Inflammatory Biomarker Trends Predict Respiratory Decline in COVID-19 Patients

In this single-center, retrospective cohort analysis of hospitalized coronavirus disease 2019 (COVID-19) patients, we investigate whether inflammatory biomarker levels predict respiratory decline in patients who initially present with stable disease. Examination of C-reactive protein (CRP) trends reveals that a rapid rise in CRP levels precedes respiratory deterioration and intubation, although CRP levels plateau in patients who remain stable. Increasing CRP during the first 48 h of hospitalization is a better predictor (with higher sensitivity) of respiratory decline than initial CRP levels or ROX indices (a physiological score of respiratory function). CRP, the proinflammatory cytokine interleukin-6 (IL-6), and physiological measures of hypoxemic respiratory failure are correlated, which suggests a mechanistic link. Our work shows that rising CRP predicts subsequent respiratory deterioration in COVID-19 and may suggest mechanistic insight and a potential role for targeted immunomodulation in a subset of patients early during hospitalization.

Getting up to Speed: A Resident-Led Inpatient Curriculum for New Internal Medicine Interns

INTRODUCTION

The transition from medical school to internship is an important milestone in medical training and often is a challenge for trainees. This resident-designed and -led inpatient curriculum for internal medicine interns was created to address common clinical scenarios and how best to manage them.

METHODS

During the Intern Summer Curriculum, interns participated in weekly small-group sessions facilitated by senior residents. Each case-based session was structured around a clinical topic. Working in pairs with an expert faculty member as a reviewer, volunteer junior and senior residents reviewed and edited each session. During the 2 years we conducted surveys of learners and instructors in the curriculum, there were 200 intern learners and 68 resident instructors.

RESULTS

The Intern Summer Curriculum was evaluated highly by all participants. Of the intern and resident survey responses, 92% (N = 77) of interns felt that the curriculum should be continued for future interns, and 100% (N = 50) of residents felt that residents should continue to teach in this program. Interns felt that the curricular content helped them better understand topics they commonly encountered and improved their ability to perform day-to-day tasks. Resident instructors felt that teaching in this program was a valuable learning experience and helped strengthen teaching skills.

DISCUSSION

This resident-run inpatient curriculum for internal medicine interns can serve as a valuable learning experience for the intern learners, as well as for the resident instructors, and aid in bringing all interns up to speed at the beginning of intern year.

Imatinib mesylate-induced lichenoid drug eruption

Imatinib mesylate (imatinib) is a tyrosine kinase inhibitor initially approved by the US Food and Drug Administration in 2001 for chronic myeloid leukemia (CML). Since then, the number of indicated uses for imatinib has substantially increased. It is increasingly important that dermatologists recognize adverse cutaneous manifestations of imatinib and are aware of their management and outcomes to avoid unnecessarily discontinuing a potentially lifesaving medication. Adverse cutaneous manifestations in response to imat-inib are not infrequent and can include dry skin, alopecia, facial edema, and photosensitivity rash. Other less common manifestations include exfoliative dermatitis, nail disorders, psoriasis, folliculitis, hypotrichosis, urticaria, petechiae, Stevens-Johnson syndrome, erythema multiforme, Sweet syndrome, and leukocytoclastic vasculitis. We report a case of imatinib-induced lichenoid drug eruption (LDE), a rare cutaneous manifestation, along with a review of the literature.