Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted the health care system in various ways, one of which is the implementation of telemedicine as a part of the daily clinical practice for many physicians. Sofía is a Mexican health care and technology startup that implemented an appbased telemedicine program during this pandemic in Mexico. Materials and Methods: The telemedicine program included on-demand video consultations with internal medicine specialists from March to September 2020. In the following study, we present a descriptive analysis of all the patients in the telemedicine program, called Coronaid. Results: 2,585 video consultations were conducted for a total of 1,545 patients and 44.4% of these were associated with respiratory symptoms. Of all patients, 46% were female and the mean age was 34 years, 52.2% were overweight or obese, and 25% presented at least one comorbid condition. Aside from respiratory complaints, the most common chief complaints were associated with gastrointestinal, psychiatric, and genitourinary symptoms. Patient satisfaction after video consultation services was >80%. Discussion: During the COVID-19 pandemic, an applicationbased telemedicine program had a high patient satisfaction rate in a significant sample of young patients, which can be attributed to the accessibility of the medical services and widespread use of smartphones in this patient demographic. Conclusion: Telemedicine has proven to be a useful, safe, and effective tool to improve patients' health, which has been boosted by the COVID-19 pandemic. The use of mobile applications and video consultation services can encourage patients to improve their health and prevent complications in the short and long terms.

Cardiac angiosarcoma is a rare and clinically challenging pathology. It is a high-grade primary malignant tumor of the heart tissue that has many variants, of which the epithelioid variant is rarely present in the heart or the great vessels. As with many other cardiac tumors, it is mainly a diagnosis of exclusion and the initial diagnostic test is an echocardiogram followed by a biopsy with immunohistochemistry analysis to ascertain the type of tumor. The differential diagnosis of cardiac tumors is challenging due to the overlapping clinical manifestations with different cardiac tumors and systemic diseases. Cardiac angiosarcomas are often aggressive with a poor prognosis even with treatment. Herein, we present a case of the epithelioid variant of a cardiac angiosarcoma in addition to a thorough review of the recent literature on the clinical manifestation, diagnosis, and treatment of this type of tumors.

Lepidopterism is a term that refers to a spectrum of medical conditions, typically involving the skin, that result from contact with the adult or larval forms of certain butterflies and moths. There are more than 165,000 species of these insects, however, only about 12 species are known to harm humans, most commonly in the form of contact dermatitis. Among these species, the Megalopyge opercularis, commonly called the "Puss Caterpillar", is known to cause a painful and pruritic cutaneous reaction when its venom encounters the skin. Although caterpillar stings are not a common etiology of dermatological rashes, physicians must perform a detailed history and have a high degree of suspicion to arrive to the correct diagnosis and avoid unnecessary medications and therapeutics. We present a case of a 14-month-old boy who presents to the pediatric clinic with a unilateral red rash on the anterior aspect of the left leg, from the distal thigh to the shin. The parents report that the boy was sitting in the park, when he suddenly started to cry. They state that the rash began to spread and that red marks are growing. The patient's parents brought the caterpillar specimen in a bag, clinching the diagnosis. The patient was treated with antihistamine drugs for symptom relief and was recommended to wash thoroughly the area with soap and water. The patient returned to the clinic four days later and the rash had resolved. When encountering an acute onset rash in a patient with recent exposure to nature environments and other open spaces with trees, lepidopterism should be considered in the differential diagnosis and promptly treated. Furthermore, the physician must educate the patients on how to avoid exposure, and special care should be implemented with asthmatic and atopic patients, because although rare, anaphylactic reactions to these stings have been reported.

Background Early identification of different COVID-19 clinical presentations may depict distinct pathophysiological mechanisms and guide management strategies. Objective To determine the aggressiveness of SARS-CoV-2 using symptom progression in COVID-19 patients. Design Historic cohort study of Mexican patients. Data from January-April 2020 were provided by the Health Ministry. Setting Population-based. Patients registered in the Epidemiologic Surveillance System in Mexico. Participants Subjects who sought medical attention for clinical suspicion of COVID-19. All patients were subjected to RT-PCR testing for SARS-CoV-2. Measurements We measured the Period between initial symptoms and clinical progression to COVID-19 suspicion (PISYCS) and compared it to the primary outcomes (mortality and pneumonia). Results 65,500 patients were included. Reported fatalities and pneumonia were 2176 (3.32%), and 11568 (17.66%), respectively. According to the PISYCS, patients were distributed as follows: 14.89% in <24 hours, 43.25% between 1–3 days, 31.87% between 4–7 days and 9.97% >7 days. The distribution for mortality and pneumonia was 5.2% and 22.5% in <24 hours, 2.5% and 14% between 1–3 days, 3.6% and 19.5% between 4–7 days, 4.1% and 20.6% >7 days, respectively (p<0.001). Adjusted-risk of mortality was (OR [95% CI], p-value): <24 hours = 1.75 [1.55–1.98], p<0.001; 1–3 days = 1 (reference value); 4–7 days = 1.53 [1.37–1.70], p<0.001; >7 days = 1.67 [1.44–1.94], p<0.001. For pneumonia: <24 hours = 1.49 [1.39–1.58], p<0.001; 1–3 days = 1; 4–7 days = 1.48 [1.41–1.56], p<0.001; >7 days = 1.57 [1.46–1.69], p<0.001. Limitations Using a database fed by large numbers of people carries the risk of data inaccuracy. However, this imprecision is expected to be random and data are consistent with previous studies. Conclusion The PISYCS shows a U-shaped SARS-CoV-2 aggressiveness pattern. Further studies are needed to corroborate the time-related pathophysiology behind these findings.

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