A 75-year old man with a history of hypertension, hemorrhagic cerebral infarction one year before, right-sided hemiparesis, and atrial fibrillation was brought to my hospital because of suspicious COVID-19 infection. He was seen in the ER because of a few days of dyspnea which became progressed and bad clinical condition. 7 days before the current presentation patient fell from its bed, and after that, he started to feel pain in his right part of the chest. He also noticed purple discoloration of his feet and left hand, which was painful and progressed further during the next days. He started to have DYSPNOEA, which also progressed. CBC: showed leukocytosis (26,9) and chest X-ray was described as bilateral pneumonia. On exam, the patient was alert, disoriented in time, immobile on the bed, with an obvious right hemiparesis, afebrile, tachypneic (R: 24/min), and bradycardic (P: 55/min), hypoxic (SpO2: 80%), with normal blood pressure. PHYSICAL EXAMINATION: showed dusky purple discoloration of both feet and fingers of the left hand. The patient's right feet showed some darker areas, which could be hematomas. CHEST EXAMINATION: showed the painful right side & we spotted the fracture of the 7th rib. Auscultation of lungs revealed bilateral inspiratory crackles, predominantly on the right side. The heart rhythm was regularly-regular. The rest of the examination was unremarkable. LAB ANALYSIS: revealed elevated urea (11,1) and creatinine (371), hypoalbuminemia (22), elevated LDH (705), and slightly elevated CK (201). The CRP was elevated (272,5), and coagulation panel was highly abnormal - aPTT 85,1s, PT 15%, INR >6,0, fibrinogen 2,4, and D-dimer 162 (normal <0,5). My (differential) diagnosis list for this patient was: - Fat embolism - Warfarin overdose - Bilateral pneumonia - Sepsis He didn't have any criteria for COVID-19, and also, its clinical presentation and disease course was not consistent with COVID-19 infection. The patient was transferred to ICU for further treatment. What do you say on this? I am mostly inclined to fat embolism in the first place, which was complicated, but I do not have experience with this diagnosis. What is your opinion on this case, what would be your further diagnostics and treatment?

This is a10 yr old male c his of fever and cough 8 days.his of swelling affecting left upper and lower limb associated c pain.o/ e res distress,decreased air entry on left side c e/0 painful pitting edema of Lt upper and lower limb.joint movement restricted. left normal.CBC polymorph I nuclear leucocytosis.urine normal,renal parameters normal. dd

62 year female was admit in govt hospital 8 days back with diagnosis of dvt rt leg and thrombus in ivc. Pt came to with c/o dyspnea, cough from three days and blood in sputum from one day. On examination bp was 140/90, b/l crepts, clubbing was present. Pt was o2 dependent and spo2 was 70 %, with o2 it was 94%. Investigations are as below Expert opinions are welcomed Update 1 : 2DECHO -severe pulmonary artery hypertension -Dialeted RA RV -thrombus in IVC -LVEF 55%

45 y male Chronic smoker / DM since 3 years on irregular treatment . C/o severe pain in left leg since 28th April , progressive in nature . No other medical history Spot diagnosis Advice further line of management !!

23yrs/M presented to ED with a Generalized painful skin rash over upper and lower extremities for the past 3 days and SOB × 2days and decreased urine output.She developed fever and cough one week prior to developing these rashes for which she took Azithromycin + PCM ,5 hours after taken medicine she developed rashes,The rash progressed over 3 days and get worsen.Patient COVID RAPID ANTIGEN POSITIVE.DIAGNOSIS AND MANAGEMENT PLAN? *Chief Complaints* SOB,FEVER *Vitals* BP - 100/60,Spo2 -82%,RR -25 *Physical Examination* Chest - B/l Crackles *Investigations* Hb -10,WBC -20000,Urea -125,Creat -2.4