COVID-19: Review of a 21st Century Pandemic from Etiology to Neuro-psychiatric Implications.

COVID-19 is a severe infectious disease that has claimed >150,000 lives and infected millions in the United States thus far, especially the elderly population. Emerging evidence has shown the virus to cause hemorrhagic and immunologic responses, which impact all organs, including lungs, kidneys, and the brain, as well as extremities. SARS-CoV-2 also affects patients', families', and society's mental health at large. There is growing evidence of re-infection in some patients. The goal of this paper is to provide a comprehensive review of SARS-CoV-2-induced disease, its mechanism of infection, diagnostics, therapeutics, and treatment strategies, while also focusing on less attended aspects by previous studies, including nutritional support, psychological, and rehabilitation of the pandemic and its management. We performed a systematic review of >1,000 articles and included 425 references from online databases, including, PubMed, Google Scholar, and California Baptist University's library. COVID-19 patients go through acute respiratory distress syndrome, cytokine storm, acute hypercoagulable state, and autonomic dysfunction, which must be managed by a multidisciplinary team including nursing, nutrition, and rehabilitation. The elderly population and those who are suffering from Alzheimer's disease and dementia related illnesses seem to be at the higher risk. There are 28 vaccines under development, and new treatment strategies/protocols are being investigated. The future management for COVID-19 should include B-cell and T-cell immunotherapy in combination with emerging prophylaxis. The mental health and illness aspect of COVID-19 are among the most important side effects of this pandemic which requires a national plan for prevention, diagnosis and treatment.

Increased dose of betamethasone for transforaminal epidural steroid injections is not associated with superior pain outcomes at 4 weeks.

BACKGROUND: Fluoroscopically guided transforaminal epidural steroid injections (FG-TFESIs) have been shown to provide both immediate and long-term improvement in patient's self-reported pain. Administration of the lowest possible dose of epidural betamethasone is desired to minimize side effects while maintaining efficacy. We hypothesize that a 3 mg or a 6 mg dose of betamethasone will demonstrate equivalent analgesic properties. OBJECTIVES: To compare the analgesic efficacy of 3 mg and a 6 mg dose of betamethasone for use in FG-TFESI. STUDY DESIGN: Retrospective evaluation. SETTING: Academic outpatient pain center. METHODS: One hundred fifty-eight patients underwent FG-TFESI for lumbar back pain between 2012 and 2013. Depending on the date of service, a dose of 3 mg or a dose of 6 mg betamethasone was used in the single level unilateral TFESI. Opioid consumption and NRS pain score were analyzed pre-procedurally and at a clinic visit 4 weeks post-procedurally. RESULTS: Changes in numerical rating scale (NRS) pain score (-1.21 +' 2.61 vs. -0.81 +' 2.40 respectively, P = 0.17) and changes in opioid consumption as measured in oral morphine equivalents (-2.94 +' 16.4 mg vs. -2.93 +' 14.8 mg, P = 0.17) were statistically equivalent between both groups. Intergroup sub-analysis of those with > 50% reduction in baseline VRS {sp} pain score was not different (15.2% vs. 34%, P = 0.56), and the proportion with a VRS pain score < 3 were similar (24.5% vs. 23.8%, P = 0.92). LIMITATIONS: Potential selection bias inherent with study design. CONCLUSIONS: Reduction in NRS pain scores and narcotic usage at 4 weeks after FG-TFESI were statistically equivalent between patients who received 3 mg or 6 mg of betamethasone, suggesting that a lower steroid dose has similar analgesic efficacy. IRB Number: Cedars Sinai Medical Center Institutional Review Board Pro00031594

Perioperative factors associated with HCAHPS responses of 2,758 surgical patients.

OBJECTIVE: To determine perioperative treatments and events associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey responses. DESIGN: Retrospective analysis. SETTING: Single tertiary care, academic, urban, level-1 trauma center. PARTICIPANTS: Final cohort represents 2,758 consecutive surgical inpatients meeting criteria for evaluation by HCAHPS. EXPOSURES: Responses to four HCAHPS questions were compared against 19 perioperative treatments and events. MEASURES: Positive and negative responses to HCAHPS questions. RESULTS: Patients responding affirmatively with a "9" or "10" to "what number would you use to rate this hospital" were associated with decreased lengths of hospitalization, greater lengths of surgery, decreased intraoperative opioid equianalgesic doses, greater preoperative midazolam doses, shorter post anesthesia care unit (PACU) lengths of stay and decreased last PACU numerical rating scale (NRS) pain scores. Patients responding affirmatively with "yes, definitely" to "would you recommend this hospital to your family" were associated with decreased last PACU NRS pain scores. Patients responding affirmatively with "yes, always" to "How often did the hospital staff do everything to help with your pain" were associated with decreased hospital lengths of stay, decreased chronic benzodiazepine use, greater chronic NSAID use, and decreased PACU lengths of stay. Patients responding affirmatively with "yes, always" to "how often was your pain well controlled" were associated with decreased chronic opioid use, decreased chronic benzodiazepine use, greater chronic NSAID use, increased length of surgery, decreased last PACU NRS pain score, and decreased first PACU NRS pain scores. Subgroup analysis of patients undergoing different types of surgery further characterized factors associated with HCAHPS responses among different surgical populations. CONCLUSIONS: These data suggest that demographic factors, preadmission medications, and PACU pain scores but not analgesic medications are associated with patient satisfaction with regards to both pain management and overall satisfaction.

Skull base osteomyelitis: the effect of comorbid disease on hospitalization.

OBJECTIVES/HYPOTHESIS: Skull base osteomyelitis is a rare disease that has a high morbidity and mortality rate if diagnosis and treatment are delayed. Our objective was to perform a more detailed analysis of skull base osteomyelitis in the inpatient population. We also provide a more comprehensive evaluation of comorbid disease and severity of illness in this population and describe their effects on the duration and cost of hospital stay. STUDY DESIGN: Review of the California Hospital Discharge Database between the years 1990 and 2000. METHODS: Information evaluated included age, race, insurance, charges and length of hospital stay, comorbid disease, severity of illness, and disposition. Data were analyzed using analysis of variance and linear regression analysis. RESULTS: The overall incidence of skull base osteomyelitis ranged from 57 to 95 cases annually (median 75.5). Whites (69.3%) were more likely to present with the disease than Native Americans (13.2%), African Americans (6.5%), or Asians (2.9%). The majority of patients diagnosed with skull base osteomyelitis had Medicare or public assistance (62%) compared with those with Preferred Provider Organization or Health Maintenance Organization insurance (27%). Increased length of hospital stay and increased charges incurred during hospitalization were significantly associated (P < .05) with aplastic anemia, renal disease, arteriosclerosis, facial nerve dysfunction, and diabetes. Severity of illness and the presence of one or more comorbid conditions also significantly affected the duration and charges incurred during hospital stay (P < .05). CONCLUSIONS: The presence of concurrent illness with skull base osteomyelitis significantly affects the duration of hospital stay and the charges incurred during hospitalization.

Treatment of culture-negative skull base osteomyelitis.

OBJECTIVE: To evaluate the efficacy of a therapeutic regimen in the treatment of patients with culture-negative skull base osteomyelitis. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral hospital. PATIENTS: Eight patients with diabetes mellitus presented with otalgia and were found to have positive technetium and gallium scans of the temporal bone. These patients, however, all had negative cultures of their external auditory canals. All patients had been treated with ototopic drops and two patients had undergone a 2-week course of oral quinolones. INTERVENTIONS: All patients were treated with a 6-week course of intravenous ceftazidime or aztreonam for penicillin-allergic patients, oral ciprofloxacin at a higher dose than normal, and topical aminoglycoside steroid drops. MAIN OUTCOME MEASURES: Resolution of the temporal bone gallium scan abnormality, recurrence rate, and time to discharge from the hospital. RESULTS: The patients were discharged from the hospital within 4 days from admission. All patients showed resolution of the temporal bone abnormality on the gallium scan at the 6-week time point. The median follow-up period was 6 months, and none of the patients had a recurrence of the infection. CONCLUSION: The above-described treatment regimen will result in a high cure rate and a short hospitalization period.