Early Routine Biomarkers of SARS-CoV-2 Morbidity and Mortality: Outcomes from an Emergency Section

Background. COVID-19 is a severe acute respiratory disease caused by SARS-CoV-2, a virus belonging to the Coronaviridae family. This disease has spread rapidly around the world and soon became an international public health emergency leading to an unpredicted pressure on the hospital emergency units. Early routine blood biomarkers could be key predicting factors of COVID-19 morbidity and mortality as suggested for C-reactive protein (CRP), IL-6, prothrombin and D-dimer. This study aims to identify other early routine blood biomarkers for COVID-19 severity prediction disclosed directly into the emergency section. Methods. Our research was conducted on 156 COVID-19 patients hospitalized at the Sapienza University Hospital “Policlinico Umberto I” of Rome, Italy, between March 2020 and April 2020 during the paroxysm’s initial phase of the pandemic. In this retrospective study, patients were divided into three groups according to their outcome: (1) emergency group (patients who entered the emergency room and were discharged shortly after because they did not show severe symptoms); (2) intensive care unit (ICU) group (patients who attended the ICU after admission to the emergency unit); (3) the deceased group (patients with a fatal outcome who attended the emergency and, afterward, the ICU units). Routine laboratory tests from medical records were collected when patients were admitted to the emergency unit. We focused on Aspartate transaminase (AST), Alanine transaminase (ALT), Lactate dehydrogenase (LDH), Creatine kinase (CK), Myoglobin (MGB), Ferritin, CRP, and D-dimer. Results. As expected, ANOVA data show an age morbidity increase in both ICU and deceased groups compared with the emergency group. A main effect of morbidity was revealed by ANOVA for all the analyzed parameters with an elevation between the emergency group and the deceased group. Furthermore, a significant increase in LDH, Ferritin, CRP, and D-dimer was also observed between the ICU group and the emergency group and between the deceased group and ICU group. Receiver operating characteristic (ROC) analyses confirmed and extended these findings. Conclusions. This study suggests that the contemporaneous presence of high levels of LDH, Ferritin, and as expected, CRP, and D-dimer could be considered as potential predictors of COVID-19 severity and death.

Metoclopramide-induced Acute Dystonia Misdiagnosed as an Epileptic Seizure in a Lupus Patient

Acute dystonic reactions are the most prevalent extrapyramidal adverse effects associated with metoclopramide. It could be mistaken for a variety of other conditions, such as seizures, tetanus, and encephalitis, to name a few possibilities. We present a case of a 26-year-old female misdiagnosed as having an epileptic seizure who was rushed to the emergency unit with an involuntary bilateral upward deviation of the eyes, spasm, stiffness, lateral deviation of the neck, and protrusion of the tongue. Symptoms occurred 36 hours after the commencement of metoclopramide, used to treat nausea and vomiting in the referring hospital. All the laboratory work was normal. The drug was discontinued and 5 mg of intravenous biperiden was administered. The symptoms subsided in about 10 minutes with no recurrence. Metoclopramide-induced acute dystonia not only creates an anxious environment for patients but may also be life-threatening. Due to the high probability of misdiagnosis, detailed drug history and a high index of suspicion are critical in making the correct diagnosis.

Correlation Analysis between Hemoglobin and C-Reactive Protein in Patients Admitted to an Emergency Unit

Anemia and inflammation are common clinical conditions in emergency departments. This study explored a cohort of patients admitted to the emergency department with a particular interest in determining the frequency of anemia and inflammation and the association between hemoglobin (Hb) and C-reactive protein (CRP) concentrations. The study included 125 patients categorized according to their demographic (gender and age) and clinical condition (Hb and CRP concentrations, pathological background, and diagnostic). We found that anemia and inflammation were simultaneously present in 36.0% of the cohort, reaching 67.0% in patients that were subsequently hospitalized. The Hb level was significantly lower in patients with elevated concentration of CRP when compared to individuals with normal CRP levels (11.58 ± 2.23 vs. 13.25 ± 1.80, p = 0.001); furthermore, we found a significantly negative correlation between Hb concentration and the CRP level (rs = −0.42, p < 0.001). The linear regression model applied to the cohort showed that CRP levels explain 15% of Hb variations. The sensitivity of the CRP/Hb ratio (cut-off = 1.32) as a predictor of hospitalization was 80.0%, with a specificity of 68.4% for all patients. These findings confirmed the prevalence of anemia and inflammation and identified a moderate but significant association between Hb and serum CRP in a heterogeneous group of patients admitted to the emergency department.

Successful anesthetic management in a case of grade V splenic injury in covid 19 positive patient: A case report

Splenic injuries are amongst the most frequent trauma-related injuries which requires emergency surgeries demanding meticulous surgical and anesthetic management. The aim while managing splenic trauma patients, is to restore homeostasis and normal pathophysiology in the body by achieving hemostasis with an emergency splenectomy. To date, there have been few reports describing the anaesthetic management of COVID-19 patients presenting for emergency surgery. In this article, we outline the anaesthetic management for a case with hemoperitoneum, posted for emergency exploratory laparotomy and splenectomy in our operating theatre who was incidentally diagnosed to be COVID positive in the emergency unit by a rapid antigen test.

SP4.1.12 The impact of COVID-19 on the pattern of presentations with acute lower gastrointestinal bleeding

Aims Following the initial surge of COVID-19 cases in Spring 2020, data began to emerge on the negative impact of the disease on outcomes for serious medical conditions such as heart disease and stroke. However, the impact of COVID-19 on the pattern of emergency presentations with lower gastrointestinal bleeding (LGIB) has not been published to date. Methods We designed a clinical coding search strategy to identify all adult patients with acute LGIB presenting to the Emergency Department (ED) and the Surgical Emergency Unit (SEU) at a UK university hospital from January to July 2020. For context, data on number of overall presentations to ED and SEU were also collated for the same period. Results 169 patients (median age 63 (16-94) years, 54.4% male) with acute LGIB were identified across the six months. A graphical representation of these data demonstrated notable trends. Overall weekly ED attendances dropped by 52.0% after the national lockdown (from 1500 to 720 patients), before returning to 77.7% of pre-lockdown levels by the end of the study period (1165 patients). Pre-lockdown, there was a fluctuating number of weekly attendances with acute LGIB. After lockdown, consistently fewer patients presented and there was a reduction in the variability of numbers week on week. Conclusions These novel data support recently published trends demonstrating a post-lockdown fall in emergency attendances, although the decrease in weekly attendance with acute LGIB was less marked, perhaps reflecting the concerning nature of this symptom for patients.

Molecular Study of COVID-19 and its Relationship to Pityriasis Rosea

Background: A new type of coronavirus family (SARS-CoV-2), that has been detected in individuals with several clinical symptoms named (COVID-19), was recognized as a pandemic on March 11, 2020. Numerous researches have been conducted on manifestations of skin disease related to COVID-19, i.e.rashes, pityriasis rosea (PR), vascular markings, and lesions as pimple-like. Aim: This study aims to find out if the Coronavirus can affect (PR) development which also can be considered as a trigger and symptom for other types of infections. Material and Methods: A case series descripting the dermatological finding of COVID-19 in Thi-Qar Governorate, a collective sample taking from inpatients, outpatients, the emergency unit of Al Hussein Teaching Hospital, and inwards of Al-Shefaa’ Isolation Hospital. The study has been done over a four-month period (June-September, 2020.) Results: 19 patients (10 females and 9 males), who have infected with Coronavirus and were suffering from (PR), are included in this study. The highest percentage of females 52.6% and males 47.4%. The distribution of patients according to the incidence of (PR) in typical and anomalous manners had the percentage of typical 77.9% and abnormal 21.1%. The highest percentage was in moderate Covid-19 (84.2%), while it was 15.8% in mild Covid-19. There was no significant statistical difference in mean age distribution according to gender while there were significant statistical differences according to (PR) and COVID-19 class. More studies are needed to evaluate whether or not these lesions are associated with the virus. Conclusion: The (PR) was one of the dermatological finding of COVID-19, that did not have a clear role in the distribution of the disease according to the background of the patients and also the severity of COVID-19. It can be triggered by COVID-19 and completely cured with the clearance of the disease. Recommendation: An accurate robust cutaneous documentation related to Covid19 is required to increase the knowledge of disease as well as its epidemiology

Congestive Cardiac Failure: A Case Report

Introduction: Congestive Cardiac Failure (CCF) is an anomalous clinical condition involving insufficient heart pumping and filling. Cardiac failure causes the heart to be unable to provide enough blood to meet the tissue's oxygen needs. Heart disease is the most common explanation why older people are admitted to hospitals or are in need of palliation. This puts a huge economic strain on the health care system. The dynamic, progressive nature of heart failure also leads to poor results, with hospital readmissions being the costliest. About half of those patient die within 5 years after diagnosis. Case presentation [1]: A male patient of 62years from Aarvi Naka was admitted to Medicine Intensive Care Unit (MICU), AVBRH on 11th January 2020 with a known case of Ischemic Cardiomyopathy which was diagnosed itself at AVBRH on 22nd October 2018 and a known case of diabetes and hypertension for 10 years. My patient was brought to AVBRH Emergency Unit on 11th January 2020 with a chief complaint of breathlessness for 2 days, sweating over both feet for 5 days and generalized weakness for 2 weeks. He was having difficulty in breathing for about 2 days which eventually become severe on 11th January 2020 evening and was brought immediately to AVBRH and got admitted on the same day. The patient was delirious and vomit two times on admission.