Clinical medicine (London, England)
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Case Reports
Images of the month: Demonstrative oral mucosal sarcoidosis in a patient with pulmonary disease.
Sarcoidosis is a multisystem granulomatous disease that preferentially affects the lungs and intrathoracic lymph nodes. Oral involvement is quite rare and usually appears in patients with known systemic sarcoidosis but it may also be the initial finding of a systemic disease. ⋯ Recognising oral sarcoidosis may be difficult but it is important not to miss an asymptomatic pulmonary sarcoidosis. Patients with oral lesions of sarcoidosis should be screened for systemic disease.
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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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Obese patients are at increased risk of exacerbations from viral respiratory infections. During the H1N1 pandemic, obesity was associated with an increased risk of influenza-associated intensive care unit (ICU) admission and death, longer duration of mechanical ventilation, and longer duration of ICU and hospital length of stay compared with the non-obese. These observations have raised a concern about the correlation between obesity and the current COVID-19 pandemic. ⋯ Also, it has been clearly illustrated that obese patients are potentially more vulnerable to COVID-19 and more contagious than lean patients. The comorbidities associated with obesity were found to be correlated with a severe clinical course of COVID-19 and increased mortality and high BMI has been shown to be correlated with hospitalisation, the need for mechanical ventilation and non-survival. The review also sheds light on the challenges that obese patients pose for healthcare providers inside and outside ICUs.
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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.