Altered mental status is a predictor of poor outcomes in COVID-19 patients: A cohort study.

INTRODUCTION: Several studies have described typical clinical manifestations, including fever, cough, diarrhea, and fatigue with COVID-19 infection. However, there are limited data on the association between the presence of neurological manifestations on hospital admission, disease severity, and outcomes. We sought to investigate this correlation to help understand the disease burden. METHODS: We delivered a multi-center retrospective study of positive laboratory-confirmed COVID-19 patients. Clinical presentation, laboratory values, complications, and outcomes data were reported. Our findings of interest were Intensive Care Unit (ICU) admission, intubation, mechanical ventilation, and in-hospital mortality. RESULTS: A total of 502 patients with a mean age of 60.83 ± 15.5 years, of them 71 patients (14.14%) presented with altered mental status, these patients showed higher odds of ICU admission (OR = 2.06, 95%CI = 1.18 to 3.59, p = 0.01), mechanical ventilation (OR = 3.28, 95%CI = 1.86 to 5.78, p < 0.001), prolonged (>4 days) mechanical ventilation (OR = 4.35, 95%CI = 1.89 to 10, p = 0.001), acute kidney injury (OR = 2.18, 95%CI = 1.28 to 3.74, p = 0.004), and mortality (HR = 2.82, 95%CI = 1.49 to 5.29, p = 0.01). CONCLUSION: This cohort study found that neurological presentations are associated with higher odds of adverse events. When examining patients with neurological manifestations, clinicians should suspect COVID-19 to avoid delayed diagnosis or misdiagnosis and lose the chance to treat and prevent further transmission.

Variety and Complexity of Surgical Exposure, Operative Autonomy, and Program Reputation Are Important Factors for Orthopaedic Sports Medicine Fellowship Applicants.

PURPOSE: To identify the factors considered most important by sports medicine fellowship applicants when deciding where to apply and ultimately interview. METHODS: An anonymous, electronic survey was distributed in 2018 via e-mail to orthopaedic surgery residents who applied to a specific orthopaedic sports medicine fellowship program in 2015 and 2016. The survey included questions regarding the number of fellowships applications per respondent and the number of interviews they were offered and accepted. Questions regarding the application process were included. Participants also were asked to rank 9 criteria from most to least important (1 being most important; 9 being least important) when deciding where to apply or accept interviews. Each criterion's score reflects its average ranking among respondents. RESULTS: Among the 99 orthopaedic surgery residents applying to this fellowship program, 42 (42.4%) completed the survey. The factors considered most influential included variety and complexity of surgical exposure (2.16), autonomy (3.72), and reputation of faculty members (4.05). The factors considered least important were program size (7.21), job placement of past fellows (7.07), and geographic location (5.68). CONCLUSIONS: Variety and complexity of surgical exposure, operative autonomy, and program reputation were valued as the most important factors for orthopaedic surgery residents applying to sports medicine fellowship programs. CLINICAL RELEVANCE: The information obtained in this study may provide sports medicine fellowship programs and orthopaedic residents with a better understanding of factors that are considered to be important by sports medicine fellowship applicants. This will improve training for future sports medicine specialists, thus improving the care that they provide to their patients.

Cancer and COVID-19: analysis of patient outcomes.

Background: We sought to investigate the outcomes associated with COVID-19 disease in cancer patients. Methods: We conducted a retrospective cohort study of laboratory-confirmed COVID-19 patients. Results: Of the 206 patients included, 57 had at least one preexisting malignancy. Cancer patients were older than noncancer patients. Of the 185 discharged cases, cancer patients had a significantly higher frequency of unplanned reintubation (7.1% vs 0.9%, p < 0.049), and required longer hospital stay (8.58 ± 6.50 days versus 12.83 ± 11.44 days, p < 0.002). Regression analysis revealed that obesity and active smoking were associated with an increased risk of mortality. Conclusion: Outcomes in COVID-19 appear to be driven by obesity as well as active smoking, with no difference in mortality between cancer and noncancer patients.

In this study, we aimed to investigate how COVID-19 affected cancer patients and whether this altered their survival outcomes. To do this, we examined data from a database of patients who have passed through our institution ­ a retrospective cohort analysis. Of the 206 patients we included in the study from this database, 57 had at least one preexisting cancer. Cancer patients tended to be older than noncancer patients. Of the 185 discharged patients, cancer patients required longer hospital stays, but there was no difference in mortality. Disease complications and intensive care unit admission with obesity and active smoking put patients in our cohort at increased risk of death. To conclude, outcomes in COVID-19 patients appear to be driven by obesity as well as active smoking, with no difference in mortality between cancer and noncancer patients.