In March 2020, the World Health Organization declared the spread of SARS-CoV-2 a global pandemic. To date, coronavirus disease-2019 (COVID-19) has spread to over 200 countries, leading to over 1.6 million cases and over 99,000 deaths. Given that there is neither a vaccine nor proven treatment for COVID-19, there is currently an urgent need for effective pharmacotherapy. To address the need for an effective treatment of SARS-CoV-2 during the worldwide pandemic, this systematic review of intravenous (IV) remdesivir was performed. Remdesivir, an anti-viral prodrug originally developed to treat Ebola virus disease, has shown broad spectrum activity against the Coronavirus family. A recent case report reported improvement of clinical symptoms with remdesivir in a patient with COVID-19. After conducting a systematic search of 18 clinical trial registries and three large scientific databases, we identified 86 potentially eligible items. Following removal of duplicates (n = 21), eligible studies were reviewed independently by two authors. After the first round of screening, inter-rater agreement was 98.5% (κ = 0.925). After the second round of full-text screening, inter-rater agreement was 100%. A total of seven ongoing and recruiting clinical trials of remdesivir (100–200 milligrams, intravenous [IV]) were included. We identified the following primary outcomes: patients discharged (n = 2); time to clinical status improvement (n = 2); improved O2 saturation (n = 2); body temperature normalization (n = 2); and clinical status (n = 1). Secondary outcomes in all identified studies included documentation of adverse events. Phase 3 trials are expected to be completed between April 2020–2023. Therefore, despite supportive data from in vitro and in vivo studies, the clinical effectiveness of IV remdesivir for treatment of COVID-19 and potential side effects remain incompletely defined in the human population.

BackgroundAfghanistan’s public health system was neglected during decades of military and civil conflict, and trends in infectious disease occurrence remain poorly characterized. This study examines cyclical and long-term trends of six vaccine-preventable diseases: pneumonia, diarrhea, meningitis, typhoid, measles, and acute viral hepatitis.MethodsUsing weekly data collected between 2009 and 2015 through Afghanistan’s Disease Early Warning System, we calculated monthly case counts, and fit a Poisson regression with a Fourier transformation for seasonal cycles and dummy variables for year.ResultsWe found the greatest incidence of diarrhea and typhoid in the summer, pneumonia in the winter, and measles in the late spring. Meningitis and acute viral hepatitis did not demonstrate substantial seasonality. Rates of pneumonia and diarrhea were constant across years whereas rates of meningitis, typhoid, and acute viral hepatitis decreased. Measles incidence increased in 2015.ConclusionsCommunicable disease reporting systems can guide public health operations–such as the implementation of new vaccines, and permit evaluation of health interventions. For example, measles supplementary immunization activities in Afghanistan have not slowed long-term transmission of the disease, but decreases in typhoid fever and acute viral hepatitis are probably tied to improvements in sanitation in the country.

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By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

A well-developed man in his 20s presented to our hospital with a clinically significant elevation in serum calcium level to (14.1 mg/dL [reference range, 8.6-10.2 mg/dL]) found on routine laboratory tests. He was highly functional and denied abdominal pain, dysuria, anxiety, lethargy, and constipation. Findings from his physical examination were within normal limits. He did not have any palpable thyroid nodules or cervical lymphadenopathy. Given his elevated calcium level, parathyroid hormone (PTH) was drawn, and results returned significantly elevated at 1377 pg/mL (reference range, 10-65 pg/mL). Because of the extremely elevated PTH level, a technetium Tc 99m sestamibi single-photon emission computed tomographic/computed tomographic (SPECT/CT) scan was obtained, which identified a lesion in the location of the right inferior parathyroid gland, measured at 2.2 cm (Figure , A). In addition, CT showed associated lytic bone lesions of the left mandibular ramus, left scapula, and C5 vertebra (Figure , B). What is your diagnosis? A.Parathyroid carcinoma B.Multiple myeloma C.Primary bone tumor D.Osteitis fibrosa cystica Diagnosis D.Osteitis fibrosa cysticaThe patient underwent right inferior parathyroidectomy, with intraoperative return to normal PTH levels of 50 pg/mL after removal of the affected gland. He recovered without issues postoperatively. Final pathologic findings demonstrated a parathyroid adenoma weighing 5.9

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Hyperpigmentation disorders are highly prevalent and disproportionately affect patients with skin of color. Studies suggest that over 65% of Black or African American patients haveexperienced at least one episode of hyperpigmentation due to skin damage or irritation. Notably, melasma and postinflammatory hyperpigmentation are the two most common forms of dyschromia in patients with skin of color. Additionally, otherconditionssuch as lichen planus and erythema dyschromicum perstans can have a more severe presentation and significant morbidity in this patient population. Thus, hyperpigmentation disorders can benefit greatly from prompt and accurate diagnosis that results in more precise management. In this review, we present the most updated information regarding dermoscopy, reflectance confocal, and conventional light microscopy in the diagnosis of hyperpigmentation disorders in skin of color. In addition, we summarize the benefits and pitfalls of some of these techniques, with a special emphasis on their accuracy and potential to assess favorable treatment outcomes. We also describe recent studies that have compared these diagnostic techniques across many disorders of hyperpigmentation and the practical findings that can be applied to everyday practice. We recognize that the cost of equipment, clinician training, and device availability are all critical factors when choosing the ideal diagnostic tool and provide varied approaches to improve accuracy. Today, diagnosing and treating hyperpigmentation skin conditions has become easier through technological advances.More reliable, noninvasive techniques such as dermoscopy and reflectance confocal microscopy show promise as adjuncts to guide laser and light therapies and monitor treatment response in dermatology clinics and clinical trials.

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