Direct primary care (DPC) is an emerging model of care distinguished by lower price points for quality comprehensive services. The affordability of DPC attracts a broad patient population that may encompass a wide range of socioeconomic needs. It is critical to identify social determinants of health (SDH) in DPC practices to design strategies aimed to mitigate social risk factors, especially for vulnerable populations that can only afford DPC. As part of this SDH screening initiative, the purpose of the present descriptive study was to assess the SDH characteristics of patients from an urban DPC clinic. To identify these SDH factors, a cohort of 31 patients from the DPC clinic was asked to complete a questionnaire from the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE). The survey outcomes revealed top socioeconomic needs in the domains of stress (77.4%), insurance (51.6%), social integration and support (38.7%), unmet medicine or healthcare needs (35.5%), and unemployment (32.2%). In adopting a community-based participatory research (CBPR) approach, the research team shared the survey outcomes with the DPC clinic to facilitate improvements in overall patient care and implementation of services aimed to address social risk factors as identified in the study.

Introduction: Hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome is a leading cause of maternal mortality. The emergence of Coronavirus disease 2019 (COVID-19) has led to challenges in diagnosing HELLP syndrome due to overlapping clinical and laboratory presentations. We report a case of HELLP syndrome complicated by COVID-19 infection. Case Description: An otherwise healthy pregnant 31-year-old female presented with fever, myalgia, and headache. She was found to be COVID-positive with laboratory signs of HELLP syndrome. Symptoms and laboratory findings trended toward normal post-partum confirming the diagnosis of HELLP syndrome. Discussion: A prompt diagnosis of HELLP syndrome is essential to avoid maternal and fetal complications. Clinicians should be aware of the similarities in presentation between HELLP syndrome and COVID-19 for timely diagnosis and treatment.

To the Editor: The COVID-19 pandemic led to a tragic loss of life and an economic collapse that rivaled the Great Depression. During the early stages of the pandemic, the detrimental health effects of

Purpose: Coronaviruses (CoV) are single-stranded RNA viruses that transmit from animal species to humans, causing a threat to global health. We aim to summarize common imaging findings of 3 betacoronaviruses (b-CoVs) and the common clinical manifestation, to provide a better understanding of the courses of the disease. Material and methods:The Pubmed and Google Scholar databases were searched for the terms "SARS-CoV" OR "COVID-19" OR "MERS-CoV". Imaging-specific searches included keyword searches for "CT" AND "imaging". Clinical presentation-specific searches included keyword searches for "clinical" AND "manifestation" AND "cardiovascular" OR "neurology" OR "gastrointestinal" OR "hematology". In total, 77 articles were selected for discussion in the current literature review.Results: Human b-CoVs infection presented consistent indications of ground-glass opacities (GGO), consolidation, and interlobular septal thickening. Pleural effusion was also common in all 3 b-CoVs, but it was least present in SARS-CoV-2 infection. Bilateral lung involvement was common to both MERS-CoV and SARS-CoV-2 infection. Cardiovascular, neurological, haematological, and gastrointestinal were common clinical presentations found in patients infected with b-CoVs. Conclusions:The comparison of imaging findings can be applied in clinical practice to distinguish the 3 CoV through different imaging modalities. It is crucial to understand the possible imaging findings and clinical presentations to better understand the course of the disease as well as prepare for future variants.

Direct primary care (DPC) is a growing model of care that is suggested as an alternative to traditional fee-for-service healthcare. Patient-reported experiences of DPC can provide unique insight into the impact of joining the model and inform quality improvement. The purpose of this study was to investigate patient perceptions of DPC. Thirty-one participants were initially recruited for the study and completed a survey assessing patient demographics. Of the 31 participants, 10 went on to complete the focus group interviews. Qualitative analysis of focus group transcripts identified common themes and subthemes. Focus group findings were stratified into 4 themes including quality of care, access to care, affordability, physician qualities, and reasons for choosing DPC. The top positive subthemes were good communication, joining DPC due to poor past healthcare experiences, and physician personability. The most common negative subthemes were difficulty referring to specialists outside the practice, poor communication, and poor access to medications. All findings were presented and discussed with the investigated clinic to facilitate improvements in healthcare delivery.