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FETAL ALCOHOL SYNDROME. FETAL ALCOHOL SYNDROME(FAS)/FETAL ALCOHOL SPECTRUM DISORDER(FASD). is a birth defect caused by exposure to alcohol during pregnancy. *There is no cure for FASD. *A person with FASD can get help with their learning and behavior to maximize their independence and achievements. *WHO recommends that pregnant woman should avoid alcohol. *Drinking during pregnancy can cause brain damage , leading to a range of developmental,cognitve and behavioral problems which can appear at any time during childhood. *In the united states,FAS is one of the leading cause of birth defects and most common cause of preventable mental retardation. SYMPTOMS. *CHARACTERISTIC FACIAL FEATURES. Microcephaly. Small palpebral fissures. Epicanthic folds. Depressed nose. Flattened philtrum. Thin upper lip. Micrognathia. *CENTRAL NERVOUS SYSTEM PROBLEMS. Mental retardation. Hyperactivity. Delayed development of gross motor skills such as rolling over,sitting up,crawling and walking. Delayed development of fine motor skills such as grasping objects with thumb and index finger,and transferring objects from one hand to the other. Impaired language development. Memory problems,poor judgement,distractibility,impulsiveness Problems with learning. Seizures. *Decreased birth weight. Hearing disorders. CAUSE OF FAS. FAS is caused by a women's use of alcohol during pregnancy.the alcohol that a pregnant women drinks travels through her blood stream across the placenta to the fetus.A fetus breaks down alcohol much more slowly than an adult.this exposure of the fetus to alcohol causes FAS. TREATMENT. As the child has mental and behavioral problems,they need special education classes,supplemental classroom aids. PREVENTION. PREGNANT WOMAN MUST ABSTAIN FROM ALCOHOL. *

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

Hello everyone, Here are some important facts about COVID-19. From Clinical presentations to treatment. Please check it out and feel free to add more points. CLINICAL PRESENTATION: In a study describing 1099 patients with COVID-19 pneumonia in Wuhan, the most common clinical features at the onset of illness were: •Fever in 88% •Fatigue in 38% •Dry cough in 67% •Myalgias in 14.9% •Dyspnea in 18.7% Pneumonia appears to be the most common and severe manifestation of infection. In this group of patients breathing difficulty developed after a median of five days of illness. Acute respiratory distress syndrome developed in 3.4% of patients. Other symptoms •Headache •Sore throat •Rhinorrhea •Gastrointestinal symptoms About 80% of confirmed COVID-19 cases suffer from only mild to moderate disease and nearly 13% have the severe disease (dyspnea, respiratory frequency ≥30/minute, blood oxygen saturation≤93%, PaO2/FiO2 ratio <300, and/or lung infiltrates >50% of the lung field within 24-48 hours). Critical illness (respiratory failure septic shock, and/or multiple organ dysfunction/failure) is noted in only in less than 6% of cases. INCUBATION PERIOD: The exact incubation period is not known. It is presumed to be between 2 to 14 days after exposure, with most cases occurring within 5 days after exposure. THE SPECTRUM OF ILLNESS SEVERITY: Most infections are self-limiting. COVID-19 tends to cause more severe illness in the elderly population or in patients with underlying medical problems. As per the report from the Chinese center for disease control and prevention that included approximately 44,500 confirmed Infections with an estimation of disease severity. • Mild illness was reported in 81% of patients. • Severe illness (Hypoxemia, >50% lung involvement on imaging within 24 to 48 hours) in 14%. • Critical Disease (Respiratory failure, shock, multi-organ dysfunction syndrome) was reported in 5 percent. • Overall case fatality rate was between 2.3 to 5%. AGE AFFECTED: • Mostly middle-aged (>30 years) and elderly. • Symptomatic infection in children appears to be uncommon, and when it occurs, it is usually mild. **The 4th version of Belgian guidance for COVID 19 is published on19th March 2020. It is one of the most precise guidelines published yet. Some points from that: 1. Chloroquine is found to have good efficacy in vitro and it reduces the duration of viral shedding. But the drug has a narrow therapeutic window and cardiac toxicity is the most limiting side effect. 2. Hydroxychloroquine is more potent and is superior to chloroquine according to the very recent Gautret’ study. 3. Azithromycin may have a viral suppressive effect, but this needs to be proved as it was noticed accidentally in 6 patients of Gautret’ study. But I think it is a good choice for coverage of bacterial pneumonia. 4. Lopinavir/Ritonavir recently shown not to provide clinical benefit in hospitalized patients with COVID-19. It may reduce ICU stay if given within 10 days of infection but not beyond. 5. Remdesivir is promising but the studies are ongoing. Also, availability is a key issue. 6. Corticosteroids are not recommended as a systemic adjunctive treatment. 7. Paracetamol is the first-line analgesic and antipyretic over NSAIDs which are used with caution. 8. No need to stop ACEIs/ARBs in non-hospitalized patients. CONSIDER changing ACEIs/ARBs to another equivalent antihypertensive in hospitalized patients. 9. Antiviral therapy is not indicated in all patients with suspected/confirmed COVID19.

A 64 year old male on tacrolimus, brought with tachypnea and low O2 saturation (50% RA). Deterioration with fever over a week. Note the miliary appearance of infiltrates in this COVID patient.

Patient male, 42 years old. Sudden postoperative pain in the sternum for 3 days in the emergency department, the electrocardiogram is shown below. Emergency room BP160 / 102mmHg, symmetrical blood pressure in both upper limbs, double lungs (-), early diastolic murmur in the aortic valve area. *Discussion: * 1. ECG analysis. 2. Diagnostic considerations? 3. What to check next?