While COVID-19 wreaks havoc across the world, countries in South and South-East Asia and Latin America are faced with the prospect of a second epidemic: dengue. Further complicating the picture is that the early signs and symptoms of dengue and COVID-19 could be similar, making it a risk that patients may be wrongly diagnosed early in the course of disease. This is confounded further by a report from Singapore of false-positive dengue antibody testing in two COVID-19 patients, and the presence of co-infection of dengue and COVID-19 in Thailand. Unless urgent measures are taken, there is a risk that dengue and COVID-19 could overwhelm healthcare systems across multiple countries.
Medically unexplained symptoms (MUS) are those with no identified organic aetiology. Our emergency department (ED) perceived an increase in MUS frequency during COVID-19. The primary aim was to compare MUS incidence in frequent attenders (FAs) during COVID-19 and a control period. A retrospective list of FA-MUS presenting to our ED from March to June 2019 (control) and March to June 2020 (during COVID-19) was compared. Fisher's exact test was used to compare binomial proportions; this presented as relative risk (RR) with 95% confidence intervals (95%CI).During COVID-19, ED attendances reduced by 32.7%, with a significant increase in the incidence of FA-MUS and FA-MUS ED visits compared to control; RR 1.5 (95%CI 1.1-1.8) p=0.0006, and RR 1.8 (95%CI 1.6-2.0), p<0.0001, respectively. Despite reduced ED attendances during COVID-19, there was a significant increase in the incidence of FA-MUS patients and corresponding ED visits by this cohort. This presents a challenge to ED clinicians who may feel underprepared to manage these patients effectively.
Background Medically Unexplained Symptoms (MUS) refer to symptoms with no identified organic aetiology, and are amongst the most challenging for patients and Emergency Department (ED) staff. Providers working in our ED perceived an increase in severity and frequency of these types of presentations during the COVID-19 pandemic. Methods A retrospective list of frequent attenders (FA) presenting five or more times to the ED between two 122-day periods were examined: 01 Mar to 30 Jun 2019 (Control) and 2020 (COVID-19). The FA group were then examined to identify patients presenting with MUS (FA-MUS). Results The total number of ED attendances during the control period was n=42,785 which reduced to n=28,806 in the COVID-19 period, a decrease of 32.7%. The control FA cohort had n=44 FA-MUS patients with 149 ED visits. This increased to n=65 FA-MUS patients with 267 visits during COVID-19, p=0.44. There was a significant increase in the proportion of all ED visits that were FA-MUS: 0.3% (control) compared to 0.9% (COVID-19); OR 2.7, p<0.001. There was a significant increase in shortness of breath amongst MUS during the COVID-19 pandemic relative to the control period (p<0.01), with no significant difference in any other MUS category. Conclusion Whilst the total number of ED attendances reduced by almost one third during COVID-19, the actual number of all visits by frequent attenders with MUS increased and the proportion of attendances by these tripled during the same period. This presents an increasing challenge to ED clinicians who may feel underprepared to manage these patients effectively.
<p>COVID-19 infection has made a great impact on the health and economy of many countries. Low middle-income countries are yet to experience the worst of it. There are lots of issues, such as, appropriate resource management that will come alongside the infection that can make the condition even worse. For how long this virus will stay with us is yet to be known. In the situation, whole surgical management cannot be postponed for a longer period that can damage the patient’s health. There are lots of queries that will also come up with the viral infection, for example, how should we use our limited test kits, when should we use PPE and which one, how should we select surgical cases, how to ensure proper post-operative care, and another vital question how can we protect health workers from getting infected while giving the service. We have made a bunch of recommendations for such countries to ensure proper preparation against this pandemic. These considerations can ensure the highest care for the patients with surgical conditions and also guarantee maximum protection of the health care teams from admission to operation, operation to ward, and ward to discharge.</p>
Necrotising fasciitis is a rapidly progressing soft tissue infection associated with significant morbidity and mortality. We present a case of cervical necrotising fasciitis with mediastinal extension in a diabetic young male who was COVID-19 positive. He presented with a five-day history of left-sided neck swelling which was fluctuant, red and painful. Subsequent debridement and management of the wound were complicated by the comorbid SARS-CoV2 infection due to potential need for proning. This case highlights the complex interplay between the management of two significant conditions; the surgical approach to necrotising fasciitis and the concern of deterioration due to COVID-19.
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