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Whether profound carcinoembryonic antigen (CEA) elevations, such as > 20 times the upper limit of normal, are of diagnostic use remain unknown. Herein, we present a case of a 55-year-old female with profound serum CEA elevation and multiple pelvic masses but with no evidence of a primary gastrointestinal tumor following upper endoscopy and colonoscopy. Subsequent immunostaining of resected pelvic masses confirmed adenocarcinoma of colorectal origin. This case report highlights the possible diagnostic role of profound CEA elevation, particularly in cases of unknown primary tumors.

The pathophysiology of coronavirus disease 2019 (COVID-19) involves multi-organ dysfunction, particularly involving the respiratory, cardiovascular and hematological systems. This dysfunction is partly due to systemic inflammation causing a wide array of pathological sequelae thus posing a significant challenge to management despite the advances in treatment made thus far. In this report, we present a COVID-19 patient who developed a transient complete heart block and was temporarily paced as a complication of a saddle pulmonary embolus (PE). The mechanism of complete heart block is unclear, may be related to strain, ischemia, or vagal response. We believe that this is a unique sequence of events in a COVID-19 patient and, to our knowledge, is the first of its kind to be reported.

Background: Antiviral medications (AV) are available to mitigate mortality, morbidity, and absenteeism associated with influenza. Management of the burden of influenza is a concern to governing organizations, and thus it is important to understand how AVs are used in practice. To address this, the study reviewed recommendations and guidelines for AV use in situations of seasonal, pandemic, and novel/variant influenza from organizations around the world. Methods: Electronic databases, government and international websites, and Google were searched for guidelines and recommendations developed at the national and international levels by governments, intergovernmental organizations, and task forces that identify AV use recommendations. Results: Of 609 documents retrieved from the electronic search and manual review, 57 were included. Neuraminidase inhibitors (NIs) were recommended for use in nearly 80% of guidelines. Oseltamivir or oseltamivir/zanamivir were recommended for use in 38.6% and 40.4% of guidelines, respectively. Most guidelines based their recommendations on explicit evidence, the majority of which cited WHO documents. AV use was recommended for the general population in 42 guidelines; oseltamivir was recommended most commonly for both prophylaxis and treatment. Conclusions: The majority of guidelines covering subpopulations recommended the use of AVs. Details of AV administration (dose, duration, and timing), when reported, were consistent by indication. Guidelines recommending use of adamantanes were either published before 2007 or recommended their use for specific subpopulations. Guidelines were generally consistent in recommending the use of NIs for indication, type of influenza, setting, subpopulation, and evidence used to inform the recommendation.

Objectives People of South Asian ethnicity are under-represented in health research studies. The objectives of this scoping review were to examine the barriers and facilitators to recruitment of South Asians to health research studies and to describe strategies for improving recruitment. Design Scoping review Methods Using the Arksey and O’Malley framework for scoping reviews, we comprehensively searched electronic databases (MEDLINE via PubMed, Cochrane Library, CINAHL and PsycINFO). Studies that identified barriers and facilitators to recruitment, or recruitment strategies for South Asian populations were included. Recruitment barriers, facilitators and strategies were grouped thematically and summarised narratively. Synthesis Of 1846 potentially relevant articles, 15 met the inclusion criteria and were included in the thematic synthesis. Multiple facilitators and barriers to enrolment of South Asians in health research studies were identified; these most commonly related to logistical challenges, language and cultural barriers, concerns about adverse consequences of participating and mistrust of research. Several actionable strategies were discussed, the most common being engagement of South Asian communities, demonstration of cultural competency, provision of incentives and benefits, language sensitivity through the use of translators and translated materials and the development of trust and personal relationships. Conclusion There is a growing awareness of the barriers and facilitators to recruitment of South Asian participants to health research studies. Knowledge of effective recruitment strategies and implementation during the grant funding stages may reduce the risk of poor recruitment and representation of South Asians.