Background: The coronavirus disease 2019 (COVID-19) has been identified in over 110 million people with no studies comparing pre-infection pulmonary function to post-infection. This study's aim was to compare preinfection and post-infection pulmonary function tests (PFT) in COVID-19 infected patients to better delineate between preexisting abnormalities and effects of the virus. Methods: This was a retrospective multi-center cohort study. Patients were identified based on having COVID-19 and a pre-and post-infection PFT within one year of infection during the time period of March 1, 2020 to November 10, 2020. Findings: There was a total of 80 patients, with an even split in gender; the majority were white (n = 70, 87¢5%) and never smokers (n = 42, 52¢5%). The majority had mild to moderate COVID-19 disease (n = 60, 75¢1%) with 25 (31¢2%) requiring hospitalization. There was no difference between the pre-and post-PFT data, specifically with the forced vital capacity (FVC) (p = 0¢52), forced expiratory volume in 1 s (FEV1) (p = 0¢96), FEV1/FVC(p = 0¢66), total lung capacity (TLC) (p = 0¢21), and diffusion capacity (DLCO)(p = 0¢88). There was no difference in the PFT when analyzed by hospitalization and disease severity. After adjusting for potential confounders, interstitial lung disease (ILD) was independently associated with a decreased FEV1 (-2¢6 [95% CI, -6¢7 to -1¢6] vs. -10¢3 [95% CI, -17¢7 to -2¢9]; p = 0¢03) and an increasing age (p = 0¢01) and cystic fibrosis (-1¢1 [95% CI, -4¢5 to-2¢4] vs. -36¢5 [95% CI, -52¢1 to -21¢0]; p < 0¢01) were associated with decreasing FVC when comparing pre and post infection PFT. Only increasing age was independently associated with a reduction in TLC (p = 0¢01) and DLCO (p = 0¢02) before and after infection. Interpretation: This study showed that there is no difference in pulmonary function as measured by PFT before and after COVID-19 infection in non-critically ill classified patients. There could be a relationship with certain underlying lung diseases (interstitial lung disease and cystic fibrosis) and decreased lung function following infection. This information should aid clinicians in their interpretation of pulmonary function tests obtained following COVID-19 infection.

Hypokalemic periodic paralysis (HOKPP) is a rare neuromuscular disorder caused by altered transport of cellular potassium that leads to significant muscle weakness of the extremities. Paralytic attacks are induced by a drop in the serum potassium level and they have been associated with specific triggers. This case describes a 21-year-old male who has had recurrent presentations of acute paralytic attacks following vigorous physical activity. At presentation, this patient exhibited flaccid paralysis of all skeletal muscles below the neck, but was alert and oriented with stable vital signs. The patient was found to have a potassium level of 2.1 mmol/L and an EKG demonstrating U waves (characteristic of hypokalemia). The patient was treated with potassium supplementation with resolution of symptoms. The mainstay of prevention of long term permanent muscle weakness is avoidance of triggers that can lead to hypokalemia. Through education on disease process and lifestyle modifications, we were able to end the cycle of recurrent hospital readmissions and the subsequent financial burden this generated for the patient and his family.

Renal vein thrombosis is a rare, but potentially serious complication in patients with renal transplantation as it can lead to non-reversible graft injury and failure. Often this clinical entity is found in the early transplantation period, and the available management strategies are associated with favourable patient outcomes. The incidence, pathophysiology and outcomes for the delayed occurrence of renal vein thrombosis are unknown. The case here describes a unique situation with an excellent clinical outcome related to early diagnosis and appropriate care.

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A 35-year-old man presented for evaluation of recurrent fever associated with multiple ear and sinopulmonary infections since age 30 years. He reported a history of thrombocytopenia at age 14 years that was treated successfully with oral prednisone. Evaluation at an outside hospital revealed recurrence of thrombocytopenia, for which he had been treated with varying doses of prednisone for the past 5 years. At the time, he was also informed that he had an enlarged spleen and generalized lymphadenopathy based on imaging. His history was notable for tobacco use, recently discontinued 2 months before presentation, no exposures or risk factors for human immunodeficiency virus (HIV), and no exotic pets or travel. Of note, review of medical records revealed that 2 years before the current presentation, the patient had received pneumococcal polysaccharide vaccine version PPSV23 and subsequently had negative serologic results. The patient had no other notable medical history. His medications included prednisone, 10 mg orally every other day, and over-the-counter loratadine daily.On physical examination, the patient was afebrile, with a heart rate of 96 beats/min with a regular rhythm, blood pressure of 157/117 mm Hg, and normal respiratory effort at 16 breaths/min with 99% oxygen saturation while breathing room air. He was in no apparent distress. Ear, nose, and throat examination revealed a mildly erythematous left tympanic membrane but no other abnormalities. No swollen cervical or supraclavicular lymph nodes were appreciated. Cardiopulmonary examination findings were normal. Abdominal examination was remarkable for a palpable spleen approximately 3 cm below the costal margin in the midclavicular line but no hepatomegaly; the abdomen was nontender and not distended with normoactive bowel sounds.Laboratory values on initial evaluation included the following (reference ranges provided parenthetically): hemoglobin, 15.1 g/dL (13.2-16.6 g/dL); hematocrit, 46% (38.3%-48.6%); platelet count, 164 Â

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