Outbreak of COVID-19 among vaccinated and unvaccinated homeless shelter residents — Sonoma County, California, July 2021

In July 2021, the Sonoma County Health Department was alerted to three cases of COVID-19 among residents of a homeless shelter in Santa Rosa, California. Among 153 shelter residents, 83 (54%) were fully vaccinated; 71 (86%) vaccinated residents had received the Janssen COVID-19 vaccine and 12 (14%) received an mRNA (Pfizer BioNTech or Moderna) COVID-19 vaccine. Within 1 month, 116 shelter residents (76%) received positive SARS-CoV-2 test results, including 66 fully vaccinated residents and 50 not fully vaccinated. 9 fully vaccinated and 1 unvaccinated were hospitalized for COVID-19. All hospitalized cases had at least one underlying medical condition. Two deaths occurred, one in a vaccinated resident and one in a non-vaccinated resident. Specimens from 52 residents underwent whole genome sequencing; all were identified as SARS-CoV-2, Delta Variant AY.13 lineage. Additional mitigation measures are needed in medically vulnerable congregate setting where limited resources make individual quarantine and isolation not feasible.

Extramedullary Hematopoiesis Presenting as Progressive Headache: A Case Report and Review of Literature

Extramedullary Hematopoiesis (EMH) is defined as the production of blood cells in organs other than bone marrow. Intracranial EMH is a rare condition. In this article, we presented a case of intracranial EMH presenting as progressive headache. Our patient was a 33-yearold man with thalassemia presenting with acute progressive flaccid quadriplegia, severe progressive headache, and decreased level of consciousness. His imaging studies showed evidence of intracranial and presacral EMH. Most asymptomatic intracranial EMH can present as a variety of symptoms, including progressive headache; therefore, the differential diagnosis should be kept in mind when evaluating a patient with a relevant underlying medical condition.

A fatal case of acute encephalopathy in a child due to coxsackievirus A2 infection: a case report

Background Certain types of enteroviruses, including coxsackieviruses, cause encephalitis, and other neurological complications. However, these pathogens rarely cause fatal infections, especially in immunocompetent infants. In this study, we present a rare case of acute encephalopathy caused by coxsackievirus A2 (CV-A2), which progressed rapidly in a previously healthy female child. Case presentation In June 2013, a 26-month-old female child from Kanagawa, Japan, was found unresponsive during sleep. She was healthy until that morning. Her temperature was 37 °C at 08:00. She was feeling fine and went to the nursery that same morning. However, her condition worsened around noon. Therefore, she went home and slept at around 13:00. Surprisingly, after 2 h, her parents checked on her and found that she was lying on her back and was not breathing. Hence, she was immediately taken to a hospital by ambulance, but she was declared dead on arrival at the hospital. Subsequently, pathological autopsy and pathogenetic analysis, including multiple pathogen detection real-time PCR, were conducted to investigate the cause of death. The examination results revealed that she had an infectious respiratory disease and acute encephalopathy due to a CV-A2 infection. Conclusions Based on our findings, we concluded that a previously healthy girl who had no immediate history of underlying medical condition were susceptible to death by acute encephalopathy due to CV-A2 infections. We proposed this conclusion because the patient’s condition progressed rapidly in less than 2 h and eventually led to her death. This is the first report on an acute encephalitis-dependent death in a child due to CV-A2 infection.

Regulating Death: A Brief History of Medical Assistance in Dying

Unique reports of suicide and euthanasia date back more than 2 millennia, reflecting evolving philosophies of death and dying as expressions of the mores dominating a given era. One longstanding theme in the history of decisions to die has been staunch opposition founded in religious claims that one’s body is a trust from the divine (and therefore not wholly in their ownership). The role of the physician has also been traditionally estranged from participation in such decisions, dating back to rudimentary conceptions of medical ethics in the Hippocratic notion primum non nocere (‘first, do no harm’). However, fundamental principles in the modern philosophy of medicine lend support to the idea that physicians can be justified in actions which cause some harm, in so far as they are acting to fulfil a greater ethical imperative. This brief historical review explores the inception of modern North American medical assistance in dying (MAiD) policy through a series of critical case studies in the unfolding of its practice. Medically assisted dying has presently been legalised in Canada and some United States jurisdictions, but with critical caveats surrounding circumstances of mature minors, advance directives and mental illness as participants’ sole underlying medical condition. While the modern regulations surrounding MAiD continue to take shape, the palliative care community is well-positioned to both guide and scrutinise the ethics of this practice.

Modern insights into ophthalmic manifestations of rheumatic diseases

This literature review is devoted to the analysis of modern insights into ophthalmological manifestations (according to the data of foreign scientific literature in the PubMed system for 20172020) of the most common rheumatic diseases (rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, systemic scleroderma, systemic vasculitis), which are characterized by damage to all structures of the eye and its adnexa: eyelids, orbital tissues, eyeball tunics, vessels, optic nerve and vitreous. Ocular lesion may be an onset, one of the diagnostic signs, or a biomarker of underlying medical condition.

Comorbidities: A Decider of Severe Clinical Outcomes in COVID-19 Patients

Background: Comorbidity is the biggest decider in COVID-19 pandemic whether the infected person will develop the severe clinical outcome or not. It is one of the few conclusions that has widespread acceptance. Summary:After analyzing the case fatalities of COVID-19, many patients were found to be having either one of many conditions which are commonly called as comorbidities due to which they cannot made it to survivors list. Also several COVID-19 patients requiring the sophisticated medical attention like ventilators and oxygen support system have any kind of underlying medical condition. Deteriorated immune system is one of the reasons behind slipping into severe symptoms category. Conclusion: It is established that comorbidities are the major influencer in COVID-19 infected patients. More study is needed to further segregate the data on the basis of each comorbidity.

Confusion and mental status changes in a medically ill child

Delirium is an acute, transient syndrome of global brain dysfunction that is the pathophysiological consequence of an underlying medical condition or toxic exposure. It affects 13% to 44% of hospitalized children. Signs and symptoms of delirium include disturbances in attention, awareness, and cognition that develop over a short period of time and fluctuate in severity. Patients with suspected delirium should undergo a physical examination and laboratory investigation to determine potential underlying medical etiologies. The primary treatment of delirium is identification and management of the underlying medical condition. Antipsychotics may be used to manage symptoms that threaten safety or impede the provision of medical care. Children with delirium may also benefit from supportive psychotherapy, involvement with child-life specialists, and other stress reduction strategies.

Death by SARS-CoV 2 - a Romanian COVID-19 multi-centre comorbidity study

Evidence regarding the relation between SARS-CoV-2 mortality and the underlying medical condition is scarce. We conducted an observational, retrospective study based on Romanian official data about location, age, sex and comorbidities for COVID-19 fatalities. Our findings indicate that males, hypertension, diabetes, obesity and chronic kidney disease were most frequent in the COVID-19 fatalities, that the burden of disease was low, and that the prognosis for 1-year survival probability was high in the sample. Evidence shows that age-dependent pairs of comorbidities could be a negative prognosis factor for the severity of disease for the SARS-CoV 2 infection.

Death by SARS-CoV 2: a Romanian COVID-19 multi-centre comorbidity study

Evidence regarding the relation between SARS-CoV-2 mortality and the underlying medical condition is scarce. We conducted an observational, retrospective study based on Romanian official data about location, age, gender and comorbidities for COVID-19 fatalities. Our findings indicate that males, hypertension, diabetes, obesity and chronic kidney disease were most frequent in the COVID-19 fatalities, that the burden of disease was low, and that the prognosis for 1-year survival probability was high in the sample. Evidence shows that age-dependent pairs of comorbidities could be a negative prognosis factor for the severity of disease for the SARS-CoV 2 infection.