Introduction/Objective Severe acute respiratory distress syndrome caused by coronavirus 2 (SARS-COV-2) is a new respiratory disease -COVID-19. A virus from the Coronaviridae family, highly contagious and virulent took over the world in a very short time causing the 2019/2020 pandemic. We are presenting the case of COVID-19 transmission among family members, patients of various ages, sex, clinical presentation and findings, who have been infected in different ways. Case reports Three patients are described, all with different coronavirus-specific symptomatology. Symptoms ranged from fatigue and loss of appetite with no other, more prominent symptoms in the youngest patient, to fever, high temperature, diarrhoea, muscle ache and chest pain during inspiration in the oldest patient. The third patient's dominant symptoms were dry, non-productive cough, lack of oxygen, shortness of breath and perspiration on exertion, headache and normal temperature, with radiographically confirmed bilateral pneumonia. Laboratory findings (leukopenia, lymphocytopenia with elevated C-reactive protein levels, high erythrocyte sedimentation rate and lactate dehydrogenase levels) were consistent with a viral infection, highly suspicious of SARS-COV-2, which was confirmed with a real-time RT-PCR test in all three patients. After being hospitalized in the Clinical Hospital Center "Zemun" Department of Pulmonology and treated with symptomatic, antiviral and antibiotic therapy, the disease regressed and the RT-PCR tests became negative. Conclusion SARS-COV-2 is a very aggressive and potent cause of the coronavirus disease. The presented cases confirm the possibility of quick transmission within a family through direct and indirect contact, as well as the diversity of symptoms, laboratory and clinical findings. Our clinical examples are similar in symptomatology and available results to cases from other parts of the world hit with the pandemic.
Introduction/Objective The acute coronary syndrome is a medical condition that Emergency Medical Service physicians deal with daily. An especially prompt reaction is required when an ST elevation in the aVR lead is discovered, as it signifies a critical coronary lesion. The objective of the article is to present how educated the Emergency Medical Service doctors included in the STEMI network are in recognizing and treating the aVR lead elevation, as an atypical ECG finding. Case report Three patients with chest pain lasting from 30 minutes to 2.5 hours are presented. The ECG recording shows significant ST segment depressions >1mm in 6 or more leads (I, II, III, aVL, aVF, V2-V6) coupled with a 3-4mm ST elevation in the aVR lead and similar or slightly less pronounced ST elevation in V1. The strategy for primary PCI had been initialized for all three patients, who were then, after consultation with interventional cardiologists in UHMC Bezanijska kosa, Clinical Hospital Centre Zvezdara and the Military Medical Academy and having taken the initial dose of dual antiplatelet therapy (except for the third patient), transported to the hospital catheterization labs in these three institutions. Conclusion ST segment depression of 1 mm or more in six or more leads (inferolateral depression) coupled with ST segment elevation in aVR and/or V1 points to the threevessel disease (3VD) or left main coronary artery (LMCA) obstruction. The Emergency Medical Service doctors react adequately and promptly and, pending consultation with interventional cardiologists, the patients arrive directly into the catheterization lab. The final decision about reperfusion therapy is made by cardiologists and cardiac surgeons. Early invasive approach and adequate therapy (PCI/CABG) lower the risk of cardiogenic shock development and death.
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