Clinical medicine (London, England)
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Case Reports
Guillain-Barré syndrome associated with leptomeningeal enhancement following SARS-CoV-2 infection.
Patients with coronavirus disease 2019 (COVID-19) typically present with respiratory symptoms, but little is known about the disease's potential neurological complications.We report a case of Guillain-Barré syndrome (GBS) following a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, in association with leptomeningeal enhancement. ⋯ Leptomeningeal enhancement is an atypical feature in GBS, but could be a marker of its association with SARS-CoV-2 infection.
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Medical teams continue to treat many patients with COVID-19 infection. This disease can result in profound hypoxaemia that may necessitate intubation and invasive mechanical ventilation in those who are critically ill. This intervention carries risk to both patients and healthcare workers and utilises significant hospital resource for prolonged periods. ⋯ The prone position in conscious non-ventilated patients with COVID-19 infection may improve oxygenation in the short term and defer or prevent the need for intubation in some. However, clinicians must be aware that there is a small evidence base for this intervention currently. This review sets out evidence regarding the use of this technique to aid the decision making of frontline staff.
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Practice Guideline
Restarting gastrointestinal endoscopy in the deceleration and early recovery phases of COVID-19 pandemic: Guidance from the British Society of Gastroenterology.
Many non-emergency clinical services were suspended during COVID-19 pandemic peak. It is essential to develop a plan for restarting services following the peak. ⋯ Key recommendations include the following: all patients should have need for endoscopy assessed by senior clinicians and prioritised according to criteria we have outlined; once the need for endoscopy is confirmed, patients should undergo telephone screening for symptoms using systematic questionnaires; all outpatients should undergo RT-PCR testing for COVID-19 virus 1-3 days prior to endoscopy; and PPE should be determined by patient risk stratification, the nature of the procedure and the results of testing. While this guidance is tailored to endoscopy services, it could be adapted for any interventional medical discipline.
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Blood culture negative endocarditis (BCNE) accounts for up to 20% of infective endocarditis. While the most common cause of BCNE remains the initiation of antibiotics prior to culture, intracellular organisms such as Coxiella and Bartonella spp account for a significant proportion of cases. Identifying the infecting organism remains important to ensure optimal antimicrobial treatment. ⋯ Over half of patients with infective endocarditis now undergo early surgery and 16S ribosomal ribonucleic acid (rRNA) polymerase chain reaction (PCR) of excised tissue can be vitally important to secure a diagnosis. Molecular testing is likely to become a key tool in improving outcomes from BCNE and contribute to an improved understanding of the aetiology. We advocate modifying the Duke criteria to incorporate organisms identified on molecular testing, including 16S rRNA PCR, in particular from explanted tissue.
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We describe a case of an 82-year-old man who developed an anterior ST-elevation myocardial infarction (STEMI) and left ventricular thrombus while an inpatient following a diagnosis of severe COVID-19 infection (SARS-CoV-2). His D-dimer was significantly elevated at 12,525 ng/mL (normal range <243). ⋯ Clinicians should be aware of this possibility in such patients, with a severely prothrombotic state as a possible underlying aetiology. Further research is required to establish any causative link, pathophysiological mechanisms and whether modification to existing venous thromboembolism prophylaxis strategies may also reduce arterial thrombotic complications of severe COVID-19 infection.