COVID-19 related MIS-C (Multisystem inflammatory syndrome in children) can present with cardiovascular complications like shock, arrhythmias, pericardial effusion, and coronary artery dilatation. The majority of MIS-C associated coronary artery abnormalities are dilation or small aneurysms which are transient and resolve in a few weeks[[1, 2]](#ref-0001). We present here a case of a 3-month-old child who was noted to have giant aneurysms of her coronary arteries (LAD and RCA) twenty-six days after testing positive for COVID-19. She was treated with IVIG, infliximab, and glucocorticoids along with aspirin, clopidogrel and enoxaparin. She did not show any signs of coronary ischemia or cardiac dysfunction but continued to have persistent giant coronary artery aneurysms involving the LAD (z-score ~35) and RCA (z-score ~30) [Fig. 1]. This study emphasizes the importance of early detection and aggressive management of MIS-C to prevent potentially life-threatening consequences.

A Pneumothorax in the Setting of COVID-19 Associated Pneumatoceles in a Pediatric PatientEsther Blondeau-Lecomte, BA1, Nancy Joseph, MBBS11Department of Pediatrics, University of Florida, Gainesville, FL, USA

The 2019 novel coronavirus (2019-nCoV) is a respiratory pathogen able to cause a wide spectrum of disease, transmitted through the air and by droplet spread when an infected person sneezes or by contact with contaminated objects.

Aim: We aimed to examine fetal cardiac output (CO) in patients who recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Materials: This prospective study included 48 pregnant women recovered from SARS-CoV-2 infection and 50 control cases. SARS-CoV-2 infection was diagnosed by polymerase chain reaction (PCR) test in patients. Fetal echocardiographic evaluations were performed at 24-37 weeks of gestation in pregnant women who recovered from the infection and control group. Results: The median value of ultrasound evaluation was 34 (2.6) weeks of gestation in the recovery from the SARS-CoV-2 infection (RSI) group, and 32 (7.6) weeks in the control group (p=0.565). Left cardiac output (LCO) z score was significantly lower in the RSI group than the control group (p=0,041). LCO and combine cardiac output (CCO) z score were significantly lower in the severe disease group than mild, moderate disease groups, and controls (p=0,019 and p=0,013). CCO (mL/min/kg) was decreased in the severe disease group when compared with control and mild disease groups (p=0,044). Fetal distress, preterm delivery rate, and neonatal intensive care unit (NICU) admission were found to be higher in the severe disease group compared to the control group (p=0,010, p=0,009, and p<0,001 respectively). Conclusion: In the present study, fetal cardiac output in pregnant women with recovery from SARS-CoV-2 infection was found significantly decreased, especially in whom had severe diseases. Placental dysfunction and inflammatory cytokines might cause fetal cardiac changes. Further studies could be clarified on the impact of SARS-CoV-2 infection on fetal cardiac function.

A document by Sergio Bonini. Click on the document to view its contents.

Autopsy was performed on a COVID-19 patient, who suddenly died despite the extensive anti-viral and anti-inflammatory therapies. Although moderate subpleural fibrosis was seen, pathology of DAD, a well-known cause for pulmonary failure, was minimum. Instead, severe hemorrhage was observed. Therapeutic effects were indicated, however why severe hemorrhage occurred was unclear.

We report a rare case of a 50-year-old female with covid19 presented to the emergency department where supplementary oxygen is delivered via non-invasive face mask ventilation. x-ray imaging performed the existence of pneumoperitoneum. CT scan was not applicable due to the advanced status of the paient.

Cases of aspergillosis superinfection have been reported as acute complications of Covid-19. Here we report a case of combined chronic necrotizing pulmonary aspergillosis, aspergilloma and fibrosing aspergillosis in a 31-year-old woman with a history of Covid-19. This unusual association deserves special attention in a secondary immunocompromised patient after Covid-19.

Background: With the emergence of SARS-CoV-2, influenza surveillance systems in Spain were transformed into a new syndromic sentinel surveillance system. The Acute Respiratory Infection Surveillance System (SiVIRA in Spanish) is based on a sentinel network for Acute Respiratory Infection (ARI) surveillance in Primary care, and a network of sentinel hospitals for Severe ARI (SARI) surveillance in hospitals. Methods: Using a test-negative design and data from SARI admissions notified to SiVIRA between January 1 and October 3, 2021, we estimated COVID-19 VE against hospitalization, by age group, vaccine type, time since vaccination and SARS-CoV-2 variant. Results: VE was 89% (95% CI: 83-93) against COVID-19 hospitalization overall in persons aged 20 years and older. VE was higher for mRNA vaccines, and lower for those aged 80 years and older, with a decrease in protection beyond 3 months of completing vaccination, and a further decrease after 5 months. We found no differences between periods with circulation of Alpha or Delta SARS-CoV-2 variants, although variant-specific VE was slightly higher against Alpha. Conclusions: The SiVIRA surveillance system, with a network of sentinel hospitals in Spain was able to describe clinical and epidemiological characteristics of SARI hospitalizations, monitor the circulation of SARS-CoV-2 and other respiratory viruses, and provide data to measure the effectiveness of COVID-19 vaccination in the population under surveillance. Our results add to evidence of high VE of mRNA vaccines against severe COVID-19 and waning protection with time since vaccination.

We evaluated uptake and factors associated with COVID-19 vaccination among health workers (HWs) in Azerbaijan. Among 1,575 HWs, 73% had received at least one dose and 67% received two doses; all received CoronaVac. Factors associated with vaccination uptake included no previous COVID-19 infection, older age, belief in the vaccine’s safety, previous vaccination for influenza, having patient-facing roles, and good or excellent health by self-assessment. These findings could inform strategies to increase vaccination uptake as the campaign continues.

A middle-aged woman with history of the administration of COVID-19 vaccine and valve replacement surgery before her symptoms, was admitted with bilateral palpable purpuric lesions in the lower extremities and headache . Based on the initial diagnosis of vasculitis , corticosteroid therapy was initiated and resolved the skin lesion

The side effects of COVID-19 vaccination were mostly self-restricted local reactions that quickly resolved. Nevertheless, rare autoimmune hepatitis cases have been reported in some vaccinated individuals. This article presents a young man who developed fulminant hepatitis a few days after vaccination with the first dose of the AstraZeneca COVID-19 vaccine.

There are many challenges that can arise while providing home care to a terminally ill patient. Isolation of infected patients was used to prevent COVID-19 infection. In home care, where informal caregivers play an important role, such measures could result in the loss of caregivers.

We describe the demographic, clinical, radiological and laboratory findings relating them also to the severity and clinical outcome of 129 children (0-18 years) which were admitted to a tertiary care pediatric hospital in Mexico City due to SARS- CoV-2 infection between April 1, 2020, to March 31, 2021. The infection was confirmed using RT-PCR. Fever (82.2%), tachypnea (72.1%) and cough (71.3%) were the most commonly reported signs at the moment of hospitalization. The most frequent radiological pattern that stood out was the interstitial pattern (66.7%). History of oncologic pathology (25.6%) was the most frequent past medical history. ESR (erythrocyte sedimentation rate) was the only laboratory value significantly associated with severity (p=0.015). NSAIDs (93%), antibiotics (57.4%), and steroids (40.3%) were the most common medication given. The average hospitalization stay was 14.2 days, 21.7% of the total patients required transfer to the intensive care unit. At discharge, 20.2% required oxygen on an outpatient basis, and unfortunately 7.0% of the patients who were admitted to the institute for COVID-19 died. Our findings confirm that COVID‐19 in children has a mild presentation except for patients with hematologic/oncologic co-morbidities which had severe presentations.

Transverse myelitis can be a complication of SARS-CoV-2 infection. We report the case of transverse myelitis related to SARS-CoV-2 infection. Beyond the disease itself, neurological involvement affects functionality. In this situation, Physical and Rehabilitation Medicine plays a crucial role in managing patient rehabilitation.

The present study aimed to report a case with COVID-19 with a history of chronic diseases, beta thalassemia intermedia, and DM. A 25-year-old man visited with covid 19 and treatment with IFN-β1a. According to the present report, the use of IFN-β1a was effective as a treatment option for COVID-19.

We experienced the case of a patient with advanced breast cancer who failed to receive comprehensive care despite regular video conferencing with her physician during the COVID-19 pandemic, resulting in delayed detection of liver metastasis. Inter-hospital collaboration is required to provide uninterrupted cancer care to those disproportionately affected by crises.

Aims: To update our previously reported systematic review and meta-analysis of observational studies on cardiovascular drug exposure and COVID-19 clinical outcomes by focusing on newly published randomized controlled trials (RCTs). Methods: More than 500 databases were searched between 1-Nov-2020 and 2-Oct-2021 to identify RCTs that were published after our baseline review. One reviewer extracted data with other reviewers verifying the extracted data for accuracy and completeness. Results: After screening 22,414 records, we included 24 and 21 RCTs in the qualitative and quantitative syntheses, respectively. The most investigated drug classes were angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARBs) and anticoagulants, investigated by 10 and 11 studies respectively. In meta-analyses, ACEI/ARBs did not affect hospitalization length (mean difference/MD -0.42, 95% CI -1.83; 0.98 days, n=1183), COVID-19 severity (risk ratio/RR 0.90, 95% CI 0.71; 1.15, n=1661) and mortality (RR 0.92, 95% CI 0.58; 1.47, n=1646). Therapeutic anticoagulation also had no effect (hospitalization length MD -0.29, 95% CI -1.13 to 0.56 days, n=1449; severity RR 0.86, 95% CI 0.70;1.04, n=2696; and, mortality RR 0.93, 95% CI 0.77;1.13, n=5689). Other investigated drug classes were antiplatelets (aspirin, 2 trials), antithrombotics (sulodexide, 1 trial), calcium channel blockers (amlodipine, 1 trial) and lipid modifying drugs (atorvastatin, 1 trial). Conclusion: Moderate- to high-certainty RCT evidence suggests that cardiovascular drugs such as ACEIs/ARBs are not associated with poor COVID-19 outcomes, and should therefore not be discontinued. These cardiovascular drugs should also not be initiated to treat or prevent COVID-19 unless they are needed for an underlying currently approved therapeutic indication.

We experienced a patient with Legionella Pneumonia immediately after discharge from COVID-19. It is very important to accurately detect pathogens of infectious diseases particularly in the time of COVID-19 pandemic.

Phantosmia is the sensation of a fragrance intermittently or continuously when no odorant trigger is available. Without any further complaints, COVID-19 individuals may experience olfactory hallucination. Phantosmia was unnoticed for a long time sinc

A 38-year-old female developed chronic joint pain one month after testing positive for SARS-CoV2. Physical examination revealed warmth and tenderness of the wrists and small joints of the hands. Rheumatoid factor and anti-CCP were elevated. Hands MRI showed synovitis of small joints. The patient was diagnosed with rheumatoid arthritis (RA).

Abstract Background This study aimed to evaluate whether changes in practice and patient behaviour due to the covid-19 pandemic impacted the presentation, management, and outcomes of patients with deep neck space infections (DNSI). Design Retrospective cohort study including all adults presenting to the otolaryngology department at a tertiary UK centre with a DNSI during the first 12 months of the covid-19 pandemic (n = 27), and those from the previous 12 month period (n = 26). Patients with peritonsillar abscess which did not involve deep neck spaces radiologically were excluded. Results The covid-19 pandemic cohort tended to present later after onset of symptoms (5.96 days vs 3.25 days, p = 0.0277), have abscess formation rather than inflammation only (77.8% vs 34.6%, p < 0.01), and develop complications (33.3% vs 7.7%, p = 0.0394). Not reaching statistical significance, the covid-19 pandemic cohort also had larger volume abscess (25.18cm3 vs 14.5cm3, p = 0.291), longer hospital stay (14.48 days vs 6.35 days, p = 0.114), and longer intensive care stay (7.88 days vs 1.78 days, p = 0.0992). Non-significant changes were noted in management, with the covid-19 pandemic cohort being seven times more likely to undergo tracheostomy (25.9% vs 3.8%, p = 0.0504), and more likely to undergo transcervical drainage (37% vs 19.2%, p = 0.224) and hot tonsillectomy (11.1% vs 0%, p = 0.236). Conclusion This study demonstrates the covid-19 pandemic led to delayed presentation and more severe infection, requiring more radical management in patients with DNSI.

Introduction Extracorporeal membrane oxygenation (ECMO) is implemented as a rescue therapy in COVID-19 related acute distress respiratory syndrome (ARDS) and refractory hypoxemia. Google trends (GT) is an ongoing-developing web-kit providing feedback on specific population’s interests. This study uses GT to analyze the United States (US) general population interest in ECMO as COVD-19/ARDS salvage therapy. Methods GT was used to access data searched for the term ECMO and COVID-19. The gathered information included data from March 2020 through July 2021 within US territories. Search frequency, time intervals, sub-regions, frequent topics of interest, and related searches were analyzed. Data was reported as search frequency on means, and a value of 100 represented overall peak popularity. Results The number of Google searches related to the terms ECMO and COVID-19 has surged and sustained interest over time ever since the initial reports of COVID-19 in the US, from an initial mean of 34% in March 2020 to a 100% interest by April 2020, resulting in an up-to-date overall average of 40% interest. Over time West Virginia, Gainesville, and Houston, lead the frequency of searches in sub-region, metro and city areas, respectively. Top search terms by frequency include: ECMO machine, COVID ECMO, what is ECMO, ECMO treatment and VV ECMO. Parallel to this, the related rising terms are: COVID ECMO, ECMO machine COVID, ECMO for COVID, ECMO machine coronavirus, and ECMO vs ventilator. Seemingly, medical-relevant websites fail to adequately address these for patient therapeutic education (PTE) purposes. Conclusions GT complements the understanding of interest in ECMO for COVID-19. When properly interpreted, the use of these trends can potentially improve on PTE and therapy awareness via specific medical relevant websites.

Coronavirus disease 2019 (COVID-19) vaccination is reportedly safe and effective. The histologic features of post-COVID-19 vaccination myocarditis are unknown. We present a 77-year-old Japanese woman who was diagnosed with eosinophilic myocarditis using endomyocardial biopsy, 7 days after receiving the second dose of BNT162b2 COVID-19 vaccine. Methylprednisolone pulse therapy was effective.