COVID-19-associated acute pancreatitis: a systematic review of case reports.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) mainly involves the respiratory system but can also affect the digestive system and cause several gastrointestinal manifestations. Acute pancreatitis has been reported as one of the rare presentations of COVID-19. This study aimed to systematically review case reports on COVID-19-associated acute pancreatitis. METHODS: Publications were retrieved through a comprehensive search in four databases on October 1, 2021. Eligible ones that demonstrated the potential association of acute pancreatitis and COVID-19 were included for data extraction. RESULTS: After screening 855 citations, 82 articles containing 95 cases were included, and their data were extracted. The most common presentation was abdominal pain (88/95, 92.6%), followed by nausea/vomiting (61/95, 64.2%). Mortality was reported in 10.5% of cases. The initial presentation was acute pancreatitis, COVID-19, and concomitant in 32.6% (31/95), 48.4% (46/95), and 18.9% (18/95) of cases, respectively. Among the included cases, acute pancreatitis severity was associated with ICU admission, COVID-19 severity, and the outcome. Also, the initial presentation was associated with COVID-19 severity (P values ˂0.05). CONCLUSIONS: Current evidence indicates that acute pancreatitis can present before, after, or concomitant with COVID-19. Appropriate investigations should be performed in cases with suspicious clinical presentations. Longitudinal studies should address whether or not, there is a causative relationship between COVID-19 and acute pancreatitis.

Student support systems for undergraduate medical students during the COVID-19 pandemic: a systematic narrative review of the literature.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has boosted medical students' vulnerability to various problems. Given the stressful nature of medical disciplines, considerable attention must be paid to student support systems during pandemics. This study aimed to review the current literature regarding medical student support systems systematically. METHODS: We performed a systematic review of six databases and grey literature sources in addition to a hand search in the references of the articles on April 5, 2021. We included all studies about support for undergraduate medical students delivered in response to the COVID-19 pandemic. In conducting this review, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS: A total of 3646 articles were retrieved from the databases, and 16 additional papers were extracted from other sources. After removing duplicates, we screened 2434 titles and abstracts according to our criteria. Among them, 32 full-text articles were assessed for eligibility. Ultimately, 10 studies were included for review. We identified two major themes: (a) academic support and (b) mental health support. All of the included studies utilized online methods whether for transitioning from previous support systems or developing novel approaches. Students and faculty members seemed to be receptive to these new systems. Despite indicating outstanding program outcomes, most studies merely described the positive effects of the program rather than providing a precise evaluation. CONCLUSION: There are several methods of supporting medical students who are experiencing unprecedented changes in their educational trajectory. Due to substantial differences in undergraduate medical education in different regions of the world, cultural and contextual-oriented support is indispensable for developing a safe learning environment. Future research should investigate the question of the extent to which online support can supersede in-person strategies.

Effects of COVID-19 pandemic and lockdown on mental health of Iranian people.

INTRODUCTION: The highly contagious novel coronavirus disease 2019 (COVID-19) emerged recently as a global pandemic. An efficient way to mitigate the spread of the disease is lockdown and quarantine. OBJECTIVE: This study aimed to evaluate the Iranian population's mental health under lockdown during the COVID-19 pandemic. MATERIAL AND METHODS: The General Health Questionnaire-28 (GHQ-28) was utilized to assess the mental health and psychosocial wellbeing of Iranian residents through an online survey. The questionnaire was sent on April 3, 2020, and remained open to responses until April 10, 2020. This period was the time of complete lockdown in Iran. Inclusion criteria included either gender, reading Farsi, internet access, and being between the ages of 18 and 65. Respondents with scores ≥ 24 were classified as having psychiatric problems. RESULTS: Of 35,529 completed surveys, 28,790 were eligible for analysis. 73.4% of the respondents were female. The majority of the participants were between the ages of 26 to 45. Of the participants, 35.5% had scores in the pathological range. We found that females, younger residents, singles, and individuals with lower education had higher levels of psychopathology. CONCLUSIONS: Our study suggests that the psychological impacts of the COVID-19 pandemic and quarantine are wide-ranging, substantial, and can be long-lasting.

Surgical outcomes of myelomeningocele repair: A 20-year experience from a single center in a middle-income country.

BACKGROUND AND PURPOSE: Spina bifida is the second major cause of congenital disorders and the most common central nervous system congenital malformation compatible with life primarily. Herein, we describe the short-term outcome of post-natal Myelomeningocele (MMC) surgical management and predictors of its postoperative complications and mortality. METHODS: This retrospective chart review studies the children who underwent post-natal surgical management for MMC in Namazi hospital, a tertiary referral center, in southern Iran from May 2001 to September 2020. RESULTS: 248 patients were included in this study. The mean age at the operation was 8.47 ± 8.69 days. The most common site of involvement of MMC was Lumbosacral (86%, n = 204). At the evaluation conducted prior to the operation, cerebrospinal fluid leak was observed in 7% (n=16) of the patients. Postoperatively, 5.7% of the patients expired in the 30-day follow-up after the operation (n = 14), while 24% needed readmission (n = 47). The most common complications leading to readmission were wound dehiscence (n = 10, 42%) and wound purulence (n = 6, 25%). Only the site of the lesion (p-value = 0.035) was associated with postoperative complication. After controlling for potential confounders, the site of the lesion (adjusted odds ratio = 0.146, 95% confidence interval = 0.035-0.610, p-value = 0.008) and age at surgery (adjusted odds ratio = 1.048, 95% confidence interval = 1.002-1.096, p-value = 0.041) were significantly associated with mortality CONCLUSIONS: The age of the patients at the surgery and the site of the lesion are the two factors that were associated with mortality. However, further investigations into preoperative interventions and risk factors to mitigate the risk of complications and mortality are highly encouraged.

A novel scoring system for early assessment of the risk of the COVID-19-associated mortality in hospitalized patients: COVID-19 BURDEN.

BACKGROUND: Corona Virus Disease 2019 (COVID-19) presentations range from those similar to the common flu to severe pneumonia resulting in hospitalization with significant morbidity and/or mortality. In this study, we made an attempt to develop a predictive scoring model to improve the early detection of high risk COVID-19 patients by analyzing the clinical features and laboratory data available on admission. METHODS: We retrospectively included 480 consecutive adult patients, aged 21-95, who were admitted to Faghihi Teaching Hospital. Clinical and laboratory features were collected from the medical records and analyzed using multiple logistic regression analysis. The final data analysis was utilized to develop a simple scoring model for the early prediction of mortality in COVID-19 patients. The score given to each associated factor was based on the coefficients of the regression analyses. RESULTS: A novel mortality risk score (COVID-19 BURDEN) was derived, incorporating risk factors identified in this cohort. CRP (> 73.1 mg/L), O2 saturation variation (greater than 90%, 84-90%, and less than 84%), increased PT (> 16.2 s), diastolic blood pressure (≤ 75 mmHg), BUN (> 23 mg/dL), and raised LDH (> 731 U/L) were the features constituting the scoring system. The patients are triaged to the groups of low- (score < 4) and high-risk (score ≥ 4) groups. The area under the curve, sensitivity, and specificity for predicting mortality in patients with a score of ≥ 4 were 0.831, 78.12%, and 70.95%, respectively. CONCLUSIONS: Using this scoring system in COVID-19 patients, the patients with a higher risk of mortality can be identified which will help to reduce hospital care costs and improve its quality and outcome.

Competencies required for medical students to confront the COVID-19 pandemic: A needs assessment study.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) has turned attention to the essential competencies needed to confront pandemics for a physician. However, medical students, as future physicians, are not adequately trained for such a situation. This study aimed to determine the essential competencies for a medical student to face the COVID-19 pandemic. MATERIALS AND METHODS: We performed this mixed-method needs assessment study at Shiraz University of Medical Sciences in May-June 2020 in three steps: the first step was a brainstorming session followed by a nominal group technique with the experts' participation. The second step was determining the validity of competencies by calculating the content validity ratio. In the third and last step, three rounds of the modified Delphi technique were held with the participation of 22 medical faculty members and 45 undergraduate medical students to reach a consensus about the competencies utilizing quantitative analysis. RESULTS: A total of 30 key competencies essential for a medical student were obtained through the current study. They were categorized into four major themes: (1) developing knowledge and abilities for effective diagnosis and treatment of COVID-19, (2) demonstrating safety principles correctly, (3) demonstrating effective behavior, and (4) determining the meta-competencies. CONCLUSIONS: Although medical students will be the frontline physicians in the future pandemics, they are not prepared to display the diversity of requisite skills to practice effectively and safely. This study provides essential competencies for medical students during the COVID-19 pandemic and underlines the importance of a paradigm shift from traditional time-based to competency-based education.

Two novel Warburg micro syndrome 1 cases caused by pathogenic variants in RAB3GAP1.

In this study, we detected a novel pathogenic variant and a previously reported variant in RAB3GAP1 by whole-exome sequencing (NM_001172435.2: c.1552C>T, p.Gln518*; c.1471C>T, p.Arg491*). The first patient is a 3-year-old girl who presented with bilateral congenital cataracts, developmental delay, abnormal craniofacial features, drug-resistant constipation, and corpus callosum hypoplasia. The proband of the second family is a 13-year-old boy who suffers from developmental delay, quadriplegia, intellectual disability, abnormal craniofacial features, and corpus callosum hypoplasia.