Curēus
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Case Reports
Intracranial Hemorrhage in a Patient With COVID-19: Possible Explanations and Considerations.
Some of the reported neurological manifestations of COVID-19 are encephalopathy, headache, ischemic, hemorrhagic stroke, Miller Fisher syndrome, cranial neuropathies, and Guillain-Barre syndrome. We report a case of a 75-year-old COVID-19 patient with life-threatening intracranial hemorrhage. The initial labs on admission showed D-dimer of 1.04 µg/mL, which increased to 3.74 µg/mL the next day, PT/INR of 13.7 seconds/1.2, aPTT of 22 seconds, fibrinogen of 386 mg/dL, WBC of 9.71 K/µL, Hgb of 14.1 g/dL, platelet of 315 x 103/µL, LDH of 965 U/L, and CRP of 35.2 mg/dL. ⋯ The CT of the head without contrast revealed a left-sided acute subdural hematoma, causing left to right midline shift, a large left temporal intraparenchymal, and subarachnoid hemorrhage with transtentorial herniation, leading to death. This case illustrates a combination of factors including hypertension, triple therapy (aspirin, clopidogrel, and enoxaparin), and underlying coagulopathy due to COVID-19, which contributed to the life-threatening intracranial hemorrhage in this patient. Therefore, this raises a concern about the safety of starting these patients preemptively on a therapeutic dose of anticoagulation.
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Introduction The aim of the survey was to investigate the changes, methods, and preferences in regional anesthesia (RA) applications during the COVID-19 pandemic in Turkey. Methods The questionnaire prepared on surveymonkey.com was sent to anesthesiology and reanimation specialists by e-mail. Results A total of 126 physicians participated in the study. ⋯ Conclusion Neuraxial blocks play an important role in RA applications. PNB comprise one-quarter of RA applications during the pandemic. The importance of ultrasound has gradually increased in RA applications worldwide, as well as in Turkey, during the pandemic.
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This case series describes clinical course of three COVID-19 patients who presented with major thromboembolic events. Patient 1 is a 57-year-old male with asymptomatic COVID-19 who presented with a large left ventricular thrombus. His hospital course was complicated with a stroke. ⋯ This case series demonstrates that thromboembolic event can be the presenting feature of COVID-19 and can occur in the patients with asymptomatic or mild COVID-19. Diffuse endothelial injury and hypercoagulability play a pivotal role in recurrent thromboembolic events despite the anticoagulation. Therapeutic anticoagulation may be considered for severe COVID-19 patients and patients with important comorbidities or pre-existing endothelial dysfunction.
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The coronavirus disease 2019 (COVID-19) pandemic affects the education of medical students around the world and countries have had differing responses in dealing with this dynamic situation. The role of medical students in fighting this pandemic is controversial and it is yet to be elucidated how they can best be of service. The aim of this study is to evaluate the working fields of volunteering students and the impact of the pandemic on final year students from a student's perspective. ⋯ The majority of medical students are willing to make a significant contribution in the response to COVID-19 and do not wish to be overlooked. Furthermore, the current pandemic offers novel educational opportunities for medical students.
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Case Reports
Coevality of Systemic Lupus Erythematosus With Sickle Cell Trait: A Not So Uncommon Entity.
The coexistence of systemic lupus erythematosus (SLE) with sickle cell trait is quite sparingly reported in literature. Here, we narrate the case of a 17-year-old girl from Eastern India with sickle cell trait who presented with acute lupus pneumonitis. The challenges to the final diagnosis of SLE with sickle cell trait were because of the often lesser degree of clinical suspicion at the outset. ⋯ After ruling out infective causes, she was found to be antinuclear antibody (ANA) positive and with stage 4 lupus nephritis. Emphasis should be given to the presence of autoimmune conditions in patients with sickle hemoglobinopathies, including sickle cell trait wherein atypical or systemic involvement may occur. Such association holds more importance as sickle hemoglobinopathies is one of the major hemoglobinopathies reported in this part of the country.