Challenge in challenging times: a case report of ruptured isthmic ectopic pregnancy in an asymptomatic COVID-19 positive patient

Emergency surgical management of patients who are COVID-19 positive is extremely challenging for the treating doctors as there is a need to keep the balance between delivering optimal medical care to the patient, preventing spread to others and protecting ourselves. COVID-19 manifestations in pregnant women are similar to non-pregnant patients. The patient may be asymptomatic or may present with symptoms like cough, cold, fever and shortness of breath. In obstetric emergencies like ruptured ectopic pregnancy, when a patient presents in casualty with history of amenorrhea, pain abdomen and features of shock, main priority for the clinician is to stabilize them and treat the underlying cause so as to save their life. We report the emergency management of a hemodynamically unstable ruptured ectopic pregnancy at 9 weeks of gestation in a COVID-19 positive patient. It was stressful for the treating doctors because of high infectivity of the disease, scarcity of resources during the pandemic and precarious condition of the patient.

Selected issues in sport-related concussion (SRC|mild traumatic brain injury) for the team physician: a consensus statement

Selected Issues in Sport-Related Concussion (SRC|Mild Traumatic Brain Injury) for the Team Physician: A Consensus Statement is title 22 in a series of annual consensus documents written for the practicing team physician. This document provides an overview of selected medical issues important to team physicians who are responsible for athletes with sports-related concussion (SRC). This statement was developed by the Team Physician Consensus Conference (TPCC), an annual project-based alliance of six major professional associations. The goal of this TPCC statement is to assist the team physician in providing optimal medical care for the athlete with SRC.

The importance of implementing inpatient virtual coverage in an endocrinology practice: lessons learned thus far from the COVID-19 pandemic

The COVID-19 pandemic has rapidly changed the landscape of medical care and the healthcare system needs to quickly adapt in order to continue providing optimal medical care to hospitalized patients in an efficient, effective, and safe manner. Endocrinology diseases are commonly present in patients with COVID-19 and often are major risk factors for development of severe disease. The use of electronic consultation and telemedicine have already been well-established in the outpatient setting but yet not commonly implemented in the inpatient arena. This type of remote medical care has the potential to provide a reliable delivery of endocrine care while protecting providers and patients from spreading infection. This short review intends to provide the initial steps for the development of an inpatient telemedicine endocrine service to patients with endocrine diseases. Telehealth will become part of our daily practices and has a potential to provide a safe and efficient method of consultative service.

Management of cardiovascular emergencies during the COVID-19 pandemic

BackgroundIt has been reported that patients attending the emergency department with other pathologies may not have received optimal medical care due to the lockdown measures in the early phase of the COVID-19 pandemic.MethodsThis was a retrospective study of patients presenting with cardiovascular emergencies to four tertiary regional emergency departments in western India during the government implementation of complete lockdown.Results25.0% of patients during the lockdown period and 17.4% of patients during the pre-lockdown period presented outside the window period (presentation after 12 hours of symptom onset) compared with only 6% during the pre-COVID period. In the pre-COVID period, 46.9% of patients with ST elevation myocardial infarction underwent emergent catheterisation, while in the pre-lockdown and lockdown periods, these values were 26.1% and 18.8%, respectively. The proportion of patients treated with intravenous thrombolytic therapy increased from 18.4% in the pre-COVID period to 32.3% in the post-lockdown period. Inhospital mortality for acute coronary syndrome (ACS) increased from 2.69% in the pre-COVID period to 7.27% in the post-lockdown period. There was also a significant decline in emergency admissions for non-ACS conditions, such as acute decompensated heart failure and high degree or complete atrioventricular block.ConclusionThe COVID-19 pandemic has led to delays in patients seeking care for cardiac problems and also affected the use of optimum therapy in our institutions.

Prostatic abscess: an unusual cause of delirium associated with lower urinary tract symptoms

Our case describes an 80-year-old gentleman who presented with delirium and lower urinary tract symptoms. Initially treated for a urinary tract infection, he became more unwell with features of physiological decompensation secondary to sepsis. A computerized tomography scan was performed in light of the findings of suprapubic tenderness, which on examination revealed a prostatic abscess. On discussion with urology and microbiology colleagues a plan for antibiotics was constructed and the gentleman recovered without the need for invasive interventions. Our case goes on to discuss the merits of imaging for the elderly care physician when the diagnosis is not clear or when the clinical picture is of deterioration despite optimal medical care.

ASSUMPTIONS OF MAXIMAL INDIVIDUALISM IN THE TIME OF THE COVID-19 PANDEMIC: ETHICAL ASPECTS

Maximal individualism, which is currently a prevalent trend in the way many patients think, places high hopes in the achievements of biomedicine and assumes that everyone should always receive optimal medical care. Such an approach is in line with many normative and legal acts operating worldwide, including the Declaration of Human Rights. However, its feasibility and effectiveness in the time of the COVID-19 pandemic raises numerous ethical, social and economic dilemmas. The culture of prosperity and excess, characteristic of contemporary Western societies, makes it even more challenging to come to terms with this situation.

Psychiatric aspects of Traumatic Brain Injury in professional sports

For nearly a century it has been hypothesized, that repetitive head trauma can lead to adverse neurological and psychiatric conditions [1]. Still, it took the discovery of Chronic Traumatic Encephalopathy (CTE) in a player of the National Football League to bring widespread public and scientific attention to this important topic on the intersection of neurology, psychiatry and sports medicine [2,3]. Traumatic Brain Injuries are a significant medical and socioeconomic burden that reaches far beyond professional sports, leading to the disability of millions worldwide [4,5,6]. An understanding of the psychiatric aspects of head trauma therefore is necessary among physicians to assure optimal medical care for these patients.