Search

Case Presentation A 60-year-old man with no significant medical history presented to the pulmonology clinic with 2 years of progressive weakness and shortness of breath. Showering and other activities of daily living caused him significant fatigue and dyspnea. He had a 20-pack-year smoking history, but no significant history of alcohol or illicit drug use. He did not take any prescribed or over-the-counter medications for chronic medical conditions and had never been on statin therapy. Vital signs were significant for an oxygen saturation of 91% on 4-L nasal cannula. He required up to 6 L of oxygen during a walk test. Physical examination showed mild inspiratory crackles in the lung bases, loud splitting of the second pulmonic valve (P2) with a right parasternal heave, and 2+ pitting edema in the lower extremities. There was muscle weakness, pain, and wasting of the proximal upper and lower extremities, particularly in his legs. He denied any joint pain, and there was no evidence of rash or dysphagia.

Systemic capillary leak syndrome is a rare disorder characterized by dysfunctional inflammatory response, endothelial dysfunction, and extravasation of fluid from the vascular space to the interstitial space leading to shock, hemoconcentration, hypoalbuminemia, and subsequent organ failure. The condition may be idiopathic or secondary to an underlying cause, which can include viral infections. Here we describe a patient with acute coronavirus disease 2019 (COVID-19) infection who presented with hemoconcentration, shock, and hypoalbuminemia. The patient subsequently developed rhabdomyolysis and compartment syndrome of all four extremities, requiring fasciotomies. This is the first reported case of systemic capillary leak syndrome associated with COVID-19 infection. This case adds to the evolving spectrum of inflammatory effects associated with this viral infection.

Chronic illness requires frequent medical treatments and lifestyle restrictions that increase academic and socioemotional stressors for families. This paper presents academic intervention recommendations based on a hospital’s approach to improving educational outcomes for children with chronic illness. A case study on an intervention for a girl with sickle cell disease (SCD) and a history of stroke. SCD is a relatively common chronic illness that has physical and psychosocial side effects that are central to other chronic illnesses (Platt, Eckman, & Hsu, 2016). A quality improvement approach resulted in five cycles of interventions that were assessed with both qualitative and quantitative measures. The initial strategy of improving academics through collaboration among the school, hospital, and family resulted in psychosocial, but not academic, improvements. Frequent tutoring, which was most achievable using online platforms, resulted in the greatest gains. The girl passed previously failed classes and advanced to the next grade. Recommendations for how to improve academic outcomes for children with chronic illness using the presented intervention strategies are discussed.

One fifth of school aged children in the US have a chronic medical illness and represent an underserved and educationally disadvantaged population. In particular, children with sickle cell disease (SCD) of all genotypes spend significant amounts of time in the medical settings and represent a potentially "captive audience" where hospitalization time can include educational activities. Accordingly, we saw an opportunity for Biomedical Engineering (BME) undergraduates at Georgia Institute of Technology, who are taught biology, medicine, engineering, and design to implement a new paradigm of K-12 Science, Technology, Engineering, and Mathematics (STEM) programming, where human physiology is used as a model framework. In collaboration with hospital school teachers at Children's Healthcare of Atlanta, we created a novel educational program where we (1) leverage the patient's own medical experience as motivation for learning, (2) develop hands-on interactive activities to teach STEM concepts that are adaptable for the patient's cognitive level, (3) provide undergraduate students with high quality meaningful patient interactions and clinical experiences, and (4) provide innovative educational programming for hospitals. The BME undergraduates enrolled in a human-centered design course focusing on iterative design, development and implementation of hands-on interactive STEM activities rooted in human physiology (Fig. 1A). Each activity contains state and national K-12 STEM standards. The BME undergraduates are well-suited to teach in the hospital environment, as they experience a strong STEM curriculum and are able to capture the true interdisciplinary nature of medical science in each activity. The undergraduates and patients are near-peer age, relationship-building occurs quickly, the patients admire them and enjoy their time together. During the 2018-19 school year we developed learning assessment questions for 2 of the most requested activities, assessing each SCD patient's mastery of the learning objectives. In the Blood Jar activity (Fig. 1B), the SCD patient builds a model of blood, learning the composition, function of each component, and importance of hydration. Sixty-five patients participated, 43% of grade K - 2, 61% of 3 - 5, 85% of 6th through High School scored Thoroughly Demonstrated. In the Bone activity (Fig. 1C), each SCD patient constructs a bone model to understand the function and structure of a bone. Twenty-nine patients participated, 28% of grade K - 2, 30% of 3 - 5, 88% of 6 - 8, and 75% of high school scored Thoroughly Demonstrated. Patient feedback (Fig. 1D) has been overwhelmingly positive, stating the activities are "fun" and "engaging" and requesting additional visits from the BME undergraduates. BME undergraduate expressed growth and learning of: disease pathophysiology, teaching and learning styles, and effective and succinct communication skills. In Georgia, Life Science is taught in 5th and 7th grade, our target demographic. Our results show at least 75% of patients in 6th grade and above demonstrated thorough understanding of the STEM topics taught, while K - 5 grade did not achieve that level of understanding. Lower scores for those patients are attributed to difficulties remembering new scientific vocabulary. Many of the BME undergraduates in our program are pre-med and use the experiences and meaningful interactions with patients in their medical school applications. As stated by a BME undergraduate after a patient interaction, "the white blood cells are like soldiers in the army! I like that! This analogy prompted the patient to think of his future. It reminded me the littlest things can make a big difference. This makes me even more excited to go into medicine." Our program represents an innovative approach to teaching STEM by: engaging SCD children, who are uniquely suited to learn important STEM concepts within the context of their own disease, provide learning to SCD patients during extended absences from school, allowing BME undergraduate students to design, develop, and teach STEM activities, provide meaningful clinical experience, and supplying quality educational programming for the hospital. This collaborative program can be straightforwardly implemented at other pediatric institutions with robust college volunteer programs and hospital school programs. Our activities can be exported and implemented at other institutions. Disclosures Lam: Sanguina, Inc: Current equity holder in private company.