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A 58 year old male, non-smoker, asthmatic patient was referred with 3 weeks history of breathlessness, wheezing, and dry cough. He had a history of acute severe asthma many years ago. However, he had not required ventilatory support during that period. Since then, he had self-medicating intermittently with oral salbutamol and theophylline only. On examination, the patient had dyspnoea at rest and tachycardia. Oxygen saturation was 90% on room air. Respiratory examination revealed bilateral polyphonic rhonchi; otherwise, he was normal. Arterial blood gas analysis revealed hypoxemia (PaO2: 54 mmHg) with respiratory alkalosis (pH: 7.43, PaCO2: 32.3 mmHg and Bicarbonate: 20 mEq/l). Let's discuss the case on today's World Asthma Day

COVID-19?? 68 year old male with no significant past medical history or surgical history. Presented with shortness of breath, and chest pain. In the emergency department, the patient has a saturation of 79% on room air and is in Moderat respiratory distress. It requires 10 L of nasal oxygen high flow to obtain 93% oxygen saturation. The patient is also febrile to 101°F. Social history: non-smoker, non-drinker. Surgical history: no surgical history. What do you say about the case?

44-year-old male, stigmata of HIV, presented with shortness and respiratory distress. Patient was intimated and sedated. The patient is a known MDR-TB patient, on further investigation found to have completed treatment in 2015. Other history was not obtained. On arrival patient x/ray reviewed (attached - Image 1) and bilateral infiltrates noted as well as ? right lung mass. The patient sent for urgent non-contrast CTB (NAD) and chest. CT findings: ‘Basal infiltrates bilaterally, no cavities, faint effusions with no gross adenopathy. Active TB is very unlikely. Cardiomegaly with PAH. Paraseptal emphysema - mild degree only. Right pericardiac mass (mediastinal).” Patient management is ongoing. What are your valuable suggestions?

77 yeas old female with a background notable of metastatic small bowel GIST. The patient is on chemotherapy, HTN, thyroidectomy, cholecystectomy presented with 10 day Hx of intermittent fevers, nonproductive cough, and increased Shortness of breath. PO2 8.8 on FiO2 0.85 on admission Admitted to ICU and Intubated Lung protective ventilation commenced but desaturated to 80% following RIJ CVC. Decompressed by the bedside and a CXR was performed that revealed large pneumothorax. The chest drain inserted with pneumothorax resolved gradually. 1 day after admission the admitting diagnosis was confirmed COVID-19. What are your experiences and knowledge of managing COVID-19 patients? Please discuss

A 75-year old man with a history of hypertension, hemorrhagic cerebral infarction one year before, right-sided hemiparesis, and atrial fibrillation was brought to my hospital because of suspicious COVID-19 infection. He was seen in the ER because of a few days of dyspnea which became progressed and bad clinical condition. 7 days before the current presentation patient fell from its bed, and after that, he started to feel pain in his right part of the chest. He also noticed purple discoloration of his feet and left hand, which was painful and progressed further during the next days. He started to have DYSPNOEA, which also progressed. CBC: showed leukocytosis (26,9) and chest X-ray was described as bilateral pneumonia. On exam, the patient was alert, disoriented in time, immobile on the bed, with an obvious right hemiparesis, afebrile, tachypneic (R: 24/min), and bradycardic (P: 55/min), hypoxic (SpO2: 80%), with normal blood pressure. PHYSICAL EXAMINATION: showed dusky purple discoloration of both feet and fingers of the left hand. The patient's right feet showed some darker areas, which could be hematomas. CHEST EXAMINATION: showed the painful right side & we spotted the fracture of the 7th rib. Auscultation of lungs revealed bilateral inspiratory crackles, predominantly on the right side. The heart rhythm was regularly-regular. The rest of the examination was unremarkable. LAB ANALYSIS: revealed elevated urea (11,1) and creatinine (371), hypoalbuminemia (22), elevated LDH (705), and slightly elevated CK (201). The CRP was elevated (272,5), and coagulation panel was highly abnormal - aPTT 85,1s, PT 15%, INR >6,0, fibrinogen 2,4, and D-dimer 162 (normal <0,5). My (differential) diagnosis list for this patient was: - Fat embolism - Warfarin overdose - Bilateral pneumonia - Sepsis He didn't have any criteria for COVID-19, and also, its clinical presentation and disease course was not consistent with COVID-19 infection. The patient was transferred to ICU for further treatment. What do you say on this? I am mostly inclined to fat embolism in the first place, which was complicated, but I do not have experience with this diagnosis. What is your opinion on this case, what would be your further diagnostics and treatment?