In December 2019, a cluster of fatal pneumonia cases presented in Wuhan, China. They were caused by a previously unknown coronavirus. All patients had been associated with the Wuhan Wholefood market, where seafood and live animals are sold. The virus spread rapidly and public health authorities in China initiated a containment effort. However, by that time, travelers had carried the virus to many countries, sparking memories of the previous coronavirus epidemics, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), and causing widespread media attention and panic. Based on clinical criteria and available serological and molecular information, the new disease was called coronavirus disease of 2019 (COVID-19), and the novel coronavirus was called SARS Coronavirus-2 (SARS-CoV-2), emphasizing its close relationship to the 2002 SARS virus (SARS-CoV). The scientific community raced to uncover the origin of the virus, understand the pathogenesis of the disease, develop treatment options, define the risk factors, and work on vaccine development. Here we present a summary of current knowledge regarding the novel coronavirus and the disease it causes.

A relatively recent addition to the arsenal of antidiabetic drugs used for the treatment of type 2 diabetes mellitus (T2DM) has been the “incretin mimetics,” a group of drugs that work on the glucagon-like peptide-1 (GLP-1) receptor and enhance insulin secretion from the pancreatic β-cells in a glucose-dependent manner, more potently in hyperglycemic conditions, while suppressing glucagon secretion at the same time. Therefore, it was assumed that this class of drugs would have a lower risk of hypoglycemia than insulin secretagogues like sulphonylureas. However, GLP-1 receptor agonists have been proposed to cause hypoglycemia in healthy normoglycemic subjects implying that their action is not as glucose-dependent as once thought. Other studies concluded that they might not induce hypoglycemia and the risk is dependent on other individual factors. However, the FDA announced that the 12 GLP-1 receptor agonists currently available on the market had potential safety signs and evaluated the need for regulatory action. This review provides an overview of the studies that investigated the possible hypoglycemic effect of GLP-1 receptor agonists. In addition, the current review describes other adverse effects of GLP-1 receptor agonist treatment.

The changing climate of healthcare and physician training has brought challenges to maintaining appropriate ICU staffing. In order to expand coverage, our pediatric intensive care unit (PICU) transitioned from a traditional resident model to one with critical care trained APPs. There is limited data describing how replacing residents with APPs will effect patient care and the satisfaction and confidence of nursing staff. PICU bedside nurses’ assessment of patient care and overall satisfaction and confidence will remain stable with the replacement of residents with APPs. A pre/post intervention survey. A 14 point questionnaire was emailed to PICU nurses while the ICU was staffed by residents (ER and pediatric; 4-5 per day and 1 per night) and 6 months after residents were replaced by APPs (2 per day and 1 per night). The question format was five-point Likert scale. Pre-intervention responses: 58, post-intervention: 44. Data was assessed using Cochran’s test for linear trend or Fisher’s exact test. The APPs scored statistically higher vs the residents in 12 of the 14 questions that included prioritizing patient care, addressing nurses concerns, knowing the limits of their abilities, time spent with patients, families and nurses, working as a team, and developing a professional relationship with staff. Bedside nurses expressed they had to locate the attending directly, bypassing the APPs, less frequently than residents with more critically ill patients. On two of the questions regarding less critically ill patients, the nurses scored APPs and residents the same. The data supports the concept that in the specialized environment of an academic pediatric ICU, an APP program can be successfully implemented while maintaining bedside nurse satisfaction and confidence. Maintaining (or improving) ICU nurse satisfaction may have indirect benefits of improving the care of both patients and their families as well as reducing nursing turnover, thus lowering healthcare costs.