RESUMEN
SARS-CoV-2 is a newly identified virus that causes COVID 19, spreading very fast in the world. Uncontrolled diabetes in pregnancy can increase the risk of pregnancy outcomes. Pregnant women are at high risk of developing a viral infection, like SARS-COV and on the other hand, diabetes ketoacidosis (DKA) which is coupled with COVID-19, can increase maternal mortality. The patient was a 27-years-old female G3P1L1Ab1 with a history of a previous cesarean section. On 26 March 2020, a fetal ultrasound revealed intra-uterine fetal death (IUFD) and also diagnosis of DKA and COVID-19 in the patient that she was expired eventually due to the uncontrolled DKA. In this case report, a pregnant woman with a diagnosis of IUFD, DKA and COVID-19 simultaneously is described. To the best of the authors of this paper's knowledge, no previous work has been reported for the comorbidity of diabetes and COVID-19 in pregnancy, but it seems that the coincidence of the above-mentioned diseases can delay the recovery period and also can increases maternal and fetal mortality. When DKA and COVID-19 appear in the patient simultaneously, we cannot control DKA by the routine protocol treatments of DKA which were used formerly.
RESUMEN
INTRODUCTION: Clinical reasoning as a critical and high level of clinical competency should be acquired during medical education, and medical educators should attempt to assess this ability in medical students. Nowadays, there are several ways to evaluate medical students' clinical reasoning ability in different countries worldwide. There are some well-known clinical reasoning tests such as Key Feature (KF), Clinical Reasoning Problem (CRP), Script Concordance Test (SCT), and Comprehensive Integrative Puzzle (CIP). Each of these tests has its advantages and disadvantages. In this study, we evaluated the reliability of combination of clinical reasoning tests SCT, KF, CIP, and CRP in one national exam and the correlation between the subtest scores of these tests together with the total score of the exam. METHODS: In this cross sectional study, a total number of 339 high ranked medical students from 60 medical schools in Iran participated in a national exam named "Medical Olympiad". The ninth Medical Olympiad was held in Shahid Beheshti University of Medical Sciences, Tehran, Iran, under the direct supervision of the Ministry of Health and Medical Education in summer 2017. The expert group designed a combination of four types of clinical reasoning tests to assess both analytical and non-analytical clinical reasoning. Mean scores of SCT, CRP, KF, and CIP were measured using descriptive statistics. Reliability was calculated for each test and the combination of tests using Cronbach's alpha. Spearman's correlation coefficient was used to evaluate the correlation between the score of each subtest and the total score. SPSS version 21 was used for data analysis and the level of significance was considered <0.05. RESULTS: The reliability of the combination of tests was 0.815. The reliability of KF was 0.81 and 0.76, 0.80, and 0.92 for SCT, CRP, and CIP, respectively. The mean total score was 169.921±41.54 from 240. All correlations between each clinical reasoning test and total score were significant (P<0.001). The highest correlation (0.887) was seen between CIP score and total score. CONCLUSION: The study showed that combining different clinical reasoning tests can be a reliable way of measuring this ability.
