COVID-19 pandemic has created a global health crisis. Though respiratory symptoms have been the usual manifestations, the presentation in some cases may be atypical with various neurological and cutaneous manifestations. We present a case of a 63-year-old female diagnosed with COVID-19 and associated rare manifestations during her visit to Europe.
Purpose: Given that nearly a quarter of the US physician workforce are international medical graduates (IMGs), many of whom remain on temporary work visas for prolonged periods due to processing delays, the pandemic has posed unique challenges to these frontline workers and has arbitrarily limited our physician workforce. Objective: The objective of the study is to understand the role of IMG physicians practicing in the US, their limitations and challenges due to immigration related issues. Methods: Using a cross-sectional survey across social media platforms, we obtained data from IMGs regarding their role in healthcare, to the impact of visa-related restrictions on their personal and professional lives. Results: A total of 2630 IMGs responded to the survey, Hospital Medicine (1684, 65.7%) being the predominant specialty encountered. 64.1% were practicing in Medically Underserved Areas (MUA) or Health Professional Shortage Areas (HPSA), with 45.6% practicing in a rural area. Nearly 89% of respondents had been involved with direct care of COVID-19 patients, with 63.7% assuming administrative responsibilities for COVID-19 preparedness. 93% physicians expressed inability to serve in COVID-19 surge areas due to visa-related restrictions. 72% physicians reported that their families would be at risk for deportation in case of their disability or death. Most respondents (98.8%) felt that permanent resident status would help alleviate the above concerns. Conclusion: Easing immigration restrictions could prove significantly bolster the current physician workforce and prove beneficial in our response to the COVID-19 pandemic.
Introduction: Annually, 5% of sudden deaths are due to Abdominal Aortic Aneurysm (AAA) rupture. AAA ruptures have worse outcomes in females than males and occur at a smaller size in females. USPSTF recommends a one-time ultrasound screening for males aged 65-75 years who ever smoked. There is insufficient evidence to screen females aged 65-75 years who ever smoked in-spite of the available evidence. The objective of this study is to compare the characters, mortality and morbidity of ruptured AAAs in females and males. Methods: This is a retrospective review of 117 patients from two teaching institutions over a period of six years. A total of 39 parameters were compared between males and females including demographic characters, co-morbidities like hypertension, dyslipidemia, diabetes mellitus, cardiovascular diseases; previous history of AAA; medications, characters of aneurysm, type of surgery and its outcome; post-operative complications and long term survival. Results: The incidence of AAA rupture was higher in males (68%) than in females (32%). Females had a later age of death from AAA rupture. There was a significant difference in the size of AAA rupture between females (mean=7.4 cm) and males (mean=8.2 cm); p = 0.04. The probability to undergo surgery for ruptured AAA was significantly lower for females as compared to males (p=0.03). Females had higher overall mortality (p=0.001) and post-operative mortality after surgical repair (p=0.02) from AAA. Female gender was an independent predictor of higher length of ICU stay, incidence of postoperative complications, use of vasopressors and use of ventilator. Conclusion: Using a similar threshold of size of AAA for elective surgery for both males and females might not be appropriate. AAA screening might be warranted for high risk females owing to the higher morbidity and mortality.