Initial TLC, NLR, LDH, CRP, D- Dimer, and Procalcitonin in Intubated vs Non Intubated COVID-19 Patients br

COVID-19 is an acute respiratory disease caused by the SARS-CoV-2 virus that has caused a pandemic with symptoms of upper respiratory infection, respiratory failure, and even mortality. Several asymptomatic patients, with no shortness of breath, were found to experience impaired oxygenation in examination for objective data (happy hypoxia). Thus, objective data are needed, including data on inflammatory parameters (TLC, NLR, LDH, CRP, D-dimer and PCT) to monitor the severity and prognosis of COVID-19 patients. This study aimed to evaluate the inflammatory parameters in the initial days of treatment for COVID-19 patients between intubated and non-intubated patients during hospitalization. The study was conducted in the COVID was a retrospective cross-sectional comparative analytical observational study that involved patients' first laboratory examination results. The statistical analysis was performed using Mann Whitney test for numerical data and Chi Square test for categorical data. There were significant differences in inflammatory parameters values in both groups (p<0.01). The TLC values of intubated patients were lower than those of non-intubated patients, while the NLR, LDH, CRP, D-dimer and PCT values of intubated COVID-19 patients were higher than those of non-intubated patients.

THE EVALUATION OF VITAMIN D DEFICIENCY AS A RISK FACTOR IN THE CASE OF PATIENTS WITH MODERATE COVID-19

The paper aimed to evaluate the role of vitamin D in patients with moderate COVID-19. A total number of 128 patients, divided into two groups based on their clinical outcome, were evaluated. The group of patients with a positive outcome consisted of 82 patients (POG), while the group with a negative outcome consisted of 46 patients (NOG). We determined at two different moments (on the patients??? admission and their discharge) the plasma level of vitamin D (25-hydroxy vitamin D) along with the levels of inflammatory markers in COVID-19 as C reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, fibrinogen, the total leukocyte count and total cholesterol. The level of 25-hydroxy vitamin D was significantly lower in the NOG group when compared to the POG group, while levels of LDH and CRP in the NOG group were significantly higher than those found in the POG group. The levels of CRP and fibrinogen decreased in the POG group during hospitalization. The levels of CRP, as well as the total leukocyte count were inversely correlated with the levels of 25hydroxy vitamin D. This study brings new information on the interaction between vitamin D and pro-inflammatory markers and highlights the role of this vitamin in the modulation of the immune response in patients with moderate COVID-19.

Lessons in clinical reasoning ‒ pitfalls, myths, and pearls: a case of confusion, disequilibrium, and "picking at the air".

OBJECTIVES: Defects in human cognition commonly result in clinical reasoning failures that can lead to diagnostic errors. CASE PRESENTATION: A 43-year-old female was brought to the emergency department with 4-5 days of confusion, disequilibrium resulting in several falls, and hallucinations. Further investigation revealed tachycardia, diaphoresis, mydriatic pupils, incomprehensible speech and she was seen picking at the air. Given multiple recent medication changes, there was initial concern for serotonin syndrome vs. an anticholinergic toxidrome. She then developed a fever, marked leukocytosis, and worsening encephalopathy. She underwent lumbar puncture and aspiration of an identified left ankle effusion. Methicillin sensitive staph aureus (MSSA) grew from blood, joint, and cerebrospinal fluid cultures within 18 h. She improved with antibiotics and incision, drainage, and washout of her ankle by orthopedic surgery. CONCLUSIONS: Through integrated commentary on the diagnostic reasoning process from clinical reasoning experts, this case underscores how multiple cognitive biases can cascade sequentially, skewing clinical reasoning toward erroneous conclusions and driving potentially inappropriate testing and treatment. A fishbone diagram is provided to visually demonstrate the major factors that contributed to the diagnostic error. A case discussant describes the importance of structured reflection, a tool to promote metacognitive analysis, and the application of knowledge organization tools such as illness scripts to navigate these cognitive biases.