Curēus
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Introduction The coronavirus disease 2019 (COVID-19) pandemic has resulted in the suspension of our pediatric clerkship, which may result in medical student skill erosion due to lack of patient contact. Our clerkship has developed and assessed the feasibility of implementing a video-recorded oral presentation assignment and formative assessment centered on virtual case-based modules. Methods This retrospective study examined the feasibility of providing a remote formative assessment of third-year medical student video-recorded oral presentation submissions centered on virtual case-based modules over a one-week time period after pediatric clerkship suspension (March 16th to 20th, 2020). ⋯ This study demonstrated the possibility of remotely assessing oral presentation skills centered on virtual case-based modules using a patient presentation tool intended for non-virtual patients. This may prepare students for their clinical experiences when COVID-19 restrictions are lifted. Future studies are needed to determine if suspended clerkships should consider this approach.
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Background and objective COVID-19 is a highly disseminating viral disease imparted by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), which was declared a global pandemic by the World Health Organization. In our study, we aimed to describe the clinical characteristics of the first 100 hospitalized patients of confirmed COVID-19 in a developing country. Materials and methods The study included all the admitted patients (n = 100) having COVID-19 polymerase chain reaction (PCR) positive, and evaluated clinical profiles and characteristics of the patients linking to disease severity. Results Out of the 100 patients, 67 were in the ward, 33 were in ICU, 78 of them recovered, while 22 deaths reported. ⋯ Amongst the patients admitted in ICU, there were significant differences in the total leukocyte count (P = 0.001), neutrophils and lymphocytes (P =< 0.001), monocytes (P = 0.027), urea (P =< 0.001), creatinine (P = 0.002), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) increasing with disease severity, lymphocyte-to-monocyte ratio (LMR) and lymphocyte-to-C-reactive protein ratio (LCR) decreasing with mortalities. Gamma-glutamyl transferase (GGT) followed by aspartate aminotransferase (AST) are frequent hepatic derangements, while C-reactive protein (CRP) levels predicting ICU admission with area under the curve (AUC): 0.806, positive predictive value (PPV): 85.1% and lactate dehydrogenase (LDH) predicting mortality with AUC: 0.877, PPV: 97.3%, while NLR (AUC: 0.806, PPV: 95.8%) for mortality and neutrophils (AUC: 0.773, PPV: 87.5%) for ICU patients. Conclusion A number of factors are linked with disease severity and mortality along with dynamic changes of the laboratory investigations during hospital stay affecting prognosis.
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Case Reports
Extracorporeal Membrane Oxygenation Support in a Young Patient With COVID-19 Infection.
Critically ill patients with coronavirus disease 2019 (COVID-19) infection often require mechanical ventilation, and still many of them will progress to worsening hypoxia and death. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used in some centers, but its role in the setting of COVID-19 infection is still unclear to date. We describe a case of a young female patient with obesity but otherwise no other underlying medical conditions who was admitted with respiratory failure secondary to COVID-19. ⋯ The high resource cost is a challenge to the health care system in times of a global pandemic. Considering the limitations of this resource-intensive therapy, clinical judgment is crucial to decide whether ECMO is an appropriate option for the patient. However, for young patients with no underlying conditions who are critically ill despite optimized mechanical ventilation, we believe that extracorporeal therapy represents a reasonable option when available.
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We present a case of a 39-year-old male who presented with chest pain without fever or respiratory symptoms. Troponins were elevated and electrocardiogram (ECG) was inconclusive for ST-elevation myocardial infarction (STEMI). ⋯ Although COVID-19 manifests primarily as respiratory disease, few cases of cardiac injury without respiratory involvement or febrile illness have been reported. This case illustrates that COVID-19 can present atypically and affect an isolated non-respiratory organ system.
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The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerging in Wuhan city of China, was the cause of a rare type of pneumonia evolving rapidly in pandemic early at the beginning of 2020. The rapid human-to-human transmission of SARS-CoV-2 increases the risk of in-hospital transmission, requiring re-definement of musculoskeletal trauma management and postoperative care. ⋯ The principles involve the management of the Orthopaedic medical and nursing personnel, alterations of the workflow in the wards, operating rooms and outpatient clinics from the admission to the discharge of an orthopaedic patient. In addition, we present the recommended principles of management of traumatic orthopaedic injuries highlighting those deserving admission and in-hospital care and those that can be treated in the outpatient setting or day surgery clinics.