Dominic Awuah

Bio: Dominic Awuah is an academic researcher from Hurley Medical Center. The author has contributed to research in topics: Serratia infection & Stroke. The author has co-authored 2 publications.

Acute confusional state as a prognostic sign of COVID-19 large-vessel occlusion (LVO).

Abstract: COVID-19 is well known for its respiratory symptoms, but severe presentations can alter haemostasis, causing acute end-organ damage with poor outcomes. Among its various neurological presentations, cerebrovascular events often present as small-vessel strokes. Although uncommon, in predisposed individuals, large-vessel occlusions (LVOs) can occur as a possible consequence of direct viral action (viral burden or antigenic structure) or virus-induced cytokine storm. Subtle presentations and complicated stroke care pathways continue to exist, delaying timely care. We present a unique case of COVID-19 LVO manifesting as an acute confusional state in an elderly man in April 2020. CT angiography revealed 'de novo' occlusions of the left internal carotid artery and proximal right vertebral artery, effectively blocking anterior and posterior circulations. Delirium can lead to inaccurate stroke scale assessments and prolong initiation of COVID-19 stroke care pathways. Future studies are needed to look into the temporal relationship between confusion and neurological manifestations.

Serrating through vascular access catheters: a great masquerader with severe systemic manifestations.

Abstract: Serratia marcescens, time and again, has demonstrated its ability to easily adhere and infect vascular access catheters, making them a bona fide source of hospital outbreaks and contributing to adverse patient outcomes. We present a unique case of a severe recurrent Serratia infection, leading to persistent bacteria in the blood, haematogenous dissemination and subsequent development of abscesses, to a degree not reported in the literature before. These infections are exceedingly challenging to eradicate, owing to multiple virulence mechanisms and the deep seeding ability of this microorganism. Serratia infections require a multifaceted approach with intricacies in identification, therapeutics and surveillance, all of which are sparsely reported in the literature and reviewed in this report.

Understanding the state of confusion in patients with psychosis during COVID-2019 pandemic: A report of two cases

Abstract: Introduction. There is a lot of evidence that coronavirus disease 2019 has various manifestations. This paper presents a report of two cases with the aim to indicate the multifactorial etiology of confusional states in patients with mental disorders at the time coronavirus disease 2019 pandemic. The severe acute respiratory syndrome coronavirus-2 affects not only the respiratory and cardiovascular systems, but also the brain, kidneys and other organ systems. One of the first manifestations of this infection can be mental confusion. Case Study. The first patient, a woman diagnosed with schizoaffective psychosis, suddenly presented with confusion, followed by hypersedation which was at first attributed to overmedication. In another patient, with the diagnosis of bipolar affective disorder, sudden confusion (delirium) was initially recognized as an element of mental disorder deterioration. A more detailed observation revealed that the confused state in both patients was caused by severe acute respiratory syndrome coronavirus-2 infection. Discussion. It is common for the manifestations of severe acute respiratory syndrome coronavirus-2 infection to include respiratory and cardiovascular syimptoms. However, symptoms related to other organs and organ systems, including changes in neurological and psychological status, should not be ignored. Conclusion. It was noticed that confusion and delirium-like states are quite common early symptoms of coronavirus disease 2019. In psychiatric patients, it is always necessary to rule out the organic etiology of the consciousness disorder and immediately proceed with the diagnostic procedures. One should certainly keep in mind that diagnostic errors are possible, not only due to various manifestations of the infection, but also due to the stigmatization of mental illness, which must be overcome in order to provide the best possible treatment effects.