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We aimed to determine publication trends in leading clinical research journals (impact factor >20) during the rise of the coronavirus disease 2019 (COVID-19) pandemic and to check for an increase in publication times of non-COVID-19 original research articles.

We collected publication data from five print-based medical journals and one online journal--JAMA The Journal of the American Medical Association, The Lancet (Lancet), The New England Journal of Medicine, Annals of Internal Medicine, The BMJ (BMJ), and BMC Medicine (BMC Med)--for the December 2019 through May 2020 period. We categorized each article as either "COVID-19-related" or "non-COVID-19-related". When available, we further extracted data on submission-to-acceptance dates and acceptance-to-publication dates for original research articles for the January through July 2019 and January through July 2020 periods. We compared the time from submission to publication for non-COVID-19 original research articles during the two periods and tested fon times for the period from January through July 2019.Mitral regurgitation can be a debilitating disease that has many etiologies. Frequent causes are mitral valve prolapse, rheumatic fever, dilated cardiomyopathy, and infective endocarditis. Another rare, but often overlooked cause is caseous calcification of the mitral annulus. This rare disease can lead to dangerous complications such as stroke and arrhythmias. In this report, we present an 84-year-old male with chronic kidney disease who was found to have mitral regurgitation secondary to caseous calcification of the mitral annulus. The goal of this report is to bring clinical awareness to this disease so that it is included in the differential diagnosis of mitral regurgitation.Anaphylaxis is a life-threatening hypersensitivity reaction where rapid, early administration of epinephrine (adrenaline) can be lifesaving in the first aid setting. There are instances where a single dose of epinephrine does not relieve symptoms and a second dose may be required to further mitigate symptoms and preserve life. We performed a scoping review as part of an update to a previously conducted International Liaison Committee on Resuscitation First Aid Task Force (ILCOR) review. PubMed and Embase were searched using the strategy from the 2015 ILCOR review (dates January 1, 2015 to October 22, 2019) and a review of the grey literature (all dates up to November 18, 2019) was performed to identify data on the requirement, use, and effectiveness of a second dose of epinephrine. Each search was rerun on June 26, 2020. We included all human studies of adults and children with an English abstract. Critical outcomes included resolution of symptoms, adverse effects, and complications of second dosing of epinepfrom a second dose of epinephrine.Acute blood loss anemia occurs due to many variants. The standard of care in managing acute blood loss anemia is challenged in this case. Jehovah's Witnesses's (JW) management of blood loss anemia continues to remain a controversy in medicine since they do not allow the use of blood products. This case highlights the management of acute blood loss anemia, utilizing a multidisciplinary bloodless approach in a JW who underwent an endovascular aneurysmal repair (EVAR) of an impending rupture of abdominal aortic aneurysm (AAA). The severity of anemia with hemoglobin of 2.7 g/dL and survival outcome is unique; however, the minimal hemoglobin level required to sustain life is still unclear.
Abnormal placentation such as placenta accreta, increta, and percreta are frequent causes of post-partum hemorrhage, which results in maternal morbidity and mortality. Aprevious history of cesarean section, placenta previa, and pre-eclampsia are the important risk factors for abnormal placentation.A reliable antenatal diagnosis and planned surgical approach can reduce the incidence of maternal morbidity and mortality from massive hemorrhage.

To study the incidence of abnormal placentation and the association of various risk factors with abnormal placentation.

A retrospective study over a period of eight years in patients with peripartum hysterectomies due to abnormal placentation presenting with massive hemorrhage.

We received a total of 10 emergency hysterectomy specimens during an eight‑year period. MDL-800 clinical trial Of the cases, placenta accreta accounted for 40% (4/10), increta up to 40% (4/10), and percreta 20% (2/10).Analysis of these findings with parity showed 20% of the women were uniparous(2/10), and 80% weragement planning of these patients.Objectives This observational retrospective study was undertaken to ascertain the prevalence of coronavirus disease 2019 (COVID-19) among typical ambulatory care patients. In our hospital, ambulatory care unit (ACU) was supposed to be a COVID-19 free area, and, hence, as per the guidelines, even basic personal protection equipment (PPE) was not provided during the early phase of pandemic. Methods We identified 443 patients who presented to our ACU between March and June 2020 with chest pain or shortness of breath suspected of pulmonary embolism or acute coronary syndrome, which normally makes the bulk of referrals to ACU. As per protocol, patients with COVID-19-like symptoms, e.g., fever, cough, sore throat, and loss of taste and smell, were excluded from ACU. We then, reviewed computed tomography (CT) scans for radiological evidence of COVID-19, and lab data for COVID-19 polymerase chain reaction (PCR) or antibody tests, to find out if any of our patients turned out to be suffering from COVID-19 unexpectedly. Results We found 13 patients with radiological or serological evidence of COVID-19, which equates to a prevalence of 2.93% in this cohort of our ambulatory care patients. Four in our patient cohort showed radiological features that were highly suggestive of COVID-19 pneumonia; 47 chest CT scans were performed, which may suggest a prevalence of around 8.5% (4/47) on radiological ground if everyone was offered a CT scan. Conclusions Due to limited access to data, our result is likely an underestimation of the actual prevalence of COVID-19 among our ACU patients, highlighting the need to review the safety and PPE guidelines for the ambulatory clinic and any similar out-patient areas.
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