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Introduction: Limited information exists on patients with suspected coronavirus disease 2019 (COVID-19) who return to the emergency department (ED) during the first wave. In this study we aimed to identify predictors of ED return within 72 hours for patients with suspected COVID-19.Methods: Incorporating data from 14 EDs within an integrated healthcare network in the New York metropolitan region from March 2–April 27, 2020, we analyzed this data on predictors for a return ED visit—including demographics, comorbidities, vital signs, and laboratory results.Results: In total, 18,599 patients were included in the study. The median age was 46 years old [interquartile range 34-58]), 50.74% were female, and 49.26% were male. Overall, 532 (2.86%) returned to the ED within 72 hours, and 95.49% were admitted at the return visit. Of those tested for COVID-19, 59.24% (4704/ 7941) tested positive. Patients with chief complaints of “fever” or “flu” or a history of diabetes or renal disease were more likely to return at 72 hours. Risk of return increased with persistently abnormal temperature (odds ratio [OR] 2.43, 95% CI 1.8-3.2), respiratory rate (2.17, 95% CI 1.6-3.0), and chest radiograph (OR 2.54, 95% CI 2.0-3.2). Abnormally high neutrophil counts, low platelet counts, high bicarbonate values, and high aspartate aminotransferase levels were associated with a higher rate of return. Risk of return decreased when discharged on antibiotics (OR 0.12, 95% CI 0.0-0.3) or corticosteroids (OR 0.12, 95% CI 0.0-0.9).Conclusion: The low overall return rate of patients during the first COVID-19 wave indicates that physicians’ clinical decision-making successfully identified those acceptable for discharge.

Historical perceptions regarding the severity of traumatic spinal cord injury has led to considerable disparity in triage to tertiary care centers. This article retrospectively reviews a large regional trauma database to analyze whether the diagnosis of spinal trauma affected patient transfer timing and patterns. The Pennsylvania Trauma database was retrospectively reviewed. All acute trauma patient entries for level I and II centers were categorized for diagnosis, mechanism, and location of injury, analyzing transportation modality and its influence on time of arrival. A total of 1162 trauma patients were identified (1014 blunt injuries, 135 penetrating injuries and 12 other) with a mean transport time of 3.9 hours and a majority of patients arriving within 7 hours (>75%). Spine trauma patients had the longest mean arrival time (5.2 hours) compared to blunt trauma (4.2 hours), cranial neurologic injuries (4.35 hours), and penetrating injuries (2.13 hours, p

Finally, on March 12, 2013, a major American newspaper, The Wall Street Journal, reported on the plight of Dr. Cyril Karabus (1,2). Dr. Karabus is the 78 year old pediatric oncologist from Claremont, Capetown, South Africa who is well known as the retired head of the Oncology and Hematology Unit of the Red Cross Children’s Hospital, University of Cape Town, as well as for his devoted service to poor children in the apartheid era. In 2002, he cared for a three-year old Yemeni girl with acute myelogenous leukemia during a locum tenens in the United Arab Emirates (UAE).

BACKGROUND The incidence of esophageal adenocarcinoma (EA) has increased more rapidly than any other cancer (with the exception of malignant melanoma) in the United States over the past 30 years. Gastroesophageal reflux disease (GERD) is the strongest risk factor for the development of Barrett’s esophagus, which in turn leads to the rise of most EA’s. In a large portion of persons with sleep disorders, perhaps as high as 30%, GERD is a major causal or contributing factor. It has been proposed that the use of hypnotics for the treatment of sleep disorders may exacerbate the damaging effects of refluxate on the esophageal epithelium by reducing the frequency and effectiveness of normal clearance mechanisms (figure 1).

Many of Shakespeare's characters suffer from the myriad of medical and surgical ailments that afflict mankind. Although many of these diseases serve merely to enhance the subtle shading of character in Shakespearean drama, certain disorders seem to provide a vital focus for the basic theme and plot development of the plays. No group of disorders is more implicated by the behavior and thought patterns of Shakespeare's characters than neuropsychiatric disease. Othello, the Moor of Venice stands out as a striking example of a tragedy in which the main character suffers grievous consequences from a disease that affects his behavior and thereby directs the course and outcome of the play. In this essay, I will attempt to correlate the history, signs, and symptoms of Othello's disease with recognized neurological conditions, specifically partial psychomotor seizure disorders. I will cite many bits of evidence, although none are conclusive without a physical examination and diagnostic electroencephalogram. I will also make an argument in favor of Shakespeare's medical as well as literary expertise .

Mycoplasma pneumonia, a well known cause of acute respiratory infection in man, has been reported to frequently include central nervous system manifestations as part of its clinical course (1,2). The spectrum of neurologic syndromes associated with the disease is vast, ranging from direct invasion of brain and meninges by the organism to non-invasive parainfectious encephalopathy (3). This is a case report of an individual who presented to the emergency room in an acute psychotic state as the single manifestation of a parainfectious encephalopathy secondary to mycoplasma pneumonia infection of the lung.

Mycoplasma pneumonia, a well known cause of acute respiratory infection in man, has been reported to frequently include central nervous system manifestations as part of its clinical course (1,2). The spectrum of neurologic syndromes associated with the disease is vast, ranging from direct invasion of brain and meninges by the organism to non-invasive parainfectious encephalopathy (3). This is a case report of an individual who presented to the emergency room in an acute psychotic state as the single manifestation of a parainfectious encephalopathy secondary to mycoplasma pneumonia infection of the lung.

Many of Shakespeare's characters suffer from the myriad of medical and surgical ailments that afflict mankind. Although many of these diseases serve merely to enhance the subtle shading of character in Shakespearean drama, certain disorders seem to provide a vital focus for the basic theme and plot development of the plays. No group of disorders is more implicated by the behavior and thought patterns of Shakespeare's characters than neuropsychiatric disease. Othello, the Moor of Venice stands out as a striking example of a tragedy in which the main character suffers grievous consequences from a disease that affects his behavior and thereby directs the course and outcome of the play. In this essay, I will attempt to correlate the history, signs, and symptoms of Othello's disease with recognized neurological conditions, specifically partial psychomotor seizure disorders. I will cite many bits of evidence, although none are conclusive without a physical examination and diagnostic electroencephalogram. I will also make an argument in favor of Shakespeare's medical as well as literary expertise .