Gallstone ileus: A rare cause of small intestine obstruction

Gallstone ileus is a very rare cause of mechanical bowel obstruction with often‐delayed presentation and nonspecific symptoms. Aerobilia is found in approximately 50% of patients with gallstone ileus.     

An autopsy case of COVID‐19 with a sudden death: Clinico‐pathological comparison

Autopsy was performed on a COVID‐19 patient, who suddenly died despite the extensive anti‐viral and anti‐inflammatory therapies. Although moderate subpleural fibrosis was seen, pathology of DAD, a well‐known cause for pulmonary failure, was minimum. Instead, severe hemorrhage was observed. Therapeutic effects were indicated; however, why severe hemorrhage occurred was unclear.     

Clinical outcomes of post‐renal transplant patients with COVID‐19 infection in the ICU: A single‐center case series

Most of the post‐renal transplant patients are taking immunosuppressive medications, including calcineurin inhibitors, anti‐proliferative agents, and steroids. This case series highlights the clinical characteristics and outcomes of eight post‐renal transplant patients with severe COVID‐19 infection admitted to the intensive care unit.     

Implications of end‐of‐life home care compared with hospital‐based care during the COVID‐19 pandemic: A case report

Restriction on hospital visits for COVID‐19 infection control continues to have a significant negative impact on patients and their families. For a patient receiving palliative care, this social isolation may deteriorate their mental health. In such situations, home care could be a viable solution to this problem.     

Suprachoroidal hemorrhage during phacoemulsification surgery associated with recent COVID‐19: A report of two cases

To report two cases of suprachoroidal hemorrhage during otherwise uncomplicated phacoemulsification, in whom COVID‐19 was documented with a positive PCR test about 1 month before the surgery and the importance of postponing elective surgeries for several months after infection.     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Acute lower limb ischemia in an ICU admitted patient diagnosed with the COVID‐19: A case report

Thromboembolic events have been reported in the hospitalized patient since the beginning of the COVID‐19 pandemics. ICU‐admitted patients demonstrated a significantly higher risk of developing VTE. Although evidence of arterial thrombosis was less common in ICU‐admitted patients, consequences were typically more severe, including limb loss and death. This study reports another ICU‐admitted patient with lower extremity arterial thrombosis diagnosed with COVID‐19.     

Hematological characteristics of COVID‐19 patients with fever infected by the Omicron variant in Shanghai: A retrospective cohort study in China

BackgroundA wave of the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection has rapidly spread in Shanghai, China. Hematological abnormalities have been reported in coronavirus disease 2019 (COVID‐19) patients; however, the difference in hematological parameters between COVID‐19 patients with fever and patients who are febrile from other causes remains unexplored.MethodsThis retrospective cohort study enrolled 663 SARS‐CoV‐2 positive patients identified by RT‐PCR. Clinical parameters, including age, sex, and threshold cycle values of all COVID‐19 patients, and hematological parameters of COVID‐19 patients in the fever clinic were abstracted for analysis.ResultsOverall, 60.8% of COVID‐19 patients were male, and the median age was 45 years. Most of COVID‐19 patients were asymptomatic, while 25.8% of patients showed fever and 10.9% of patients had other emergencies. COVID‐19 patients with fever had significantly lower white blood cells (WBCs), neutrophils, lymphocytes, platelets and C‐reactive protein (CRP), and significantly higher monocyte‐to‐lymphocyte ratio (MLR), platelet‐to‐lymphocyte ratio (PLR), mean platelet volume (MPV), and mean platelet volume‐to‐platelet ratio (MPR) levels, compared with those in SARS‐CoV‐2 negative patients with fever from other causes (p < 0.05). Neutrophil‐to‐lymphocyte ratio (NLR), PLR, and systemic inflammatory index (SII) levels were significantly higher in COVID‐19 patients with emergencies (p < 0.05). WBCs showed the best performance with an area under the curve (0.756), followed by neutrophils (0.730) and lymphocytes (0.694) in the diagnosis of COVID‐19 in the fever clinic.ConclusionWBCs, neutrophils, lymphocytes, platelets, CRP and MLR, PLR, and MPR may be useful in early diagnosis of COVID‐19 in the fever clinic.     

Acute pericarditis complicated with pericardial effusion as first presentation of COVID‐19 in an adult sudanese patient: A case report

Acute pericarditis is an uncommon presentation of COVID‐19. Here, we described a case of a 50‐year‐old male patient who presented with chest pain without fever or cough and diagnosed with acute pericarditis complicated by pericardial effusion due to COVID‐19 after exclusion of other causes and received supportive treatment and improved over two weeks.     

Erythrodermic flare‐up of psoriasis with COVID‐19 infection: A report of two cases and a comprehensive review of literature focusing on the mutual effect of psoriasis and COVID‐19 on each other along with the special challenges of the pandemic

The COVID‐19 pandemic has been extra challenging for patients with chronic diseases. Psoriasis is one of the chronic conditions that its treatment mostly relies on immunosuppressants. In this study, we report two cases with a long history of psoriasis that COVID‐19 infection caused them to undergo erythrodermic psoriasis.     

Remdesivir for COVID‐19 pneumonia in patients with severe chronic kidney disease: A Case series and review of the literature

Remdesivir was the first antiviral agent to receive FDA authorization for severe COVID‐19 management, which restricts its use with severe renal impairment due to concerns that active metabolites might accumulate, causing renal toxicities. With limited treatment options, available evidence on such patient groups is important to assess for future safety.     

Management of Acute Coronary Syndromes in Patients with Diabetes: Implications of the FREEDOM Trial

Background

Diabetes mellitus (DM) is a powerful independent risk factor for multivessel, diffuse coronary artery disease (CAD). The optimal coronary revascularization strategy in DM is not clearly defined, but past trials have suggested an advantage for coronary artery bypass grafting (CABG). Recently, the Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM) trial found patients randomized to CABG had lower rates of death and myocardial infarction (MI) compared with those randomized to percutaneous coronary intervention (PCI).

Objective

This article reviews the contemporary management of patients with DM presenting with acute coronary syndromes, particularly ST-elevation MI, in the post-FREEDOM era.

Methods

We undertook a comprehensive review of published literature addressing trials in this field performed to address current knowledge both in the pre- and post-FREEDOM era.

Results

The implications of FREEDOM for patients with acute coronary syndrome are that CABG provides a significant benefit, compared with PCI with drug-eluting stents, to patients with DM and multivessel coronary artery disease; and that patients similar to those enrolled in FREEDOM should receive CABG in preference to PCI. The relevance of FREEDOM’s findings to the large proportion of patients who would not meet inclusion criteria—including patients with an acute coronary syndrome undergoing an early or emergent invasive strategy, remains uncertain.

Discussion

FREEDOM’s outcomes have generated uncertainty regarding best practice once thrombolysis in myocardial infarction grade 3 flow is re-established in patients with DM and multivessel disease. Current interventional guidelines recommend optimally treating the culprit artery; however, decisions made at the time of revascularization influence future revascularization strategies, particularly stent choice and resultant P2Y₁₂ receptor antagonist therapy. The preferred method for future revascularization may be questioned if the patient's residual coronary stenoses do not, post-PCI, meet the FREEDOM inclusion criteria, or where the left anterior descending artery is the infarct-related artery, and after left anterior descending artery PCI the patient would not receive an internal mammary graft. The management of residual disease and the preferred (further) revascularization strategy needs to be tested in an appropriately powered randomized trial.

Conclusions

The optimal revascularization strategy in patients with acute coronary syndrome, diabetes, and multivessel disease, in particular those with ST elevation, is unclear, and not guided by level A (or B) evidence. Currently CABG is favored over PCI, and an individually tailored, collaborative approach, guided by a multidisciplinary heart team, should be employed.     

The Feasibility of a Pediatric Distance Learning Curriculum for Emergency Nurses During the COVID-19 Pandemic: An Improving Pediatric Acute Care Through Simulation Collaboration

IntroductionTo develop and evaluate the feasibility and effectiveness of a longitudinal pediatric distance learning curriculum for general emergency nurses, facilitated by nurse educators, with central support through the Improving Acute Care Through Simulation collaborative.MethodsKern’s 6-step curriculum development framework was used with pediatric status epilepticus aimed at maintaining physical distancing, resulting in a 12-week curriculum bookended by 1-hour telesimulations, with weekly 30-minute online asynchronous distance learning. Recruited nurse educators recruited a minimum of 2 local nurses. Nurse educators facilitated the intervention, completed implementation surveys, and engaged with other educators with the Improving Pediatric Acute Care through Simulation project coordinator. Feasibility data included nurse educator project engagement and curriculum engagement by nurses with each activity. Efficacy data were collected through satisfaction surveys, pre-post knowledge surveys, and pre-post telesimulation performance checklists.ResultsThirteen of 17 pediatric nurse educators recruited staff to complete both telesimulations, and 38 of 110 enrolled nurses completed pre-post knowledge surveys. Knowledge scores improved from a median of 70 of 100 (interquartile range: 66-78) to 88 (interquartile range: 79-94) (P = .018), and telesimulation performance improved from a median of 60 of 100 (interquartile range: 45-60) to 100 (interquartile range: 85-100) (P = .016). Feedback included a shortened intervention and including physician participants.DiscussionA longitudinal pediatric distance learning curriculum for emergency nurses collaboratively developed and implemented by nurse educators and Improving Pediatric Acute Care through Simulation was feasible for nurse educators to implement, led to modest engagement in all activities by nurses, and resulted in improvement in nurses’ knowledge and skills. Future directions include shortening intervention time and broadening interprofessional scope.     

Dilemma of Tocilizumab therapy for a patient with critical COVID‐19 disease and neutropenia: Case report and review of the literature

Infection following SARS‐Co V‐2 leading to COVID‐19 disease is associated with significant morbidity and mortality. The clinical entity, COVID‐19 cytokine storm syndrome (CSS) is a severe immunological manifestation of the disease associated with ominous consequences. Tocilizumab is interleukin‐6 inhibitors that has been shown to hamper the catastrophic outcomes of CCS including the need for mechanical ventilation as well as reduce mortality, but the usage is limited by warnings of reactivation of potential latent infections or immune dysfunctions including severe neutropenia. We describe a case of 39‐year‐old Nepalese male patient with a background of scleritis maintained on azathioprine and rituximab therapy with normal baseline parameters including complete blood count who presented with acute COVID‐19 infection including associated leukopenia as well as severe neutropenia (absolute neutrophil count of 300 cells/µl), then progressed to critical disease culminating into CSS. Based on risks and benefits evaluation, the patient was treated with tocilizumab reinforced with granulocytes‐colony stimulating factor (G‐CSF, Filgrastim) to full recovery and safe outcome including reversal of neutropenia.     

Noninvasive Ventilation in the Management of Respiratory Failure Due to COVID-19 Infection: Experience From a Resource-Limited Setting

ObjectiveTo study the role of noninvasive ventilation (NIV) in Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV2) related acute respiratory failure (C-ARF).Patients and MethodsPatients with C-ARF managed on NIV were categorized as NIV success or failure (death or intubation). Factors associated with failure were explored using regression analysis and expressed as odds ratio (OR) with 95% CI.ResultsBetween April 1, 2020, and September 15, 2020, a total of 286 patients with a mean ± SD age of 53.1±11.6 years and Acute Physiology and Chronic Health Evaluation II score of 11.1±5.5 were initiated on NIV. Of the 182 patients (63.6%) successfully managed on NIV alone, 118 had moderate or severe acute respiratory distress syndrome. When compared with NIV success, NIV failure was associated with lower admission PaO₂ to fraction of inspired oxygen ratio (P<.001) and higher respiratory rate (P<.001). On penalized logistic regression analysis, NIV failure was associated with higher Acute Physiology and Chronic Health Evaluation II score (OR, 1.12; 95% CI, 1.01 to 1.24), severe acute respiratory distress syndrome (OR, 3.99; 95% CI, 1.24 to 12.9), D-dimer level of 1000 ng/mL DDU (to convert to mg/L, divide by 1000) or greater (OR, 2.60; 95% CI, 1.16 to 5.87), need for inotropes or dialysis (OR, 12.7; 95% CI, 4.3 to 37.7), and nosocomial infections (OR, 13.6; 95% CI, 4.06 to 45.9). Overall mortality was 30.1% (86/286). In patients requiring intubation, time to intubation was longer in nonsurvivors than survivors (median, 5; interquartile range, 3-8 vs 3; interquartile range, 2-3 days; P<.001).ConclusionNoninvasive ventilation can be used successfully in C-ARF. Illness severity and need for non–respiratory organ support predict NIV failure.