ABSTRACT
Introduction: COVID-19 is a well-known cause of severe ARDS (acute respiratory distress syndrome), however recent data suggests that COVID-19 could represent a unique form of lung injury that places patients at increased risk of various uncommon complications such as pneumothorax, pneumomediastinum and subcutaneous emphysema. Studies so far have reported an increased incidence of barotrauma in intubated COVID-19 patients with unclear predictors. Our study aims to identify the different variables associated with development of pneumothorax, pneumomediastinum and subcutaneous emphysema in critically ill COVID-19 patients. Methods: We examined patients admitted to the intensive care unit from March 2020 to Feb 2021 at a large tertiary care center in Detroit, Michigan. We identified a total of 25 patients with COVID-19 ARDS requiring mechanical ventilation who developed pneumothorax, 12 who developed pneumomediastinum and 7 with subcutaneous emphysema. We compared those to 66 patients admitted with COVID-19 ARDS also requiring mechanical ventilation who did not develop any of these complications. The mean age of patients in our subject group was 61.81 years compared to a mean of 69.05 years in the control group. Male patients accounted for 58.33% of the subject group and 60.61% in the control group. Results: we detected a statistically significant difference in the modified Sequential Organ Failure Assessment Score (mSOFA) between the patients who developed these complications compared to those who did not (p<0.0001), with score being surprisingly lower in the group who developed the complication as opposed to those who did not (median mSOFA in subjects 3.5, n=32 vs median mSOFA in controls 11, n=66). Analysis of the subgroups of the mSOFA score revealed no statistically significant difference in the PF ratio (p=0.1995), platelet counts (p=0.065) and total bilirubin (p=0.4403). However, MAP was noted to be significantly lower in the control group than in the subject group accounting for a higher mSOFA score (p=0.0031). Similarly, creatinine was noted to be higher in the control group (p<0.0001) compared to the subject group. Discussion: In viewing our baseline patient characteristics we found a statistically significant difference (p<0.0001) in the rate of baseline chronic kidney disease between our subjects and control patients, with control patients having 100% baseline CKD and subjects having 19.4% baseline CKD. This could account for the higher mSOFA scores in controls. Conclusion: mSOFA did not predict the development of pneumothorax, pneumomediastinum or subcutaneous emphysema in patients admitted with COVID-19 ARDS requiring mechanical ventilation.
ABSTRACT
Background: The coronavirus disease of 2019 (COVID-19) has challenged and disrupted medical education worldwide. Objective structured clinical examination (OSCE) is one of the types of assessment for undergraduate medical students that has been conducted for first-year medical students in the College of Medicine. Peer student training on participating in OSCE has been conducted prior to the pandemic. The aim of this study was to assess medical students’ perception of online virtual peer student video training on participating in the OSCE. Methods: Medical student’s council team prepared a video demonstration on the steps of participating in OSCE. In October 2020, the video was provided online for first-year medical students (n = 302) prior to their OSCE. After the completion of the OSCE exam, a 10 – item questionnaire was distributed on the students’ perception on the impact of the peer student video demonstration on students’ orientation about the OSCE. The questionnaire was sent by Google Forms. The results were expressed as a percentage on a Likert scale. Results: About 74.17% (n = 224) of students responded to the online questionnaire. More than half of the students (n = 126, 56%) found the steps of conduction of the OSCE well explained, provided the sufficient orientation (n = 121, 54%), and found the video stimulating (n = 122, 54%). In addition, the majority of students (n = 160, 71%) learned and understood the steps of the OSCE and 152 students (68%) found that the video helped introducing them to the concept of OSCE. Almost half the students found that the video helped lowering the stress level before the OSCE (n = 91, 41%), eased the steps of the OSCE (n = 113, 50%), and found that the materials were well prepared and explained (n = 126, 56%). Conclusions: The virtual video demonstration of the OSCE during the COVID-19 pandemic had an overall positive perception from first-year medical students. However, peer student’s orientation on the OSCE will continue after the pandemic. Further supports for first-year medical students are needed during the pandemic. © 2021 Journal of Nature and Science of Medicine.