Rapid Clinical Deterioration With Sepsis and Persistent Hypertension in a Pediatric Patient During Recent COVID-19 Crisis.

We present a child with a clear and classic COVID-19 symptomatic picture that rapidly progressed to sepsis with persistent hypertension. This patient, a five-year-old Hispanic female child was brought to our emergency department on March 21, 2020, with fever, productive cough, shortness of breath with chest tightness, abdominal pain, and diarrhea for a week. Her condition deteriorated rapidly, and she developed sepsis within 24 hours, needing intensive care unit admission and ventilator support. She tested negative for COVID-19 Biofire ® nucleic acid tests (BioFire Diagnostics, Salt Lake City, Utah 84108 USA); however, she was recently exposed to COVID-19 cases at her school. This case highlights the importance of a high index of COVID-19 suspicion in children in the endemic areas despite negative COVID-19 tests for keeping a watchful eye to prevent sudden deterioration and unexpected complications.

Modern techniques of teaching and learning in medical education: a descriptive literature review.

This article was migrated. The article was marked as recommended. OBJECTIVES: Education is a dynamic process that has to be refined periodically. Lack of innovative teaching techniques in academics makes medical curricula inadequate in making a significant stride towards the future. The objective of this review is to describe and assess alternative methods of teaching and learning which can be supplementive or alternative to traditional lectures for promoting active student participation and smooth flow of information. METHODS: A review of literature is performed with PubMed and EBSCO using the keywords: "learning" OR "didactic learning" OR "alternative learning" OR "modern learning techniques" AND "medical education". Databases were searched and 500 studies were identified out of which 200 were selected for further screening based on inclusion criteria and exclusion criteria. Articles were surveyed based on their relevance and significance to our study objectives with both qualitative and quantitative studies were examined. RESULTS: Case-based learning, evidence-based medicine, problem-based learning, simulation-based learning, e-learning, peer-assisted learning, observational learning, flipped classroom and team based learning are some of the modern learning methodologies. The various learning methods discussed attend to individual learning differences allowing students to broaden their thinking and professional knowledge by improving logical and critical thinking, clinical reasoning, and time management. Early introduction of integrative approaches develop student competency and leadership equipping students for a smooth transit into the clinical practice. CONCLUSION: This study highlights the importance and challenges of modern learning systems. With technological advancement and wider implications of medical information, students require innovative skills through inter-professional learning. It is necessary to introduce and implement flexible medical curricula that accommodates distinct modern teaching to effectively balance and bridge the gap between traditional teaching methodologies and modern educational requirements.

Convalescent Blood Products in COVID-19: A Narrative Review.

The coronavirus disease 2019 (COVID-19) pandemic has left the world in a state of desolation with overburdening public health systems in a short period. Finding possible preventative and therapeutic measures to counter severe respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, has been the priority. A possible solution is convalescent blood products (CBP), primarily convalescent plasma (CP) and immunoglobulins, as an adjunctive therapy. CBP has been tried on the previous coronavirus epidemics with severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Therefore, we reviewed the clinical utility of CBP and available evidence in COVID-19. We found some of the current anecdotal studies demonstrate promising therapeutic potential, but many of these studies do not meet the academic rigours to substantiate its use with confidence. However, the compassionate use of CBP in critically ill COVID-19 patients can be an option while we await a definitive answer from ongoing randomised clinical trials.

Epidemiological Differences of COVID-19 Over the World.

Background Coronavirus disease 2019 (COVID-19), originally, from Wuhan, China, has now spread to most countries across the globe and devastated global healthcare systems. The impact of this disease has, however, shown baffling variations in prevalence in different regions of the world. The aim of this short review is to identify differential national COVID-19 prevalence of COVID-19, as well as to suggest these epidemiological differences.  Methods A review of studies was conducted using PubMed and Google Scholar search engines. Search tactics were centered on COVID-19 ("COVID-19" AND "coronavirus") and BCG vaccination ("BCG vaccination" OR "Bacillus Calmette-Guérin" OR "vaccine") Results It is found that national prevalence differences may be linked with BCG childhood immunization history. A statistically insignificant difference was observed in COVID-19 prevalence when comparing countries with a BGC policy and countries without it (P> 0.05). This inconclusivity suggests the influence of confounders in this study. Conclusions National differences in COVID-19 cases can be attributable to immunologic regulations, such as BCG vaccination protocols. Caution should be taken in establishing a correlation between COVID-19 prevalence and BCG vaccination, partly due to the weak quality of statistical data on COVID-19 related to poor testing rates in countries with BCG vaccination policy. Nonetheless, the analysis of the epidemiological aspects of COVID-19 will shed light on future efforts towards effective control and prevention.

New-Onset Seizure as the Only Presentation in a Child With COVID-19.

We present a child with a new-onset isolated afebrile seizure in coronavirus disease 2019 (COVID-19). This patient, an 11-year-old Hispanic male, was brought to our ED in New York city on May 01, 2020, during the ongoing COVID-19 crisis with seizure. There was no fever and/or respiratory and gastrointestinal complaints. His general and systemic examination did not reveal any abnormality. Similarly, his biochemical profiles were within normal limits, and the radiological study, including a chest X-ray and CT scan, showed normal findings. His polymerase chain reaction (PCR) was positive for SARS-CoV2. The patient was admitted for observation after consultation with pediatric neurology, and his condition progressively improved with anti-seizure medications. This case highlights the need for recognizing an uncommon and atypical presentation in COVID-19 as the new cases are unfolding rapidly across the globe.

Chloroquine and hydroxychloroquine as a repurposed agent against COVID-19: a narrative review.

The predicament arising from the coronavirus disease 2019 (COVID-19) pandemic has become one of the most significant modern public health challenges. Despite uncertainties in the viral determinants and pathogenesis, it is crucial to accurately inspect all available evidence to construct accurate clinical guidelines for optimised patient care. This study aims to discuss the available evidence for the use of chloroquine (CQ) and hydroxychloroquine (HCQ) against COVID-19. Early in vitro studies of CQ/HCQ against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are convincing. But contradictory evidence exists on the clinical use of CQ/HCQ, either alone or in combination with azithromycin. As of now, there is no compelling clinical evidence on CQ, HCQ, and azithromycin in COVID-19 and the available evidence is limited to methodologically inferior non-randomised studies. Studies have also shown detrimental drug reactions to CQ and 'HCQ plus azithromycin', mainly cardiac side effects in hospitalised patients with coexisting cardiovascular comorbidities. Therefore, we recommend that physicians avoid high doses and exercise extreme caution in the compassionate use of CQ/HCQ, either alone or in combination with other antiviral drugs.