ABSTRACT
Background: The COVID-19 pandemic has caused an international healthcare crisis and produced a large healthcare burden. Diabetes mellitus (DM) is a common disease that can be controlled via pharmacologic agents; however, many patients have poor glycemic control, leading to disease-related complications. DM has been reported in the literature to be associated with increasing morbidity and mortality in COVID-19 patients. The authors aim to assess the associations between glucose homoeostasis and COVID-19 disease severity and mortality. Methods: A retrospective chart review of patients ages 18-100 years of age admitted with COVID-19 between January 2020 and December 2021 was performed. The primary outcome was COVID-19 mortality with respect to haemoglobin A1C levels of less than 5.7%, 5.7-6.4%, and 6.5% and greater. Disease severity was determined by degree of supplemental oxygen requirements (ambient air, low-flow nasal cannula, high-flow nasal cannula, non-invasive mechanical ventilation, and invasive mechanical ventilation). COVID-19 mortality and severity were also compared to blood glucose levels on admission as grouped by less than 200 mg/dl and greater than or equal to 200 mg/dl. Results: A total of 1156 patients were included in the final analysis. There was a statistically significant association between diabetic status and mortality (P=0.0002). Statistical significance was also noted between admission blood glucose ≥200 mg/dl and mortality (P=0.0058) and respiratory disease severity (P=0.0381). A multivariate logistic regression for predicting mortality showed increasing haemoglobin A1C was associated with increased mortality (odds ratio 1.72 with 95% CI of 1.122-2.635). Conclusions: In our 2-year retrospective analysis, there was an association between a diagnosis of DM and COVID-19-related mortality. Hyperglycaemia on admission was found to be statistically significant with mortality in patients diagnosed with COVID-19. Glucose homoeostasis and insulin dysregulation likely play a contributing factor to COVID-19 disease severity and mortality.
ABSTRACT
Breast cancer is widely known as the most common cancer in women in the United States. If left untreated, it can have detrimental effects. If the breast cancer is aggressive in nature, it can metastasize to the lymph nodes, bones, liver, lungs, and brain. A rare location of metastasis is the leptomeninges, specifically the pia and arachnoid matter. This term is coined as leptomeningeal carcinomatosis. Its diagnosis can be challenging to make as patients can present with non-specific symptoms. We present the case of an elderly female with a prior history of breast cancer that was treated with 12 cycles of chemotherapy with paclitaxel, radiation to her left axilla, and daily anastrozole for 3 years who came into the emergency department for worsening confusion, urinary incontinence, and difficulty ambulating. Cerebral spinal fluid obtained from a lumbar puncture supported a diagnosis of leptomeningeal carcinomatosis.
ABSTRACT
With sporadic surges of COVID-19, medical professionals are continuously expanding their knowledge and contributing to medical literature through experiences and research. We present a rare case of a 65-year-old Hispanic male diagnosed with COVID-19-induced immune thrombocytopenic purpura (ITP). Commonly seen in cases with COVID-19-vaccine-induced thrombocytopenia, there are very few published case reports of ITP as a result of the COVID-19 virus.
ABSTRACT
Google Trends is a useful tool for evaluating the public interest in interstitial lung diseases (ILD). The interest in ILD is much lower compared to lung cancer although both conditions are associated with significant morbidity and mortality. https://bit.ly/38QzPce.
ABSTRACT
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) virus has been known to manifest various non-pulmonary complications in the affected patient, including both venous and less frequently, arterial thrombosis. Ongoing research is necessary to determine who might benefit from therapeutic anticoagulation as well as potentially develop an algorithm to predict thromboembolic events in this patient population. We present a case of a 65-year-old man with a past medical history of hypertension, diabetes type 2, and a previous cerebrovascular accident who was admitted with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19). On admission to the hospital, the patient was initiated on therapeutic anticoagulation. Subsequently, he developed left lower limb ischemia. Imaging discovered arterial thrombosis in the bilateral deep femoral and left popliteal arteries. Consequently, the patient required catheter directed thrombolysis for partial reperfusion. Unfortunately, the patient succumbed to the complications of COVID-19. This case is notable in that it highlights the arterial thrombophilia associated with COVID-19 despite early intervention with therapeutic anticoagulation.
