Notes

Examination associated with pathological and also biological options that come with small renal world using the tumour dimensions
It has been hypothesized that silent hypoxemia is the cause of rapid progressive respiratory failure with severe hypoxia that occurs in some COVID-19 patients without warning.

A 60-year-old male presented cough without any breathing difficulty. Vital signs showed blood pressure 130/75mmHg, pulse 84x/minute, respiratory rate (RR) 21x/minute, body temperature 36.5C, and oxygen saturation (SpO2) 75% on room air. RT-PCR for COVID-19 were positive. On third day, he complained of worsening of breath shortness, but his RR was still normal (22x/minute) with SpO2 of 98% on 3L/minute oxygen via nasal cannula. On fifth day, he experienced severe shortness of breath with RR 38x/minute. He was then intubated using a synchronized intermittent mandatory ventilation. ZK53 Blood gas analysis showed pH 7.54, PaO2 58.9mmHg, PaCO2 31.1mmHg, HCO3 26.9mEq/L, SaO2 94.7%, FiO2 30%, and P/F ratio 196mmHg. On eighth day, his condition deteriorated with blood pressure 80/40mmHg with norepinephrine support, pulse 109x/minute, and SpO2 72% with ventilator. He experienced cardiac arrest and underwent basic life support, then resumed strained breathing with return of spontaneous circulation. Blood gas analysis showed pH 7.07, PaO2 58.1mmHg, PaCO2 108.9mmHg, HCO3 32.1mEq/L, SaO2 78.7%, FiO2 90%, and P/F ratio 65mmHg. Three hours later, he suffered cardiac arrest again and eventually died.

Possible mechanisms of silent hypoxemia are V/Q mismatch, intrapulmonary shunting, and intravascular microthrombi.

Silent hypoxemia might be considered as an early sign of deterioration of COVID-19 patients, thus, physician may be able to intervene early and decrease its morbidity and mortality.
Silent hypoxemia might be considered as an early sign of deterioration of COVID-19 patients, thus, physician may be able to intervene early and decrease its morbidity and mortality.
The world has changed dramatically since the COVID-19 pandemic began. Jordan was among countries which enforced early lock-down for most non-vital services. Health care was mainly directed to cope with COVID-19 cases. The pandemic posed challenges for all patients, including dermatology patients especially those on systemic treatments. This resulted in interruption of medical care and exacerbation of pre-existing skin diseases for many patients.

A cross-sectional, questionnaire-based study of dermatology patients on systemic treatment prior to corona pandemic. After lockdown was lifted, patients taking systemic treatments were evaluated for continuity of care during lockdown period and how that affected their skin condition. Demographic data, details of skin condition, continuity of care and impact on skin condition data were collected and analyzed.

154 patients (120 males, 34 females) were included. The majority (around 80%) of patients were unable to attend to dermatology clinics or do the needed lab ckdown. Some patients (42%) had flare up of their skin condition as a result.
Diffuse idiopathic skeletal hyperostosis (DISH), or Forestier disease, is a condition characterized by calcification and ossification of ligaments and enthuses (ligament and tendon insertion sites), which mainly affect the vertebral column. The clinical manifestation of DISH is variable. Some patients can be completely asymptomatic, whereas others can complain of painful stiffness, decreased range of movement, and myelopathy symptoms. OPLL usually produce myelopathy symptoms. Combined of OPLL and DISH are rare case.

A 59 years old woman patient complained of neck and shoulder pain in the last 20 years ago, with decreased neck range of motion and dysphagia. There was no gross abnormality on patient's neck and back. Cervical x ray was showing a continuous ossification extending from the anterior surface of C2 to C7 in lateral radiograph. A similar ossification was also noticed on the posterior surface of the vertebral bodies from C2 to C6 abutting the spinal canal.

Despite striking abnormal appearance of cervical DISH and OPLL seen on radiologic examinations, absence of myelopathy is an indication to non-operative treatment. Presence of dysphagia was not an indication of surgery in this patient, as dysphagia was not severe and myelopathy was absent. Patient was observed during her clinical course to document the progression of myelopathy. Prophylactic surgery was not indicated for this patient, and progression of myelopathy during observation is an indication for surgical intervention.

Diffuse and large abnormalities in cervical area with normal neurological function is not indication for surgery. Selective treatment based on individual case.
Diffuse and large abnormalities in cervical area with normal neurological function is not indication for surgery. Selective treatment based on individual case.
COVID-19 pandemic has resulted in a strong impact on students' wellbeing, with associated uncertainty about the future. We conducted a cross-sectional survey to assess the psychological effects of COVID-19 on the medical education of final year students in Pakistan.

We conducted prospective, cross-sectional survey, as a snapshot, from June 07, 2020 till June 16, 2020, among final year medical and dental students. The 20-questions survey questionnaire was based on rating-scale items to focus on psychological symptoms, institutional preparedness for such crisis and confidence in becoming a future doctor. Descriptive statistics were calculated using Multivariate regression analysis.

Majority of participants (n = 1753/2661, 65.9%) were female. Despite timely closure of institutes, delay in the start of the online teaching (beta coefficient 0.08, P-value 0.02) was significantly correlated with the depressive symptoms. A significant percentage of students (n = 1594, 59.9%) wanted a delay in exit exams due to dical curricula is crucial to pursue ceaseless medical education and to become a safe future doctor.Malignant Pleural mesothelioma (MPM) is a rare disease which is associated with a poor prognosis. Front line chemotherapy represents the cornerstone in the management of MPM, and the place of radical surgery is controversial and reserve in early-stage disease. However prolonged survival (more than 24 months) can be observed in rare cases and only in the context of multimodal treatment including surgical management. We report the case of a patient suffering from an epithelial MPM with a 14-years progression-free survival after trimodal treatment including extrapleural pneumonectomy followed by chemotherapy and radiotherapy. This case illustrates that despite being an aggressive disease, multimodal management including radical surgery may allow a prolonged response in MPM but requires a whole-life surveillance.
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