Evaluation of Mortality and Morbidity According to Initial Symptoms in COVID-19 Patients Using Clinical Epidemiologic Data from the Korea Centers for Disease Control & Prevention

Background and Objectives: This study aimed to investigate whether initial symptoms of COVID-19 are associated with mortality and morbidity. Materials and Methods: The data of 5628 laboratory-confirmed COVID-19 patients were collected by the Korea Centers for Disease Control and Prevention. The maximum level of morbidity during hospital admission was classified as mild or severe, and patient mortality was recorded. Clinical symptoms were categorized as respiratory, gastrointestinal, general, and neurologic symptoms. The hazard ratios (HRs) for clinical symptoms associated with mortality were analyzed using the Cox proportional hazards model. The odds ratios (ORs) for clinical symptoms associated with morbidity were analyzed using the logistic regression model. Results: Of the included COVID-19 patients, 15.4% (808/5253) were classified as having severe morbidity. Morbidity was related to the clinical symptoms of cough, sputum, shortness of breath, vomiting/nausea, diarrhea, fever, and altered mental status or confusion. According to the symptom categories, respiratory and general symptoms were related to high morbidity (OR = 1.41, 95% CI = 1.30–1.53, p < 0.001 for respiratory symptom and OR = 1.37, 95% CI = 1.18–1.59, p < 0.001 for general symptom). Mortality was associated with the clinical symptoms of shortness of breath, fever, and altered mental status or confusion. Among the symptom categories, respiratory symptoms were associated with a 1.17-fold increased HR for mortality (95% CI = 1.04–1.32, p = 0.008). Conclusions: Initial respiratory symptoms were related to high morbidity and mortality in COVID-19 patients.

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Prevalence of COVID-19-like Symptoms among People Living with HIV, and Using Antiretroviral Therapy for Prevention and Treatment

Current HIV Research ◽

10.2174/1570162x18666200712175535 ◽

2020 ◽

Vol 18 (5) ◽

pp. 373-380 ◽

Cited By ~ 3

Author(s):

SeyedAhmad SeyedAlinaghi ◽

Maryam Ghadimi ◽

Mahboubeh Hajiabdolbaghi ◽

Mehrnaz Rasoolinejad ◽

Ladan Abbasian ◽

...

Keyword(s):

Respiratory Symptoms ◽

Antiretroviral Treatment ◽

Clinical Symptoms ◽

Cross Sectional Study ◽

People Living With Hiv ◽

Shortness Of Breath ◽

Sectional Study ◽

Limited Data ◽

Cross Sectional ◽

Living With Hiv

Background: COVID-19 has spread globally with remarkable speed, and currently, there is limited data available exploring any aspect of the intersection between HIV and SARSCoV- 2 co-infection. Objective: To estimate the prevalence of clinical symptoms associated with COVID-19 among people living with HIV (PLWH) in Tehran, Iran. Design: Cross-sectional study. Methods: A total of 200 PLWH were recruited through the positive club via sampling, and completed the symptom-based questionnaire for COVID-19, which was delivered by trained peers. Results: Of 200 participants, respiratory symptoms, including cough, sputum, and shortness of breath, were the most prevalent among participants, but only one person developed symptoms collectively suggested COVID-19 and sought treatments. Conclusions: It appears that existing infection with HIV or receiving antiretroviral treatment (ART) might reduce the susceptibility to the infection with SARS-CoV-2 or decrease the severity of the infection acquired. Further research is needed to understand causal mechanisms.

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Covid-19 Associated Subdural Hematoma: A Case Report Intracranial Hemorrhage in the Setting of Covid-19

10.47363/jpmrs/2021(3)137 ◽

2021 ◽

pp. 1-2

Author(s):

Kirill Alekseyev ◽

Keyword(s):

Mental Status ◽

Intracranial Hemorrhage ◽

Subdural Hematoma ◽

Altered Mental Status ◽

Shortness Of Breath ◽

Intracranial Hemorrhages ◽

Angiotensin Converting Enzyme 2 ◽

Global Spread ◽

Thrombotic Complications ◽

Possible Cause

Coronavirus disease 2019 (COVID-19) is a pandemic that began in December 2019 as a result of the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We frequently associate COVID-19 with symptoms of fever, shortness of breath, and pneumonia; however, we are slowly uncovering the fact that systems other than the respiratory are being affected. We present a 60-year-old female who presented with altered mental status and was found to have COVID-19 induced subdural hematoma. Although intracranial hemorrhages are extremely rare in the setting of COVID-19, it is known that the affinity of SARS-CoV-2 to the angiotensin-converting enzyme 2 receptors, in addition to the cytokine storm, predisposes infected individuals to intracranial hemorrhages. Thus, it is crucial to consider intracranial hemorrhage as a possible cause of altered mental status in patients infected with COVID-19 and weigh the potential risk versus benefits of utilizing anticoagulants when managing the thrombotic complications of this virus.

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Measles-induced Acute Disseminated Encephalomyelitis in a Non-vaccinated Patient

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_001331 ◽

2020 ◽

Author(s):

Deeba Ali ◽

Arnaud Detroz ◽

Yilmaz Gorur ◽

Lionel Bosquee ◽

Noel Lorenzo Villalba ◽

...

Keyword(s):

Lumbar Puncture ◽

Mental Status ◽

Broad Spectrum ◽

Respiratory Symptoms ◽

Altered Mental Status ◽

Acute Disseminated Encephalomyelitis ◽

Immunocompetent Adult ◽

Blood Tests ◽

Acute Meningitis ◽

Cutaneous Rash

We reported a case of measles-induced acute disseminated encephalomyelitis (ADEM) in a 40-year-old immunocompetent adult. The patient presented a week after the development of respiratory symptoms and a cutaneous rash, and was admitted to hospital for altered mental status. Blood tests showed hyperleukocytosis, thrombopenia and cytolysis. A lumbar puncture was consistent with acute meningitis and the patient was initially treated with antiviral and wide broad-spectrum antibiotics. Serology and PCR for measles came back positive.

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Meropenem for management of valproic acid overdose: a case report

Drug Metabolism and Personalized Therapy ◽

10.1515/dmpt-2019-0028 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Daniel Muñoz-Pichuante ◽

Lorenzo Villa-Zapata ◽

Russi Lolas

Keyword(s):

Valproic Acid ◽

Case Report ◽

Mental Status ◽

Clinical Symptoms ◽

Significant Risk ◽

Altered Mental Status ◽

Pharmacological Interaction ◽

Case Presentation ◽

Concurrent Use ◽

Clinical Scenarios

AbstractObjectivesValproic acid (VPA) is an anticonvulsant used in several clinical scenarios. VPA has been increasingly associated with intentional or unintentional overdose. In patients presenting with severe VPA overdose, supportive care and airway protection are cornerstones of treatment, while levocarnitine is suggested in patients with hyperammonemia and hemodialysis is recommended in patients with VPA serum concentrations (SC) >1,300 mg/L and presence of cerebral edema or shock. Meropenem is a carbapenem antibiotic with a broad spectrum of activity. The pharmacological interaction between VPA and meropenem is characterized by a rapid decrease in VPA concentrations, which contraindicates concurrent use.Case presentationThe following case report describes the use of meropenem to enhance the clearance of VPA in the case of severe VPA overdose. A patient with altered mental status was transported to the emergency department (ED) after VPA overdose. Meropenem was prescribed for significant elevated VPA SC. An important decline in SC was observed with short-term meropenem dosing, and an improvement in mental status occurred shortly after administration.ConclusionsCarbapenem therapy has the potential to be used as last line strategy in the management of severe VPA overdose in patients where SC represent a significant risk of toxicity and clinical symptoms suggest difficulty managing the patient.

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466. Symptom Profile of Hospitalized, Adult Patients with COVID-19 – Findings From COVID-Net Database

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.665 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S335-S335

Author(s):

Chun T Siu ◽

Amogh Joshi

Keyword(s):

Retrospective Analysis ◽

Mental Status ◽

Signs And Symptoms ◽

Altered Mental Status ◽

Hospitalized Patients ◽

Shortness Of Breath ◽

Neurologic Manifestation ◽

Symptom Profile ◽

Patient Reported ◽

Control And Prevention

Abstract Background According to the Center for Disease Control and Prevention (CDC), there is a disproportional number of COVID-19 deaths in hospitalized patients that increases based on age. Among COVID-19 related deaths in hospitalized patients, 8 of 10 patients are age 65 years and older. By looking at the latest data, the objective of this retrospective analysis is to evaluate the symptom profile in patients hospitalized with COVID-19 and determine if certain symptoms are seen more in older patients. Methods We performed a retrospective analysis using the COVID-Net database. This database contains information involving COVID-19 laboratory-confirmed hospitalization across 14 states. Medical history, signs, and symptoms at admission were collected by COVID-NET surveillance officers and reported during the period of March 1st to May 31st. For our analysis, we only included adults patients age 18 and above. Further descriptive statistics were stratified by age into two groups: age 18-64, and age ≥ 65. Results We identified 60,363 patients age 18 and above with COVID-19 confirmed hospitalizations. Cough, shortness of breath, and fevers/chills were the most common symptoms at respectively 67%, 66%, and 65%. Patients age ≥ 65, when compared to patients age 18-64, were less likely to have cough (56.7% vs 73.8%), shortness of breath (58.1% vs 72.1%), fever/chills (54.7% vs 71.%), dysgeusia (2.3% vs 7%), and anosmia (1.2% vs 6%). The only presentation that was more common in patients age 65+, than in patients age 18-64, was altered mental status (26.9% vs 5.2%). Overall inpatient mortality was higher in the age ≥ 65 group (8.9% vs 2%). Among the 2,922 COVID-19 decedents, 75.3% were age ≥65. Conclusion Published in April 2020, preliminary data from COVID-Net on approximately 180 patient reported that only 8.2% of patients age ≥ 65 had altered mental status2. Since then, our analysis noted that altered mental status is more commonly seen in the age group ≥ 65 than previously reported. The percentage of decedents age ≥ 65 in this analysis is similar to the 74.8% (N= 10,647) reported in a large study that focused specifically on COVID-19-related deaths3. Our analysis highlights that altered mental status is a common neurologic manifestation in elderly patients hospitalized with COVID-19. Disclosures All Authors: No reported disclosures

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Epidemiological Distribution of Reported West Nile cases in Houston, Texas, 2014-2017

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v11i1.9864 ◽

2019 ◽

Vol 11 (1) ◽

Author(s):

Razina Khayat ◽

Alex Nguyen ◽

Sudipa Biswas ◽

Hafeez Rehman ◽

Kirstin Short ◽

...

Keyword(s):

Mental Status ◽

Disease Surveillance ◽

Clinical Symptoms ◽

White Male ◽

Altered Mental Status ◽

West Nile ◽

Limb Weakness ◽

Infected People ◽

Vector Borne Diseases ◽

Disease Surveillance System

ObjectiveTo demonstrate an overview of the epidemiological and clinical distribution of reportable West Nile cases in Houston, Texas, from 2015-2017.IntroductionWest Nile virus (WNV) is considered the leading cause of domestically acquired arboviral disease and is spread through mosquitoes. In general, the majority of the cases are asymptomatic. One in five people infected will display mild symptoms like fever, headache, body ache, nausea, and vomiting. Only about 1 in 150 people infected will develop serious neurologic complications such as encephalitis and meningitis. According to CDC, in 2017, there were 133 confirmed cases including 5 deaths and 14 presumptive blood donors reported in the State of Texas. Out of the confirmed cases, there were 85 neuroinvasive and 48 non-neuroinvasive disease cases.MethodsData were extracted from Houston’s Electronic Disease Surveillance System (HEDSS) from January 1, 2014, to December 31, 2017. A total of 45 confirmed cases are included in this analysis to examine the epidemiologic characteristics of the WNV cases.A confirmed case is an illness with onset of acute focal limb weakness and an MRI showing a spinal cord lesion largely restricted to gray matter and spanning one or more spinal segments.ResultsAmong the confirmed cases, 67% of were males. Age group 60 and above (47%) had the highest proportion of WNV cases. Whites (26%) represented the highest number of confirmed cases followed by Hispanics (24%).Seventy six percent of the cases were hospitalized. Non-neuroinvasive clinical presentations found among confirmed WNV cases were fever (94%), headache (76%) followed by chills and rigors (68%). Among the neuroinvasive presentations, altered mental status had the highest proportion (24%), followed by stiff necks (18%), Ataxia (12%), and seizure (9%).ConclusionsWNV is mostly prevalent in White male adults over 60 years of age, with majority of cases have common neuroinvasive symptoms like altered mental status, stiff necks, and Ataxia. For non-neuroinvasive cases clinical symptoms were fever, headache, chills and rigors.WNV infection is a markedly underreported disease as most of the infected people do not seek medical care due to mild or no symptoms. Currently there are no specific treatments available. Thus, continued monitoring and surveillance activities are warranted for prevention and control of WNV complications as well as decreasing the risk of infection.ReferencesCDC: West Nile Virus [Internet]. Atlanta: Center for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), and Division of Vector-Borne Diseases (DVBD); Last reviewed: September 19, 2018.Available from: https://www.cdc.gov/westnile/index.html

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Acute brain trauma, lung injury, and pneumonia: more than just altered mental status and decreased airway protection

AJP Lung Cellular and Molecular Physiology ◽

10.1152/ajplung.00485.2016 ◽

2017 ◽

Vol 313 (1) ◽

pp. L1-L15 ◽

Cited By ~ 18

Author(s):

Parker J. Hu ◽

Jean-Francois Pittet ◽

Jeffrey D. Kerby ◽

Patrick L. Bosarge ◽

Brant M. Wagener

Keyword(s):

Brain Injury ◽

Lung Injury ◽

Pulmonary Edema ◽

Mental Status ◽

Nosocomial Pneumonia ◽

Altered Mental Status ◽

Pulmonary Complications ◽

Cellular Mechanisms ◽

Mortality And Morbidity ◽

Lung Immunity

Traumatic brain injury (TBI) is a major cause of mortality and morbidity worldwide. Even when patients survive the initial insult, there is significant morbidity and mortality secondary to subsequent pulmonary edema, acute lung injury (ALI), and nosocomial pneumonia. Whereas the relationship between TBI and secondary pulmonary complications is recognized, little is known about the mechanistic interplay of the two phenomena. Changes in mental status secondary to acute brain injury certainly impair airway- and lung-protective mechanisms. However, clinical and translational evidence suggests that more specific neuronal and cellular mechanisms contribute to impaired systemic and lung immunity that increases the risk of TBI-mediated lung injury and infection. To better understand the cellular mechanisms of that immune impairment, we review here the current clinical data that support TBI-induced impairment of systemic and lung immunity. Furthermore, we also review the animal models that attempt to reproduce human TBI. Additionally, we examine the possible role of damage-associated molecular patterns, the chlolinergic anti-inflammatory pathway, and sex dimorphism in post-TBI ALI. In the last part of the review, we discuss current treatments and future pharmacological therapies, including fever control, tracheostomy, and corticosteroids, aimed to prevent and treat pulmonary edema, ALI, and nosocomial pneumonia after TBI.

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The Speech-Language Pathologists' Role in Mild Traumatic Brain Injury for Middle and High School–Age Children: Viewpoints on Guidelines From the Centers for Disease Control and Prevention

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-18-0296 ◽

2019 ◽

Vol 28 (3) ◽

pp. 1363-1370 ◽

Cited By ~ 2

Author(s):

Jessica Brown ◽

Katy O'Brien ◽

Kelly Knollman-Porter ◽

Tracey Wallace

Keyword(s):

High School ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Disease Control ◽

Mild Traumatic Brain Injury ◽

School Age Children ◽

School Age ◽

Speech Language Pathologists ◽

Control And Prevention ◽

Centers For Disease Control

Purpose The Centers for Disease Control and Prevention (CDC) recently released guidelines for rehabilitation professionals regarding the care of children with mild traumatic brain injury (mTBI). Given that mTBI impacts millions of children each year and can be particularly detrimental to children in middle and high school age groups, access to universal recommendations for management of postinjury symptoms is ideal. Method This viewpoint article examines the CDC guidelines and applies these recommendations directly to speech-language pathology practices. In particular, education, assessment, treatment, team management, and ongoing monitoring are discussed. In addition, suggested timelines regarding implementation of services by speech-language pathologists (SLPs) are provided. Specific focus is placed on adolescents (i.e., middle and high school–age children). Results SLPs are critical members of the rehabilitation team working with children with mTBI and should be involved in education, symptom monitoring, and assessment early in the recovery process. SLPs can also provide unique insight into the cognitive and linguistic challenges of these students and can serve to bridge the gap among rehabilitation and school-based professionals, the adolescent with brain injury, and their parents. Conclusion The guidelines provided by the CDC, along with evidence from the field of speech pathology, can guide SLPs to advocate for involvement in the care of adolescents with mTBI. More research is needed to enhance the evidence base for direct assessment and treatment with this population; however, SLPs can use their extensive knowledge and experience working with individuals with traumatic brain injury as a starting point for post-mTBI care.

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