Clinical medicine (London, England)
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The objective was to explore if chest X-ray severity, assessed using a validated scoring system, predicts patient outcome on admission and when starting continuous positive pressure ventilation (CPAP) for COVID-19. ⋯ We outline a scoring system to stratify X-rays by severity and directly link this to prognosis. However, we were unable to demonstrate this association in the patients commencing CPAP.
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Case Reports
Image of the month: Mauriac variant: a rare complication of poorly controlled diabetes.
We present a case of Mauriac syndrome in a young woman with poorly controlled type 1 diabetes mellitus. Liver complications are well known in the context of type 2 diabetes mellitus, it is associated metabolic complications and with the non-alcoholic fatty liver disease spectrum. This case brings to light a less well-known liver complication associated with type 1 diabetes mellitus.
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During COVID-19 there has been increased pressure on mental health services internationally. In this report, we compare admissions to one acute medical unit (AMU) for patients with mental health problems during the COVID-19 pandemic (April, May and June 2020) to the same period of time in 2019. We found an increase in this cohort of patients in 2020, both as an absolute number and as a proportion of the medical take. We outline some strategies which we have adopted locally to improve care for this patient group.
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A cohort of the first 50 COVID-19 patients in East Tyrol, a region in the southwest of Austria, were monitored in home quarantine. Specific viral ribonucleic acid was detected in throat swabs and stool samples. Analysis indicated a median virus shedding duration of 13 days; however, statistical outliers highlight the importance of consequent testing. ⋯ Investigation revealed seven relapses and viral shedding fluctuation in four cases. A follow-up examination shed light on seroconversion which could be observed in 35 of 40 participants. This further clarifies the necessity of establishing discharge standards and follow-up management for COVID-19 patients.
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The COVID-19 pandemic has necessitated rapid adaptation of healthcare providers to new clinical and logistical challenges. Following identification of high levels of emergency department (ED) reattendance among patients with suspected COVID-19 at our centre, we piloted a rapid remote follow-up service for this patient group. We present our service framework and evaluation of our pilot cohort of 192 patients. ⋯ This framework reduced unplanned ED reattendances in comparison with a retrospective comparator cohort (4.7% from 22.6%). We reproduced these findings in a validation cohort with a high prevalence of acute COVID-19, managed through the clinic in September-October 2020, where we identified an unplanned ED reattendance rate of 5.2%. We propose that rapid remote follow-up is a mechanism by which ambulatory patients can be clinically supported during the acute phase of illness, with benefits both to patient care and to health service resilience.