369. Clinical Characteristics of the First 177 Patients Admitted with COVID-19 at a Bronx Community Hospital

Abstract Background The first case of COVID-19 was admitted on March 15th 2020 to our community based hospital in the Bronx, NY. The aim of this study is to describe the clinical characteristics and outcome of these first COVID-19 patients. Patient Characteristics and Outcome Methods IRB approved retrospective chart review study of all COVID-19 patients admitted during March 2020 focusing on patient characteristics, co-morbidities, clinical manifestations and outcome. Results A total of 177 patients were admitted during March 2020: 57% African American 23.1% Hispanic and 16.9% White. 44.9% female, average age 60 years, and 90% had at least one comorbidity. Outcome was available on all patients except for one who was transferred to another institution for ECMO. Overall mortality was 33%. Clinical presentation: 69.4% presented with cough or shortness of breath, 15.8% with diarrhea, nausea, vomiting or abdominal pain, and 14.6% with myalgia, dizziness or altered mental status. 6.2% presented only with fever. However 59.8% of patients presented with fever and respiratory or gastrointestinal symptoms. Mortality The table compares patients who died vs discharged (either home or to a short term facility). Those that were 65 years or older, hypertensive or presented to the ER with an oxygen saturation of 94% or lower, were more likely to die. Ventilated patients: 31.6% of patients were intubated with a mortality rate of 77%. 22% of these patients were intubated in the first 24 hours. Compared to non-intubated patients, there was no difference in BMI, diabetes, hypertension, COPD/Asthma, use of statins, aspirin or calcium channel blockers. Intubated patients older than 64 years had significantly higher mortality rates (p=0.0001). Conclusion This cohort of COVID-19 patients is unique as almost all received Hydroxychloroquine and Azithromycin. Only 9% received steroids and even fewer received an interleukin-6 inhibitor, convalescent plasma or Remdesivir. African Americans and Hispanics accounted for 80% of patients. Greater than 90% received Medicaid. Overall mortality was 33%. The most common presentation was respiratory followed by gastrointestinal symptoms. The overall mortality was 33% but increased to 77% in intubated patients. Age, hypertension, and ER oxygen saturation correlated with mortality. Disclosures All Authors: No reported disclosures

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Retrospective analysis of clinical characteristics of 405 patients with COVID-19

Journal of International Medical Research ◽

10.1177/0300060520949039 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052094903 ◽

Cited By ~ 1

Author(s):

Ting Zhan ◽

Meng Liu ◽

Yalin Tang ◽

Zheng Han ◽

Xueting Cheng ◽

...

Keyword(s):

Clinical Characteristics ◽

Severe Disease ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Circulatory System ◽

Respiratory Illnesses ◽

Reactive Protein ◽

Circulatory System Diseases ◽

History Of ◽

Abnormal Lymphocyte

Objective This study was performed to investigate the clinical characteristics of patients with coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods We analyzed the electronic medical records of 405 hospitalized patients with laboratory-confirmed COVID-19 in the Third Hospital of Wuhan. Results The patients’ median age was 56 years, 54.1% were female, 11.4% had a history of smoking, and 10.6% had a history of drinking. All cases of COVID-19 were community-acquired. Fever (76.8%) and cough (53.3%) were the most common clinical manifestations, and circulatory system diseases were the most common comorbidities. Gastrointestinal symptoms were present in 61.2% of the patients, and 2.9% of the patients were asymptomatic. Computed tomography showed ground-glass opacities in most patients (72.6%) and consolidation in 30.9%. Lymphopenia (72.3%) and hypoproteinemia (71.6%) were observed in most patients. About 20% of patients had abnormal liver function. Patients with severe disease had significantly more prominent laboratory abnormalities, including an abnormal lymphocyte count and abnormal C-reactive protein, procalcitonin, alanine aminotransferase, aspartate aminotransferase, D-dimer, and albumin levels. Conclusion SARS-CoV-2 causes a variety of severe respiratory illnesses similar to those caused by SARS-CoV-1. Older age, chronic comorbidities, and laboratory abnormalities are associated with disease severity.

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Fatal hemorrhagic pneumonia in patients with hematologic diseases and Stenotrophomonas maltophilia bacteremia: a retrospective study

BMC Infectious Diseases ◽

10.1186/s12879-021-06420-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lixia Zhu ◽

Lulu Wang ◽

Yuping Zhang ◽

Rongrong Chen ◽

Xueying Li ◽

...

Keyword(s):

Risk Factors ◽

Stenotrophomonas Maltophilia ◽

Clinical Characteristics ◽

Clinical Manifestations ◽

Hematologic Diseases ◽

Hemorrhagic Pneumonia ◽

Independent Risk Factors ◽

High Level ◽

Clinical Records ◽

Overall Mortality

Abstract Background Fatal hemorrhagic pneumonia is one of the most severe manifestations of Stenotrophomonas maltophilia (SM) infections. Here, we aimed to investigate the clinical characteristics of SM bacteremia and to identify the risk factors of hemorrhagic pneumonia caused by SM in patients with hematologic diseases. Methods The clinical records of 55 patients diagnosed with hematologic diseases and SM bacteremia were retrospectively reviewed. We compared patients’ clinical characteristics and outcomes between the hemorrhagic pneumonia group and non-hemorrhagic pneumonia group. Results Twenty-seven (49.1%) patients developed hemorrhagic pneumonia. The overall mortality rate of SM bacteremia was 67.3%. Hemorrhagic pneumonia (adjusted HR 2.316, 95% CI 1.140–4.705; P = 0.020) was an independent risk factor of 30-day mortality in hematological patients with SM bacteremia. Compared with the non-hemorrhagic pneumonia group, patients in the hemorrhagic pneumonia group were older and showed clinical manifestations as higher proportions of isolated SM in sputum culture, neutropenia and elevated procalcitonin (PCT). Multivariate analysis showed that neutropenia, high levels of PCT, prior tigecycline therapy within 1 month were independent risk factors associated with hemorrhagic pneumonia. Conclusions Neutropenia, high level of PCT and prior tigecycline therapy within 1 month were significant independent predictors of hemorrhagic pneumonia in hematologic patients with SM bacteremia. Due to no effective antibiotics to prevent hemorrhagic pneumonia, prophylaxis of SM infection and its progression to hemorrhagic pneumonia is particularly important.

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Epidemiological investigation and intergenerational clinical characteristics of 24 coronavirus disease patients associated with a supermarket cluster: a retrospective study

BMC Public Health ◽

10.1186/s12889-021-10713-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Suochen Tian ◽

Min Wu ◽

Zhenqin Chang ◽

Yunxia Wang ◽

Guijie Zhou ◽

...

Keyword(s):

Symptom Onset ◽

Clinical Characteristics ◽

First Generation ◽

Clinical Manifestations ◽

Index Patient ◽

Time Interval ◽

First Case ◽

Group A ◽

Group B ◽

Epidemiological Characteristics

Abstract Background In view of the ongoing coronavirus disease (COVID-19) pandemic, it remains unclear whether the severity of illness and time interval from symptom onset to release from quarantine differ between cases that originated from clusters and cases reported in other areas. This study aimed to assess epidemiological and intergenerational clinical characteristics of COVID-19 patients associated with cluster outbreaks to provide valuable data for the prevention and control of COVID-19. Methods We identified the first employee with COVID-19 at a supermarket and screened the close contacts of this index patient. Confirmed cases were divided into two groups according to the generation (first generation comprising supermarket employees [group A] and second or third generations comprising family members or friends of the supermarket employees [group B]). The epidemiological and clinical characteristics of the two groups were retrospectively compared. Results A total of 8437 people were screened, and 24 COVID-19 patients were identified. Seven patients (29.2%) were asymptomatic; three patients were responsible for six symptomatic cases. The interval from the confirmation of the first case to symptom onset in symptomatic patients was 5–11 days. The clinical manifestations of symptomatic patients upon admission were non-specific. All patients (including the seven asymptomatic patients) were admitted based on chest computed tomography features indicative of pneumonia. There were 11 cases in group A (first generation) and 13 cases in group B (second generation, 11 cases; third generation, 2 cases), with no significant differences in clinical and epidemiological characteristics between the two groups, except for sex, duration from symptom onset to hospitalization, and underlying disease (P > 0.05). Conclusions For cluster outbreaks, it is important to comprehensively screen close the contacts of the index patient. Special attention should be paid to asymptomatic cases. The clinical management of cluster patients is similar to that of other COVID-19 patients.

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443. Comparison of Clinical Characteristics of Endemic vs. SARS-CoV-2 Coronavirus Infection in Patients Admitted to a Community Teaching Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.636 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S288-S289

Author(s):

Paula Ann Politis ◽

Michael J Oravec ◽

Lisa Hoisington ◽

Michael Tan ◽

Shanu Agarwal ◽

...

Keyword(s):

Clinical Characteristics ◽

Gastrointestinal Symptoms ◽

Care Facility ◽

Patient Characteristics ◽

Smoking History ◽

Upper Respiratory Tract ◽

Significant Difference ◽

Pcr Method ◽

Serious Disease ◽

Tract Infections

Abstract Background Endemic coronaviruses [EC] (NL63, 229E, OC43, HKU1) have been identified in humans since the 1960s. Most are associated with mild upper respiratory tract infections (RTIs) but can be associated serious disease. More recently, novel coronaviruses associated with SARS, MERS, and COVID-19 caused by SARS-CoV-2 have emerged and are often associated with serious disease and death. With this report, we compare presenting clinical characteristics and some outcomes of patients hospitalized with RTIs caused by ECs or by SARS-CoV-2 (COVID-19). Methods Patients admitted to the Summa Health System with RTIs associated with EC were identified via multiplex PCR method (BioFire™). Patients admitted with COVID-19 were identified by real-time, reverse transcriptase-PCR method using one of several platforms. Patients were selected from two existing quality improvement registries encompassing EC and COVID-19 cases. We compared clinical characteristics and outcomes of EC patients to those of COVID-19 patients using chi-squared tests for proportions and independent samples t-tests for means. Results Shown in Table 1. Significant differences in patient characteristics with EC vs. COVID-19 included: older age, primarily Caucasian, smoking history, requiring O2 supplementation on admission, and having chronic heart, lung, or renal disease. Significant differences in patient characteristics with COVID-19 vs. EC included: admission from extended care facility, obesity, presenting with fever, gastrointestinal symptoms and/or myalgia, presence of radiographic infiltrates, abnormal liver tests, and longer length of stay (LOS). A non-significant difference was noted in 30 day mortality rates. Coronavirus OC43 accounted for 54% of EC strains. Conclusion There were significant differences in clinical characteristics between the two groups with EC patients more likely to have lung disease (often COPD) and requiring admission for need of O2 supplementation. COVID-19 patients were more likely to present with a febrile illness associated with pneumonia and require longer LOS (often requiring O2 supplementation later in hospitalization). Patients admitted with COVID-19 present with different clinical characteristics than those with EC with numerically higher mortality rate. Disclosures All Authors: No reported disclosures

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Clinical characteristics of COVID-19 patients with clinically diagnosed bacterial co-infection: A multi-center study

PLoS ONE ◽

10.1371/journal.pone.0249668 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249668

Author(s):

Shengyang He ◽

Wenlong Liu ◽

Mingyan Jiang ◽

Peng Huang ◽

Zhi Xiang ◽

...

Keyword(s):

Clinical Characteristics ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Ground Glass Opacity ◽

Cell Counting ◽

Cardiovascular Comorbidities ◽

Laboratory Results ◽

Multi Center Study ◽

Blood Cell Counting ◽

White Blood Cell Counting

Objective To understand the clinical characteristics of COVID-19 patients with clinically diagnosed bacterial co-infection (CDBC), and therefore contributing to their early identification and prognosis estimation. Method 905 COVID-19 patients from 7 different centers were enrolled. The demography data, clinical manifestations, laboratory results, and treatments were collected accordingly for further analyses. Results Around 9.5% of the enrolled COVID-19 patients were diagnosed with CDBC. Older patients or patients with cardiovascular comorbidities have increased CDBC probability. Increased body temperature, longer fever duration, anhelation, gastrointestinal symptoms, illness severity, intensive care unit attending, ventilation treatment, glucocorticoid therapy, longer hospitalization time are correlated to CDBC. Among laboratory results, increased white blood cell counting (mainly neutrophil), lymphocytopenia, increased procalcitonin, erythrocyte sedimentation rate, C-reaction protein, D-dimer, blood urea nitrogen, lactate dehydrogenase, brain natriuretic peptide, myoglobin, blood sugar and decreased albumin are also observed, indicating multiple system functional damage. Radiology results suggested ground glass opacity mixed with high density effusion opacities and even pleural effusion. Conclusion The aged COVID-19 patients with increased inflammatory indicators, worse lymphopenia and cardiovascular comorbidities are more likely to have clinically diagnosed bacterial co-infection. Moreover, they tend to have severer clinical manifestations and increased probability of multiple system functional damage.

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Characteristics, management and outcome of prehospital pediatric emergencies by a Dutch HEMS

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01579-8 ◽

2021 ◽

Author(s):

Michelle Berdien Oude Alink ◽

Xavier Roland Johnny Moors ◽

Senned Karrar ◽

Robert Jan Houmes ◽

Dennis Den Hartog ◽

...

Keyword(s):

Pediatric Patients ◽

Prehospital Care ◽

Survival Rates ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Helicopter Emergency Medical Service ◽

Primary Objective ◽

Trauma Patients ◽

Trauma Group ◽

Overall Mortality

Abstract Background In prehospital care, the Helicopter Emergency Medical Service (HEMS) can be dispatched for critically injured or ill children. However, little detail is known about dispatches for children, in terms of the incidence of prehospital interventions and overall mortality. The primary objective of this study is to provide an overview of pediatric patient characteristics and incidence of interventions. Methods A retrospective chart review of all patients ≤ 17 years who received medical care by Rotterdam HEMS from 2012 until 2017 was carried out. Results During the study period, 1905 pediatric patients were included. 59.1% of patients were male and mean age was 6.1 years with 53.2% of patients aged ≤ 3 years. 53.6% were traumatic patients and 49.7% were non-traumatic patients. 18.8% of patients were intubated. Surgical procedures were performed in 0.9%. Medication was administered in 58.1% of patients. Cardiopulmonary resuscitation (CPR) was necessary in 12.9% of patients, 19.9% were admitted to the intensive care unit and 14.0% needed mechanical ventilation. Overall mortality was 9.5%. Mortality in trauma patients was 5.5% and in non-trauma group 15.3%. 3.9% of patients died at the scene. Conclusions Patients attended by HEMS are at high risk of prehospital interventions like CPR or intubation. EMS has little exposure to critically ill or injured children. Hence, HEMS expertise is required to perform critical procedures. Trauma patients had higher survival rates than non-traumatic patients. This may be explained by underlying illnesses in non-traumatic patients and CPR as reason for dispatch. Further research is needed to identify options for improving prehospital care in the non trauma pediatric patients.

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Postoperative cognitive dysfunction: progress mechanisms and clinical characteristics

Medical alphabet ◽

10.33667/2078-5631-2019-2-19(394)-29-33 ◽

2019 ◽

Vol 2 (19) ◽

pp. 29-33

Author(s):

K. B. Manysheva ◽

M. A. Akhmedov ◽

A. A. Rakhmanova ◽

S. M. Khutalieva

Keyword(s):

Cognitive Dysfunction ◽

Clinical Characteristics ◽

Cognitive Deficit ◽

Neuropsychological Testing ◽

Postoperative Cognitive Dysfunction ◽

Clinical Manifestations ◽

Postoperative Recovery ◽

Neuropsychological Rehabilitation ◽

Brain Barrier Permeability ◽

The Central Nervous System

The article is devoted to the study of postoperative cognitive dysfunction — a syndrome that is often found in the postoperative period and does not depend on the volume of surgeon. Based on the analysis of the results of modern studies, the authors cite the most likely etiological causes of the syndrome, grouped according to different categories of risk factors. The pathogenetic algorithm for cognitive dysfunction includes the appearance of systemic inflammation, improving blood-brain barrier permeability with the endothelial dysfunction, the migration of inflammatory agents into the central nervous system, and the formation of oxidative stress. The clinical manifestations of cognitive deficit in the outcome of surgeon performed under general anesthesia, the authors illustrate with their own observations of patients with a neurosurgical profile with spinal pathology operated on with the use of propofol anesthesia, comparing the results of neuropsychological testing with an assessment of the level of anxiety. In conclusion, the authors outline a strategy for the prevention of postoperative cognitive dysfunction and recommend conducting neuropsychological rehabilitation as an important component of postoperative recovery for all patients with a diagnosed cognitive deficit that occurred after surgery.

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Celiac Disease in Kosovar Albanian Children: Evaluation of Clinical Features and Diagnosis

Current Pediatric Reviews ◽

10.2174/1573396316666200116093753 ◽

2020 ◽

Vol 16 (3) ◽

pp. 241-247

Author(s):

Atifete Ramosaj-Morina ◽

Alije Keka-Sylaj ◽

Arbana Baloku Zejnullahu ◽

Lidvana Spahiu ◽

Virgjina Hasbahta ◽

...

Keyword(s):

Celiac Disease ◽

Disease Onset ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Dominant Mode ◽

Primary School Children ◽

Cross Sectional ◽

Classical Form ◽

Wide Range ◽

The Mean

Background: Celiac disease is an immune-mediated disorder characterized by variable clinical manifestations, specific antibodies, HLA-DQ2/DQ8 haplotypes, and enteropathy. Objectives: The aim of this study was to present the clinical spectrum and patterns of celiac disease in Kosovar Albanian children. Methods: A cross-sectional retrospective study was performed with Albanian children aged 0-18 years, treated for celiac disease in the Pediatric Clinic, University Clinical Center of Kosovo from 2005 to 2016. Results: During the study period, 63 children were treated for celiac disease. The mean age at diagnosis was 5.5 years (SD ± 3.31). The mean age at celiac disease onset was 3.3 years (SD ± 2.02), while the mean delay from the first symptoms indicative of celiac disease to diagnosis was 2.2 years (SD ± 2.09). More than 70% of the patients were diagnosed in the first 7 years of life, mainly presented with gastrointestinal symptoms, while primary school children and adolescents mostly showed atypical symptoms (p<0.001). The classical form of celiac disease occurred in 78% of the cases. Sixty (95%) patients carried HLA-DQ2.5, DQ2.2 and/or HLA-DQ8 heterodimers, and only three of them tested negative. Conclusions: Kosovo, as the majority of developing countries, is still facing the classical form of celiac disease as the dominant mode of presentation; as a result, most children with other forms of the celiac disease remain undiagnosed. : Physicians should be aware of the wide range of clinical presentations and utilize low testing thresholds in order to prevent potential long-term problems associated with untreated celiac disease.

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Upbeat vertical nystagmus after brain stem cavernoma resection: a rare case of nucleus intercalatus/nucleus of roller injury

Journal of Neurology ◽

10.1007/s00415-020-09891-4 ◽

2020 ◽

Vol 267 (10) ◽

pp. 2865-2870

Author(s):

Torstein R. Meling ◽

Aria Nouri ◽

Adrien May ◽

Nils Guinand ◽

Maria Isabel Vargas ◽

...

Keyword(s):

Rare Case ◽

Vascular Malformations ◽

Clinical Manifestations ◽

Neurological Injury ◽

Medial Longitudinal Fasciculus ◽

Blurred Vision ◽

Complete Excision ◽

First Case ◽

Vertical Nystagmus ◽

Upbeat Nystagmus

Abstract Introduction CNS cavernomas are a type of raspberry-shaped vascular malformations that are typically asymptomatic, but can result in haemorrhage, neurological injury, and seizures. Here, we present a rare case of a brainstem cavernoma that was surgically resected whereafter an upbeat nystagmus presented postoperatively. Case report A 42-year old man presented with sudden-onset nausea, vomiting, vertigo, blurred vision, marked imbalance and difficulty swallowing. Neurological evaluation showed bilateral ataxia, generalized hyperreflexia with left-sided predominance, predominantly horizontal gaze evoked nystagmus on right and left gaze, slight left labial asymmetry, uvula deviation to the right, and tongue deviation to the left. MRI demonstrated a 13-mm cavernoma with haemorrhage and oedema in the medulla oblongata. Surgery was performed via a minimal-invasive, midline approach. Complete excision was confirmed on postoperative MRI. The patient recovered well and became almost neurologically intact. However, he complained of mainly vertical oscillopsia. The videonystagmography revealed a new-onset spontaneous upbeat nystagmus in all gaze directions, not suppressed by fixation. An injury of the rarely described intercalatus nucleus/nucleus of Roller is thought to be the cause. Conclusion Upbeat nystagmus can be related to several lesions of the brainstem, including the medial longitudinal fasciculus, the pons, and the dorsal medulla. To our knowledge, this is the first case of an iatrogenic lesion of the nucleus intercalatus/nucleus of Roller resulting in an upbeat vertical nystagmus. For neurologists, it is important to be aware of the function of this nucleus for assessment of clinical manifestations due to lesions within this region.

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Can an amino acid mixture alleviate gastrointestinal symptoms in neuroendocrine tumor patients?

BMC Cancer ◽

10.1186/s12885-021-08315-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Aman Chauhan ◽

Satya Das ◽

Rachel Miller ◽

Laura Luque ◽

Samuel N. Cheuvront ◽

...

Keyword(s):

Amino Acid ◽

Neuroendocrine Tumor ◽

Gastrointestinal Symptoms ◽

Retrospective Chart Review ◽

Final Analysis ◽

Acid Mixture ◽

Tumor Patients ◽

Short Gut Syndrome ◽

Oral Rehydration ◽

The Mean

Abstract Background Neuroendocrine tumors, although relatively rare in incidence, are now the second most prevalent gastrointestinal neoplasm owing to indolent disease biology. A small but significant sub-group of neuroendocrine tumor patients suffer from diarrhea. This is usually secondary to carcinoid syndrome but can also be a result of short gut syndrome, bile acid excess or iatrogenic etiologies. Recently, an amino acid based oral rehydration solution (enterade® Advanced Oncology Formula) was found to have anti-diarrheal properties in preclinical models. Methods A retrospective chart review of all NET patients treated with enterade® AO was performed after IRB approval. Results Ninety-eight NET patients who had received enterade® AO at our clinic from May 2017 through June 2019 were included. Patients (N = 49 of 98) with follow up data on bowel movements (BMs) were included for final analysis. Eighty-four percent of patients (41/49) had fewer BMs after taking enterade® AO and 66% (27/41) reported more than 50% reduction in BM frequency. The mean number of daily BMs was 6.6 (range, 3–20) at baseline before initiation of therapy, while the mean number of BMs at 1 week time point post enterade® AO was 2.9 (range, 0–11). Conclusions Our retrospective observations are encouraging and support prospective validation with appropriate controls in NET patients. This is first published report of the potential anti-diarrheal activity of enterade® AO in NET patients.

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