Virtual Medicine, Virtual Disease, Real Consequences

This chapter investigates the hypothesis that the COVID-19 pandemic was the perfect storm due to the misalignment of competing elements of the US healthcare system, the economic commoditization of disease, the economic commoditization of healthcare delivery, and inadequate data to inform medical decision making on a mass scale. The culmination of a decades-long devolution away from patient care to healthcare or more appropriately sick-care created a system that was unable to quickly find the common ground needed to deal with the pandemic known as COVID-19.

Exploring the Outcomes That Matter Most to Young People Treated for Chronic Pain: A Qualitative Study

Global and national policies state that all children and young people should be part of decision making and that outcomes that matter to them should take priority, yet patient-centred outcomes have been identified as a gap in the paediatric chronic pain literature. This study gave youths experiencing chronic pain a platform to have their views heard. Using novel methods, twenty-one young people, aged 11 to 18 years old, completed a semi-structured interview in which they constructed a timeline drawing to symbolise their treatment. They identified when aspects of their life changed (outcomes) and described the importance of these changes. Thematic analysis identified four themes that emerged at different stages of the treatment: “perfect storm”; “turning points”; “disconnect”; and; “free”. “Turning points” were points in time when the narrative of the young person took a turn in a different direction. At these points, the outcomes important to them also changed. Youths initially prioritised outcomes related to pain, then during treatment the focus became their emotional functioning, with role functioning and “going out” becoming the focus at the end. The stage of treatment as perceived by the young person impacted which outcomes mattered most.

Mucormycosis and its association with coronavirus disease – 19

The pandemic coronavirus disease (COVID – 19) has been turning out to be an agonizing catastrophe among the human population all over the world. Among a perfect storm of the 2nd wave of COVID – 19, there is widespread and significant challenge due to the prevalence of the “MUCORMYCOSIS - the Black fungus infection.” It is a deadly but rare opportunistic fungal infection that mainly affects the immunocompromised people. It has been associated with COVID -19 as a Post – COVID manifestation among the recovered patients. The article provides information about Mucormycosis, its etiology, pathogenesis, predisposing factors, clinical manifestations, diagnosis, and management.

COVID-19 and chronic diabetes: the perfect storm for reactivation tuberculosis?: a case series

Background The coronavirus disease 2019 pandemic is predicted to have a net negative effect on tuberculosis control, with an estimated excess of 6.3 million tuberculosis cases and 1.4 million deaths by 2025. Programmatic issues such as the lockdown of tuberculosis services affect all patients, while biosocial factors have a differential impact on an individual’s risk for tuberculosis or adverse tuberculosis outcomes. Case presentation We report three Hispanic cases of incident tuberculosis (two males, 43 and 44 years old; one female, 49 years old) after resolution of coronavirus disease episodes. Coincidentally, all cases shared a common risk factor: a chronic history poorly controlled diabetes. Conclusions Our findings alert to the threat posed by the synergy between coronavirus disease and diabetes, on tuberculosis reactivation. In medium- to high-risk settings for tuberculosis, we recommend implementation of routine screening for latent tuberculosis infection in these cases, and preventive tuberculosis treatment in those who are positive.

Financial Exploitation of Older Adults During the Early Months of the COVID-19 Pandemic

COVID-19 created a “perfect storm” for financial exploitation directed at older adults. We invited adults aged 60 and older enrolled in gerontology research registries at Virginia Tech, Florida State University, Wayne State University, and University of Pittsburgh to complete an on-line survey about experiences with financial exploitation by strangers. The 997 respondents ranged in age from 60 to 98 (M = 71.3; SD = 6.8); most identified as White (93.4%), female (64.2%) and living with a spouse/partner (58%). Approximately one-half of respondents (56.87%) reported experiencing a scam attempt about COVID-19 issues. Most contact by scammers was electronic (49%) and frequently occurred two or more times (40%). Most respondents ignored the request (i.e., hung up phone, deleted text/email, threw away mail). However, 9% sent the requested payment, and 4% gave the scammer their personal information. Confidence in financial matters and having attended financial educational programs protected older adults from being scammed.

216 The ‘inflammatory perfect storm’: a case of COVID-19 pneumonia complicated by pulmonary embolism

Aims The inflammatory ‘cytokine storm’ that distinguishes COVID-19 pneumonia is associated with a state of systemic hypercoagulability, which leads to thrombotic complications on the venous, arterial, and microvascular side. Indeed, in patients with COVID-19, systemic inflammation, coagulation activation, hypoxemia, and immobilization expose a high risk of pulmonary embolism, which significantly worsens the prognosis of these patients. Methods and results In this report, we discuss the case of a 71-year-old female, with no prior medical history, admitted to the emergency department for syncope, dyspnoea, and fever started 48 h earlier. At presentation, ear temperature was 37 °C, oxygen saturation was 96% on oxygen therapy (6 l/min), the patient appeared hypertensive (160/80 mmHg) and tachycardic (114 b.p.m.). Laboratory tests revealed normal white blood cells count (10 000/μl) and increased C reactive protein (5.60 mg/dl), troponin I (0.417 ng/ml), and d-dimer levels (15743 ng/ml). Electrocardiogram showed sinus tachycardia at HR of 120/min, normal atrioventricular conduction time, new onset right bundle branch block, and inverted T waves on DIII. Considering the symptoms, CTPA was performed, revealing massive acute bilateral pulmonary embolism with peripheral ground glass opacities. Those findings were suggestive of COVID-19 pneumonia. Indeed, the patient was positive for SARS-CoV-2 infection, and a diagnosis of COVID-19 pneumonia complicated by pulmonary embolism was made. Treatments included oxygen, subcutaneous low molecular weight heparin (LWMH), and corticosteroids have been administrated according to current international guidelines. Since no haemodynamic instability was observed during hospitalization the patient was discharged on Warfarin therapy for 6 months. Conclusions In COVID-19 patients treated in a hospital the incidence of pulmonary embolism (PE) is very high. Patients with COVID-19 infection have respiratory symptoms, which often may not be distinguishable from pulmonary embolism symptoms. So, unexpected respiratory worsening, signs of right ventricular dysfunction on transthoracic echocardiogram, and ECG changes should lead to suspicion of the co-presence of pulmonary embolism. This case report shows how COVID-19 infection can be strongly associated with thrombotic complications. For this reason, the guidelines recommend anticoagulation at standard prophylactic doses in all patients admitted with COVID-19 infection.