ABSTRACT
Objective: To determine the impact of a simulated hospital on a neurology clerkship of 5-year medical students during the coronavirus pandemic in Bogota, Colombia. Background: The COVID-19 pandemic has led to the disruption of all sectors of the economy including education. According to UNESCO, over 1.37 million young people, including medical students, were affected by the closure of the education system. The main challenge for medical education has consisted in offering clerkships within a biosafety environment. The simulated hospital emerges as a teaching tool that guarantees the development of medical skills in a biosafety environment. Design/Methods: A quasi-experimental design was conducted in a population of 5th-year medical students during their neurology clerkship. Our sample comprised two similar groups, one received a traditional face-to-face format during 2019, whereas the second group received a mixed virtual and simulation-based clerkship in 2020. All students in the pandemic group answered a Likert scale survey regarding their satisfaction with the simulated hospital. To evaluate theoretical knowledge acquisition students of both groups were required to perform a mid-term and a final examination. Results: Most of the students considered the simulated hospital a useful addition that should be incorporated into their medicine curriculum regardless of the pandemic. From the results, it is clear that students perceived that exposure to a simulated hospital facilitated their learning process (93.1%) and allowed greater interaction with the teacher compared to a face-to-face environment (77.3%). The difference in test results was not clinically significant. Conclusions: Our study shows that a simulated hospital is a highly efficient method to acquire clinical skills in trainees with improvement in medical knowledge and satisfaction evidenced by the Likert scales and comparable results in academic evaluations. Our experience indicates that exposure to a simulated hospital should be integrated into the curricular milestones of the medical education program regardless of the pandemic.
ABSTRACT
Background: Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease worldwide. The mainstay of treatment involves lifestyle modifications such as weight loss, exercise, and dietary changes to prevent the progression of liver disease. Since the emergence of the coronavirus disease 2019 (COVID-19), research efforts have focused on the influence of liver disease on COVID-19 and the impact of COVID-19 on those living with liver disease. The aim of this study was to assess the metabolic impact of COVID-19 on lifestyle behaviors of patients with NAFLD. Methods: We investigated the impact of the COVID-19 pandemic on dietary and lifestyle habits in patients with NAFLD using an online questionnaire. The questionnaire was distributed to patients identified to have a diagnosis of NAFLD or non-alcoholic steatohepatitis (NASH) through a search of the hospital electronic medical records system. Demographic information, anthropometric data, and dietary and lifestyle habits before and during the pandemic were inquired. The survey was conducted from December 2020 to March 2021. Results: A total of 360 out of 2,800 individuals responded to the survey. Incomplete surveys were excluded. Among the 312 respondents included, 84.6% identified ethnically as Caucasian, 60.6% were female, and 77.4% described themselves as overweight or obese. The mean age was 60.7 years. Of the respondents, 39.6% (p=0.002) and 51.4% (p<0.001) felt that their dietary habits and lifestyle habits significantly worsened, respectively. Consumption of fruits, vegetables, and water increased while the consumption of salty snacks, frozen desserts, and sugary beverages decreased during COVID-19 (Table 1). Moreover, there was a marked decrease in fast food consumption and increase in homecooked meals (Table 1). There was a decrease in physical activity and an increase in screen time on working and non-working days primarily due to entertainment and boredom. Conclusion: Patients with NAFLD felt that their dietary and lifestyle habits were negatively impacted by the COVID-19 pandemic. Healthy dietary modifications were made in food and beverage consumption patterns before and during the pandemic. However, there was an increase in sedentary behaviors reflected by decreased physical activity and increased screen time. Our findings signify the importance of recognizing the impact of a global pandemic on healthy lifestyle and its downstream effects on patients with NAFLD.
ABSTRACT
Susac syndrome (SuS) is an autoimmune-mediated microvessel occlusion disease of the central nervous system, retina and inner ear. Treatment consists in the use of corticosteroids, intravenous immunoglobulin, mycophenolate mofetil, tacrolimus, rituximab and cyclophosphamide. Immunocompromised patients may be at higher risk of severe COVID-19 and, simultaneously, infections could exacerbate SuS disease activity. A 32 years-old female with extremely severe SuS, treated with a combination of mycophenolate mofetil, rituximab, cyclophosphamide and oral prednisone, developed a life-threatening COVID-19 infection. Immunosuppressants were stopped and anticoagulant therapy was instituted. Forty-one days after COVID-19 infection diagnosis, she was discharged with her neurological status unchanged. Even considering the life-threatening COVID-19 infection risk, maintaining combined immunosuppression is advised in an extremely severe SuS. Confirmation of COVID-19 infection would be the only reason to stop immunosuppressants. COVID-19 hypercoagulable state may increase thrombosis risk. Anticoagulant treatment is associated with COVID-19 lower mortality and, arguably, with a better prognosis of SuS. © 2020, Sociedade Portuguesa de Neurologia. All rights reserved.