Patient: Female, 21-year-old Final Diagnosis: Optic neuritis Symptoms: Vision changes Medication:— Clinical Procedure: — Specialty: Infectious Diseases • Neurology Objective: Rare co-existance of disease or pathology Background: Since the outbreak of the SARS-CoV-2 infection, extensive research has been conducted on the pulmonary implications of this novel disease. However, there has been limited data on the extrapulmonary manifestations. There have been few documented causes of optic involvement and little is understood about the pathophysiology around its presentation and the possible treatments to prevent long-term complications. Here, we describe a case of optic neuritis in a female patient concurrently infected with SARS-CoV-2. Given the plethora of evidence supporting neurological manifestations of the virus, we hypothesize that there is an association between our patient’s optic neuritis and her infection with SARS-CoV-2. Case Report: A 21-year-old woman with no past medical history who presented with blurry vision in her left eye. Optic neuritis was suspected with physical examination and confirmed with imaging of the optic nerve. Further diagnostic evaluation was nonsuggestive of multiple sclerosis and other demyelinating diseases; however, the patient was found to be positive for SARS-CoV-2. Steroids and remdesivir treatment were started, but without the presence of any respiratory symptoms. The patient’s symptoms completely resolved by day 5 of hospitalization and she was discharged home without any complications. Conclusions: Optic neuritis has remained an uncommon complication of SARS-CoV-2. This rather rare complication of SARS-CoV-2 is one that clinicians should be cognizant of due to the long-term implications of optic neuritis. Furthermore, it is pertinent to consider ophthalmic involvement in SARS-CoV-2 infection to appropriately guide patient care during the pandemic, as prompt treatment can lead to improved outcomes.
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INTRODUCTION The clinical course of Coronavirus 19 disease (COVID-19) remains unpredictable. In the setting of pandemic disease, investigations such as arterial blood gases are difficult to obtain on admission. This retrospective study evaluated the ability of the systemic inflammatory response syndrome (SIRS), quick sequential organ failure assessment (qSOFA), and national early warning signs (NEWS) scores to predict in-hospital mortality. These scoring systems require limited data and may offer utility with regard to predicting outcomes on admission. METHODS Demographic, clinical, and outcome data were analyzed in 520 patients admitted for COVID-19 between March 20, 2020 and May 5, 2020. SIRS, qSOFA, and NEWS scoring was applied to each patient based on their admission characteristics. Receiver Operator Curve (ROC) analyses were completed to assess the predictive accuracy for in-hospital mortality. The need for ICU level of care was evaluated as a secondary composite outcome. Univariate regression analyses were completed to assess the predictive function of each scoring threshold. RESULTS Of 520 patients enrolled, 57.5% were male. Of the cohort, 53.8% were Hispanic, 33.3% were African American, 5.8% were Asian, and 7.3% were Caucasian. Mean age was 61.6 years of age. A total of 182 patients (35%) died in hospital. 179 patients (34.4%) required ICU level of care. NEWS demonstrated the greatest discrimination for in-hospital mortality (AUC 0.716 [95% CI, 0.671-0.762]) and ICU admission (AUC 0.641 [95% CI, 0.591-0.691]). The predictive ability of SIRS criteria was more modest for in-hospital mortality (AUC 0.611 [95% CI, 0.560-0.662]) and ICU admission (AUC 0.571 [95% CI, 0.520-0.622]). qSOFA demonstrated the least discrimination for in-hospital mortality (AUC 0.534 [95% CI, 0.479-0.588]) and ICU admission (AUC 0.545 [95% CI, 0.491-0.599]). A mortality rate of 59.76% was observed in patients with a NEWS score ≥ 5 (OR 3.354 [95% CI,). Likewise, a mortality rate of 56.48% was observed in patients with a SIRS score ≥ 2 (OR 1.77 [95% CI, 1.21-2.59]), while a mortality rate of 30.33% was observed in patients with a qSOFA score ≥ 2 (OR 2.124 [95% CI,). CONCLUSION Our findings suggest NEWS offers the best prognostic accuracy in predicting in-hospital mortality, as compared to qSOFA and SIRS scoring systems.
The coronavirus disease 2019 COVID-19 pandemic is a major public health crisis. Obesity has emerged as a significant comorbidity for COVID-19 severity. To study the association of both pandemics, we conducted an observational, retrospective cohort study involving 521 patients admitted with Covid-19 to an inner city, community hospital in Brooklyn, NY in the period March 20 to May 2, 2020. Of the cohort, 57.6% was men, mean age was 61.6±17.2 years, and mean BMI was 29.0 ± 8.2 kg /m2. 11% had BMI > 40 kg/m2. 53.9% was Hispanic, 33.3% was African American, 7.1% was White, with a predominance of type 2 diabetes (99%). Diabetes, hypertension, coronary artery disease and chronic kidney disease were found in 45%, 41.5%, 15%, and 20.1% cases, respectively. Mean HbA1c was 5.8%± 1.1 in patients with no history of diabetes, 3% presented with diabetic ketoacidosis, mortality rate was 30.6%. Non-survivors were significantly older (median age 68 vs 56, p < 0.03) and had higher rate of microvascular and macrovascular diseases. In patients with diabetes, mortality rate was 40.1%. HbA1c was similar between survivors and non-survivors. Older age and hyperglycemia on admission were the risk factors for mortality. Only 30% of the cohort had normal weight (BMI<25), 30% was overweight and 40% was obese. In univariate analysis, the characteristics at admission significantly associated with mortality were age, BMI, hyperglycemia, diabetes and DKA in patients with or without diabetes. In age- and sex-adjusted multivariable analysis only BMI 30–39 kg/m2 (OR = 1.63; 95% CI, 1.10, 2.43; p = 0.015), BMI >40 kg/m2 (OR = 2.05; 95% CI, 1.22, 3.44; p = 0.007) and DKA (OR = 1.77; 95% CI, 1.18, 2.64; p = 0.005) remained positively associated with higher mortality. In summary, BMI, and DKA but not diabetes, were positively and independently associated with mortality in patients hospitalized with Covid-19. Reference: (1) Popkin et al., Obesity Reviews 2020 August;21(11):e13128. (2) Cariou et al., Diabetologia 2020 May;63(8): 1500–1515.
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