CMEO Podcast: Coronavirus Disease 2019 (COVID-19) and Inflam | Figure 1

Figure1COVID-19

CMEO Podcast: Coronavirus Disease 2019 (COVID-19) and Inflammatory Bowel Disease

The COVID-19 pandemic created many challenges and uncertainty in our healthcare system. One component facing clinicians managing patients with inflammatory bowel disease (IBD) is whether or not to continue providing certain pharmacotherapies in patients who are at increased risk of infection because they are immunocompromised. The consensus of gastroenterologists is that decisions should be made on a case-by-case basis, but that overall, uncontrolled disease activity and inflammation present more harm to individual patients than remaining on their biologic therapy.

Dr. Rubin, Dr. Regueiro, and Dr. Dalal have been on the frontlines of the pandemic and have been leaders in guiding care for patients with IBD based on current evidence and experience. This CMEOCast podcast is a featured excerpt from the broader virtual symposium Ulcerative Colitis in the 21st Century: Incorporating Guidelines and Real-World Evidence in Practice to Enhance Patient-Centered Care presented to assist health care providers in optimizing the management of patients with IBD during the COVID-19 pandemic.

Start activity now

Why you should join Figure 1

April 7, 2020

A paper published in JAMA on April 6th describes the outcomes of patients with confirmed SARS-CoV-2 infection who were admitted to Intensive Care Units in Lombardy, Italy. Of the 1,591 patients admitted to the ICUs, most were men (82 percent) and the average age was 63 years old. Almost all patients—99 percent—required at least some help with breathing, including 88 percent who required a mechanical ventilation (a breathing machine). At the time of the study, 26 percent of the patients followed in this study had already died, while another 58 percent remain in the ICU.
This study is notable for several reasons. First, this study represents the largest group of ICU patient outcomes described since the start of the covid-19 pandemic. Second, the authors shared intricate details in this publication, providing important insights into the needs of covid-19 patients ICUs. Finally, the results provide further evidence that older patients with chronic disease (high blood pressure, lung disease, etc) tend to fare poorly when they become sick with covid-19. While this study may not immediately provide “practice-changing” information for emergency physicians and other hospital providers, it is a stark reminder that older patients with multiple medical problems may require higher levels of medical care.
Shared with permission from Brief19, a daily review of #covid-19 research and policy.

The coronavirus disease 2019 (COVID-19) pandemic revealed a myriad of postinfectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequelae, many of which remain poorly understood. We describe a rare presentation of a patient developing 2 simultaneous COVID-19 sequelae: transverse myelitis and acquired von Willebrand syndrome (AVWS). There have been numerous published case reports of patients developing transverse myelitis after a diagnosis of COVID-19. However, none have described AVWS as an observed complication from SARS-CoV-2 infection. To our knowledge, this case report is the first to describe AVWS as a result of COVID-19 infection, suggesting that patients with a prior diagnosis of COVID-19 are susceptible to developing this rare bleeding disorder.

Management of acute stroke is challenging under normal circumstances, but a confluence of factors related to the COVID-19 pandemic has made it particularly challenging in recent weeks in the United States.
Beyond affecting millions of people worldwide, the COVID-19 pandemic is exerting real but poorly understood impacts on the treatment of other medical emergencies, including acute stroke. Some of these effects are illustrated by two cases we managed in the first weeks after the pandemic’s emergence in Northeast Ohio.
Case 1. One patient called emergency medical services after nine days of experiencing symptoms of aphasia and right hemiparesis. During evaluation on our mobile stroke treatment unit, the patient was asked about the long delay in seeking care and responded that it was due to being “afraid to come out due to the coronavirus.”
Case 2. A second patient was transferred to Cleveland Clinic for mechanical thrombectomy after presenting with right middle cerebral artery syndrome. She had a history of flu-like symptoms over the prior 10 days. In view of these symptoms, the patient was managed as if she had possible COVID-19 and precautionary measures were taken, which included intubation prior to thrombectomy, to prevent aerosol spread, and the use of personal protective equipment (N95 respirators, surgical masks, gowns and protective eyewear) for all providers in the procedure room. As a result, treatment initiation was delayed.

Program Overview: Managing Advanced Prostate Cancer in the COVID-19 Era: What Do Oncologists Need to Know?

Will provide oncologists with the most up-to-date evidence-based information and expert guidance on selecting and sequencing therapies in advanced prostate cancer and managing patient care during the COVID-19 pandemic.
Presenter(s): Steven Ludlow, PharmD, BCOP, BCPS; Alicia K. Morgans, MD, MPH; Scott T. Tagawa, MD, MS, FACP; 1 AMA PRA Category 1 Credit

Trending now

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.
He had a history of hypertension, long-term smoking, and a sedentary lifestyle.
On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.
Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

A patient in late teens presented after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family.