A Case Report of Invasive Mucormycosis in a COVID-19 Positive and Newly-Diagnosed Diabetic Patient.

This is a case report of a 46-year-old female with undiagnosed diabetes, COVID-19, and mucormycosis. Mucormycosis is a rare, rapidly progressive disease process characterized by an insidious onset of vague symptoms and is associated with a high mortality rate. The patient initially presented at two outside ophthalmology clinics due to right eye pain and was prescribed steroids. Upon presentation to our institution's Emergency Department, the patient's pain had significantly increased along with new symptoms of ptosis and failure to adduct the right eye. Laboratory results demonstrated leukocytosis, hyperglycemia, and a positive SARS-CoV-2 test. Magnetic resonance imaging confirmed a diagnosis of mucormycosis and the patient underwent surgery and began intravenous antifungal therapy. This discussion addresses the presenting features of mucormycosis in the emergency department while highlighting the need for immediate investigation due to the fungi's rapidly progressive nature. Topics: Mucormycosis, mucor, diabetes, COVID-19, ROCM.

Greater explosive quadriceps strength is associated with greater knee flexion at initial contact during landing in females.

This study investigated the influences of explosive quadriceps strength and landing task on sagittal plane knee biomechanics. Forty female participants performed isometric knee extensions on a dynamometer and had lower extremity biomechanics assessed during double-leg jump-landings (DLJL) and single-leg jump-cuts (SLJC). Explosive quadriceps strength was quantified by calculating rate of torque development (RTD) between torque onset and 100 ms after onset on a dynamometer. Participants were stratified into high and low RTD groups. Landing biomechanics were compared using 2 (Group) × 2 (Task) mixed-model ANOVAs. The relationships between quadriceps RTD and landing biomechanics were also assessed using simple, bivariate correlations. Across RTD groups, greater knee flexion at initial contact (KFIC), peak vertical ground reaction force, peak anterior tibial shear force, and peak internal knee extension moment, and lesser peak knee flexion was observed during SLJC compared to DLJL. The high RTD group exhibited significantly greater KFIC than the low RTD group across landing tasks. Greater quadriceps RTD was significantly associated with greater KFIC during SLJC, but not during DLJL. As landing with lesser KFIC is a risk factor for ACL injury, greater explosive quadriceps strength capacity might be beneficial for facilitating the use of safer landing mechanics during athletic tasks.

Heating Intravenous Fluid Tubing in an Experimental Setting for Prehospital Hypothermia.

OBJECTIVE: Hypothermia secondary to environmental exposure is a serious condition. Active external warming measures to treat it may prove challenging in the prehospital setting. We conducted an experimental study to measure the ability of commercially available heating elements to warm intravenous (IV) fluids during infusion. METHODS: 250-milliliter bags of dextrose 10% solution were suspended inside a refrigerator. IV tubing was coiled, and the tubing output was placed inside a thermally insulated cup. The tubing was heated directly with a hand warmer, a meals ready-to-eat heater, or a heating blanket. Fluids were run through the IV line. The temperature of the fluid at the tubing output was measured. The initial and final infusion temperatures for the methods were compared. RESULTS: The use of hand warmers, meals ready-to-eat heaters, and heating blankets to warm IV tubing did increase the temperature of the fluids but was ineffective at achieving the desired mean infusion temperature of 35°C to 42°C. CONCLUSION: Although the mean temperature increase did not meet the established experimental threshold, further research is needed to determine whether the fluid warming effect of these commercial heating elements used in the prehospital environment is significant enough to limit heat loss while repleting the dextrose of a hypothermic, hypoglycemic patient.

A comparison of simulation versus didactics for teaching ultrasound to Swiss medical students.

BACKGROUND: Point-of-care ultrasound is an increasingly common imaging modality that is used in a variety of clinical settings. Understanding how to most effectively teach ultrasound is important to ensure that medical students learn pre-clinical content in a manner that promotes retention and clinical competence. We aim to assess the effectiveness of simulation-based ultrasound education in improving medical student competence in physiology in comparison to a traditional didactic ultrasound curriculum. METHODS: Subjects were given a pre and post-test of physiology questions. Subjects were taught various ultrasound techniques via 7 hours of lectures over two days. The control group received 2 additional hours of practice time while the experimental group received 2 hours of case-based simulations. A physiology post-test was administered to all students to complete the two-day course. RESULTS: Totally 115 Swiss medical students were enrolled in our study. The mean pre-course ultrasound exam score was 39.5% for the simulation group and 41.6% for the didactic group (P>0.05). The mean pre-course physiology exam score was 54.1% for the simulation group and 59.3% for the didactic group (P>0.05). The simulation group showed statistically significant improvement on the physiology exam, improving from 54.1% to 75.3% (P<0.01). The didactic group also showed statistically significant improvement on the physiology exam, improving from 59.3% to 70.0% (P<0.01). CONCLUSION: Our data indicates that both simulation curriculum and standard didactic curriculum can be used to teach ultrasound. Simulation based training showed statistically significant improvement in physiology learning when compared to standard didactic curriculum.