Coronavirus 2019 (COVID-19) has been reported to trigger Guillain–Barré syndrome (GBS). While uncommon, recurrent GBS (rGBS) episodes, triggered by antecedent viral infections, have been reported in a small proportion of GBS patients, here we describe a patient with a recurrent case of GBS, occurring secondary to COVID-19 infection. Before this patient’s episode, he had two prior GBS flares, each precipitated by a viral infection followed by complete recovery besides intermittent paresthesias. We also consider the nosology of this illness in the spectrum of rGBS and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), with their differing natural histories, prognosis, and therapeutic approaches. For patients who have a history of inflammatory demyelinating polyradiculopathies who develop COVID-19, we recommend close observation for neurologic symptoms over the next days and weeks.

Clinicians around the world are experiencing skin breakdown due to the prolonged usage of masks while working long hours to treat patients with COVID-19. The skin damage is a result of the increased friction and pressure at the mask-skin barrier. Throughout the COVID-19 pandemic, clinicians have been applying various skin barriers to prevent and ameliorate skin breakdown. However, there are no studies to our knowledge that assess the safety and efficacy of using these skin barriers without compromising a sufficient mask-face seal. We report the largest study to date of various skin barriers and seal integrity with quantitative fit testing (QNFT). Our pilot study explores whether the placement of a silicone scar sheet (ScarAway®), Cavilon™, or Tegaderm™ affects 3M™ half-face mask respirator barrier integrity when compared to no barrier using QNFT. We collected data from nine clinicians at an academic Level 1 trauma center in New Jersey. We found that the silicone scar sheet resulted in the lowest adequate fit while Cavilon™ provided the highest fit factor when compared to other interventions (p<0.05). Our findings help inform clinicians considering barriers for comfort when wearing facemasks during the COVID-19 pandemic and for future pandemics.

SUPPORTING INFORMATIONAdditional supporting information may be found online in the Supporting Information section at the end of this article. Appendix S1. Supplementary Text S1. Details of the SARS-CoV-2 RT-PCR test on nasopharyngeal swab. Figure S1. Graphical representation of temporal patterns of viral shedding The attached graphs represent the smoothing curves of the delay: X = Days since symptom onset, Y = RT-PCR Cycle threshold (Ct) value. Comparison of RT-PCR initial Ct value and death at 1 month and comparison of a persistently RT-PCR positive test at 1 month and the Charlson Comorbidity Index were performed using the Mann-Whitney Wilcoxon Test. Oddsratio (OR), is the multiplication of the risk that PCR is positive at 1 month when the Charlson Index increases by 1.

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Background Patients who present to the emergency department (ED) with acute chest pain should receive a thorough history and exam to rule out rare, life-threatening conditions, such as drug-induced acute aortic dissections (AD). Case presentation A 34-year-old man with a history of uncontrolled hypertension, smoking, and “ecstasy” use presented to the ED with an acute type A aortic dissection (AD). Following surgery to repair the dissection, he developed compartment syndrome of the lower extremity requiring muscle excision and neurolysis with subsequent wound debridement procedures. Conclusion Physicians treating adults with symptoms and signs of aortic dissection should take a focused history about substance use and include AD on their differential. In addition, the extremities should be monitored for signs and symptoms of ischemia throughout the acute peri-surgical period(s).

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Infection with SARS-CoV-2 leading to COVID-19 induces hyperinflammatory and hypercoagulable states, resulting in arterial and venous thromboembolic events. Deep vein thrombosis (DVT) has been well reported in COVID-19 patients. While most DVTs occur in a lower extremity, involvement of the upper extremity is uncommon. In this report, we describe the first reported patient with an upper extremity DVT recurrence secondary to COVID-19 infection.