Telemedicine, Not The Panacea We Thought It Would Be. A Tale Of Caution

In the last few decades, the growing use of telemedicine has allowed access to healthcare at reduced costs and increased monitoring of chronic conditions, especially in underserved and rural areas. It is a tool of great value in low-income countries where there is a paucity of specialists. In the height of the COVID-19 pandemic, telemedicine was used to screen patients with COVID-19 like symptoms and send them to test sites directly. This helped minimize unnecessary healthcare staff and patient exposure to the infection and helped decompress ERs. Due to a lack of testing resources, many mildly symptomatic patients were presumed to have COVID-19 infection and advised to self-isolate at home. We present a case of delayed diagnosis of acute leukemia resulting in a life-threatening presentation with leukostasis. This case highlights the need for a physical exam, lab investigations, and close follow-up for new patient complaints seen over telemedicine. It also highlights the lack of evidence for the efficacy and safety of telemedicine in patients with new complaints

Septic Shock

Objectives: Definition and epidemiology of septic shock Early goal directed therapy Targets during resuscitation Timing of treatment How much fluids is enough? Pressors and MAP targets Refractory shoc

Primary Immunodeficiency in a 74-Year-Old Male With Chronic Productive Cough: A Rare Case of Common Variable Immunodeficiency

Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency. It presents with variable degrees of immunodeficiency resulting in a variety of clinical presentations and complications. This report describes the case of newly diagnosed CVID in a 74-year-old man with no history of recurrent infections or hospitalizations. He presented with chronic productive cough, wheezing, shortness of breath and fatigue. Physical examination showed bilateral rhonchi and scattered wheezes. Pulmonary function tests showed moderate obstructive defect with partial reversibility and decreased diffusion lung capacity for carbon monoxide (DLCO). Chest computed tomography (CT) showed bilateral lower lobe peribronchial thickening and mildly enlarged lymph nodes in the mediastinum and upper abdomen. Bronchoscopy with alveolar lavage was done and respiratory samples grew . He had negative acid fast bacillus stain and negative tuberculosis and fungal cultures. He received a course of antibiotics resulting in brief improvement in symptoms followed by another exacerbation. Repeat sputum cultures grew . Further testing showed severely depressed levels of immunoglobulin. His symptoms ultimately improved with immunoglobulin replacement therapy. A broad differential, including CVID, needs to be considered in working up a patient with a chronic productive cough and recurrent lower respiratory tract infection