and COVID-19 is advised, as well as rapid and accurate diagnostic tests and treatment.


id: cord-302244-uwicyuhk
author: Hoilat, Gilles J
date: 2020-08-01
txt: ./txt/cord-302244-uwicyuhk.txt
cache: ./cache/cord-302244-uwicyuhk.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.9506
doi: 10.7759/cureus.9506
summary:
  We present a case of a healthy 32-year-old male with no past medical history who presented with shortness of breath, tested positive for COVID-19, and was found to have a large acute saddle pulmonary embolism. Recent findings revealed that patients with severe cases of COVID19 who are admitted to the intensive care unit with respiratory failure had a predominant hypercoagulable state leading to thromboembolism [1] . We present a case of a healthy patient who presented to the hospital with dyspnea, was found to be COVID-19 positive, and was diagnosed with an acute saddle pulmonary embolism. The incidence of acute pulmonary embolism in a patient with COVID-19 remains unknown [6] . Our patient was a healthy male who presented with no risk factors for thromboembolic disease and no symptoms of viral pneumonia but still developed a large saddle embolism.

title:
  Percutaneous Mechanical Pulmonary Thrombectomy in a Patient With Pulmonary Embolism as a First Presentation of COVID-19

abstract:
  There has been a high incidence of thromboembolic diseases in patients with coronavirus disease 2019 (COVID-19) pneumonia. We present a case of a healthy 32-year-old male with no past medical history who presented with shortness of breath, tested positive for COVID-19, and was found to have a large acute saddle pulmonary embolism.


id: cord-302597-e8n5o69p
author: Ahmed, Nishat
date: 2020-09-22
url: https://doi.org/10.7759/cureus.10590
doi: 10.7759/cureus.10590
title:
  Sporadic Fusobacterium Bacteremia as an Atypical Cause of Acute Hepatitis in a Young Caucasian Woman

abstract:
  Fusobacterium species are gram-negative anaerobic non-spore-forming bacteria, which colonize mucous membranes in humans. Over the recent decade, the significance of these organisms has been increasingly recognized. We describe a rare case of acute hepatitis, which was found to be likely due to Fusobacterium nucleatum, grown on blood culture. In our case, the hepatitis caused by this microorganism resolved completely without any long-term sequelae to the liver, through conservative management namely intravenous antibiotics and supportive therapy only. This case highlights that early detection and prompt treatment in a case of acute hepatitis resulted in a good outcome. In addition, this case also illustrates that the differential diagnosis can be varied in cases of acute hepatitis.


id: cord-302786-ibt7mupq
title: Fatal Outcome in a Kidney-Pancreas Transplant Recipient With COVID-19
author: Suwanwongse, Kulachanya
date: 2020-06-18
txt: ./txt/cord-302786-ibt7mupq.txt
cache: ./cache/cord-302786-ibt7mupq.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8691
doi: 10.7759/cureus.8691
summary:
  Despite a growing report on clinical characteristics and prognosis of patients with COVID-19, the data in the special population, including transplant recipients, is still limited. We proposed that the pre-existing T-cell dysfunction from the long-term use of immunosuppressive agents in organ transplant recipients adversely affects COVID-19 prognosis and worsens COVID-19 mortality. However, impaired immune functions may paradoxically protect transplant patients from the hyper-inflammatory response to SARS-CoV-2 and thus dampen the disease severity. Long-term immunosuppressive therapy in organ transplant recipients may alter clinical features and outcomes of COVID-19. The long-term use of immunosuppressive medications in organ transplant recipients is associated with the decrease in T-cell number and function; TAC and MMF preferentially inhibit T-cell response. However, in this report, immunosuppressive agents were discontinued in patients with severe disease, presumably with high mortality risks. Preexisting T-cell immune response deficits from long-term use of immunosuppressive agents may worsen the prognosis of COVID-19 in transplant recipients.

abstract:
  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious pathogen causing the novel coronavirus disease 2019 (COVID-19), the ongoing unprecedented pandemic in 2020. SARS-CoV-2 primarily targets the respiratory systems, so acute respiratory distress syndrome is the major cause of death. Clinical courses of COVID-19 are variable and unpredictable, while some epidemiologic and clinical factors have been found to have a negative impact on the disease prognosis. Despite a growing report on clinical characteristics and prognosis of patients with COVID-19, the data in the special population, including transplant recipients, is still limited. Herein we report on the clinical features and fatal outcome of COVID-19 in a dual pancreas-kidney transplant recipient (with failure of the pancreas graft). Our case illustrates the similarities and differences of the COVID-19 disease course between transplant recipients and the general population. We proposed that the pre-existing T-cell dysfunction from the long-term use of immunosuppressive agents in organ transplant recipients adversely affects COVID-19 prognosis and worsens COVID-19 mortality.


id: cord-303659-mzez7v4d
title: The Possibility and Cause of Relapse After Previously Recovering From COVID-19: A Systematic Review
author: Elsayed, Sarah M
date: 2020-09-05
txt: ./txt/cord-303659-mzez7v4d.txt
cache: ./cache/cord-303659-mzez7v4d.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33042702/
doi: 10.7759/cureus.10264
summary:
  There are reports of patients who tested positive for SARS-Cov-2 after clinical recovery and initial clearance of the virus. There have been reports of patients who tested positive for SARS-Cov-2 after clinical recovery and initial documented clearance of the virus. The publications included COVID-19 positive patient data and the relapse of disease was confirmed by PCR; the full text was available for these publications. Data were collected in the following categories when available: Study design; Study country; Patient demographics; Clinical signs and symptoms; Laboratory findings; Imaging studies; Dynamics of the oropharyngeal swab test; Treatment of the first presentation; The clinical picture of relapse; Day of a positive result after confirmed negative We tabulated the data using Microsoft Excel (2010, Microsoft Corp, Redmond, WA). The study reports a total of 11 patients (6 females and 5 males), all from China, who tested positive for COVID-19.

abstract:
  The severe acute respiratory distress syndrome coronavirus-2 (SARS-Cov-2) is a novel coronavirus that is believed to be mainly transmitted via droplet and contact transmission. While research is focusing on epidemiology, transmission, vaccine development, and therapeutics for coronavirus disease 2019 (COVID-19), there is a possibility of disease relapse. There are reports of patients who tested positive for SARS-Cov-2 after clinical recovery and initial clearance of the virus. Objective This systematic review aims to identify the trends of COVID-19 relapse, the effects of co-morbidities on it, and associated mortality rates. Methods We conducted a systematic search during March and April 2020 for research articles on the relapse of COVID-19 using two primary databases, PubMed and Embase. Results A total of 13 eligible studies were screened of which 11 (case reports) were eligible for data extraction. The earliest to report relapse was after two days of discharge and the latest was 22 days after discharge. The mean number of days to relapse was 12 days and the median number was seven days. There was incomplete information about comorbidities. No mortalities were reported at the time of the study.


id: cord-304090-l5rocsk5
title: A Cross-Sectional Survey on Telemedicine Use for Doctor-Patient Communication
author: Akbar, Aelia
date: 2020-09-12
url: https://www.ncbi.nlm.nih.gov/pubmed/32953359/
doi: 10.7759/cureus.10402
abstract:
  Introduction Use of computers for doctor-patient communication is increasing. Considering effective doctor-patient communication is important for good health outcomes. This study helps to determine the level of acceptance of telemedicine in general public and factors associated with it. Methods: This survey with cross-sectional analysis comprised a brief survey with 15 questions. The survey was distributed in public places to determine the opinions of the general public. Results Randomly selected 125 participants completed the questionnaire. Synchronous telemedicine was favored by young people (82% in the 18-34 age group vs 37.5% of participants aged >55 years; p<0.01), those with a higher education level (46.7% of non-college-educated persons vs 80.6% of college-educated persons; p<0.01), and frequent computer users (67% who used a computer for less than two hours a month vs 86.5% of those who used a computer more than hours a month; p=0.03). Asynchronous communication, like sending health information to doctors via a safe portal was acknowledged mostly by people who had used patient portals in the past (84.1% vs 65.4%; p=0.02). Use of patient portals was less among older users and senior citizens (20.8% use in the age group >55 vs. 51.3% in the age group 35-53 years vs. 71% in age group 18-34 years). Receiving video education for specific health concerns was favored by those who used a computer frequently (94.6% who used a computer more than two hours a month vs 77% who used a computer less than two hours a month; p =0.02). Conclusion Telemedicine is generally favored, but physicians should be mindful about older people as they may not feel comfortable. Step by step guidance should be provided especially to senior citizens for telemedicine and portal use.


id: cord-305397-4dx3q6o6
title: Seizures Related to Coronavirus Disease (COVID-19): Case Series and Literature Review
author: Ashraf, Muddasir
date: 2020-07-24
url: https://www.ncbi.nlm.nih.gov/pubmed/32850246/
doi: 10.7759/cureus.9378
abstract:
  Neurological manifestations are common in coronavirus disease 2019 (COVID-19) patients. We present three cases of COVID-19 patients with seizures. Two patients had a history of seizures but very well controlled. They presented with seizure activity likely triggered by COVID-19. The third patient had no history of seizures and presented with new onset of seizure activity. All these patients were routinely screened for COVID-19 on admission and tested positive on nasopharyngeal real-time reverse transcriptase-polymerase chain reaction (rRT-PCR). None of these patients had respiratory symptoms. Electroencephalography (EEG) was abnormal in all three patients. All these patients recovered and were discharged in a stable condition.


id: cord-305704-grzrkff9
title: Dermatological Manifestations in Patients With SARS-CoV-2: A Systematic Review
author: Almutairi, Abdulelah
date: 2020-07-28
url: https://www.ncbi.nlm.nih.gov/pubmed/32775112/
doi: 10.7759/cureus.9446
abstract:
  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been initially defined as a disease of the respiratory tract; however, with the increasing number of patients and announcing that the virus became a pandemic, new systemic clinical manifestations are observed, including dermatological manifestations. However, the identification and characteristics of these manifestations are still controversial. This review article aims to evaluate the medical literature and explore the dermatological clinical manifestations in patients with SARS-CoV-2. The literature was reviewed through MEDLINE®, Ovid, PubMed®, and Embase®. Searching terms included were a combination of "dermatological" OR "skin" AND "symptoms" OR "manifestations" AND "SARS-CoV-2". The following step was filtering the results to include only original research studies investigating the different types of skin and dermatological clinical manifestations in patients with SARS-CoV-2. A total of 879 studies were retrieved. Following the exclusion of studies on animals and including only studies on humans, 32 studies emerged. Altogether, seven studies were identified as eligible, covering 555 patients with SARS-CoV-2 who had dermatological symptoms. Three studies were retrospective, two studies were prospective, and two studies were case series. Different types of dermatological lesions can occur in patients with SARS-CoV-2, most commonly erythema, urticaria, and varicella-like rash. Dermatological manifestations with SARS-CoV-2 can be misdiagnosed with other conditions. Further studies with robust design are needed.


id: cord-306108-ja0wyr5w
title: A Review of Acute Myocardial Injury in Coronavirus Disease 2019
author: B K, Anupama
date: 2020-06-03
txt: ./txt/cord-306108-ja0wyr5w.txt
cache: ./cache/cord-306108-ja0wyr5w.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32642342/
doi: 10.7759/cureus.8426
summary:
  Although SARS-CoV-2 infection predominantly causes pulmonary complications, such as pneumonia and ARDS, the disease has also been associated with a variety of cardiovascular complications, including acute myocardial injury, myocarditis, arrhythmia, heart failure, and venous thromboembolism [6] . Hence, one potential explanation for the higher likelihood of acquiring infection, and the increased risk of severe disease and adverse outcomes in patients with COVID-19 with pre-existing CVD, maybe the elevated secretion of ACE2 in these patients, thus making them more susceptible to direct viral damage to cardiac myocytes [33] ; but, this has not yet been demonstrated in pathology studies. In a single-center, retrospective cohort study including 188 patients with COVID-19 in Wuhan, China, conducted to explore whether heart injury occurred during COVID-19 on admission and later increased mortality, approximately 11.2% of patients had high-sensitivity cardiac troponin I (hs-TnI) exceeding the clinical upper normal limit on admission.

abstract:
  In December 2019, an outbreak of pneumonia caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), occurred in Wuhan, Hubei province, China, and it has spread rapidly across the world, causing the coronavirus disease 2019 (COVID-19) pandemic. Although SARS-CoV-2 infection predominantly results in pulmonary issues, accumulating evidence suggests the increased frequency of a variety of cardiovascular complications in patients with COVID-19. Acute cardiac injury, defined as elevated cardiac troponin levels, is the most reported cardiac abnormality in COVID-19 and strongly associated with mortality. In this article, we summarize the currently available data on the association of SARS-CoV-2 and COVID-19 with acute myocardial injury.


id: cord-306878-hmy3ovuq
author: Mittal, Abhinav
date: 2020-04-27
txt: ./txt/cord-306878-hmy3ovuq.txt
cache: ./cache/cord-306878-hmy3ovuq.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.7849
doi: 10.7759/cureus.7849
summary:
  title: Refractory Acute Respiratory Distress Syndrome Secondary to COVID-19 Successfully Extubated to Average Volume-assured Pressure Support Non-invasive Ventilator Consequently, the use of respiratory devices that may potentially promote aerosolization like non-invasive positive pressure ventilation (NIPPV) for diseases such as obstructive sleep apnea (OSA), advanced chronic obstructive lung disease, pulmonary hypertension (PH), and neuromuscular respiratory disease has been called into question. We present a case of a patient with history of OSA and PH convalescing from refractory acute respiratory distress syndrome (ARDS) secondary to COVID-19 who was successfully extubated to average volume-assured pressure support (AVAPS). Strategic use of average volume-assured pressure support (AVAPS) mode of ventilation as a bridge in recovering COVID-19 has the potential to facilitate earlier extubation, conserve traditional ventilators, and prevent re-intubation/tracheostomies. We present a case of a patient with history of OSA and PH convalescing from refractory acute respiratory distress syndrome (ARDS) secondary to COVID-19 who was successfully extubated to AVAPS.

title:
  Refractory Acute Respiratory Distress Syndrome Secondary to COVID-19 Successfully Extubated to Average Volume-assured Pressure Support Non-invasive Ventilator

abstract:
  Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by the highly infectious novel SARS-CoV-2 coronavirus spread by droplet transmission. Consequently, the use of respiratory devices that may potentially promote aerosolization like non-invasive positive pressure ventilation (NIPPV) for diseases such as obstructive sleep apnea (OSA), advanced chronic obstructive lung disease, pulmonary hypertension (PH), and neuromuscular respiratory disease has been called into question. We present a case of a patient with history of OSA and PH convalescing from refractory acute respiratory distress syndrome (ARDS) secondary to COVID-19 who was successfully extubated to average volume-assured pressure support (AVAPS). A 74-year-old male with medical history notable for OSA on NIPPV, PH, and hypertension presented with respiratory failure secondary to COVID-19 confirmed on polymerase chain reaction (PCR) test. His respiratory status worsened leading to ARDS requiring intubation. He was initially extubated to high flow nasal cannula (HFNC) due to hospital policy to avoid NIPPV due to concerns of viral dissemination. He did not tolerate HFNC and required re-intubation for prolonged period. He was then medically optimized for a second attempt and extubated two days later to AVAPS with an anti-viral filter and negative pressure room with a goal of optimizing his critical illness myopathy and pre-existing OSA and PH. He tolerated extubation well, and over the next five days was weaned from alternating AVAPS/HFNC to eventually requiring two liters nasal cannula in the day and AVAPS mode at night. This case highlights a potential therapeutic option for patients with severe respiratory failure secondary to COVID-19. This patient’s pre-existing comorbidities of OSA and PH markedly increased his risk for extubation failure on HFNC. The use of AVAPS after his second extubation attempt helped ensure ventilation and oxygenation non-invasively. COVID-19 can lead to prolonged dependence on mechanical ventilation. This pandemic has the potential to create medical resource scarcities, especially in rural areas where ventilators and trained personnel are already in short supply. By using AVAPS mode, this patient was able to rehabilitate his myopathy and participate in intermittent weaning of HFNC to ultimately simple nasal cannula. AVAPS is useful tool to facilitate extubation, as it allows non-invasive support of respiratory dynamics, particularly in those with co-morbidities such as OSA and PH. Further, larger scale studies are needed to determine its exact role during the COVID-19 pandemic.


id: cord-307070-tqxvu3pu
author: Iqbal, Phool
date: 2020-09-20
url: https://www.ncbi.nlm.nih.gov/pubmed/33101802/
doi: 10.7759/cureus.10555
title:
  Should We Rely on Screening Tests for Further Management Alone in Polymerase Chain Reaction Negative COVID-19 Patients? A Case Series

abstract:
  Since the declaration of coronavirus disease 2019 (COVID-19) disease as a pandemic by the World Health Organization (WHO), it has been a challenge to the whole medical community. Researchers and clinicians have been trying to explain and explore its mechanism and pathophysiology to get a better understanding of this disease, as it has exhausted the healthcare resources and has impacted human life in general. Many tests have been developed including polymerase chain reaction (PCR) of the virus and rapid diagnostic testing in patients based on IgM/IgG serology. But owing to variable sensitivity and specificity of these tests, it has created a challenging situation to proceed with the further management plan. We are reporting a case series where we experienced the dilemma of diagnosing COVID-9 disease in our patients and further plan of care.


id: cord-307306-ju0vcalk
title: Upholding Scientific Duty Amidst Poisonous Disinformation
author: Barbosa, Daniel A. N.
date: 2020-07-22
url: https://www.ncbi.nlm.nih.gov/pubmed/32850213/
doi: 10.7759/cureus.9339
abstract:
  Because of a recent politically-biased Lancet editorial, the world’s opinion has been directed against the Brazilian government over the rising numbers of COVID-19 cases in the country. This is an example of reporting data without accounting for important covariates. Epidemiological figures should always be corrected for population size. In fact, Brazil is not even on the list of the 10 countries with the highest number of deaths per 100,000 people. Belgium, the United Kingdom, and Spain are the most affected countries in this regard. The disinformation presented by a renowned medical journal has ignited severe criticisms against a Chief-of-State for not promoting a generalized lockdown in a country of continental size. As scientists, we have a duty to stress the caveats of science instead of fueling political attacks, and we should refrain from jumping to uninformed conclusions without considering well-analyzed data. Moreover, while there is no evidence to endorse the efficacy of a generalized lockdown in socioeconomically vulnerable populations, it is undoubtedly associated with severe nationwide adverse effects.


id: cord-307357-qm456cik
author: Ulloa, Nicolas
date: 2020-09-21
txt: ./txt/cord-307357-qm456cik.txt
cache: ./cache/cord-307357-qm456cik.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10577
doi: 10.7759/cureus.10577
summary:
  Patients may lack well-known risk factors such as intravenous drug use, previous history of IE, and prosthetic heart valves, which can make it more difficult to consider in the differential diagnosis, especially during the influenza season and novel coronavirus disease 2019 (COVID-19) pandemic in which there is an abundance of patients presenting with flu-like illness. Obtaining timely blood cultures and administering appropriate empiric antibiotics in the ED coupled with early transthoracic/transesophageal echocardiogram (TTE/TEE) are essential to guiding therapy once the patient is admitted to the hospital. A high index of suspicion is required, especially in patients with additional findings such as splenic abscess, embolic phenomenon, focal neurologic deficit, mycotic aneurysm, decompensated heart failure, new murmurs, or pleural effusions. A high index of suspicion is required, especially in patients with additional findings such as splenic abscess, embolic phenomenon, focal neurologic deficit, mycotic aneurysm, decompensated heart failure, new murmurs, or pleural effusions.

title:
  A Clinical Challenge in the Emergency Department: A Case of Klebsiella Infective Endocarditis Presenting With Splenic Abscess

abstract:
  Infective endocarditis (IE) is a serious bacterial infection of the endocardium and/or heart valves that carries considerable morbidity and mortality. Often presenting with very non-specific symptoms, this disease presents many challenges to the emergency medicine practitioner. A 47-year-old male with no pertinent medical history presented to the emergency department complaining of shortness of breath. He stated that his symptoms had been persistent for the last three weeks and were associated with malaise and fatigue. CT of the abdomen/pelvis with IV contrast revealed a 7-cm hypodensity of the spleen concerning for abscess versus infarct. He denied any trauma or IV drug use. Follow-up ultrasound was ordered, which characterized the hypodensity as a splenic abscess. An echocardiogram was recommended for possible IE, and cardiology was consulted. The transthoracic echocardiogram was performed on hospital day 2, which showed minimal mitral valve thickening with mild mitral regurgitation. The interventional radiology (IR) service was consulted for the splenic abscess in order to perform CT-guided drainage. An IR drain was successfully placed on hospital day 3. On the same day, blood cultures grew Klebsiella pneumoniae. On hospital day 5, that patient was transferred to the ICU for possible empyema formation with signs of respiratory distress. The patient underwent CT of the chest that showed the development of a left-sided effusion. The patient had also been persistently tachycardic and febrile, with high leukocytosis since admission and worsening respiratory status. Transesophageal echocardiogram (TEE) was scheduled but put on hold due to worsening respiratory status. Repeat TEE was scheduled five days later, which showed mitral regurgitation and increased size of the vegetation despite antibiotic therapy. Two days later, he was scheduled for mitral valve repair. When reviewing our case, the patient had both common and uncommon aspects of splenic abscess or IE. First, despite having respiratory symptoms for two weeks, the primary reason he came to the hospital was due to the new onset of fevers. He was febrile, tachycardic, and with significant leukocytosis. He continued to have fevers despite antibiotic therapy and IR drainage of the abscess. With no history of IV drug use history, negative transthoracic echocardiography, lack of immunocompromising condition, and blood cultures with gram-negative rods, IE became less likely of a diagnosis. Establishing the diagnosis of IE proved to be exceptionally complicated, especially in the setting of a COVID-19 pandemic. The most notable challenge was having a high index of suspicion despite any risk factors. The patient was a previously healthy 47-year-old male with no medical problems. IE continues to be a clinical challenge for physicians, especially in the emergency department, due to the lack of diagnostic criteria such as positive blood cultures or vegetations visualized on echocardiographic studies. IE has a wide gamut of presentations with different levels of acuity. Diagnosis is more straightforward when patients present with obvious risk factors, but, in many cases, such as this one, those risk factors may be absent. A high index of suspicion is required, especially in patients with additional findings such as splenic abscess, embolic phenomenon, focal neurologic deficit, mycotic aneurysm, decompensated heart failure, new murmurs, or pleural effusions.


id: cord-307489-2liu4anc
author: Elavia, Nasha
date: 2020-05-23
txt: ./txt/cord-307489-2liu4anc.txt
cache: ./cache/cord-307489-2liu4anc.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32596069/
doi: 10.7759/cureus.8249
summary:
  title: An Atypical Presentation of Acute Pulmonary Embolism With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pneumonia Clinical presentation and severity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) varies greatly amongst patients, as supported by recent literature. Here, we would like to describe a case of acute bilateral pulmonary embolism (PE) presenting with atypical gastrointestinal symptoms in a patient with SARS-CoV-2 infection. This atypical presentation of PE is unique to our case and highlights the significance of a high index of clinical suspicion for SARS-CoV-2 and its associated thrombogenic effect, even in patients with atypical symptoms. Here, we would like to describe a case of acute bilateral pulmonary embolism (PE) in a patient with SARS-CoV-2 pneumonia who mainly presented with gastrointestinal symptoms. Our patient however presented mainly with gastrointestinal symptoms, which have been reported with SARS-CoV-2; however, with significant hypoxia in the absence of a respiratory viral syndrome although with a low pretest probability for PE, we decided to further evaluate the patient for hypoxia.

title:
  An Atypical Presentation of Acute Pulmonary Embolism With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pneumonia

abstract:
  Clinical presentation and severity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) varies greatly amongst patients, as supported by recent literature. This poses an ongoing challenge in the diagnostic and therapeutic approach for managing these patients. Here, we would like to describe a case of acute bilateral pulmonary embolism (PE) presenting with atypical gastrointestinal symptoms in a patient with SARS-CoV-2 infection. This atypical presentation of PE is unique to our case and highlights the significance of a high index of clinical suspicion for SARS-CoV-2 and its associated thrombogenic effect, even in patients with atypical symptoms.


id: cord-307697-ds4uw7y1
author: Ahmed, Jawad
date: 2020-06-10
txt: ./txt/cord-307697-ds4uw7y1.txt
cache: ./cache/cord-307697-ds4uw7y1.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8550
doi: 10.7759/cureus.8550
summary:
  Whereas, doctors in Pakistan reported to have poor availability of PPE with only 37.4% having access to masks/N95 respirator, 34.5% to gloves, 13.8% to face-shields or goggles, and 12.9% to full-suit/gown. Whereas, doctors in Pakistan reported to have poor availability of PPE with only 37.4% having access to masks/N95 respirator, 34.5% to gloves, 13.8% to face-shields or goggles, and 12.9% to full-suit/gown. In contrast, doctors in Pakistan reported to have poor availability of PPE with only 37.4% (n = 130) having access to masks/N95 respirator, 34.5% (n = 120) to gloves, 13.8% (n = 48) to face-shields or goggles, and 12.9% (n = 44) to full-suit/gown. In our study, 73% of doctors from Pakistan and 58.4% from the US reported that HCWs in their hospitals had been infected with COVID-19. To conclude, there is a shortage of PPE in hospitals of the US and Pakistan due to COVID-19 and doctors are feeling scared working without adequate protection in the pandemic situation.

title:
  Availability of Personal Protective Equipment (PPE) Among US and Pakistani Doctors in COVID-19 Pandemic

abstract:
  Background The coronavirus disease (COVID-19) pandemic has put an excessive strain on healthcare systems across the globe, causing a shortage of personal protective equipment (PPE). PPE is a precious commodity for health personnel to protect them against infections. We investigated the availability of PPE among doctors in the United States (US) and Pakistan. Methods A cross-sectional study, including doctors from the US and Pakistan, was carried out from April 8 to May 5, 2020. An online self-administered questionnaire was distributed to doctors working in hospitals in the US and Pakistan after a small pilot study. All analysis was done using Statistical Package for Social Science (SPSS) version 23.0 (IBM Corp., Armonk, NY). Results After informed consent, 574 doctors (60.6% from Pakistan and 39.4% from the US) were included in the analysis. The majority of the participants were females (53.3%), and the mean age of the participants was 35.3 ± 10.3 years. Most doctors (47.7%) were from medicine and allied fields. Among the participants, 87.6% of doctors from the US reported having access to masks/N95 respirators, 79.6% to gloves, 77.9% to face-shields or goggles, and 50.4% to full-suit/gown. Whereas, doctors in Pakistan reported to have poor availability of PPE with only 37.4% having access to masks/N95 respirator, 34.5% to gloves, 13.8% to face-shields or goggles, and 12.9% to full-suit/gown. The reuse of PPE was reported by 80.5% and 60.3% physicians from the US and Pakistan, respectively. More doctors from Pakistan (50.6%) reported that they had been forced to work without PPE compared to doctors in the US (7.1%). Conclusion There is a lack of different forms of PPE in the US and Pakistan. Doctors from both countries reported that they had been forced to work without PPE. Compared to the US, more doctors from Pakistan reported having faced discrimination in receiving PPE.


id: cord-307716-ffoiv1ma
title: Clavicular Osteomyelitis Secondary to Candida Parapsilosis Infection
author: Ranjit, Eukesh
date: 2020-06-19
txt: ./txt/cord-307716-ffoiv1ma.txt
cache: ./cache/cord-307716-ffoiv1ma.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8699
doi: 10.7759/cureus.8699
summary:
  Management of Candidal osteomyelitis with surgical debridement and antifungal therapy is recommended by the Infectious Disease Society of America (IDSA) based on anecdotal case reports and open-label series [5] . The patient presented with pain and swelling of the right upper chest, which was found to be caused by fungal clavicular infection with Candida parapsilosis. The patient had a past medical history of diabetes mellitus type II, morbid obesity (body mass index of 47.4), obstructive sleep apnea on bilevel positive airway pressure (BiPAP), chronic obstructive pulmonary disease (COPD), major depressive disorder, fibromyalgia, hepatitis C secondary to intravenous drug use (IVDU), polysubstance abuse on suboxone maintenance therapy, anxiety disorder, closed body fracture of the sternum, and sternal osteomyelitis. Although the patient was not HIV-positive, he did have underlying health conditions and had undergone treatments associated with fungal osteomyelitis and diabetes, and had a history of IVDU and broad-spectrum antibiotic use [10] .

abstract:
  Candida parapsilosis osteomyelitis is a rare diagnosis. Candidal infection can occur via hematogenous or local spread. A localized swelling around a bony structure should raise clinical suspicion. Diagnosis is made by a combination of imaging modalities and biopsy. Anecdotal case reports have been reported in medical literature and treatment guidelines are very limited. Treatment modality includes a combination of surgical debridement and antifungal therapy.


id: cord-310738-fnsf2qqm
title: Micronutrients in COVID-19 Positive Pregnancies
author: Yalcin Bahat, Pinar
date: 2020-09-23
txt: ./txt/cord-310738-fnsf2qqm.txt
cache: ./cache/cord-310738-fnsf2qqm.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32983745/
doi: 10.7759/cureus.10609
summary:
  The aim of this study was to measure serum 25(OH)D, vitamin B12, and zinc levels in COVID-19 positive pregnant women to evaluate the role of these micronutrients in treatment and prevention. The aim of this study was to measure serum 25(OH)D, vitamin B12, and zinc levels in COVID-19 positive pregnant women to evaluate the role of these micronutrients in the prevention and to evaluate the possible cause between the blood levels of micronutrients and the COVID-19 infection. Pregnant women whose PCR test was positive for COVID-19, pregnancies older than eight weeks of gestation, and women who did not receive any antibacterial or antiviral treatment during the past three months or did not receive any 25(OH)D, vitamin B12, and zinc supplements during their pregnancy were included in the study. Additionally, it has been shown that serum zinc levels correlate positively with better immune response in pregnant women against infections [17] .

abstract:
  Pregnant women are considered among the high-risk population for COVID-19. Therefore, research for methods of treatment and prevention of COVID-19 positive pregnancies carries an importance. The aim of this study was to measure serum 25(OH)D, vitamin B12, and zinc levels in COVID-19 positive pregnant women to evaluate the role of these micronutrients in treatment and prevention. A total of 44 COVID-19 positive pregnant women who were hospitalized and treated at a tertiary clinic were included in this study. The mean serum 25(OH)D level was measured to be 9.70 ± 59.14. The mean serum zinc level was 62.58 ± 2.63, and the mean serum vitamin B12 level was 295.55 ± 302.48. All these variables were significantly lower than the accepted cut-off values (p < 0.001). These low values might have contributed to a deficiency in their immune response and thus made these patients susceptible to COVID-19 infection. Supplementation of micronutrients during the pandemic could be beneficial during pregnancy for prevention.


id: cord-311043-nidu7om2
author: Erdinc, Burak
date: 2020-08-15
url: https://www.ncbi.nlm.nih.gov/pubmed/32953290/
doi: 10.7759/cureus.9772
title:
  Spontaneous Retroperitoneal Bleed Coincided With Massive Acute Deep Vein Thrombosis as Initial Presentation of COVID-19

abstract:
  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that has caused a global pandemic and unfortunately has caused a health crisis. When severe, coronavirus disease 2019 (COVID-19) can manifest with bilateral pneumonia and hypoxemic respiratory failure but also can affect different organ systems. SARS-CoV-2 infection is known to cause a hypercoagulable state resulting in acute thrombotic events, including venous thromboembolism, acute myocardial infarction, acute stroke, acute limb ischemia, and clotting of ECMO (extracorporeal membrane oxygenation) and CRRT (continuous renal replacement therapy) catheters. Even though it commonly causes thrombotic complications, bleeding complications of COVID-19 due to coagulopathy and use of anticoagulation are less commonly reported. We herein present a case of a patient with COVID-19 complicated by spontaneous retroperitoneal bleeding and massive deep vein thrombosis (DVT), which was later complicated by compartment syndrome. To the best of our knowledge, coexistence of spontaneous bleeding with massive DVT has not been reported in the current literature. This case emphasizes that COVID-19 induced hypercoagulable state can cause massive thrombosis, and patients might need anticoagulation therapy. However, clinicians should also consider the risk of hemorrhagic complications of the disease and be cautious when administering anticoagulant therapy in selected cases.


id: cord-311676-pzatzadw
title: An Observational Study of Vaping Knowledge and Perceptions in a Sample of U.S. Adults
author: Bellisario, Alexandra
date: 2020-06-24
url: https://doi.org/10.7759/cureus.8800
doi: 10.7759/cureus.8800
abstract:
  Background Vaping is the use of e-cigarettes that contain inhalants such as nicotine, tetrahydrocannabinol, and cannabidiol. Vaping is associated with e-cigarette or vaping product use associated lung injury (EVALI) and is a recognized public health crisis. Despite rising numbers of hospitalizations due to EVALI, public knowledge and perceptions of the dangers of vaping require further investigation. Objectives This exploratory study assessed knowledge and perceptions of vaping in U.S. adults. Methods This study was approved by an ethical board, and informed consent was obtained from all participants. A cohort of U.S. adults was recruited by shared links on social media. Participants completed an anonymous online survey that contained vaping knowledge and perceptions items. An a priori power analysis was conducted at 95% power and alpha = 0.05. Statistics were calculated using IBM SPSS Statistics Version 26 (IBM Corp., Armonk, NY, USA). Results A sample of 413 (N = 413) U.S. adults participated in the survey. The majority of participants (79.18%) were females, and 65.62% were between 18 and 24 years of age. Over half (62.71%) of participants were never asked about vaping use by a clinician at any visit, and 56.51% agreed that vaping can reduce stress. Of all participants, 70.91% agreed that drinking alcohol makes someone more inclined to vape. Significant positive Spearman’s rho correlations were found between vaping and the use of cannabis, cocaine, ecstasy, hallucinogens, and inhalants (p < 0.05). Conclusions We found a significant correlation between vaping and drug use. We also found that if the dangers of vaping are discussed by their health care providers, participants are more inclined to quit vaping. Unfortunately, many physicians report that they avoid discussing vaping with their patients due to lack of vaping knowledge. Our results illuminate the communication gap between patients and physicians. All clinicians need to counsel patients on the dangers of vaping, which might help prevent EVALI and related conditions.


id: cord-314216-xx5xbjqu
author: Malik, Talia
date: 2020-04-10
url: https://www.ncbi.nlm.nih.gov/pubmed/32399354/
doi: 10.7759/cureus.7621
title:
  COVID-19 and the Efficacy of Different Types of Respiratory Protective Equipment Used by Health Care Providers in a Health Care Setting

abstract:
  Coronavirus, the virus that caused the global pandemic at the beginning of 2020 and affected millions across the globe, presented as an enormous challenge to health care providers around the world. With increasing numbers of infected patients presenting daily, health care workers are struggling to take effective measures to protect themselves from transmission against the highly contagious coronavirus. This case helps us understand the implications of coronavirus-infected patients on the health care providers directly responsible for the management of these patients and the relative efficacy of different types of respiratory protective equipment mainly N95 masks and surgical masks in preventing the spread of infection among those at the front lines providing care.


id: cord-314507-fgrvrlht
author: Sule, Harsh
date: 2020-03-27
txt: ./txt/cord-314507-fgrvrlht.txt
cache: ./cache/cord-314507-fgrvrlht.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32351813/
doi: 10.7759/cureus.7433
summary:
  Objective To determine the impact of Level C personal protective equipment (PPE) on the time to perform intravenous (IV) cannulation and endotracheal intubation, both with and without the use of adjuncts. Methods This prospective, case-control study of emergency medicine resident physicians was designed to assess the time taken by each subject to perform endotracheal intubation using both direct laryngoscopy (DL) and video laryngoscopy (VL), as well as peripheral IV cannulation both with and without ultrasound guidance and with and without PPE. Our primary objective was to determine the impact of Level C PPE on the time to perform intravenous cannulation and endotracheal intubation, both with and without the use of adjuncts. studied 40 emergency physicians (residents) with and without Level C PPE and found no difference in the mean time to successful endotracheal intubation (17.86 sec vs.

title:
  Maintenance of Skill Proficiency for Emergency Skills With and Without Adjuncts Despite the Use of Level C Personal Protective Equipment

abstract:
  Objective To determine the impact of Level C personal protective equipment (PPE) on the time to perform intravenous (IV) cannulation and endotracheal intubation, both with and without the use of adjuncts. Methods This prospective, case-control study of emergency medicine resident physicians was designed to assess the time taken by each subject to perform endotracheal intubation using both direct laryngoscopy (DL) and video laryngoscopy (VL), as well as peripheral IV cannulation both with and without ultrasound guidance and with and without PPE. Results While median times were higher using VL as compared to DL, there was no significant difference between intubation with either DL or VL in subjects with and without Level C PPE. Similarly, no significant difference in time was found for intravenous cannulation in the PPE and no-PPE groups, both with and without ultrasound guidance. Conclusions Existing skill proficiency was maintained despite wearing PPE and there was no advantage with the addition of adjuncts such as video-assisted laryngoscopy and ultrasound-guided intravenous cannulation. A safe and cost-effective strategy might be to conduct basic, just-in-time PPE training to enhance familiarity with donning, doffing, and mobility, and couple this with the use of personnel who have maximal proficiency in the relevant emergency skill, instead of more expensive, continuous, skills-focused PPE training.


id: cord-317863-xf0bn3cv
author: Pata, Ramakanth
date: 2020-08-18
txt: ./txt/cord-317863-xf0bn3cv.txt
cache: ./cache/cord-317863-xf0bn3cv.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.9857
doi: 10.7759/cureus.9857
summary:
  The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, originated in Wuhan, China, and spread rapidly throughout the world, infecting millions and killing thousands. Additionally, it has a high incubation period (average 6.4 and range of 0-24 days) [2] , reproductive number (R0 ranged from 1.4 to 6.49, with a mean of 3.28) [3] , and reports have shown that the majority of patients are asymptomatic or have a mild response to the SARS-CoV-2 virus but release large amounts of viruses [2] . Furthermore, a chest X-ray showed no acute pathologies (Figure 3) , and the COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCT) was performed due to the recent outbreak of the SARS-CoV-2 virus, which came back positive. Other reports suggest a higher rate of cerebrovascular disease (mainly ischemic stroke) in severe COVID-19 patients as compared to non-severe cases [5] .

title:
  Probability of COVID-19 Being the Culprit in Neurocognitive Deception: A Case Series of Incidental Strokes in ICU Patients With COVID-19

abstract:
  The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, originated in Wuhan, China, and spread rapidly throughout the world, infecting millions and killing thousands. Although some patients have mild or even asymptomatic responses to this infection, hospitalized patients present with symptoms such as fever, cough, and difficulty breathing. Some patients have a severe response to the insult and experience rapid progression to acute respiratory distress and multiorgan failure. Furthermore, many patients developed complications due to this infection. Here, we present three patients who had strokes during their hospitalization for COVID-19 pneumonia.


id: cord-317906-u5z5cpfk
title: Atypical Neurological Manifestations of COVID-19
author: Gupta, Ishita
date: 2020-06-08
txt: ./txt/cord-317906-u5z5cpfk.txt
cache: ./cache/cord-317906-u5z5cpfk.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8518
doi: 10.7759/cureus.8518
summary:
  The novel coronavirus (SARS-CoV-2), belonging to a group of RNA-enveloped viruses and believed to be transmitted by aerosol route, is a worldwide pandemic. However, to our knowledge, there are minimal studies on the neurological manifestations in SARS-CoV-2 positive patients. Our review aims to identify the various neurological manifestations in SARS-CoV-2 positive patients, which could be an added advantage in the early diagnosis and prevention of further complications of the nervous system. Other non-neurological symptoms were diarrhea, anorexia, myalgia, sore throat, dyspnea, chest pain, fatigue, headache, arthralgia, nausea, and vomiting (see Figure 2 and Table 3 ) [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] . The presentation of olfactory symptoms in SARS-CoV-2-affected patients is due to the fact that the illness spreads through the cribriform plate, which is in close proximity to the olfactory region [30] . Neurological manifestations in COVID-19 caused by SARS-CoV-2

abstract:
  The novel coronavirus (SARS-CoV-2), belonging to a group of RNA-enveloped viruses and believed to be transmitted by aerosol route, is a worldwide pandemic. Many studies have described typical clinical manifestations such as fever, cough, fatigue, diarrhea, and nasal congestion. However, to our knowledge, there are minimal studies on the neurological manifestations in SARS-CoV-2 positive patients. Our review aims to identify the various neurological manifestations in SARS-CoV-2 positive patients, which could be an added advantage in the early diagnosis and prevention of further complications of the nervous system.


id: cord-317915-0javg3m8
author: Kumar, Jagdesh
date: 2020-04-20
url: https://www.ncbi.nlm.nih.gov/pubmed/32455057/
doi: 10.7759/cureus.7737
title:
  Knowledge, Attitude, and Practices of Healthcare Workers Regarding the Use of Face Mask to Limit the Spread of the New Coronavirus Disease (COVID-19)

abstract:
  Introduction Many countries including Pakistan are currently using face masks in their pandemic control plans. Being highly prevalent, the correct use of these masks is particularly important, as an incorrect use and disposal may actually increase the rate of transmission. The purpose of this study was to investigate the knowledge, attitude, and practices of healthcare workers (HCWs) in wearing a surgical face mask to limit the spread of the new coronavirus disease 2019 (COVID-19). Materials and Methods This survey was conducted by interviewing HCWs using a questionnaire consisting of the basic demographic characteristics, and the knowledge, attitude, and practices regarding the use of surgical face mask to limit the new COVID-19 exposure. Each correct answer was scored 1 and each incorrect answer scored 0. The total number of questions was 16, and the final score was calculated and then labeled according to the percentage (out of 16) of correct responses as good (>80%), moderate (60-80%), and poor (<60%). Results A total of 392 participants with a mean age of 42.37 ± 13.34 years (341 males and 51 females) were included in the study. The overall final results were good in 138 (35.2%), moderate in 178 (45.4%), and poor in 76 (19.3%). Around 43.6% of participants knew about the correct method of wearing the masks, 68.9% knew that there are three layers, 53% stated that the middle layer act as a filter media barrier, and 75.5% knew the recommended maximum duration of wearing it. The majority (88.2%) of participants knew that a cloth face mask is not much effective, around 79.8% knew that used face mask cannot be re-used, and 44.8% knew about the yellow-coded bag for disposal. Conclusions Knowledge, attitude, and practice of HCWs regarding the use of face masks were found to be inadequate. Studied HCWs had a positive attitude but moderate-to-poor level of knowledge and practice regarding the use of face mask. HCWs and general public awareness campaigns regarding the proper use of face mask by utilizing all social media available resources would be helpful during this pandemic.


id: cord-318321-jfpbkntx
author: Parashar, Bhupesh
date: 2020-05-18
txt: ./txt/cord-318321-jfpbkntx.txt
cache: ./cache/cord-318321-jfpbkntx.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8190
doi: 10.7759/cureus.8190
summary:
  We focus on three scenarios of cancer care: 1) radiation therapy as an alternative to surgery when immediate surgery is not possible, 2) radiation therapy as a ''bridge'' to surgery, and 3) radiation options definitively or postoperatively, given the risk of hospitalization with high-dose chemotherapy. In this review, we discuss radiation therapy (RT) options for cancer patients in three settings: 1) RT as an alternative to surgery when immediate surgery is not possible, 2) RT as a ''bridge'' to surgery and 3), radiation options definitively or postoperatively, given the risk of hospitalization with high-dose chemotherapy. If the risk of hospitalization is high, a different approach should be used: 1) sequential chemotherapy and radiation, 2) reduction of chemotherapy dose, 3) use of a less toxic concurrent systemic or targeted therapy, or 4) RT alone with an option of altered fractionation to compensate for lack of chemotherapy.

title:
  Disease Site-Specific Guidelines for Curative Radiation Treatment During ‘Limited Surgery’ and ‘Hospital Avoidance’: A Radiation Oncology Perspective From the Epicenter of COVID-19 Pandemic

abstract:
  The COVID-19 pandemic has resulted in an unprecedented situation where the standard of care (SOC) management for cancers has been altered significantly. Patients with potentially curable cancers are at risk of not receiving timely SOC multidisciplinary treatments, such as surgery, chemotherapy, radiation therapy, or combination treatments. Hospital resources are in such high demand for COVID-19 patients that procedures, such as surgery, dentistry, interventional radiology, and other ancillary services, are not available for cancer patients. Our tertiary care center is considered the center of the epicenter in the USA. As a result, all non-emergent surgeries have been suspended in order to provide hospital beds and other resources for COVID-19 patients. Additionally, ambulatory efforts to avoid treatment-related morbidity are critical for keeping patients out of emergency departments and hospitals. In this review article, we discuss evidence-based radiation therapy approaches for curable cancer patients during the COVID-19 pandemic. We focus on three scenarios of cancer care: 1) radiation therapy as an alternative to surgery when immediate surgery is not possible, 2) radiation therapy as a ‘bridge’ to surgery, and 3) radiation options definitively or postoperatively, given the risk of hospitalization with high-dose chemotherapy.


id: cord-318520-hgjv7ot9
title: Death due to Cardiac Arrest in a Young Female With Highly Suspected COVID-19: A Case Report
author: Mohamed, Sherif
date: 2020-08-30
url: https://doi.org/10.7759/cureus.10127
doi: 10.7759/cureus.10127
abstract:
  Despite the common clinical presentations of the pandemic coronavirus disease of 2019 (COVID-19) being well-known, there remain issues on its atypical or rare presentations. Moreover, despite the known risk factors for severe COVID-19 are cardiovascular disease, diabetes mellitus, hypertension, chronic lung disease, and advanced age, still younger patients suffer from this disease. Herein, we present a case report of a 28-year-old female patient who was presented to the ED with cardiac arrest, then died within 12 hours. First swab testing by reverse transcription-polymerase chain reaction (RT-PCR) came negative. However, she has typical CT features of COVID-19 pneumonia, along with an echocardiographic picture of acute cor pulmonale. Though it is rare, cardiac arrest can happen in young apparently healthy patients with COVID-19. As COVID-19 patients are commonly having clotting disorders, endothelial and organ dysfunction, coagulopathy, and liable for pulmonary thromboembolism (PTE), it is important to select those COVID-19 patients who are at higher risk of PTE, and practice CT pulmonary angiography (CTPA) for the diagnosis of PTE, especially in case of significant increase of D-dimer values.


id: cord-318660-47dqa1dd
title: Efficacy and Use of Cloth Masks: A Scoping Review
author: Jain, Mehr
date: 2020-09-13
txt: ./txt/cord-318660-47dqa1dd.txt
cache: ./cache/cord-318660-47dqa1dd.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10423
doi: 10.7759/cureus.10423
summary:
  Cloth masks have limited inward protection in healthcare settings where viral exposure is high but may be beneficial for outward protection in low-risk settings and use by the general public where no other alternatives to medical masks are available. Although guidelines from the World Health Organization (WHO) and Centre for Disease Control and Prevention (CDC) suggest various strategies to optimize the supply of PPE in healthcare settings [4, 7] , there are limited data on alternatives to surgical masks. In the current COVID-19 pandemic, Chinese recommendations on face mask use in community settings suggest that cloth masks could be used in a very low-risk population to prevent the spread of disease [13] . This review aims to integrate current studies and guidelines to determine the efficacy of cloth masks as both inward and outward protective equipment and whether they can be used in healthcare settings and/or the community in light of the PPE shortage.

abstract:
  During the coronavirus disease 2019 (COVID-19) pandemic, there has been a global shortage of personal protective equipment (PPE). In this setting, cloth masks may play an important role in limiting disease transmission; however, current literature on the use of cloth masks remains inconclusive. This review aims to integrate current studies and guidelines to determine the efficacy and use of cloth masks in healthcare settings and/or the community. Evidence-based suggestions on the most effective use of cloth masks during a pandemic are presented. Embase, MEDLINE, and Google Scholar were searched on March 31, 2020, and updated on April 6, 2020. Studies reporting on the efficacy, usability, and accessibility of cloth masks were included. Additionally, a search of guidelines and recommendations on cloth mask usage was conducted through published material by international and national public health agencies. Nine articles were included in this review after full-text screening. The clinical efficacy of a face mask is determined by the filtration efficacy of the material, fit of the mask, and compliance to wearing the mask. Household fabrics such as cotton T-shirts and towels have some filtration efficacy and therefore potential for droplet retention and protection against virus-containing particles. However, the percentage of penetration in cloth masks is higher than surgical masks or N95 respirators. Cloth masks have limited inward protection in healthcare settings where viral exposure is high but may be beneficial for outward protection in low-risk settings and use by the general public where no other alternatives to medical masks are available.


id: cord-318787-z6q11loy
author: Ahmad, Naim
date: 2020-09-14
txt: ./txt/cord-318787-z6q11loy.txt
cache: ./cache/cord-318787-z6q11loy.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33072460/
doi: 10.7759/cureus.10452
summary:
  This paper attempts to utilize the modified Susceptible-Exposed-Infectious-Recovered (SEIR) model incorporating the SD, testing, and infectiousness of exposed and infectious compartments to study the COVID-19 pandemic in Saudi Arabia. To study the dynamics of the COVID-19 epidemic, several modified SEIR models have been used to incorporate various measures, especially social distancing, testing, public responses, and mobility restrictions [2, [6] [7] [8] [9] . The objective of this paper is to model the COVID-19 pandemic in Saudi Arabia using SEIR, including SD, testing, and the infectiousness of exposed and infectious populations. Similarly, the cumulative active cases that include exposed and infectious populations fit closely and the Levene test (statistic=0.5088, p-value=0.4758) proves the same. The model results in the current scenario of restrictions and testings depict that there are multiple peaks for active cases (Figure 3) .

title:
  COVID-19 Modeling in Saudi Arabia Using the Modified Susceptible-Exposed-Infectious-Recovered (SEIR) Model

abstract:
  The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented healthcare emergencies across the globe. The World Health Organization (WHO) has proposed social distancing (SD) as a prudent measure to contain the pandemic and, hence, governments have been enacting lockdowns of varied nature. These lockdowns, causing economic and social strain, warrant the development of quantitative models to optimally manage the pandemic. Similarly, extensive testing aids in early detection and isolation, hence containing the spread of the pandemic. Compartment epidemiology models have been used extensively in modeling such infectious diseases. This paper attempts to utilize the modified Susceptible-Exposed-Infectious-Recovered (SEIR) model incorporating the SD, testing, and infectiousness of exposed and infectious compartments to study the COVID-19 pandemic in Saudi Arabia. Saudi Arabia has put restrictions on the movement of people in different phases to ascertain SD. Time-dependent parameters based on the timeline of restrictions and testing in Saudi Arabia have been introduced to capture SD and testing. The arrived model has been validated through statistical tests. The [Formula: see text] (R naught), basic reproduction number, value has ranged between 0.6014 and 2.7860 with an average of 1.4904 and currently holds at 0.8952. In the absence of SD and testing measures, the model predicts the threshold herd immunity to be 69.31% and [Formula: see text] value as 3.26. Further, scenario analysis has been conducted for alleviating the SD measure. The results show that early lifting of all restrictions may undo all efforts in the containment of the COVID-19 pandemic. The outcome of results will help policymakers and medical practitioners prepare better to manage the pandemic and lockdown.


id: cord-320656-5gu6ejul
author: Moran, Joseph V
date: 2020-09-16
txt: ./txt/cord-320656-5gu6ejul.txt
cache: ./cache/cord-320656-5gu6ejul.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10492
doi: 10.7759/cureus.10492
summary:
  In this case series, we analyzed nine patients from across our institution who were intubated to manage acute respiratory distress syndrome (ARDS) secondary to COVID-19 and subsequently developed post-extubation stridor. Our analysis suggests that prophylactic corticosteroids given in the 24-48 hours prior to elective extubation in female COVID-19 patients who were intubated for more than six days with consecutive days of intermittent prone ventilation may be helpful in reducing the incidence of post-extubation stridor in this population. In this case series, we present nine patients who required mechanical ventilation for acute respiratory distress syndrome (ARDS) secondary to COVID-19 and later developed post-extubation stridor. The patients presented in this case series possessed some of the well-described risk factors for the development of post-extubation stridor, specifically prolonged mechanical ventilation (9/9 were >8 days), obesity (6/9 had BMI >26.5), and female gender (7/9) [3] .

title:
  Post-Extubation Stridor Complicating COVID-19-Associated Acute Respiratory Distress Syndrome: A Case Series

abstract:
  Post-extubation stridor is a known complication of mechanical ventilation that affects a substantial number of all critical care patients and leads to increased morbidity and mortality. Common risk factors for the development of post-extubation stridor include female gender, older age, and prolonged length of mechanical ventilation. There may be an increased incidence of post-extubation stridor in patients who require mechanical ventilation to manage the respiratory complications of COVID-19. In this case series, we analyzed nine patients from across our institution who were intubated to manage acute respiratory distress syndrome (ARDS) secondary to COVID-19 and subsequently developed post-extubation stridor. The patients were predominantly females with prolonged intubations and multiple days of prone ventilation. While the patients in this case series possessed some of the well-described risk factors for post-extubation stridor, there may be risk factors specific to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that make these patients more susceptible to the complication. The cuff leak test was performed on the majority of patients in the case series and did not successfully predict successful extubation in this population. Our analysis suggests that prophylactic corticosteroids given in the 24-48 hours prior to elective extubation in female COVID-19 patients who were intubated for more than six days with consecutive days of intermittent prone ventilation may be helpful in reducing the incidence of post-extubation stridor in this population. Overall, this case series elucidates the need for exceptionally close monitoring of COVID-19 patients upon extubation for the development of stridor.


id: cord-321461-1s3y9kc5
title: Acute Ischemic and Hemorrhagic Stroke in COVID-19: Mounting Evidence
author: Rajdev, Kartikeya
date: 2020-08-31
txt: ./txt/cord-321461-1s3y9kc5.txt
cache: ./cache/cord-321461-1s3y9kc5.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10157
doi: 10.7759/cureus.10157
summary:
  The novel coronavirus disease of 2019 (COVID-19) is caused by the binding of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) to angiotensin-converting enzyme 2 (ACE2) receptors present on various locations such as the pulmonary alveolar epithelium and vascular endothelium. This case series describes three distinct yet similar scenarios of COVID-19 positive patients with several underlying comorbidities, wherein two of the patients presented to our hospital with sudden onset right-sided weakness, later diagnosed with ischemic stroke, and one patient who developed an acute intracerebral hemorrhage during his hospital stay. A 76-year-old woman with a past medical history of type-II diabetes mellitus, chronic obstructive pulmonary disease (COPD) on nocturnal 3 L/min home oxygen, obstructive sleep apnea on BiPAP (bilevel positive airway pressure) at home, hypertension, and dyslipidemia was diagnosed with COVID-19 infection eight days prior to her admission. Stroke (both ischemic and hemorrhagic) occurring in the setting of COVID-19 is reported to have a worse patient prognosis, with a substantially higher risk of in-hospital mortality [9] .

abstract:
  The novel coronavirus disease of 2019 (COVID-19) is caused by the binding of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) to angiotensin-converting enzyme 2 (ACE2) receptors present on various locations such as the pulmonary alveolar epithelium and vascular endothelium. In COVID-19 patients, the interaction of SARS-CoV-2 with these receptors in the cerebral blood vessels has been attributed to stroke. Although the incidence of acute ischemic stroke is relatively low, ranging from 1% to 6%, the mortality associated with it is substantially high, reaching as high as 38%. This case series describes three distinct yet similar scenarios of COVID-19 positive patients with several underlying comorbidities, wherein two of the patients presented to our hospital with sudden onset right-sided weakness, later diagnosed with ischemic stroke, and one patient who developed an acute intracerebral hemorrhage during his hospital stay. The patients were diagnosed with acute stroke as a complication of COVID-19 infection. We also provide an insight into the possible mechanisms responsible for the life-threatening complication. Physicians should have a low threshold for suspecting stroke in COVID-19 patients, and close observation should be kept on such patients particularly those with clinical evidence of traditional risk factors.


id: cord-322048-m5vbkvju
title: Common CT Findings of Novel Coronavirus Disease 2019 (COVID-19): A Case Series
author: Torkian, Pooya
date: 2020-03-27
txt: ./txt/cord-322048-m5vbkvju.txt
cache: ./cache/cord-322048-m5vbkvju.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32351814/
doi: 10.7759/cureus.7434
summary:
  The common chest CT imaging of confirmed COVID-19 cases is discussed here, which shows ground-glass opacity, crazy paving, and consolidation. The common chest CT imaging of confirmed COVID-19 cases is reported here to aid prompt clinical diagnosis. Axial thin-section unenhanced CT images obtained on March 4, 2020 show crazy paving mostly in the left and right lower lobes of the lung (Figure 2) . Up to the present time, most COVID-19 cases have shown pure GGO and consolidative lesions in 60% of their early chest CT imaging [5, 9] . When radiologists see the common chest imaging findings of this new strain of coronavirus, they can identify COVID-19 cases in a timely manner based on the appropriate epidemiologic and demographic features. Chest CT findings in 2019 novel coronavirus (2019-nCoV) infections from Wuhan, China: key points for the radiologist.

abstract:
  Given the highly infectious nature of the coronavirus disease 2019 (COVID-19) virus and the lack of proven specific therapeutic drugs and licensed vaccines effective against it, early diagnosis of the disease is of paramount importance. The common chest CT imaging of confirmed COVID-19 cases is discussed here, which shows ground-glass opacity, crazy paving, and consolidation.


id: cord-323020-9v44cg3b
author: Khaliq, Maria
date: 2020-07-24
txt: ./txt/cord-323020-9v44cg3b.txt
cache: ./cache/cord-323020-9v44cg3b.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.9373
doi: 10.7759/cureus.9373
summary:
  Objective The objective of the present study is to describe high-resolution CT (HRCT) chest manifestations of coronavirus disease 2019 (COVID-19) patients presenting to a tertiary healthcare facility in Punjab, Pakistan, and to analyze the distribution of the disease in lung fields. Each study was evaluated for the presence of ground-glass opacities (GGOs), consolidation, mixed pattern, distribution, crazy paving, reverse halo sign, nodules, pleural effusion, and other findings. Typical imaging features of COVID-19 on CT chest include ground-glass opacities (GGOs) and consolidation with bilateral and multilobe involvement and basal and peripheral predominance [5] . In this study, we describe the typical imaging features of COVID-19 pneumonia on CT chest in patients presenting to a tertiary care hospital in Punjab, Pakistan, and analyze the distribution of the disease in lung fields. The present study showed that the predominant pulmonary parenchymal pattern for this disease is ground-glass haze/opacity followed by consolidation, as seen in 88.5 and 52.8% of patients respectively.

title:
  An Analysis of High-Resolution Computed Tomography Chest Manifestations of COVID-19 Patients in Pakistan

abstract:
  Objective The objective of the present study is to describe high-resolution CT (HRCT) chest manifestations of coronavirus disease 2019 (COVID-19) patients presenting to a tertiary healthcare facility in Punjab, Pakistan, and to analyze the distribution of the disease in lung fields. Additionally, we assess the role of chest CT severity scoring (CT-SS) in determining the severity of pneumonia. Methods In this cross-sectional descriptive study conducted from March 30, 2020, to May 30, 2020, 87 confirmed COVID-19 patients undergoing HRCT scan in a tertiary care facility in Punjab, Pakistan were included. The HRCT chest was performed on the patients using a standard protocol. Each study was evaluated for the presence of ground-glass opacities (GGOs), consolidation, mixed pattern, distribution, crazy paving, reverse halo sign, nodules, pleural effusion, and other findings. Additionally, CT-SS was calculated by dividing each lung into 20 zones. Each zone was scored as 0, 1, and 2, representing no involvement, <50% involvement, and >50% involvement of one zone respectively (total score: 0-40 for each patient). The patients were classified into mild, moderate, and severe cases (mild: CT-SS of <20, moderate: CT-SS of 20-30, and severe: CT-SS of >30). Results GGO was the most common finding, as seen in 88.5% of the patients, followed by consolidations (52.8%) and crazy paving (33.3%). The majority of the patients showed the bilateral and peripheral distribution of the disease process. Vascular dilatation and bronchiectasis were seen in 10 patients; pleural effusions were observed in only two study patients, while no patient exhibited reverse halo sign or pulmonary nodules. The superior segment of lower lobes was the most commonly involved segment bilaterally. According to CT-SS, 78 (89.6%), six (6.9%), and three (3.45%) patients had mild, moderate, and severe disease respectively. Conclusion The typical imaging findings of COVID-19 on HRCT are GGOs with multilobe involvement and bilateral, peripheral, and basal predominance. CT-SS is helpful in categorizing pneumonia into mild, moderate, and severe types, thereby helping to identify patients with severe disease. This is particularly helpful in settings where fast triage is required.


id: cord-324159-jv3lknl8
author: Ashraf, Muddasir
date: 2020-09-03
txt: ./txt/cord-324159-jv3lknl8.txt
cache: ./cache/cord-324159-jv3lknl8.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10233
doi: 10.7759/cureus.10233
summary:
  We present an interesting case of acute ischemic stroke in a 26-year-old patient with coronavirus disease 2019, who presented to the hospital initially with headache, vomiting, and right-sided numbness and tingling. Unusually large numbers of stroke cases have been reported worldwide in young patients [1, 2] , reinforcing our belief that COVID-19 is a systemic disease that affects not only the lungs but also other vital organs. COVID-19 has been linked to an increased risk of venous thromboembolism and arterial thrombosis, including stroke in case series from different health centers and anecdotal reports. A single health system identified five cases of acute ischemic stroke associated with COVID-19 over two weeks, with symptoms suggesting large-vessel occlusion; all patients were under 50 years of age [1] . The interesting question that arises from this case is whether young patients with COVID-19 have an increased risk of stroke in the presence of PFO, and should prophylactic anticoagulation be initiated to prevent stroke until these patients recover from their illness?

title:
  Acute Stroke in a Young Patient With Coronavirus Disease 2019 in the Presence of Patent Foramen Ovale

abstract:
  We present an interesting case of acute ischemic stroke in a 26-year-old patient with coronavirus disease 2019, who presented to the hospital initially with headache, vomiting, and right-sided numbness and tingling. The initial workup was negative, including computed tomography (CT) of the head without contrast and CT angiography of the head and neck with no acute abnormalities. The patient was diagnosed with migraine and discharged from the emergency department. The patient developed worsening symptoms at home in the form of increasing right-sided dysmetria and weakness, gait ataxia, and dysarthria, prompting her to return to the emergency room. Magnetic resonance imaging of the brain was performed and was significant for right-sided acute ischemic cerebellar stroke, with also the involvement of the right cerebellar peduncle. Echocardiogram with a bubble study demonstrated patent foramen ovale. The patient was treated with standard guidelines for stroke.


id: cord-324565-p3jl1vie
author: Asghar, Muhammad Sohaib
date: 2020-08-05
txt: ./txt/cord-324565-p3jl1vie.txt
cache: ./cache/cord-324565-p3jl1vie.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.9575
doi: 10.7759/cureus.9575
summary:
  This study aims to identify the most effective predictive biomarker such as C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), procalcitonin (PCT), and D-dimer, among others, in predicting the clinical outcome of the disease. Conclusion Inflammatory markers are a useful guide for predicting mortality, and the study results concluded that LDH, PCT, D-dimer, CRP, and ferritin were effective biomarkers. This study aims to identify the roles of these biomarkers (CRP, ferritin, LDH, PCT, and Ddimer), among others, in predicting the severity and clinical outcome during the disease. A study undertaken in Wuhan, China, that evaluated the clinical characteristics of COVID-19 patients also found an important association of CRP with severe disease prognosis. Our study showed that LDH is also significantly increased in patients experiencing a severe course of the disease compared to those with mild infections, thereby demonstrating its role as the most potential biomarker in predicting COVID-19 severity.

title:
  Poor Prognostic Biochemical Markers Predicting Fatalities Caused by COVID-19: A Retrospective Observational Study From a Developing Country

abstract:
  Background and objectives Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are rapidly spreading, posing a serious threat to the health of people worldwide, resulting in the World Health Organization officially declaring it a pandemic. There are several biochemical markers linked with predicting the severity of coronavirus disease. This study aims to identify the most effective predictive biomarker such as C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), procalcitonin (PCT), and D-dimer, among others, in predicting the clinical outcome of the disease. Materials and methods This study was conducted as a retrospective, observational, multi-centric study, including all admitted COVID-19 positive patients only. The disease outcome was followed along with the hospital course of every patient at the time of analysis. Baseline laboratory investigations of all patients were monitored both at admission and discharge. A comparative analysis was done between the survivors (n=263) and non-survivors (n=101). Statistical analysis was conducted using IBM SPSS Statistics for Windows Version 25 (Armonk, NY: IBM Corp.). Results Of 364 patients, 65.7% were in the isolation ward, and 34.3% were in the intensive care unit; 72.3% of patients survived, while 27.7% of patients died. The mean age of the study population was 52.6 ± 15.8 years with female patients significantly younger than male patients (p=0.001) and 50 to 75 years being the most common age group (p=0.121). Among the survivors versus non-survivors of COVID-19, there were significant differences in total leukocyte count (p<0.001), neutrophil count, (p<0.001), lymphocyte count (p<0.001), urea (p<0.001), serum bicarbonate (p=0.001), CRP levels (p<0.001), LDH (p=0.013), and D-dimer (p<0.001) at admission. At discharge, the laboratory values of non-surviving patients showed significant leukocytosis (p<0.001), neutrophilia (p<0.001), lymphocytopenia (p<0.001), decreased monocytes (p<0.001), elevated urea and creatinine (p<0.001), hypernatremia (p<0.001), decreased serum bicarbonate levels (p<0.001), elevated CRP level (p=0.040), LDH (p<0.001), ferritin (p=0.001), and D-dimer (p<0.001). Among the recovered patients, the laboratory investigations at admission were significantly different from those at discharge like increased platelets (p=0.007), lower neutrophil count (p=0.001), higher lymphocyte count (p=0.005), an improved creatinine (p=0.020), higher sodium (p=0.008), increased bicarbonate levels (p<0.001), decreased CRP levels (p<0.001), and a lower LDH (p=0.039). However, the laboratory values of non-surviving patients had shown a lower hemoglobin (p=0.016), increased mean cell volume (p<0.001), significantly increased total leukocyte count (p<0.001), increased urea and creatinine (p<0.001), hypernatremia (p<0.001), increased bicarbonate (p=0.025), elevated D-dimer levels (p=0.043), and elevated PCT (p=0.021) on discharge. Receiver operating characteristic analysis concluded LDH (area under the curve [AUC]: 0.875), D-dimer (AUC: 0.803), and PCT (AUC: 0.769) were superior biomarkers to ferritin (AUC: 0.714) and CRP (AUC: 0.711) in predicting the fatality of COVID-19. Conclusion Inflammatory markers are a useful guide for predicting mortality, and the study results concluded that LDH, PCT, D-dimer, CRP, and ferritin were effective biomarkers.


id: cord-324644-sz5n7a5z
title: Atypical Manifestation of COVID-19-Induced Myocarditis
author: Rehman, Mahin
date: 2020-06-18
txt: ./txt/cord-324644-sz5n7a5z.txt
cache: ./cache/cord-324644-sz5n7a5z.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32577331/
doi: 10.7759/cureus.8685
summary:
  There was a case report that described a patient with COVID-19 with regional wall motion abnormalities who had a biopsy consistent with lymphocytic myocarditis but histopathological and viral genomic polymerase chain reaction (PCR) analysis of the biopsy did not reveal the SARS-CoV-2 viral genome to be present within the myocytes [3] . With this report, we aim to highlight an atypical presentation of COVID-19 (SARS-CoV-2)induced myocarditis as this patient was completely afebrile and had no respiratory symptoms, both of which are typical characteristics. Current consensus around COVID-19-induced myocardial injury is to maintain conservative management especially in those without suspected acute coronary syndrome (ACS) who have mild troponin elevation, as in our young patient. COVID-19-induced myocardial injury can present as a STEMI or non-STEMI (given the evidence of troponin leak) and without concurrent febrile illness or respiratory symptoms of the disease.

abstract:
  We present a case of a 39-year-old male who presented with chest pain without fever or respiratory symptoms. Troponins were elevated and electrocardiogram (ECG) was inconclusive for ST-elevation myocardial infarction (STEMI). Angiography revealed normal coronaries and the patient was found to be coronavirus disease 2019 (COVID-19) positive; he was diagnosed with COVID-19 myocarditis. With the global pandemic, more cases are emerging regarding myocardial injury induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Although COVID-19 manifests primarily as respiratory disease, few cases of cardiac injury without respiratory involvement or febrile illness have been reported. This case illustrates that COVID-19 can present atypically and affect an isolated non-respiratory organ system.


id: cord-325152-ffmo67hm
title: Onset of Ketosis-Prone Diabetes in the Setting of COVID-19 Infection
author: Siddiqui, Raheel S
date: 2020-10-03
txt: ./txt/cord-325152-ffmo67hm.txt
cache: ./cache/cord-325152-ffmo67hm.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33154847/
doi: 10.7759/cureus.10779
summary:
  Several cases of patients infected with coronavirus disease 2019 (COVID-19) presented with severe hyperglycemia along with ketoacidosis or hyperosmolar-hyperglycemic state during their acute phase of illness have been identified [3] . In our case, the patient remained mildly hyperglycemic during the course of his COVID-19 pneumonia; however, he presented with diabetic ketoacidosis six weeks after being discharged. In one study, three patients, who developed ketosis-prone diabetes mellitus immediately after documented viral infection with EBV or coxsackievirus and required insulin therapy on discharge, were followed for four to eight years; the first patient remained insulin-dependent throughout the life, the second one regained normal glucose tolerance, and the third one was being transitioned to oral antidiabetic medications [6] . Patients with COVID-19 infection who presented with diabetic ketoacidosis or hyperosmolar hyperglycemic state during the acute phase of infection have been identified [3, 9] . We reported a case of a young male who developed full-blown ketosis-prone type II diabetes mellitus status post-SARS-CoV-2 infection recovery.

abstract:
  Diabetic ketoacidosis is typically associated with type I diabetes mellitus, but it can be associated with type II diabetes mellitus under the conditions of extreme stress or as a presenting manifestation of ketosis-prone type II diabetes mellitus. A 38-year-old prediabetic male presented to the emergency room with hyperglycemia six weeks after recovery from coronavirus disease 2019 (COVID-19) pneumonia. Laboratory results showed severe hyperglycemia, metabolic acidosis, positive ketones in urine and blood, and elevated fasting C- peptide level. COVID-19 polymerase chain reaction (PCR) was negative, and immunoglobulin G (IgG) antibodies were positive. The workup was completely unremarkable for acute infection. Hemoglobin A1C increased from 6.1% to 10.8% within six weeks. The mechanism by which COVID-19 infection may trigger the onset of full-blown diabetes mellitus remains unknown. Viral infection may cause the direct destruction of pancreatic beta cells or trigger the changes in the body that induce the state of insulin resistance. Antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may cross-react or interfere with the functioning of endogenous insulin. The association between type II diabetes and COVID-19 infections needs additional investigations to ascertain the exact mechanism by which COVID-19 infection triggers the onset of full-blown diabetes mellitus.


id: cord-325531-riftp8g6
title: New-Onset Seizure as the Only Presentation in a Child With COVID-19
author: Bhatta, Sabita
date: 2020-06-25
txt: ./txt/cord-325531-riftp8g6.txt
cache: ./cache/cord-325531-riftp8g6.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8820
doi: 10.7759/cureus.8820
summary:
  We present a child with a new-onset isolated afebrile seizure in coronavirus disease 2019 (COVID-19). Despite being generally mild in children, we have witnessed vague clinical pictures in COVID-19, ranging from asymptomatic in the mildest form to severe respiratory distress [2] . Here, we aim to report an uncommon neurological manifestation, isolated afebrile seizure, in a child with COVID-19. Description of isolated afebrile seizure in COVID-19 is scarce among children, and neurological manifestations have not been extensively studied [6] [7] . Our case highlights seizure as one of the uncommon, but potential presentations of COVID-19 in children. investigated preliminary COVID-19 findings and found one out of 10 infected children with seizures, while others presented predominantly with fever, cough, and diarrhea [10] . As new cases are unfolding each day, it is essential to recognize seizure as a potential COVID-19 presentation in the pediatric age groups.

abstract:
  We present a child with a new-onset isolated afebrile seizure in coronavirus disease 2019 (COVID-19). This patient, an 11-year-old Hispanic male, was brought to our ED in New York city on May 01, 2020, during the ongoing COVID-19 crisis with seizure. There was no fever and/or respiratory and gastrointestinal complaints. His general and systemic examination did not reveal any abnormality. Similarly, his biochemical profiles were within normal limits, and the radiological study, including a chest X-ray and CT scan, showed normal findings. His polymerase chain reaction (PCR) was positive for SARS-CoV2. The patient was admitted for observation after consultation with pediatric neurology, and his condition progressively improved with anti-seizure medications. This case highlights the need for recognizing an uncommon and atypical presentation in COVID-19 as the new cases are unfolding rapidly across the globe.


id: cord-325732-hva5dasd
author: Krawiec, Conrad
date: 2020-06-20
txt: ./txt/cord-325732-hva5dasd.txt
cache: ./cache/cord-325732-hva5dasd.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8726
doi: 10.7759/cureus.8726
summary:
  Methods This retrospective study examined the feasibility of providing a remote formative assessment of third-year medical student video-recorded oral presentation submissions centered on virtual case-based modules over a one-week time period after pediatric clerkship suspension (March 16th to 20th, 2020). This is a feasibility study requesting students to video-record an oral presentation centered on a virtual case-based module for formative assessment during a time period (March 16th, 2020 until March 19th, 2020) when Pennsylvania State College of Medicine third-year medical students were abruptly restricted from providing direct patient care during the pediatric clerkship. Third-year medical students -(1) part of our institution''s traditional curriculum, (2) rotated at the pediatric clerkship''s primary site or off-campus affiliate sites during the first month of the academic year (2020-2021), (3) were abruptly restricted from direct patient care due to the COVID-19 pandemic, and (4) completed a video-recorded oral presentation centered on a virtual case-based module -were included in this study.

title:
  Remote Assessment of Video-Recorded Oral Presentations Centered on a Virtual Case-Based Module: A COVID-19 Feasibility Study

abstract:
  Introduction The coronavirus disease 2019 (COVID-19) pandemic has resulted in the suspension of our pediatric clerkship, which may result in medical student skill erosion due to lack of patient contact. Our clerkship has developed and assessed the feasibility of implementing a video-recorded oral presentation assignment and formative assessment centered on virtual case-based modules. Methods This retrospective study examined the feasibility of providing a remote formative assessment of third-year medical student video-recorded oral presentation submissions centered on virtual case-based modules over a one-week time period after pediatric clerkship suspension (March 16th to 20th, 2020). Descriptive statistics were used to assess the video length and assessment scores of the oral presentations. Results Twelve subjects were included in this study. Overall median assessment score [median score, (25th, 75th percentile)] was 5 (4,6), described as “mostly on target” per the patient presentation rating tool. Conclusion Patient-related activities during the pediatric clerkship were halted during the COVID-19 pandemic. This study demonstrated the possibility of remotely assessing oral presentation skills centered on virtual case-based modules using a patient presentation tool intended for non-virtual patients. This may prepare students for their clinical experiences when COVID-19 restrictions are lifted. Future studies are needed to determine if suspended clerkships should consider this approach.


id: cord-325971-volbaipv
author: Neupane, Karun
date: 2020-06-26
txt: ./txt/cord-325971-volbaipv.txt
cache: ./cache/cord-325971-volbaipv.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8845
doi: 10.7759/cureus.8845
summary:
  Several drugs are being tested in the trials, and the United States Food and Drugs Administration (FDA) has given Emergency Use Authorization (EUA) for remdesivir to treat COVID-19 patients on May 1, 2020 [5] . Therapeutic remdesivir treatment in MERS-CoV inoculated rhesus macaques resulted in the reduction in clinical signs, virus replication, and the absence of lung lesions in 2/6 remdesivirtreated animals along with the reduction in lesion severity in three additional animals. In a randomized controlled clinical trial of 1063 patients conducted by the National Institute of Allergy and Infectious Disease (NIAID), remdesivir has shown the efficacy in the early results against advanced COVID-19 (NCT04280705). In a retrospective observational study involving twenty patients with severe or critical COVID-19, treatment with tocilizumab in addition to lopinavir, methylprednisolone, other symptom relievers, and oxygen therapy, resulted in body temperature of all the patients returning to normal on the first day of receiving tocilizumab and significant relief of clinical symptoms synchronously in the following days.

title:
  Potential Treatment Options for COVID-19: A Comprehensive Review of Global Pharmacological Development Efforts

abstract:
  Coronavirus disease-2019 (COVID-19), first reported in China during December of 2019, is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infection later spread very rapidly around the globe with over 8,708,008 cases reported, including more than 461,715 deaths reported across at least 216 countries by June 20, 2020. It was declared as a global pandemic by the World Health Organization (WHO) on March 11, 2020. With the rapidly increasing number of positive cases and deaths, there is a dire need for effective treatment. An urgent unmet need led to the planning and opening of multiple drug development trials for treatment and vaccine development. In this article, we have compiled comprehensive data on many candidate drugs such as remdesivir, favipiravir, ribavirin, umifenovir, arbidol, lopinavir, ritonavir, baricitinib, hydroxychloroquine, nitazoxanide, azithromycin, baloxavir, oseltamivir, losartan, and tocilizumab. We have tabulated available data on various clinical trials testing various aspects of COVID-19 therapeutics.


id: cord-327214-kcbxyhhh
title: A Review of Postmortem Findings in Patients With COVID-19
author: Eketunde, Adenike O
date: 2020-07-28
txt: ./txt/cord-327214-kcbxyhhh.txt
cache: ./cache/cord-327214-kcbxyhhh.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32864262/
doi: 10.7759/cureus.9438
summary:
  The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus originated in Wuhan, China, and has spread rapidly across the world. According to Merad and Martin''s study, the hyper inflammation in severe COVID-19 patients shared similarities with cytokine release syndromes, including macrophages activation syndrome. Minimally invasive autopsies of three COVID-19 patients in Chongqing, China revealed damage to the alveolar structure with minor serous and fibrin exudation and hyaline membrane formation [8] . The hypercoagulable state has been linked to a poor prognosis in patients with severe COVID-19, which leads to a microthrombi formation in the lungs, lower limbs, hands, brain, heart, liver, and kidneys, as a result of the activation of the coagulation pathway. There is a strong association with the hyperinflammatory state, which can be explained by most of the signs and symptoms that are exhibited by COVID-19 patients, including most of the pathological findings. Fatal eosinophilic myocarditis in a healthy 17-year-old male with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2c)

abstract:
  Multiple public health problems have been caused by various coronavirus strains over the last few years, such as the middle eastern respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and COVID-19. COVID-19, which is also known as coronavirus disease 2019, was first detected in Wuhan, China, and has significantly impacted people's health and lives. Additionally, it has led to a pandemic, and the virus has spread to over 121 countries worldwide. There is numerous information available regarding this virus. A detailed and extensive study of the morphological and histopathological findings will help understand and diagnose the disease. As it is a new disease, it is challenging to understand the mechanism of the action and disease pathology due to the limited availability of data from autopsies or biopsies. However, as the detailed mechanism of injury remains unclear, this paper aims to review the postmortem gross and histopathological findings of various organs that have been affected with coronavirus, focusing on the pulmonary, cardiac, and hematologic findings. This paper emphasizes the postmortem findings of the effect of the coronavirus disease on multiple organ systems. Advance search of the keywords on PubMed was used, limiting the search to the last five years. The eligible article is narrowed based on relevance containing postmortem findings of the novel virus; COVID-19. A total of 25 full-text articles were selected and used in the review of this paper.


id: cord-327224-e4rlbfin
author: Pascual, King John
date: 2020-08-17
txt: ./txt/cord-327224-e4rlbfin.txt
cache: ./cache/cord-327224-e4rlbfin.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.9816
doi: 10.7759/cureus.9816
summary:
  title: Environmental Health Burdens and Socioeconomic Status in Rhode Island: Using Geographic Information Systems to Examine Health Disparities in Medical School Using Rhode Island as a case study, we geocoded and visualized several environmental determinants of health via Geographic Information Systems (GIS) in the entire state and conducted a geospatial analysis to determine whether or not patterns existed along racial and class lines. We discovered that, on average, the worst-performing elementary schools, fast food restaurants, and Superfund sites in Rhode Island were clustered in neighborhoods with a larger black population and lower household income. In this study, we utilize a multi-disciplinary approach that combines GIS and citizen science to examine the distribution of environmental health burdens in Rhode Island using data from publicly available sources. This study is the first to utilize GIS to examine the relationship between community demographic data and the distribution of multiple sources of environmental health burden in Rhode Island.

title:
  Environmental Health Burdens and Socioeconomic Status in Rhode Island: Using Geographic Information Systems to Examine Health Disparities in Medical School

abstract:
  Race and class are major predictors of health outcomes in the United States. Health disparities among racial and low-income minorities often have environmental etiologies. Using Rhode Island as a case study, we geocoded and visualized several environmental determinants of health via Geographic Information Systems (GIS) in the entire state and conducted a geospatial analysis to determine whether or not patterns existed along racial and class lines. The variables that we geocoded include elementary schools, fast food restaurants, Superfund sites, and community parks. From a census tract level, we then analyzed the racial and income makeup of each geocoded site. We discovered that, on average, the worst-performing elementary schools, fast food restaurants, and Superfund sites in Rhode Island were clustered in neighborhoods with a larger black population and lower household income. Conversely, community parks and the best elementary schools in Rhode Island tended to be located near neighborhoods with a larger White population and higher household income. Our results provide additional evidence for the pervasiveness of the unequal distribution of environmental health burdens between low-income, minority communities and affluent, predominantly White communities. This summer experiential student project demonstrates the feasibility of incorporating GIS as a practical tool for learning health disparities material at a U.S. medical school. Our study also highlights the value of digital technology and citizen science in helping the public recognize and understand the various environmental factors that perpetuate health disparities.


id: cord-329412-pzv4dzow
title: Social Media Data Analytics on Telehealth During the COVID-19 Pandemic
author: Massaad, Elie
date: 2020-04-26
txt: ./txt/cord-329412-pzv4dzow.txt
cache: ./cache/cord-329412-pzv4dzow.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.7838
doi: 10.7759/cureus.7838
summary:
  Methods: We inquired Twitter public data to access tweets related to telehealth from March 30, 2020 to April 6, 2020. The most common terms appearing alongside ''telehealth'' were "covid", "health", "care", "services", "patients", and "pandemic". The geographic distribution of tweets related to telehealth and having a specific location within the United States (n=19,367) was significantly associated with the number of confirmed Covid-19 cases reported in each state (p<0.001). Our study aims to analyze the dynamics of social media data related to telehealth and understand the public activity to strategically optimize and accelerate the digital health transformation. The 10 most common words apart from "telehealth" that appeared in these tweets were "COVID", "health", "care", "services", "patients", "pandemic", "coronavirus", "healthcare", "access", "need". In this study, we retrieved and analyzed public data available on Twitter to investigate the rapid shift in telehealth adoption amidst the recent coronavirus Covid-19 pandemics.

abstract:
  Introduction: Physical distancing during the coronavirus Covid-19 pandemic has brought telehealth to the forefront to keep up with patient care amidst an international crisis that is exhausting healthcare resources. Understanding and managing health-related concerns resulting from physical distancing measures are of utmost importance. Objectives: To describe and analyze the volume, content, and geospatial distribution of tweets associated with telehealth during the Covid-19 pandemic. Methods: We inquired Twitter public data to access tweets related to telehealth from March 30, 2020 to April 6, 2020. We analyzed tweets using natural language processing (NLP) and unsupervised learning methods. Clustering analysis was performed to classify tweets. Geographic tweet distribution was correlated with Covid-19 confirmed cases in the United States. All analyses were carried on the Google Cloud computing service “Google Colab” using Python libraries (Python Software Foundation). Results: A total of 41,329 tweets containing the term “telehealth” were retrieved. The most common terms appearing alongside ‘telehealth’ were “covid”, “health”, “care”, “services”, “patients”, and “pandemic”. Mental health was the most common health-related topic that appeared in our search reflecting a high need for mental healthcare during the pandemic. Similarly, Medicare was the most common appearing health plan mirroring the accelerated access to telehealth and change in coverage policies. The geographic distribution of tweets related to telehealth and having a specific location within the United States (n=19,367) was significantly associated with the number of confirmed Covid-19 cases reported in each state (p<0.001). Conclusion: Social media activity is an accurate reflection of disease burden during the Covid-19 pandemic. Widespread adoption of telehealth-favoring policies is necessary and mostly needed to address mental health problems that may arise in areas of high infection and death rates.


id: cord-329904-e05ywn5e
title: Fatal Superimposed Bacterial Sepsis in a Healthy Coronavirus (COVID-19) Patient
author: Jose, Merin
date: 2020-05-29
txt: ./txt/cord-329904-e05ywn5e.txt
cache: ./cache/cord-329904-e05ywn5e.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8350
doi: 10.7759/cureus.8350
summary:
  We present a case of a healthy COVID positive individual, with no underlying comorbidities, who rapidly deteriorated overnight on readmission to the hospital after initial discharge and succumbed to this disease due to a superimposed bacterial infection with COVID pneumonia. This case report highlights the importance of educating COVID-19 positive patients about the precautions, as well as signs and symptoms of a superimposed bacterial infection, when their plan of care is in a home setting. It also emphasizes the potential role of checking procalcitonin levels as a part of routine laboratory investigation at initial presentation in all suspected as well as confirmed COVID-19 cases to rule out an on-going bacterial infection that can prove fatal in the course of the disease. Our emphasis from this case report is to highlight the risk of superimposed bacterial infection in COVID-19 patients.

abstract:
  Coronavirus disease 2019 (COVID-19) is a highly infectious disease caused by the newly discovered coronavirus, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). The novel coronavirus first emerged in Wuhan, China, in December 2019 and has led to a global pandemic. The virus mainly spreads through respiratory droplets from an infected person, but environmental contamination can also act as a source of infection, making social distancing an important key in containing the spread of infection. Those with underlying health conditions are more susceptible to complications such as acute respiratory distress syndrome, which can be fatal. However, healthy individuals experience a mild flu-like illness or may be asymptomatic, recuperating from the infection even without any particular intervention. We present a case of a healthy COVID positive individual, with no underlying comorbidities, who rapidly deteriorated overnight on readmission to the hospital after initial discharge and succumbed to this disease due to a superimposed bacterial infection with COVID pneumonia. This case report highlights the importance of educating COVID-19 positive patients about the precautions, as well as signs and symptoms of a superimposed bacterial infection, when their plan of care is in a home setting. It also emphasizes the potential role of checking procalcitonin levels as a part of routine laboratory investigation at initial presentation in all suspected as well as confirmed COVID-19 cases to rule out an on-going bacterial infection that can prove fatal in the course of the disease.


id: cord-330655-crfj5adf
title: COVID-19 and the Brain: Acute Encephalitis as a Clinical Manifestation
author: Haider, Asim
date: 2020-10-03
txt: ./txt/cord-330655-crfj5adf.txt
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mime: text/plain
url: https://doi.org/10.7759/cureus.10784
doi: 10.7759/cureus.10784
summary:
  The researchers confirmed the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the cerebrospinal fluid (CSF) by genome sequencing [4] . Due to suspicion of COVID-19-related encephalitis, the patient received two doses of tocilizumab (400 mg each) followed by intravenous (IV) immunoglobulin (1 g/kg) for five days. A study that specifically investigated this issue documented that 36% of the hospitalized patients with a confirmed diagnosis of an acute respiratory syndrome from COVID-19 infection had some neurological manifestations. The exact mechanism by which COVID-19 infects CNS is not well-understood due to a lack of experimental data, but it is considered a mutation of the Middle East respiratory syndrome (MERS) virus and severe acute respiratory syndrome (SARS) virus [3] . Two case series involving CSF analysis data from 12 patients reported that the CSF had no white blood cells and the PCR assay for SARS-CoV-2 was negative in all the patients [9, 10] . Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study

abstract:
  Central nervous system (CNS) viral infections result in the clinical syndromes of aseptic meningitis or encephalitis. Although the primary target of coronavirus disease 2019 (COVID-19) is the respiratory system, it is increasingly being recognized as a neuropathogen. The hallmark clinical feature is altered mental status, ranging from mild confusion to deep coma. Most patients with encephalopathy or encephalitis are critically ill. We present a case of COVID-19-related encephalitis who presented with acute delirium and new-onset seizures. The patient responded well to treatment with intravenous immunoglobulins and rituximab.


id: cord-330814-7incf20e
title: COVID-19 Pandemic: Knowledge and Perceptions of the Public and Healthcare Professionals
author: Parikh, Priyanka A
date: 2020-05-15
txt: ./txt/cord-330814-7incf20e.txt
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url: https://www.ncbi.nlm.nih.gov/pubmed/32550063/
doi: 10.7759/cureus.8144
summary:
  Background and objective The recent pandemic due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a major concern for the people and governments across the world due to its impact on individuals as well as on public health. Conclusion Most healthcare professionals and the general public that we surveyed were well informed about SARS-CoV-2 and have been taking adequate measures in preventing the spread of the same. Social media platforms arguably support the conditions necessary for attitude change by exposing individuals to correct, accurate, health-promoting messages from healthcare professionals In order to investigate community responses to SARS-CoV-2, we conducted this online survey among the general public and healthcare professionals to identify awareness of SARS-CoV-2 (perceived burden and risk), trusted sources of information, awareness of preventative measures and support for governmental policies and trust in authority to handle SARS-CoV-2 outbreak and put forward policy recommendations in case of similar future conditions.

abstract:
  Background and objective The recent pandemic due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a major concern for the people and governments across the world due to its impact on individuals as well as on public health. The infectiousness and the quick spread across the world make it an important event in everyone’s life, often evoking fear. Our study aims at assessing the overall knowledge and perceptions, and identifying the trusted sources of information for both the general public and healthcare personnel. Materials and methods This is a questionnaire-based survey taken by a total of 1,246 respondents, out of which 744 belonged to the healthcare personnel and 502 were laypersons/general public. There were two different questionnaires for both groups. The questions were framed using information from the World Health Organization (WHO), UpToDate, Indian Council of Medical Research (ICMR), Center for Disease Control (CDC), National Institute of Health (NIH), and New England Journal of Medicine (NEJM) website resources. The questions assessed awareness, attitude, and possible practices towards ensuring safety for themselves as well as breaking the chain of transmission. A convenient sampling method was used for data collection. Descriptive statistics [mean(SD), frequency(%)] were used to portray the characteristics of the participants as well as their awareness, sources of information, attitudes, and practices related to SARS-CoV-2. Results The majority (94.3%) of the respondents were Indians. About 80% of the healthcare professionals and 82% of the general public were worried about being infected. Various websites such as ICMR, WHO, CDC, etc., were a major source of information for the healthcare professional while the general public relied on television. Almost 98% of healthcare professionals and 97% of the general public, respectively, identified ‘Difficulty in breathing” as the main symptom. More than 90% of the respondents in both groups knew and practiced different precautionary measures. A minority of the respondents (28.9% of healthcare professionals and 26.5% of the general public) knew that there was no known cure yet. Almost all respondents from both the groups agreed on seeking medical help if breathing difficulty is involved and self-quarantine if required. Conclusion Most healthcare professionals and the general public that we surveyed were well informed about SARS-CoV-2 and have been taking adequate measures in preventing the spread of the same. There is a high trust of the public in the government. There are common trusted sources of information and these need to be optimally utilized to spread accurate information.


id: cord-331796-fo3i2jow
title: Legionnaires Disease Presenting as Diarrhea: A Case Report
author: Dalal, Nimit
date: 2020-09-22
txt: ./txt/cord-331796-fo3i2jow.txt
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mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33110729/
doi: 10.7759/cureus.10593
summary:
  Acute diarrhea is not an uncommon manifestation of Legionnaires disease, although isolated diarrhea symptoms with the absence of concurrent respiratory symptoms and no risk factors for Legionella makes this case a diagnostic challenge, leading to possible delay in appropriate management. We are presenting this case to inform physicians of the possibility of Legionnaires disease presenting as an isolated gastrointestinal involvement with no clinical symptoms of pneumonia at presentation. We report a case of Legionnaires disease with isolated gastrointestinal symptoms which can lead to a missed diagnosis and development of complications without treatment. We report a case of Legionnaires'' disease in 61-year-old female patient without any known history of travel, risk factors and pulmonary symptoms. The main goal of this case report is to familiarize physicians of the possibility of Legionnaires disease presenting as an isolated gastrointestinal involvement with no clinical symptoms of pneumonia at presentation.

abstract:
  Legionnaires disease is primarily a pneumonic illness with possible multisystem involvement. Major risk factors include immunodeficiency, smoking, alcoholism and chronic obstructive pulmonary disease among others. We report a peculiar case of Legionnaires disease presenting with diarrhea as the chief complaint and no respiratory symptoms throughout the course of disease. The patient had no risk factors for the disease and had no recent travel history or sick contacts. Acute diarrhea is not an uncommon manifestation of Legionnaires disease, although isolated diarrhea symptoms with the absence of concurrent respiratory symptoms and no risk factors for Legionella makes this case a diagnostic challenge, leading to possible delay in appropriate management. We are presenting this case to inform physicians of the possibility of Legionnaires disease presenting as an isolated gastrointestinal involvement with no clinical symptoms of pneumonia at presentation.


id: cord-331927-b7pfm3i0
title: Diabetic Ketoacidosis in Coronavirus Disease Patients With Type 2 Diabetes Mellitus
author: Winn, Soe P
date: 2020-08-14
txt: ./txt/cord-331927-b7pfm3i0.txt
cache: ./cache/cord-331927-b7pfm3i0.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32953287/
doi: 10.7759/cureus.9731
summary:
  Since the emergence of the coronavirus disease (COVID-19) pandemic, we have seen many cases and studies on the underlying pathophysiology of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia with or without respiratory failure. We have also learned that the angiotensin-converting enzyme receptor is one of the major entry sites of SARS-CoV-2 infection, and it might be one of the causes that predispose patients to DKA. also stated that the human pancreas also expresses ACE2, and therefore, patients with diabetes are more vulnerable to SARS-CoV-2 infection than the general population [9] . In our cases, the transient damage of pancreatic beta-cell function leading to reduced levels of serum C peptide may be the reason for our patients experiencing acute insulin-dependent DKA for a brief period during the course of COVID-19. COVID-19 may cause DKA by increasing insulin requirement induced by ACE2-mediated destruction of pancreatic beta cells, as evidenced by reversible decreased serum C peptide levels or other unexplored mechanisms.

abstract:
  The occurrence of diabetes is increasing globally and carries a variety of complications, such as thromboembolism, acute cerebrovascular accidents, and diabetic ketoacidosis (DKA). Although DKA is not commonly associated with type 2 diabetes (T2D), it can manifest in patients who have underlying comorbidities predisposed to DKA. Since the emergence of the coronavirus disease (COVID-19) pandemic, we have seen many cases and studies on the underlying pathophysiology of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia with or without respiratory failure. We have also learned that the angiotensin-converting enzyme receptor is one of the major entry sites of SARS-CoV-2 infection, and it might be one of the causes that predispose patients to DKA. However, few studies exist that explore the development of DKA in T2D with SARS-CoV-2 infection. We present two cases of patients with DKA and COVID-19 treated with an insulin regimen with no further complications.


id: cord-332065-afq26621
title: Racial Disparity Amongst Stroke Patients During the Coronavirus Disease 2019 Pandemic
author: Ghanchi, Hammad
date: 2020-09-10
txt: ./txt/cord-332065-afq26621.txt
cache: ./cache/cord-332065-afq26621.txt
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mime: text/plain
url: https://doi.org/10.7759/cureus.10369
doi: 10.7759/cureus.10369
summary:
  The primary endpoint of this study is to compare whether there was a significant difference in the proportion of patients in each reported racial category presenting with stroke during the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A statistically significant increase in the number of Black and Hispanic patients presenting with strokes was noted in California, Pacific hospitals, Western hospitals, and all hospitals in the United States during various months studied comparing 2020 to 2019. Given the recent pandemic and racial disparity among patients afflicted with SARS-CoV-2 and the possible link of this virus and cerebrovascular accidents (CVA), we sought to analyze whether there was a disparity for stroke patients presenting to hospitals during this time using the Get with the Guidelines (GWTG) National Stroke Database. The primary endpoint of this study is to compare whether there was a significant difference in the proportion of patients in each reported racial category presenting to our institution with stroke during the COVID-19 pandemic caused by SARS-CoV-2.

abstract:
  Introduction The global coronavirus disease 2019 (COVID-19) pandemic has had deleterious effects on our healthcare system. Lockdown measures have decreased the number of patients presenting to the hospital for non-respiratory illnesses, such as strokes. Moreover, there appears to be a racial disparity among those afflicted with the virus. We sought to assess whether this disparity also existed for patients presenting with strokes. Methods The Get with the Guidelines National Stroke Database was reviewed to assess patients presenting with a final diagnosis of ischemic stroke, transient ischemic attack (TIA), subarachnoid hemorrhage (SAH), or spontaneous/nontraumatic intraparenchymal hemorrhage (IPH). The period of February - May 2020 was chosen given the surge of patients affected with the virus and national shutdowns. Data from this same time during 2019 was used as the control population. Our hospital numbers and four additional regions were assessed (California hospitals, Pacific State hospitals, Western Region hospitals, and all hospitals in the United States). Patients were categorized by race (White, Black/African American, Asian, Native American, Hispanic) in each cohort. The primary endpoint of this study is to compare whether there was a significant difference in the proportion of patients in each reported racial category presenting with stroke during the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results A downward trend in total number of patients was noted in all five regional cohorts assessed. A statistically significant increase in the number of Black and Hispanic patients presenting with strokes was noted in California, Pacific hospitals, Western hospitals, and all hospitals in the United States during various months studied comparing 2020 to 2019. A statistically significant increase in the Hispanic population was noted in February and March in all California hospitals (p=0.005 and 0.02, respectively) and Pacific Coast hospitals (p=0.005 and 0.039, respectively). The Western region and all national hospitals noted a significant increase in strokes in the Hispanic population in April (p=0.039 and 0.023, respectively). A statistically significant increase of strokes in the Black population was noted in April in Pacific hospitals, Western region hospitals, and all national hospitals (p=0.039, 0.03, and 0.03, respectively). Conclusion The COVID-19 pandemic has adversely affected certain racial groups more than others. A similar increase is noted in patients presenting with strokes in these specific racial populations. Moreover, lack of testing for the SARS-CoV-2 virus may be missing a possible link between racial disparity for patients infected with the virus and patients presenting with stroke. The authors advocate for widespread testing for all patients to further assess this correlation.


id: cord-333808-deifddar
title: Remote Oncology Care: Review of Current Technology and Future Directions
author: McGregor, Bradley A
date: 2020-08-31
txt: ./txt/cord-333808-deifddar.txt
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mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33014652/
doi: 10.7759/cureus.10156
summary:
  Here we review the current literature around remote patient monitoring in cancer care and propose the use of reliable devices for capturing and reporting patient symptoms and physiology. In oncology, while implantable devices are not available, studies have shown that monitoring patient-reported outcomes reduces visits to the emergency department, decreases follow-up costs and improves overall survival [11] [12] [13] [14] . PRO-CTCAE™ (Patient-Reported Outcomes version of the Common Toxicity Criteria for Adverse Events) is a validated tool used to monitor and report toxicities related to cancer treatment in clinical trials. Emerging research shows benefits in outcomes and costs of cancer care through use of remote monitoring technology especially electronic patient reported outcomes (ePRO). Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial

abstract:
  Cancer patients frequently develop tumor and treatment-related complications, leading to diminished quality of life, shortened survival, and overutilization of emergency department and hospital services. Outpatient oncology treatment has potential to leave cancer patients unmonitored for long periods while at risk of clinical deterioration which has been exaggerated during the COVID19 pandemic. Visits to cancer clinics and hospitals risk exposing immunocompromised patients to infectious complications. Remote patient reported outcomes monitoring systems have been developed for use in cancer treatment, showing benefits in economic and survival outcomes. While advanced devices such as pulmonary artery pressure monitors and implantable loop recorders have proven benefits in cardiovascular care, similar options do not exist for oncology. Here we review the current literature around remote patient monitoring in cancer care and propose the use of reliable devices for capturing and reporting patient symptoms and physiology.


id: cord-335625-z9ifjsil
title: Lithium Toxicity in Two Coronavirus Disease 2019 (COVID-19) Patients
author: Suwanwongse, Kulachanya
date: 2020-05-31
txt: ./txt/cord-335625-z9ifjsil.txt
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url: https://doi.org/10.7759/cureus.8384
doi: 10.7759/cureus.8384
summary:
  Herein, we are reporting the clinical features and outcomes of two patients with COVID-19 who initially presented with signs and symptoms of lithium toxicity. We report two patients initially presented with acute lithium intoxication in the setting of SARS-CoV-2 infection. The second patient had mild COVID-19 infection but complicated with AKI and lithium intoxication. Our report may point out that the clinical characteristics and outcomes of COVID-19 in patients with psychiatric illness and taking lithium are similar to those of the general population. Some patients may be quarantined at home due to mild symptoms of COVID-19 but at risk of lethal complications from medication toxicity. Prompt recognition and treatment of medication toxicity will prevent patients'' morbidity and mortality. Patients with psychiatric illness and taking lithium may have similar clinical features and outcomes of COVID-19 compared to those without.

abstract:
  Coronavirus disease 2019 (COVID-19) is a highly contagious disease, which is currently causing a devastating pandemic resulting in more than millions of infected cases worldwide. Emerging evidence reports the impact of several co-morbidities on the clinical features and outcomes of COVID-19. However, the evidence regarding the association of mental health illnesses and psychiatric treatment on the prognoses of COVID-19 is still lacking. Lithium is a commonly prescribed psychiatric medication that is also well known for its highly lethal toxicity. Many factors can fluctuate the level of lithium, such as drug interaction, illness, and infection. Prompt recognition and management of lithium intoxication is required to reduce patients’ morbidity and mortality. Currently, there is no report regarding COVID-19 and lithium toxicity. Herein, we are presenting two patients with COVID-19 who initially presented with signs and symptoms of lithium toxicity. Our cases emphasize the need for special attention in taking care of patients who are taking lithium during the COVID-19 pandemic. In general, we recommend obtaining lithium levels in all patients who have been taking lithium and have the diagnosis of COVID-19.


id: cord-336488-opjjowcq
author: Kenanidis, Eustathios
date: 2020-06-17
txt: ./txt/cord-336488-opjjowcq.txt
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url: https://doi.org/10.7759/cureus.8676
doi: 10.7759/cureus.8676
summary:
  The aim of this paper is to review the existing orthopaedic literature and to present the principles of management and care implemented in the orthopaedic departments of a tertiary academic hospital in Greece to operate during COVID-19 pandemic in order to mitigate the risk of in-hospital transmission of SARS-CoV-2 to the medical, nursing and administrative orthopaedic personnel. In addition, we presented the clinical indications to delineate orthopaedic patients who deserve emergency or urgent in-hospital care from those that can be treated in the outpatient setting, as well as from the day surgery clinics or could not be admitted in the hospital, in order to decrease the SARS-CoV-2 transmission load. The proposed principles of management and care are deployed below as (1) general management of the orthopaedic departments, (2) recommendations for the management of traumatic orthopaedic injuries, (3) hospital pathways for the admitted orthopaedic patients (4) workflow of the isolated and negative pressure COVID-19 operating theatre (COT) and (5) postoperative care of the COVID-19 infected patients.

title:
  Organizing an Orthopaedic Department During COVID-19 Pandemic to Mitigate In-Hospital Transmission: Experience From Greece

abstract:
  The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerging in Wuhan city of China, was the cause of a rare type of pneumonia evolving rapidly in pandemic early at the beginning of 2020. The rapid human-to-human transmission of SARS-CoV-2 increases the risk of in-hospital transmission, requiring re-definement of musculoskeletal trauma management and postoperative care. Following the review of the existing literature on COVID-19 and similar infectious diseases, National and Hospital Board instructions for Infectious Diseases, as well as the consensus for surgical care by the consortium of the Orthopaedic Department Directors, we present the outline of the implemented principles in the orthopaedic departments of a tertiary academic hospital in Greece to operate during COVID-19 pandemic. Our overall objectives were to decrease the admission load and mitigate the risk of in-hospital transmission of SARS-CoV-2. The principles involve the management of the Orthopaedic medical and nursing personnel, alterations of the workflow in the wards, operating rooms and outpatient clinics from the admission to the discharge of an orthopaedic patient. In addition, we present the recommended principles of management of traumatic orthopaedic injuries highlighting those deserving admission and in-hospital care and those that can be treated in the outpatient setting or day surgery clinics.


id: cord-338288-vfcoyezy
title: Multi-Organ Failure in a Patient With Diabetes due to COVID-19 With Clear Lungs
author: Kabashneh, Sohaip
date: 2020-05-15
txt: ./txt/cord-338288-vfcoyezy.txt
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mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32550066/
doi: 10.7759/cureus.8147
summary:
  We report a case of a middle-aged man with DM and COVID-19 who developed seizure and altered mental status, found to have diabetic ketoacidosis (DKA), acute kidney injury, hypovolemic shock, and hyperammonemia all contributing to metabolic encephalopathy. The patient was subsequently intubated for airway protection; basic labs showed multiple abnormalities including: DKA with blood glucose (BG) 1100, anion gap 46, HCO 3 4 , beta hydroxybutyrate 65.6; he also had acute kidney injury (AKI) with creatinine (Cr) of 4.9 (baseline was 1.0), blood urea nitrogen 84 , potassium 6.4, sodium 146, chloride 96, phosphorus 18.7, lactic acid 17.3; there was also evidence of liver function abnormalities with elevated ammonia level at 244; arterial blood gas was consistent with high anion gap metabolic acidosis with pH 6.79, HCO 3 4, PaCO 2 36, PaO 2 473.

abstract:
  The pandemic of coronavirus disease 2019 has emerged in late 2019 infecting millions of people worldwide. Diabetes mellitus (DM) has been associated with severe illness and mortality mainly due to acute respiratory distress syndrome. We report a case of a middle-aged man with DM and COVID-19 who developed seizure and altered mental status, found to have diabetic ketoacidosis (DKA), acute kidney injury, hypovolemic shock, and hyperammonemia all contributing to metabolic encephalopathy. He was admitted to the ICU and subsequently intubated for airway protection; with appropriate management his condition improved and was successfully extubated. The patient had no lung involvement throughout the illness. We report this case to highlight that COVID-19 can lead to multi-organ failure in patients with DM even in the absence of lung involvement which all physicians should be mindful of.


id: cord-339188-apgdzgfz
author: Lewis, Thomas J
date: 2020-08-26
txt: ./txt/cord-339188-apgdzgfz.txt
cache: ./cache/cord-339188-apgdzgfz.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10039
doi: 10.7759/cureus.10039
summary:
  Validated data on severe respiratory viral diseases and the correlation between mortality, immunocompromised status and existing chronic conditions in infected individuals indicate that a broad set of blood-based biomarkers may best serve to stratify risk and to set policy on containment strategies in populations [7] . What separates bad, good, and great programs is "a combination of good design built on behavior change theory, effective implementation using evidence-based practices, and credible measurement and evaluation." To further support the need for more thorough risk assessment, in a global study of 84 risks, the authors concluded "Increasingly detailed understanding of the trends in risk exposure and the relative risks for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends [9] .

title:
  Reduction in Chronic Disease Risk and Burden in a 70-Individual Cohort Through Modification of Health Behaviors

abstract:
  Introduction Health risk factors, including lifestyle risks and health literacy, are known to contribute to the chronic disease epidemic. According to the Centers for Disease Control and Prevention (CDC), chronic diseases account for 90% of healthcare costs, morbidity, and mortality. In the United States, healthcare providers attempt to modulate a limited set of risks. However, chronic diseases continue to proliferate despite expansion of wellness programs and drugs to manage and prevent chronic conditions. Pandemics, exemplified by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), show that people in good health suffer mortality rates at 10% the rate compared to those with pre-existing chronic conditions. Healthcare costs and morbidity rates often parallel mortality rates. New root-cause risk and health tools that accommodate low health literacy and are linked to personalized health improvement care plans are needed to reverse the chronic disease epidemic. Reported here is a study on 70 manufacturing employees in the Midwest US using a personalized and group approach to chronic disease reversal and prevention which may also find utility in pandemic severity and policy decisions. Methods Health, lifestyle, behavior, and motivation data were collected on 70 individuals at the beginning of a nine-month disease reversal and prevention program. The data were updated every two to six months over the period. Inputs included information from a novel health risk assessment, serum biomarkers specific for chronic disease, and traditional medical information. Using all these data we generated robust, personalized, and modifiable care plans that were implemented by the participant and guided by a care team including health coaches and medical providers. Periodic renewal of profile data and biomarkers facilitated adjustment of care plans to optimize the path toward health goals set mutually by the participant and the care team. Results Ninety percent of participants experienced a favorable reduction in chronic disease biomarkers. The reduction in serum biomarkers coincided with a reduction in disease and risk attributes based on medical chart data and before and after interviews. Hemoglobin A1C, for example, lowered in all but one participant concomitant with reported improved energy and reduced need for medications in the majority of participants. Markers of inflammation lowered across the population. Most importantly each individual reported improvement in their overall health. Conclusions This simple, inexpensive, root-cause based risk and health approach generates a “do no harm” action plan that guides a care team, including the participant, on a path to improved health. The data demonstrate that changes in a novel risk calculator score coincide with changes in sensitive biomarkers for chronic disease. When the risks of an individual are reduced, the biomarkers reflect that change with self-reported wellbeing also improved. This program and process may be of value to society plagued with escalating levels of chronic disease and merits further study and implementation.


id: cord-339786-elrzlbsg
title: Acute Liver Failure in a COVID-19 Patient Without any Preexisting Liver Disease
author: Gurala, Dhineshreddy
date: 2020-08-26
txt: ./txt/cord-339786-elrzlbsg.txt
cache: ./cache/cord-339786-elrzlbsg.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10045
doi: 10.7759/cureus.10045
summary:
  Studies and data so far on coronavirus infections from China, Singapore, and other countries showed that liver enzymes elevation could be seen in 20-50% of cases. In another study published in the Lancet in February 2020 by Huang et al., an increase in aspartate aminotransferase (AST) was observed in 62% in intensive care unit (ICU) patients compared to 25% in non-ICU patients, indicating that more severe disease correlates with worsening of liver enzymes [10] . Here, we report a case of acute liver failure in an elderly patient with COVID-19 infection who did not have a history of preexisting liver disease. Here, we report a case of acute liver failure in an elderly patient with COVID-19 infection who did not have a history of preexisting liver disease. In summary, we describe the first case of acute liver failure caused by the COVID-19 infection.

abstract:
  In December 2019, an outbreak of novel coronavirus started in Wuhan, China, which gradually spread to the entire world. The World Health Organization (WHO) on February 11, 2020, officially announced the name for the disease as coronavirus disease 2019, abbreviated as COVID-19. It is caused by severe respiratory distress syndrome coronavirus 2 (SARS-CoV-2). The WHO declared SARS-CoV-2 as a pandemic on March 11, 2020. SARS-CoV-2 mainly causes fever as well as respiratory symptoms such as cough and shortness of breath. Gastrointestinal/hepatic sequelae such as diarrhea, nausea, vomiting, and elevated liver enzymes have been reported as well. Studies and data so far on coronavirus infections from China, Singapore, and other countries showed that liver enzymes elevation could be seen in 20-50% of cases. More severe disease can correlate with the worsening of liver enzymes. However, acute liver failure in patients with COVID-19 has not been described. Herein we report a case of acute liver failure in an elderly patient with COVID-19 infection who did not have a history of preexisting liver disease.


id: cord-340564-3fu914lk
title: Predicting COVID-19 Pneumonia Severity on Chest X-ray With Deep Learning
author: Cohen, Joseph Paul
date: 2020-07-28
txt: ./txt/cord-340564-3fu914lk.txt
cache: ./cache/cord-340564-3fu914lk.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.9448
doi: 10.7759/cureus.9448
summary:
  In this study, we present a severity score prediction model for COVID-19 pneumonia for frontal chest X-ray images. A neural network model that was pre-trained on large (non-COVID-19) chest X-ray datasets is used to construct features for COVID-19 images which are predictive for our task. Results This study finds that training a regression model on a subset of the outputs from this pre-trained chest X-ray model predicts our geographic extent score (range 0-8) with 1.14 mean absolute error (MAE) and our lung opacity score (range 0-6) with 0.78 MAE. In this work, we built and studied a model which predicts the severity of COVID-19 pneumonia, based on CXRs, to be used as an assistive tool when managing patient care. This "pre-training" step was performed on a large set of data in order to construct general representations about lungs and other aspects of CXRs that we would have been unable to achieve on the small set of COVID-19 images available.

abstract:
  Introduction The need to streamline patient management for coronavirus disease-19 (COVID-19) has become more pressing than ever. Chest X-rays (CXRs) provide a non-invasive (potentially bedside) tool to monitor the progression of the disease. In this study, we present a severity score prediction model for COVID-19 pneumonia for frontal chest X-ray images. Such a tool can gauge the severity of COVID-19 lung infections (and pneumonia in general) that can be used for escalation or de-escalation of care as well as monitoring treatment efficacy, especially in the ICU. Methods Images from a public COVID-19 database were scored retrospectively by three blinded experts in terms of the extent of lung involvement as well as the degree of opacity. A neural network model that was pre-trained on large (non-COVID-19) chest X-ray datasets is used to construct features for COVID-19 images which are predictive for our task. Results This study finds that training a regression model on a subset of the outputs from this pre-trained chest X-ray model predicts our geographic extent score (range 0-8) with 1.14 mean absolute error (MAE) and our lung opacity score (range 0-6) with 0.78 MAE. Conclusions These results indicate that our model’s ability to gauge the severity of COVID-19 lung infections could be used for escalation or de-escalation of care as well as monitoring treatment efficacy, especially in the ICU. To enable follow up work, we make our code, labels, and data available online.


id: cord-340660-ocvy1ge2
title: Methicillin-Resistant Staphylococcus Aureus: A Very Rare Cause of Meningitis
author: Mehmood, Maham A
date: 2020-09-10
txt: ./txt/cord-340660-ocvy1ge2.txt
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extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33062493/
doi: 10.7759/cureus.10370
summary:
  Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is mostly implicated in soft tissue and skin infections. Here, we reported a case of a 58-year-old female with MRSA bacteremia and meningitis as confirmed by positive blood cultures and cerebrospinal fluid analysis; successfully managed with vancomycin and rifampin. This paper emphasizes the need for early recognition and interventions as soon as meningitis is suspected, while identifying a case where synergistic effects of antibiotics are utilized to improve the penetration of antibiotic therapy for adequate treatment. Fifteen days into her illness, the patient had the first negative blood culture, remained afebrile and improved clinically. Approximately 50% to 90% of patients with bacterial meningitis have positive blood cultures [5] . Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children

abstract:
  Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is mostly implicated in soft tissue and skin infections. Cases with meningitis caused by CA-MRSA are rare. High index of suspicion should be kept for physicians as bacterial meningitis is a medical emergency and if untreated, has a high mortality rate. Urgent steps need to be taken to determine the cause and implement therapy. Here, we reported a case of a 58-year-old female with MRSA bacteremia and meningitis as confirmed by positive blood cultures and cerebrospinal fluid analysis; successfully managed with vancomycin and rifampin.


id: cord-341304-jdvzpvdx
title: Human Immunodeficiency Virus: A Dark Cloud With Silver Lining During the COVID-19 Pandemic
author: Pata, Rama Kanth
date: 2020-07-20
txt: ./txt/cord-341304-jdvzpvdx.txt
cache: ./cache/cord-341304-jdvzpvdx.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32832299/
doi: 10.7759/cureus.9302
summary:
  In December 2019, China reported a cluster of pneumonia patients infected by a new virus from the coronavirus family called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus quickly spread around the world and infected millions of people, and the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic on March 11, 2020. On March 22, 2020, a 67-year-old female with a past medical history of asthma, coronary artery disease (status post-coronary artery bypass graft two years ago), hypertension, hyperlipidemia, and HIV on antiretroviral medications [bictegrav/emtricit/tenofov ala (Biktarvy® 50-200-25 mg tablet, Gilead Sciences, Foster City, CA) and darunavir/cobicistat (Prezcobix® 800 mg-150 mg tablet, Janssen Pharmaceutica, Beerse, Belgium)] was brought in by emergency medical services (EMS) for progressively worsening shortening of breath associated with weakness and two episodes of watery non-bloody diarrhea for one day. showed clinical improvement in the first case of COVID-19 in the United States after the use of remdesivir [8] .

abstract:
  In December 2019, China reported a cluster of pneumonia patients infected by a new virus from the coronavirus family called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus quickly spread around the world and infected millions of people, and the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic on March 11, 2020. Although some patients show only mild or even asymptomatic response to this infection, severe disease with rapid progression to acute respiratory distress and multiorgan failure is also commonly seen. In this report, we discuss three cases of HIV patients who survived COVID-19.


id: cord-342666-7el8o6qq
author: Mahmood, Syed Uzair
date: 2020-05-23
txt: ./txt/cord-342666-7el8o6qq.txt
cache: ./cache/cord-342666-7el8o6qq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32596068/
doi: 10.7759/cureus.8248
summary:
  title: Strategies for Rational Use of Personal Protective Equipment (PPE) Among Healthcare Providers During the COVID-19 Crisis However, there are guidelines recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) to maintain the supply in the wake of this increased demand of PPE, how the manufacturers should track their supplies, and how the recipients should manage them. It should be noted that according to the World Health Organization (WHO) guidelines, medical masks and respirators should only be reserved for healthcare workers [10] . 1) The healthcare professionals who are working with patients of COVID-19 and are in direct contact should have PPE consisting of gloves, gowns, masks, face shields, and goggles. Use Personal Protective Equipment (PPE) When Caring for Patients with Confirmed or Suspected COVID-19 Rational Use of Personal Protective Equipment ( PPE) for Coronavirus Disease ( COVID-19) : Interim Guidance

title:
  Strategies for Rational Use of Personal Protective Equipment (PPE) Among Healthcare Providers During the COVID-19 Crisis

abstract:
  As the coronavirus 2019 (COVID-19) began spreading globally with no clear treatment in sight, prevention became a major part of controlling the disease and its effects. COVID-19 spreads from the aerosols of an infected individual whether they are showing any symptoms or not. Therefore, it becomes nearly impossible to point exactly where the patient is. This is where personal protective equipment (PPE) comes in. These are masks, respirators, gloves, and in hospitals where the contact with the infected and confirmed patient is direct, also gowns or body covers. The PPEs play a major role in the prevention and control of the COVID-19. The PPE is able to prevent any invasion of the virus particles into the system of an individual which is why it is an essential item to have for healthcare workers. Due to the high demand for PPEs all around the world, it is important to optimize the use of protective gear and ration the supplies so that the demand are met. However, there are guidelines recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) to maintain the supply in the wake of this increased demand of PPE, how the manufacturers should track their supplies, and how the recipients should manage them. Various strategies can be used to increase the re-use of PPEs during the COVID-19 pandemic that has modified the donning and doffing procedure.


id: cord-343819-1uki4b3d
title: Pathological Findings and Management of COVID-19 Patients: A Brief Overview of Modern-day Pandemic
author: Mian, Muhammad S
date: 2020-05-15
txt: ./txt/cord-343819-1uki4b3d.txt
cache: ./cache/cord-343819-1uki4b3d.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32550056/
doi: 10.7759/cureus.8136
summary:
  We searched using PubMed and Google Scholar using keywords such as COVID-19, coronavirus, and their combination with pathological findings, clinical features, management, and treatment to search for relevant published literature. Patients with COVID-19 had pathological findings, like ground-glass opacities, consolidations, pleural effusion, lymphadenopathy, and interstitial infiltration of inflammatory cells. There is currently no recommended treatment for COVID-19, only supportive care like oxygen, and mechanical ventilation is provided to patients in severe respiratory distress [2] . In this review article, we aim to identify and highlight clinical features, pathological and radiological findings, and possible treatment options for COVID-19 patients and to organize the little information we have on this pathogen. Keywords used were novel coronavirus, COVID-19, pathological findings, antivirals, treatment, management, and passive immunity. Based on the studies reviewed, the findings on the CT scan of COVID-19 patients are groundglass opacities, consolidation, crazy paving pattern, and air bronchogram sign.

abstract:
  Today the world is facing one of the deadliest pandemics caused by COVID-19. This highly transmissible virus has an incubation period of 2 to 14 days. It acts by attaching to the angiotensin-converting enzyme (ACE2) with the help of glycoprotein spikes, which it uses as a receptor. Real-time polymerase chain reaction (PCR; rt-PCR) is the gold standard diagnostic test, and chest X-ray and computed tomography (CT) scan are the other main investigations. Several medications and passive immunization are in use to treat the condition. We searched using PubMed and Google Scholar using keywords such as COVID-19, coronavirus, and their combination with pathological findings, clinical features, management, and treatment to search for relevant published literature. After the removal of duplications and the selection of only published English literature from the past five years, we had a total of 31 papers to review. Most of the COVID-19 affected patients have mild pneumonia symptoms, and those with severe disease have comorbidities. Patients with COVID-19 had pathological findings, like ground-glass opacities, consolidations, pleural effusion, lymphadenopathy, and interstitial infiltration of inflammatory cells. Radiological changes show lung changes such as consolidations and opacities, and the pathological findings were infiltration of inflammatory cells and hyalinization. Patients with mild symptoms should self-quarantine, whereas those with severe acute respiratory distress syndrome (ARDS) are treated in the hospital. Medications under trial include antivirals, antibacterials, antimalarials, and passive immunization. Supportive treatment such as oxygen therapy, extracorporeal membrane oxygenation, and ventilator support can also be used. The symptoms shown by patients are very mild and self-limiting. There is no definitive treatment, although a combination of hydroxychloroquine and azithromycin have shown good results, and passive immunization also shows promising results, their safety profile is yet to be studied in detail.


id: cord-344302-p0v6sl9x
title: COVID-19-Associated Acute Limb Ischemia in a Patient on Therapeutic Anticoagulation
author: Gubitosa, James C
date: 2020-09-25
txt: ./txt/cord-344302-p0v6sl9x.txt
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extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33133825/
doi: 10.7759/cureus.10655
summary:
  Therapeutic anticoagulation was empirically initiated with subcutaneous enoxaparin (1 mg/kg twice daily) given the hypercoagulable state observed in many COVID-19 patients with elevated D-dimer. The risk of thromboembolic events and the sheer magnitude of COVID-19-associated admissions have prompted many hospitals to establish novel protocols with which these individuals are provided anticoagulation at increased or even therapeutic doses compared to the more common prophylactic dose. A study of 449 COVID-19 patients demonstrated a statistically significant decrease in mortality (40.0% experimental, 64.2% control) in those receiving prophylactic doses of heparin and enoxaparin [14] . Given the cited relative deficiency of ATIII in CAC and nephrotic syndrome, one can hypothesize that an acute arterial thrombosis may have been avoided if this patient was started on an argatroban infusion from the beginning of his hospital course, which would have provided therapeutic anticoagulation independent of ATIII levels. COVID-19 associated acute limb ischemia in a patient on therapeutic anticoagulation: a case and literature review

abstract:
  Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been found to cause multiple complications across several organ systems in patterns not typically observed in previous iterations of the virus. Hemostatic mechanisms have been noted to be significantly altered in particular, resulting in a disseminated intravascular coagulation (DIC)-like picture with elements of coagulopathy as well as hypercoagulability. A 65-year-old man with hypertension, hyperlipidemia, prior tobacco use, chronic kidney disease, and diabetes presented from a correctional facility with hypoxia. The diagnosis of COVID-19 was confirmed. With his elevated D-dimer of >7,955 ng/mL (reference: 90-500 ng/mL) in the setting of COVID-19 and hypoxia, he was empirically started on therapeutic anticoagulation with enoxaparin. His oxygen requirements increased, mental status deteriorated, and platelets began falling, raising concern for heparin-induced thrombocytopenia versus DIC. Heparin products were discontinued in favor of a direct oral anticoagulant. He later became obtunded and unable to tolerate oral medications. Fondaparinux was initiated. Two days later, he was found to have acute limb ischemia of the right lower extremity. He underwent surgical thrombectomy but required an above-the-knee amputation the following day. Shortly after he died secondary to hypoxic respiratory failure. This case highlights the derangement of hemostatic mechanisms seen prominently in COVID-19 infection and raises questions as to appropriate anticoagulant choices to adequately prevent thrombosis. Thorough physical exams should be performed on all patients with COVID-19, taking into account this documented hypercoagulability. Further investigation is warranted into the use of heparin products as the anticoagulant of choice in these patients given observed deficiencies of antithrombin III (ATIII).


id: cord-344413-9lj4g0tq
title: Bilateral Hemopneumothorax in COVID-19
author: Salah, Omer
date: 2020-09-08
txt: ./txt/cord-344413-9lj4g0tq.txt
cache: ./cache/cord-344413-9lj4g0tq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33052276/
doi: 10.7759/cureus.10314
summary:
  We also reviewed some articles on the development of pneumothorax as a complication of COVID-19-associated pneumonia including tension pneumothorax, pneumomediastinum, and subcutaneous emphysema, in addition to case reports on cystic changes within the lungs as a sequel of COVID-19 infection. In view of the lack of previous history of underlying lung disease and the normal CXR on presentation along with the exclusion of some of the common causes of secondary pneumothorax, we think that COVID-19 pneumonia and its complication induced cystic changes within the lung and lead to spontaneous pneumothorax. COVID-19 could be a probable cause of spontaneous pneumothorax secondary to cystic changes and bullae formation within the lung parenchyma and should be kept in mind when evaluating patients with COVID-19 and shortness of breath, but we need further studies on the association between and pathophysiology of the occurrence of infection and pneumothorax. Spontaneous pneumothorax and subcutaneous emphysema in COVID-19 patient: case report.

abstract:
  A 50-year-old previously healthy male presented with fever and cough for seven days, positive for COVID-19, and was admitted to Hazm Meberik General Hospital and treated as a case of severe COVID-19 pneumonia. After improvement, he was transferred to a quarantine facility, and he later developed bilateral hemopneumothorax requiring bilateral chest tubes. High-resolution CT showed bilateral emphysematous bullous disease. Tuberculosis workup was negative, and alpha 1 anti-trypsin levels were normal. Repeated Chest X-ray showed improvement and chest tubes were removed. The patient was discharged with follow-up with the thoracic surgery clinic.


id: cord-345546-v7t26oos
title: Attention-Deficit/Hyperactivity Disorder Patients May Have Undiagnosed Narcolepsy
author: Wilenius, Lukas
date: 2020-06-04
txt: ./txt/cord-345546-v7t26oos.txt
cache: ./cache/cord-345546-v7t26oos.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8436
doi: 10.7759/cureus.8436
summary:
  There was a statistically significant negative correlation between serum iron levels and ADHD symptom severity. Iron deficiency in children with ADHD and lower ferritin levels have been associated with the severity of RLS symptoms [8] [9] . Our aim was to clarify the prevalence of narcolepsy symptoms among adult ADHD patients as compared to controls of the same age and gender. We also wanted to evaluate the association of low serum ferritin and iron levels to ADHD and symptoms of narcolepsy. A two-sample t-test, comparing WHO-5 scores among groups, revealed a statistically significant difference in favor of controls (means: 48.6 vs. As far as we know, no studies comparing adult ADHD patients with healthy controls, regarding narcoleptic symptoms, has been made before. UNS revealed three possible narcolepsy patients in the ADHD group. Attention-deficit/hyperactivity disorder (ADHD) symptoms in pediatric narcolepsy: a cross-sectional study

abstract:
  Background Attention-deficit/hyperactivity disorder (ADHD) patients have many comorbidities. Narcoleptic patients have a big prevalence of ADHD (15%-30%). Both groups suffer from similar symptoms and benefit from the same class of medications. As such, narcolepsy could be masked in ADHD patients. Low serum ferritin has been found both in ADHD patients as well as in patients with narcolepsy. Materials & methods We enrolled 26 participants (14 ADHD patients and 12 controls). They answered several questionnaires, and blood samples were obtained from 20 participants. We had clear exclusion criteria. Results Using the Ullanlinna Narcolepsy Scale (UNS), we identified three possible narcolepsy patients within the ADHD group and no suspects in the control group. There was a statistically significant negative correlation between serum iron levels and ADHD symptom severity. No correlation was found measuring serum ferritin levels. Conclusions Narcolepsy may be more common within ADHD patients than in the general population. Some of these patients could benefit from a change in medication. Low serum iron and ferritin levels could be relevant in ADHD pathophysiology. This requires further exploratory research.


id: cord-346930-gl573ip9
title: Emerging Pharmaceutical Treatments of Novel COVID-19: A Review
author: Hussain, Azhar
date: 2020-05-24
txt: ./txt/cord-346930-gl573ip9.txt
cache: ./cache/cord-346930-gl573ip9.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8260
doi: 10.7759/cureus.8260
summary:
  Although multiple drugs show promise in the treatment of COVID-19 via either inhibiting viral replication or preventing fusion of the virus to the ACE2 receptors, further investigation is still warranted and necessary before the admission of any type of pharmaceutical agent. This review explores various drugs and their mechanism of action which are either currently being used in clinical trials or may be used in the future for the treatment of COVID-19. Since the emergence of the virus in China in December of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread across the globe resulting in the current global pandemic. Arbidol (also known as Umifenovir) is a promising repurposed antiviral agent with a unique mechanism of action targeting the S protein/ACE2 interaction and inhibiting membrane fusion of the viral envelope to the host cell [7] .

abstract:
  As a new decade began, COVID-19 quickly gained importance as it became the cause of the current global pandemic. Research has been focusing on studying the structure of SARS-CoV-2 and investigates possible pharmaceutical approaches. With the number of cases increasing every day, globally, multiple drugs are being researched as possible candidates. Although multiple drugs show promise in the treatment of COVID-19 via either inhibiting viral replication or preventing fusion of the virus to the ACE2 receptors, further investigation is still warranted and necessary before the admission of any type of pharmaceutical agent. Furthermore, several supplements have also been documented in being utilized as treatment of COVID-19. The exact mechanism and efficacy of current candidate drugs are still being explored through clinical trials. Despite the advancements in current research with emerging treatments, social distancing and engaging in preventative measures remains crucial to attempt to prevent the occurrence of more cases and deaths, worldwide. This review explores various drugs and their mechanism of action which are either currently being used in clinical trials or may be used in the future for the treatment of COVID-19.


id: cord-347406-9cvth7j4
title: Holy Communion and Infection Transmission: A Literature Review
author: Anyfantakis, Dimitrios
date: 2020-06-21
txt: ./txt/cord-347406-9cvth7j4.txt
cache: ./cache/cord-347406-9cvth7j4.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8741
doi: 10.7759/cureus.8741
summary:
  Today, faithful people worldwide share the consecrated bread and wine retracted from a chalice with a Holy Communion spoon. The issue of coronavirus transmission by sharing the Holy Communion has been a subject of debate between science and the Greek Orthodox Church. In this route, a study performed among 681 worshippers partaking Holy Communion disclosed that they did not exert a higher risk of infection compared to those with less or no religious service attendance [13] . The authors reported that although intinction did not eliminate the risk, significantly reduced the hazard of infection compared to the practice of sipping from a common communion cup. She also added that those who believe that through the Holy Communion receive the "body and the blood of Jesus Christ" and not simply wine and bread can partake without fearing the coronavirus [16] . Risk of infectious disease transmission from a common communion cup

abstract:
  The Holy Communion originated in the Last Supper of Jesus Christ, nearly 2,000 years ago. According to the Bible, the night before his crucifixion, Jesus Christ shared with his 12 apostles a meal of bread and wine. During the meal, Christ instructed his disciplines to eat and drink in his memory, saying that bread is his body and wine is his blood. Today, faithful people worldwide share the consecrated bread and wine retracted from a chalice with a Holy Communion spoon. The novel coronavirus that emerged in December 2019 recorded a rapid exponential spread across space and time. The ongoing pandemic of coronavirus disease has affected people from all cultures and religions. In Greece, the pandemic concurred with the Easter celebration. Measures of social distancing have been implemented. Among others, churches have closed their doors to the public in order to avoid religious mass gatherings. The issue of the novel coronavirus transmission by partaking Holy Communion has received much criticism. In this review, we aimed to retrieve articles that summarize the current knowledge on the selected topic. In order to offer a balanced analysis of the subject, we have also assessed the theological framework of the Holy mystery.


id: cord-348411-nrhe8aek
title: Impact of COVID-19 on the Mental Health of Children and Adolescents
author: Shah, Kaushal
date: 2020-08-26
txt: ./txt/cord-348411-nrhe8aek.txt
cache: ./cache/cord-348411-nrhe8aek.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10051
doi: 10.7759/cureus.10051
summary:
  It is essential and obligatory for the scientific community and healthcare workers to assess and analyze the psychological impact caused by the coronavirus pandemic on children and adolescents, as several mental health disorders begin during childhood. Children exposed to stressors such as separation through isolation from their families and friends, seeing or being aware of critically ill members affected with coronavirus, or the passing of loved ones or even thinking of their own death from the virus can cause them to develop anxiety, panic attacks, depression, and other mental illnesses [11] [12] . The conducted literature search was through Medline, PubMed, PubMed Central, and Embase using the keywords, ''coronavirus,'' ''COVID-19,'' ''mental health,'' ''child and adolescent,'' ''behavioral impact,'' ''psychological conditions,'' ''quarantine,'' and ''online education.'' The indexed search aimed to identify literature and articles relevant to our focused topic.

abstract:
  The coronavirus disease 2019 (COVID-19) outbreak was first reported in Wuhan, China, and was later reported to have spread throughout the world to create a global pandemic. As of August 18th, 2020, the coronavirus had spread to more than 216 countries with at least 21,756,357 confirmed cases, resulting in 771,635 deaths globally. Several countries declared this pandemic as a national emergency, forcing millions of people to go into lockdown. This unexpected imposed social isolation has caused enormous disruption of daily routines for the global community, especially children. Among the measures intended to reduce the spread of the virus, most schools closed, canceled classes, and moved it to home-based or online learning to encourage and adhere to social distancing guidelines. Education and learnings of 67.6% of students are impacted globally due to coronavirus in 143 countries. The transition away from physical classes has significantly disrupted the lives of students and their families, posing a potential risk to the mental well-being of children. An abrupt change in the learning environment and limited social interactions and activities posed an unusual situation for children's developing brains. It is essential and obligatory for the scientific community and healthcare workers to assess and analyze the psychological impact caused by the coronavirus pandemic on children and adolescents, as several mental health disorders begin during childhood. Countries across the globe, including the United States, are in the dilemma of determining appropriate strategies for children to minimize the psychological impact of coronavirus. The design of this review is to investigate and identify the risk factors to mental health and propose possible solutions to avoid the detrimental consequence of this crisis on the psychology of our future adult generations.


id: cord-348823-u2gm3kyh
author: Baksh, Mizba
date: 2020-05-18
txt: ./txt/cord-348823-u2gm3kyh.txt
cache: ./cache/cord-348823-u2gm3kyh.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8188
doi: 10.7759/cureus.8188
summary:
  About 80% of COVID-19 infections are mild or asymptomatic and never require hospitalization but about 5% of patients become critically ill and develop acute respiratory distress syndrome (ARDS). The widely used management for ARDS in COVID-19 has been in line with the standard approach, but the need to adjust the treatment protocols has been questioned based on the reports of higher mortality risk among those requiring mechanical ventilation. Although some antimalarial and antiviral drugs may prove effective against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), their safety and efficacy are still under clinical trials. We conducted a systematic review of case reports on ARDS in SARS-CoV-2 infection to summarize the clinical presentation, laboratory and chest imaging findings, management protocols, and outcome of ARDS in COVID-19-positive patients. Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): a case series

title:
  A Systematic Review of Cases of Acute Respiratory Distress Syndrome in the Coronavirus Disease 2019 Pandemic

abstract:
  The outbreak of coronavirus disease 2019 (COVID-19) was declared a global pandemic after it spread to 213 countries and has the highest total number of cases worldwide. About 80% of COVID-19 infections are mild or asymptomatic and never require hospitalization but about 5% of patients become critically ill and develop acute respiratory distress syndrome (ARDS). The widely used management for ARDS in COVID-19 has been in line with the standard approach, but the need to adjust the treatment protocols has been questioned based on the reports of higher mortality risk among those requiring mechanical ventilation. ﻿Treatment options for this widespread disease are limited and there are no definitive therapies or vaccines until now. Although some antimalarial and antiviral drugs may prove effective against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), their safety and efficacy are still under clinical trials. We conducted a systematic review of case reports on ARDS in SARS-CoV-2 infection to summarize the clinical presentation, laboratory and chest imaging findings, management protocols, and outcome of ARDS in COVID-19-positive patients. We need ﻿more data and established studies for the effective management of the novel SARS-CoV-2 and to reduce mortality in high-risk patients.


id: cord-349868-lb2jcl8m
author: Patel, Jay
date: 2020-07-12
txt: ./txt/cord-349868-lb2jcl8m.txt
cache: ./cache/cord-349868-lb2jcl8m.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32789088/
doi: 10.7759/cureus.9151
summary:
  We present the cases of two COVID-19-positive patients treated with HCQ at our institution, which showed adverse effects of the medication. Hydroxychloroquine (HCQ), a common antimalarial and lupus drug, has been shown to potentially reduce viral carriage and the number of symptomatic days in COVID-19 patients according to an open-label non-randomized French case study of 36 patients [2] . The purpose of this case series was to highlight some of the cardiovascular complications related to HCQ and to engage in a risk-benefit analysis of its use in mild/moderate presentations of COVID-19. We believe these are among the first few cases illustrating adverse cardiovascular effects of the experimental five-day HCQ therapy in mild/moderate presentations of COVID-19. Case 2, considered as low risk, demonstrated how HCQ therapy initiated in an outpatient resulted in an adverse outcome that led to hospital admission.

title:
  Cardiovascular Considerations of Experimental Hydroxychloroquine Therapy on Patients Diagnosed With COVID-19: A Case Series Review

abstract:
  The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and its high virulence along with its variable presentation have generated a significant amount of interest within the medical community. The heterogeneous nature of the symptoms of the disease caused by SARS-CoV-2, coronavirus disease 2019 (COVID-19), ranging from being asymptomatic to severe acute respiratory distress syndrome (ARDS), has created significant interest in potential therapeutics. Given the lack of randomized controlled trials, most medications are experimental, and only anecdotal evidence is available so far regarding their efficacy. One medication that emerged as an early frontrunner as a promising therapeutic was hydroxychloroquine (HCQ), a common antimalarial and lupus drug. The adverse side effects that could result from its use did not gain much attention initially. We present the cases of two COVID-19-positive patients treated with HCQ at our institution, which showed adverse effects of the medication. While HCQ may have some therapeutic effect, it should be borne in mind that patients may experience more harm than benefit from its use.


id: cord-350375-07l9hqsr
title: An Ounce of Prevention: Coronavirus (COVID-19) and Mass Gatherings
author: Escher, Allan R
date: 2020-03-20
txt: ./txt/cord-350375-07l9hqsr.txt
cache: ./cache/cord-350375-07l9hqsr.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.7345
doi: 10.7759/cureus.7345
summary:
  Widespread, non-stop, and often sensational coverage of the coronavirus (COVID-19) has caught many governments flat-footed in efforts to protect the health and safety of their citizens. In response to the current global health event, the World Health Organization (WHO) declared COVID-19 a pandemic. Mass gatherings present a historic challenge in protecting the health and safety of attendees. Global sporting events, such as the Olympics and the World Cup, pose unique health risks to attendees and host nations. The WHO defines a mass gathering as a "concentration of people at a specific location for a specific purpose over a set period of time which has the potential to strain the planning and response resources of the country or community" [3] . In response, the WHO recently published, "Key planning recommendations for Mass Gatherings in the context of the current COVID-19 outbreak (Interim guidance)" [1] . World Health Organization: Public Health for Mass gatherings: Key Considerations

abstract:
  Widespread, non-stop, and often sensational coverage of the coronavirus (COVID-19) has caught many governments flat-footed in efforts to protect the health and safety of their citizens. In response to the current global health event, the World Health Organization (WHO) declared COVID-19 a pandemic. Mass gatherings present a historic challenge in protecting the health and safety of attendees. The majority of the prominent mass gatherings are religious in nature. Global sporting events, such as the Olympics and the World Cup, pose unique health risks to attendees and host nations. Deferment or cancellation of such mass gatherings may exert an extraordinary economic loss to the host nation. Universal adoption of best practices for infection control is the surest way for governments to prepare for mass gatherings. In these uncertain times, it is up to intergovernmental organizations to be the voice of reason.


id: cord-351120-amo51jm7
title: Prevalence of Asymptomatic SARS-CoV-2 Infection in Children and Adults in Marion County, Indiana
author: Wood, James
date: 2020-08-16
txt: ./txt/cord-351120-amo51jm7.txt
cache: ./cache/cord-351120-amo51jm7.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.9794
doi: 10.7759/cureus.9794
summary:
  Background and Objectives: Two community studies outside the US showed asymptomatic infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in adults, but not in children <10 years of age. In this study, we assessed the prevalence of asymptomatic SARS-CoV-2 infection in children and adults in Marion County, Indiana. For this reason, we conducted a community-based study of the prevalence of asymptomatic SARS-CoV-2 infection in adults and children in Marion County, Indiana. Community surveys in Iceland and Italy that included symptomatic and asymptomatic individuals found a low prevalence of infection (0.8% to 2.6%), and both studies found no infection in children <10 years of age [3, 4] . In the state of Indiana, a community prevalence study of individuals >12 years of age found an active infection rate (by PCR) of 1.7% and an overall prevalence of current (PCR) or previous infection (SARS-CoV-2 antibody) of 2.8% [8] .

abstract:
  Background and Objectives: Two community studies outside the US showed asymptomatic infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in adults, but not in children <10 years of age. In this study, we assessed the prevalence of asymptomatic SARS-CoV-2 infection in children and adults in Marion County, Indiana. Methods: Individuals living in Marion County with no symptoms of coronavirus 2019 disease (COVID-19) within seven days of enrollment were eligible for this cross-sectional household study. Study kits were delivered to the participant’s residence for self-swabbing, picked up by the study team, and tested by polymerase chain reaction (PCR) for SAR-CoV-2 infection. Results: Five hundred eleven nasal swabs were collected from 119 children and 392 adults ≥18 years of age. One participant (seven years of age) tested positive, for an overall study prevalence of 0.2% (95% CI 0, 0.6%). The participant had no known contact with a person with SARS-CoV-2 infection, and five family members tested negative for infection. The child and family members all tested negative for infection 10 and 20 days after the first test, and none developed symptoms of COVID-19 for 20 days after testing. Conclusions: Asymptomatic SARS-CoV-2 infection can occur in children <10 years with no known COVID-19 exposure. Large cohort studies should be conducted to determine prevalence of asymptomatic infection and risk of transmission from asymptomatic infection in children and adults over time.


id: cord-351267-itdorszt
title: Lebanese Healthcare System: How Will the Aftermath Look?
author: Farha, Loulwa
date: 2020-09-06
txt: ./txt/cord-351267-itdorszt.txt
cache: ./cache/cord-351267-itdorszt.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10270
doi: 10.7759/cureus.10270
summary:
  In the aftermath of the Beirut port explosion, Lebanon received immense financial and medical support from the international community in a timely fashion, which secured first level care to victims of the explosion. Nevertheless, this forced Lebanon, which was considered a prominent tertiary medical hub in the Middle East, to slowly regress into an exclusive primary care provider. From the beginning of the Lebanese economic crisis which began around a year ago, many of the small-scale hospitals and medical centers faced threats of potential bankruptcy. Hospitals and medical centers have been suffering for months to keep up with the increase in demand for intensive care unit beds, medical equipment, and medications necessary to cater to patients with severe COVID-19 infections. Three of the major tertiary medical centers serving the Beirut area were severely damaged rendering them completely non-operational, and forcing them to evacuate their patients immediately.

abstract:
  The recent Lebanese port explosion came as a continuation of a series of socioeconomic disasters the country has been facing during the past year. In addition, the massive impact of the coronavirus disease-19 (COVID-19) pandemic further hastened the collapse of the Lebanese healthcare system. In light of all those events, the Lebanese healthcare sector has faced major blows that will be difficult to recuperate from. In the aftermath of the Beirut port explosion, Lebanon received immense financial and medical support from the international community in a timely fashion, which secured first level care to victims of the explosion. Nevertheless, this forced Lebanon, which was considered a prominent tertiary medical hub in the Middle East, to slowly regress into an exclusive primary care provider. As such, it is crucial for local and regional stakeholders to build strong collaborations, and shape a unified vision of Lebanon’s future healthcare system.


id: cord-352102-ssk24jkx
author: Suwanwongse, Kulachanya
date: 2020-04-26
txt: ./txt/cord-352102-ssk24jkx.txt
cache: ./cache/cord-352102-ssk24jkx.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.7834
doi: 10.7759/cureus.7834
summary:
  Appendectomy is the gold standard of treatment for acute appendicitis; however, recent evidence suggests conservative management with intravenous antibiotics may provide similar outcomes and can be used as an alternative in selected patients. Appendectomy is the gold standard of care for patients with acute appendicitis, but recent evidence showed that conservative treatment with intravenous antibiotics may provide similar outcomes [2] . Non-operative treatment for acute appendicitis has additional benefits, including the elimination of the mortality and morbidity risks associated with surgery, as well as the complications of anesthesia, infection, and bleeding, the obliteration of the long-term complications of abdominal surgery, such as bowel obstruction and chronic wound pain, a decrease in the treatment cost and the length of hospital stay [2] [3] [4] . Although there is increasing evidence that intravenous antibiotics can be used as alternative management, especially in patients with a high operative risk, appendectomy remains the gold standard of care for patients with acute appendicitis.

title:
  Successful Conservative Management of Acute Appendicitis in a Coronavirus Disease 2019 (COVID-19) Patient

abstract:
  Appendectomy is the gold standard of treatment for acute appendicitis; however, recent evidence suggests conservative management with intravenous antibiotics may provide similar outcomes and can be used as an alternative in selected patients. Performing appendectomy in acute appendicitis patients with 2019 novel Coronavirus Disease (COVID-19) is challenging, as it involves considerable operative risks for the patients and risks for health care professionals (HCPs) exposed to COVID-19. Medical management eliminates the morbidity and mortality associated with surgery but involves significant risks of treatment failures that, in turn, may lead to perforation, peritonitis, and death. We are reporting a case of a middle-aged man with multiple co-morbidities, who was diagnosed with COVID-19 and acute appendicitis. Our patient received intravenous antibiotics for seven days with a significant improvement in symptoms. Our case report illustrates the implementation of successful conservative treatment for acute appendicitis in COVID-19 patients.


id: cord-352580-l6vkzja0
author: Iltaf, Samar
date: 2020-08-18
txt: ./txt/cord-352580-l6vkzja0.txt
cache: ./cache/cord-352580-l6vkzja0.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32953353/
doi: 10.7759/cureus.9846
summary:
  Background Coronavirus disease 2019 (COVID-19), caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), usually presents clinically with cough, fever, shortness of breath, and loss of taste and/or smell. COVID-19 can also present with neurologic signs and symptoms, including headache, hyposmia/anosmia, encephalopathy, meningoencephalitis, Guillain-Barré syndrome, stroke, and seizure. This subjective survey addressed 10 neurological manifestations of COVID-19: headache, altered sensation, nausea and vomiting, sudden hemiparesis (stroke), numbness and paresthesia, vertigo, ataxia, seizure, encephalitis/meningitis, Guillain-Barré Syndrome (GBS), and myelitis. Our study confirmed that headache (6%), altered level of consciousness and encephalopathy (2%), hemiparesis (stroke; 0.6%), GBS (0.3%) and seizure (0.3%) were the most frequently reported neurological presentations [5, 6, 7, 8] . A case study reported that a patient positive for SARS-CoV-2 presented with isolated sudden onset anosmia but no other symptoms of COVID-19 [11] .

title:
  Frequency of Neurological Presentations of Coronavirus Disease in Patients Presenting to a Tertiary Care Hospital During the 2019 Coronavirus Disease Pandemic

abstract:
  Background Coronavirus disease 2019 (COVID-19), caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), usually presents clinically with cough, fever, shortness of breath, and loss of taste and/or smell. COVID-19 can also present with neurologic signs and symptoms, including headache, hyposmia/anosmia, encephalopathy, meningoencephalitis, Guillain-Barré syndrome, stroke, and seizure. Viral transmission occurs through aerosols generated when an infected person coughs, sneezes, or exhales and by direct touching of contaminated surfaces. The present study evaluated the frequency of neurologic presentations of coronavirus disease in patients presenting at a tertiary care hospital during the COVID-19 pandemic. Methodology This cross-sectional study included 350 inpatients and outpatients (self-isolated) with polymerase chain reaction-confirmed SARS-CoV-2 infection who presented at Dow International Medical College of Karachi between March and June 2020. Of these 350 patients, 68 (18.9%) presented with neurological signs and symptoms and were further evaluated. The data were analyzed statistically using IBM Statistical Product and Service Solutions (SPSS) for Windows, version 20.0 (IBM Corp., Armonk, NY). Results The 350 patients with SARS-CoV-2 infection included 245 (70%) men and 105 (30%) women; of these, 262 (74.9%) were married, and 88 (25.1%) were unmarried. Patients ranged in age from 17 to 88 years (mean ± standard deviation, 49.5 ± 17.4 years), with 68 (18.9%) having neurological manifestations. Headache was the most frequent neurological symptom, reported in 21 (6%) patients, followed by vertigo in 12 patients (3.4%), numbness/paresthesia in 11 (3.1%), altered level of consciousness in seven (2%), hyposmia/anosmia in five (1.4%), and encephalitis in three (0.9%). Other symptoms included sudden hemiparesis (stroke) in two patients (0.6%), flaccid paralysis due to Guillain-Barre syndrome in one (0.3%), and seizure in one (0.3%). Conclusion Neurological involvement is not infrequent in patients with COVID-19. Neurologic manifestations should be carefully monitored in infected patients. COVID-19 should be suspected in patients presenting with neurological abnormalities and should be included in the differential diagnosis to prevent further virus transmission.


id: cord-352640-fycwhyfv
title: Profile of Patients Suspected to be COVID-19: A Retrospective Analysis of Early Pandemic Data
author: Goel, Ashish
date: 2020-08-29
txt: ./txt/cord-352640-fycwhyfv.txt
cache: ./cache/cord-352640-fycwhyfv.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10125
doi: 10.7759/cureus.10125
summary:
  Our study is a short retrospective analysis of the demographic and clinical profiles of subjects presenting with a mild flu-like illness to our hospital who were tested for COVID-19. We present a short retrospective analysis of the demographic and clinical profiles of subjects presenting with a mild flu-like illness to our hospital who were tested for COVID-19. A retrospective analysis of data from subjects who presented to our hospital with mild flu-like illness between the months of March and May 2020 was conducted to understand the disease profile. Data were available for 3,026 subjects who presented to our hospital with either mild flu-like symptoms or with suspected exposure to a confirmed case of COVID-19 during the early phases of the pandemic. In this retrospective analysis, we report that among subjects presenting to the hospital with a mild flu-like illness, those who tested positive for COVID-19 were significantly older and more likely to be men.

abstract:
  Background and Objectives Coronavirus disease 2019 (COVID-19), a global public health emergency of profound magnitude, has brought life to an unprecedented near-standstill. The clinical profile of the disease is still emerging and is marked by considerable geographical variability in terms of transmissibility, clinical profile, virulence, and mortality of the disease. As clinical data is being reported from around the globe, it becomes important to focus on local subjects in a global milieu, lest one misses the trees for the forest. Our study is a short retrospective analysis of the demographic and clinical profiles of subjects presenting with a mild flu-like illness to our hospital who were tested for COVID-19. It compares the differences in age and sex of those who tested positive with those negative. In addition, it reviews the length of time it might take for a case testing positive on reverse transcriptase-polymerase chain reaction (RT-PCR) test to become negative. Methodology A retrospective analysis of data from adults who presented to our hospital with a mild flu-like illness between the months of March and May 2020 was conducted to understand the disease profile. The nasal/oropharyngeal swabs were collected from each patient and were transported to state-approved laboratories chain for RT-PCR analysis. Information was collected from reports received, clinical information forms, and sample collection forms that were being maintained as a part of the clinical management protocol. Data were analysed using Stata software, version 13 (StataCorp LLC, College Station, TX, USA). Observations and Results Three thousand twenty-six subjects presented to our hospital with either mild flu-like symptoms or with suspected exposure to a confirmed case of COVID-19. The subjects had a mean age of 37.3 (± 15.1) years and 1,805 (60.3%) were males. A regression analysis revealed an adjusted odds of 1.6 (95% confidence interval (CI): 1.2, 2.1) for testing positive for males as compared to females. For every one year increase in age, the odds for testing positive increased by 1.02 (95% CI: 1.01, 1.03). Of the 2,592 individuals for whom data was available, 201 (7.6%) were found positive on RT-PCR analysis. Those testing positive were significantly older (41.0 years vs 36.8 years; p = 0.001) and more likely to be male (number: 138; 9.0% vs 6.7%; p = 0.05). Cough, followed by fever, was a common presenting feature. A survival time analysis using data from 54 participants documented 455 days of the total observation period. A median time of eight days was required for the test to convert from positive to negative if the patient remained mildly symptomatic and did not develop a severe complicated illness. The time to conversion did not differ with age or sex. Conclusions Our analysis shows that patients with COVID-19 have presented with milder symptoms and have recovered well. The low test positivity rate is indicative of the early phase of the pandemic in the country and is a reflection of active infection control measures.


id: cord-352828-4ecik6xw
author: Lagziel, Tomer
date: 2020-05-19
txt: ./txt/cord-352828-4ecik6xw.txt
cache: ./cache/cord-352828-4ecik6xw.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8198
doi: 10.7759/cureus.8198
summary:
  title: Two False Negative Test Results in a Symptomatic Patient with a Confirmed Case of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and Suspected Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) The pathogen known as severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), is notable for attacking the pulmonary system causing acute respiratory distress, but it can also severely affect other systems in at-risk individuals including cardiovascular compromise, gastrointestinal distress, acute kidney injury, coagulopathies, cutaneous manifestations, and ultimately death from multi-organ failure. We present a confirmed COVID-19 case that was transferred to our burn center for concern of Steven Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) overlap syndrome after having two negative confirmatory COVID-19 tests at an outside hospital. We present a COVID-19 case that was transferred to our burn center for concern of Steven Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) overlap syndrome after having two negative confirmatory COVID-19 tests at an outside hospital.

title:
  Two False Negative Test Results in a Symptomatic Patient with a Confirmed Case of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and Suspected Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN)

abstract:
  The recent outbreak of COVID-19 has put significant strain on the current health system and has exposed dangers previously overlooked. The pathogen known as severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), is notable for attacking the pulmonary system causing acute respiratory distress, but it can also severely affect other systems in at-risk individuals including cardiovascular compromise, gastrointestinal distress, acute kidney injury, coagulopathies, cutaneous manifestations, and ultimately death from multi-organ failure. Unfortunately, the reliability of negative test results is questionable and the high infectious burden of the virus calls for extended safety precautions, especially in symptomatic patients. We present a confirmed COVID-19 case that was transferred to our burn center for concern of Steven Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) overlap syndrome after having two negative confirmatory COVID-19 tests at an outside hospital. A 58-year-old female with a history of morbid obesity, HTN, gout, CML managed with imatinib, and chronic kidney disease presented as a transfer from a community hospital to our burn center. The patient was admitted to her community hospital with febrile, acute respiratory distress. Imaging and clinical presentation was consistent with COVID-19 and lab tests for the pathogen were ordered. During observation, while waiting for results, she was placed under patient under investigation (PUI) protocol. Once negative results were obtained, the PUI protocol was abandoned despite ongoing symptoms. Subsequently, dermatological symptoms developed and transfer to our burn center was initiated. After a second negative test result, the symptomatic patient was transferred to our burn center for expert wound management. Given the lack of resolve of respiratory symptoms and concern for the burn patient population, the patient was placed in PUI protocol and an internal COVID-19 was ordered. The patient’s initial exam under standard COVID-19 airborne precautions revealed 5% total body surface area of loss of epidermis affecting bilateral thighs, bilateral arms, and face. A dermatopathological biopsy suggested a bullous drug reaction with an erythema multiform-like reaction pattern versus SJS/TEN. Moreover, the internal COVID-19 test returned positive. The delayed positive test results and complicated hospital course with our patient required us to scale back and notify every patient and staff member whom they came in contact with, across multiple institutions. We suggest that whenever a suspected COVID-19 patient is transferred to a specialized center, they should be isolated and re-checked before joining the new patient population for treatment of the unique condition.


id: cord-353717-jjd90fyh
author: Singhavi, Ravi
date: 2020-09-25
txt: ./txt/cord-353717-jjd90fyh.txt
cache: ./cache/cord-353717-jjd90fyh.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33133827/
doi: 10.7759/cureus.10657
summary:
  title: A Case of Hemolytic Anemia With Acute Myocarditis and Cardiogenic Shock: A Rare Presentation of COVID-19 In this report, we present a case of acute hemolytic anemia with acute myocarditis and cardiogenic shock in a male patient with COVID-19 infection. In this report, we presented a case of a COVID-19 patient who developed acute myocarditis and severe acute hemolytic anemia, as evident from peripheral blood smear showing schistocytes (fragmented RBCs) in peripheral smear with acute severe anemia along with elevated LDH, which is also a surrogate marker for hemolysis. To date, no case of severe hemolytic anemias with stress cardiomyopathy/acute myocarditis in a patient of COVID-19 have been formally reported in the literature. To date, no case of severe hemolytic anemias with stress cardiomyopathy/acute myocarditis in a patient of COVID-19 have been formally reported in the literature.

title:
  A Case of Hemolytic Anemia With Acute Myocarditis and Cardiogenic Shock: A Rare Presentation of COVID-19

abstract:
  Coronavirus disease 2019 (COVID-19) cases are on the rise globally, and mortality- and survival-related data are emerging every day. In addition, upcoming reports are suggestive of increased risk of cardiac ailments in high-risk patients. In the context of cardiac involvement, acute myocarditis has become one of the unexplored areas in COVID-19 patients, which could influence the long-term outcomes. In this report, we present a rare case that warrants further study on the subject due to the paucity of data in the literature. To date, no case of severe hemolytic anemias with stress cardiomyopathy/acute myocarditis in a patient of COVID-19 has been formally reported in the literature. The bedside echocardiogram had shown a possibility of acute myocarditis. The patient’s marked left ventricular (LV) functional recovery without coronary intervention further corroborates the same. Clinicians should be aware of the diversity of cardiovascular/hematological complications, as well as focused cardiac ultrasound study and the importance of echocardiography as a good screening modality for cardiovascular and hematological complications of COVID-19 infection.


id: cord-353824-0oyvia6d
title: Coronavirus Disease 2019-Related Acute Ischemic Stroke: A Case Report
author: Farooque, Umar
date: 2020-09-08
txt: ./txt/cord-353824-0oyvia6d.txt
cache: ./cache/cord-353824-0oyvia6d.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.10310
doi: 10.7759/cureus.10310
summary:
  Here we present a case of a patient with COVID-19 who presented with acute ischemic stroke in the absence of common risk factors for cerebrovascular accidents. A 70-year-old male patient, with no prior comorbidities, presented to the emergency department (ED) with fever, cough, and shortness of breath for four days, and altered level of consciousness and right-sided weakness with the sensory loss for one day. Here we report a case of a patient with COVID-19 who presented with acute ischemic stroke without any predisposing conventional risk factors for cerebrovascular accident. Older age, high sequential organ failure assessment (SOFA) score, cardiovascular diseases, secondary infections, ARDS, acute renal injury, lymphopenia, and elevated liver enzymes, CRP, ferritin, fibrin, and d-dimers are some of the factors in COVID-19 cases which can identify patients at risk of in-hospital mortality [13] . COVID-19 is an independent risk factor for acute ischemic stroke

abstract:
  Coronavirus disease 2019 (COVID-19) is an active worldwide pandemic with diverse presentations and complications. Most patients present with constitutional and respiratory symptoms. Acute ischemic stroke remains a medical emergency even during the COVID-19 pandemic. Here we present a case of a patient with COVID-19 who presented with acute ischemic stroke in the absence of common risk factors for cerebrovascular accidents. A 70-year-old male patient, with no prior comorbidities, presented to the emergency department (ED) with fever, cough, and shortness of breath for four days, and altered level of consciousness and right-sided weakness with the sensory loss for one day. On examination, the patient had a score of 8/15 on the Glasgow coma scale (GCS). There was a right-sided sensory loss and weakness in both upper and lower limbs with a positive Babinski's sign. The pulmonary examination was remarkable for bilateral crepitation. On blood workup, there was leukocytosis and raised c-reactive protein (CRP). D-dimer, ferritin, thyroid-stimulating hormone (TSH), vitamin B12, and hypercoagulability workup were normal. Transthoracic echocardiography was also normal. COVID-19 polymerase chain reaction (PCR) detected the virus. Chest x-ray showed infiltrations in the left middle and both lower zones of the lungs in the peripheral distribution. Computed tomography (CT) scan of the chest showed peripheral and mid to basal predominant multilobar ground-glass opacities. CT scan of the head showed a large hypodense area, with a loss of gray and white matter differentiation, in the left middle cerebral artery territory. Magnetic resonance imaging (MRI) of the head showed abnormal signal intensity area in the left parietal region. It appeared isointense on T1 image and hyperintense on T2 image. It also showed diffusion restriction on the diffusion-weighted 1 (DW1) image with corresponding low signals on the apparent diffusion coefficient (ADC) map. These findings were consistent with left middle cerebral artery territory infarct due to COVID-19. The patient was intubated in the ED. He was deemed unfit for thrombolysis and started on aspirin, anti-coagulation, and other supportive measures. Patients with COVID-19 should be evaluated early for neurological signs. Timely workup and interventions should be performed in any patient suspected of having a stroke to reduce morbidity and mortality.


id: cord-354835-o0nscint
author: Roy, Sayak
date: 2020-06-04
txt: ./txt/cord-354835-o0nscint.txt
cache: ./cache/cord-354835-o0nscint.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.8440
doi: 10.7759/cureus.8440
summary:
  The correlation coefficient was calculated by plotting dependant variables the number of COVID-19 cases and the number of deaths due to COVID 19 on the Y-axis and independent variables critical-care beds per capita, the median age of the population of the country, the number of COVID-19 tests per million population, population density (persons per square km), urban population percentage, and gross domestic product (GDP) expense on health care on the X-axis. We retrieved data between January 2020 and April 8, 2020, related to population and population density, the median age of the population of a country, urban population, number of COVID-19 testing employed per million population, GDP expense of each country on health, critical care beds available per capita, from various sources as mentioned in the reference section, stated next to each of these variables in Table 1 , along with the total number of COVID-19 cases and the case fatality rate (as per WHO Situation Report, 78 [2] ).

title:
  Epidemiological Determinants of COVID-19-Related Patient Outcomes in Different Countries and Plan of Action: A Retrospective Analysis

abstract:
  Current development around the pandemic of novel coronavirus disease 2019 (COVID-19) presents a significant healthcare resource burden threatening to overwhelm the available nationwide healthcare infrastructure. It is essential to consider, especially for resource-limited nations, strategizing the coordinated response to handle this crisis effectively and preparing for the upcoming emergence of calamity caused by this yet-to-know disease entity. Relevant epidemiological data were retrieved from currently available online reports related to COVID-19 patients. The correlation coefficient was calculated by plotting dependant variables - the number of COVID-19 cases and the number of deaths due to COVID 19 on the Y-axis and independent variables - critical-care beds per capita, the median age of the population of the country, the number of COVID-19 tests per million population, population density (persons per square km), urban population percentage, and gross domestic product (GDP) expense on health care - on the X-axis. After analyzing the data, both the fatality rate and the total number of COVID-19 cases were found to have an inverse association with the population density with the variable - the number of cases of COVID-19 - achieving a statistical significance (p-value 0.01). The negative correlation between critical care beds and the fatality rate is well-justified, as intensive care unit (ICU) beds and ventilators are the critical elements in the management of complicated cases. There was also a significant positive correlation between GDP expenses on healthcare by a country and the number of COVID-19 cases being registered (p-value 0.008), although that did not affect mortality (p-value 0.851). This analysis discusses the overview of various epidemiological determinants possibly contributing to the variation in patient outcomes across regions and helps improve our understanding to develop a plan of action and effective control measures in the future.


id: cord-356332-t0ahmh0h
title: A Rare Complication of Myocardial Infarction: Ventricular Septal Defect
author: Elkattawy, Sherif
date: 2020-08-13
txt: ./txt/cord-356332-t0ahmh0h.txt
cache: ./cache/cord-356332-t0ahmh0h.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7759/cureus.9725
doi: 10.7759/cureus.9725
summary:
  Ventricular septal defect (VSD) is a rare but lethal complication of myocardial infarction. VSD is a rare but lethal complication of myocardial infarction (MI), it is also referred to as a ventricular septal rupture (VSR). Patients with a right ventricular infarction or cardiogenic shock and a ventricular septal rupture have high in-hospital mortality rate [3] . He also had a transthoracic echocardiogram, which showed a left ventricular ejection fraction (LVEF) of 30-35%, ischemic cardiomyopathy, and muscular ventricular septal defects with left to right shunting and severely elevated pulmonary artery systolic pressure as seen in Video 1. Ventricular septal defect (VSD) is a rare mechanical complication of myocardial infarction, especially in the era of reperfusion therapy [2] . Ventricular septal defect is a known however rare complication of myocardial infarction. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction Hemodynamic complications of ventricular septal rupture after acute myocardial infarction

abstract:
  Ventricular septal defect (VSD) is a rare but lethal complication of myocardial infarction. We present a case of a 65-year-old male who presented with a history of progressive shortness of breath associated with productive cough. Physical examination was significant for crepitation in both lower lung fields and bilateral lower extremity edema. Chest X-ray revealed bilateral reticular opacities with small bilateral pleural effusions. Polymerase chain reaction (PCR) for COVID was positive. Echo showed a left ventricular ejection fraction (LVEF) of 30-35%, ischemic cardiomyopathy, and muscular ventricular septal defects with left to right shunting and severely elevated pulmonary artery systolic pressure. Overtime during the hospital course, he developed respiratory and fulminant hepatic failure. Our patient had VSD due to an undiagnosed old myocardial infarction (MI). Initially heart failure was compensated and treated with medical management. Later on, he developed respiratory complications related to COVID-19 infection as well as hepatic failure in addition to a cardiomyopathy which made him a poor surgical candidate leading to death.


