Authors of the BMJ Case Reports stroke case in a COVID-19 patient

Author: ‘We want to thank all the front-line workers at Hurley’

When Smit Deliwala MD heard that his Hurley case had been published in the prestigious BMJ Case Reports journal, his first response was gratitude toward the multidisciplinary teams of health professionals at Hurley, especially since the case involved a COVID-19 patient.

“I realized that people have gone through a lot in this pandemic, especially the nurses, the techs, the aids - and all of the health-care personnel,” he said. “As residents, this is one of the only ways we can thank people, to show them what the medical field has learned, thanks to all of their efforts. … We want to use this publication to thank all the front-line workers at Hurley, who have worked with Hurley employees and COVID-19 patients and families, helping us to provide a multidisciplinary effort during the pandemic."

The case, “Acute confusional state as a prognostic sign of COVID-19 large-vessel occlusion (LVO)” [BMJ Case Rep 2021;14:e240536. doi:10.1136/bcr-2020-240536] involved a 67-year-old Hurley patient with unusual symptoms for stroke, and it exemplifies the importance of multidisciplinary care, which was essential in identifying the diagnosis in this case, he said.

“This was the second case of an unusual stroke presentation in a patient with COVID-19 [for us],” said Deliwala. “The first case, with all of the confusion and the unknowns, took longer to diagnose. With this second case, we were faster with the identification, and that was nice to see.”

The case was interesting – and took a lot of time and effort, he said. “Even Dr [Ghassan] Bachuwa said it was a really tough case. A lot of literature work went into it – there was a lot to read. … We knew it had to be high quality because the journal [British Medical Journal Case Reports, impact factor: 30] is strict. … This just shows that we have some interesting pathology here at Hurley, and there’s always something to learn from.”

Dr. Bachuwa, program director for Hurley's Internal Medicine Residency, is a seasoned researcher with hundreds of publications to his name.

With so many COVID-19 patients during the pandemic, the learning curve was shortened, Deliwala said.

“All the residents involved in the case - we can all identify COVID strokes now.”

Deliwala said research projects and case reports improve your skills as a physician.

“I had very little research experience before residency,” he said. “But Dr Bachuwa – and my program – make you go through the research process. You have to become an expert on the subject. … As a young physician, you can offset the lack of experience to make up that gap in your knowledge and experience by performing research and using those skills. With technology - it's all at your fingertips - you can review all of the stroke cases and become an expert on that topic in a short time. Back in the old days, it would take, like, 2 decades to do that."

This marks the 20th publication for Deliwala, who also has had several regional and national presentations mid-way through his second year of residency training. All of his coauthors have had several publications as well. While it’s a lot of work – especially during a pandemic – research is very doable if everyone does their part, he said.

“It’s kind of like a factory now,” he said. “We have all of the steps down. One has a good eye for cases; one reviews the patient record; one reviews all of the literature. … Once you get going, you want to keep going, you get a knack for different cases.”

Deliwala said he loves research, partly because of key people at Hurley.

“Jennifer Godlesky in the library taught me how to do a lit search,” he said. “I still go to her for certain topics. Jenny LaChance in research - I talk to her every week. The faculty in Internal Medicine … I love Hurley's resources. We have a great setup.”

And, of course, he appreciates the clinical teams who help to diagnose and treat the patients.

“We were fortunate to be supported by a good team, good nurses, good doctors. Teamwork made the difference,” he said.

Deliwala is pictured above with his co-authors. From left are: Deliwala and Hurley IM resident physicians Murtaza Hussain MD, Anoosha Ponnapalli MD, and Dominic Awuah MD, Hurley IM faculty physician Thair Dawood MD, and Hurley IM Residency Program Director Ghassan Bachuwa MD.