Clinical medicine (London, England)
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Coronavirus disease 2019 (COVID-19) is a highly contagious illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Pneumonia and acute respiratory distress syndrome (ARDS) are the most common severe complications. There is growing evidence regarding the imaging findings of COVID-19 in chest X-rays and computed tomography (CT); however, their availability to clinical staff in this pandemic outbreak might be compromised. At this moment, the role of lung ultrasound (LUS) has yet to be explored. The purpose of this case report is to describe the natural course of the disease in mild infection managed at home. ⋯ LUS is an excellent tool in the characterisation of COVID-19 infection and is more available than CT or X-ray. We emphasise the utility and the opportunity that LUS presents in some clinical scenarios, like this COVID-19 pandemic, and how it may serve as a monitoring and therapy guide.
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We report a patient with chronic diabetes and was referred for recent onset proteinuria. Light microscopy of the renal biopsy specimen showed mildly expanded mesangium with mesangial hypercellularity and segmental sclerosis, features compatible with diabetic glomerulosclerosis. ⋯ Renal biopsy is often performed for diabetic patients who present with proteinuria and light microscopy often shows features of diabetic glomerulosclerosis. Additional information may occasionally be revealed on electron microscopy, altering the subsequent plan of management.
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Case Reports
Lessons of the month 2: Chronic eosinophilic pneumonia (CEP): A rare manifestation of infliximab therapy.
We present a rare and unusual case of 22-year-old man who was on infliximab therapy for his uncontrolled ulcerative colitis. Infliximab was stopped as he didn't get any benefit from it and he ended up having subtotal colectomy and ileostomy. He presented with shortness of breath and eosinophilia and underwent a number of investigations and finally a diagnosis of chronic eosinophilia secondary to infliximab was made.
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The hypoxic patient with a normal chest X-ray can be a diagnostic challenge. This case illustrates the rational diagnostic process and describes a relatively rare but important complication of cancer metastasis. Thrombotic microangiopathy, like lymphangitis carcinomatosa, may cause respiratory failure and is a poor prognostic finding. However, unlike lymphangitis carcinomatosa, it may not have specific findings on cross-sectional imaging.
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COVID-19 poses many challenges to healthcare systems and workers. Responding to medical emergencies in patients with suspected COVID-19 will require new guidelines and protocols. Simulation can support their development. ⋯ Low-fidelity simulation can provide relevant and timely information on how prepared health systems and their workforce are to respond to emergencies. We urge NHS trusts nationally to implement simulations to identify problems and develop effective solutions.