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The IoT has been a subclass of Industry 4.0 standards that is under research from the perspective of quality of service (QoS) & security. Due to the pandemic situations like novel coronavirus smart healthcare monitoring gained growing interest in detection. In IoT data is communicated from Intra WBAN (Wireless Body Area Network) to inter-WBAN and then beyond WBAN. While transferring data from one layer to the other end-to-end data privacy is the challenge to focus on. The privacy-preserving of patients' sensitive data is difficult due to their open nature and resource-constrained sensor nodes. The proposed research design based on routing protocols achieves the patient's sensitive data privacy preservation along with minimum computation efforts and energy consumption. The proposed model is Secure Communication-Elliptic Curve Cryptography (SCECC) WBAN-assisted networks in presence of attackers is evaluated using NS2. The proposed privacy preservation algorithm uses efficient cryptographic solutions using hash, digital signature, and the optimization of the network. © 2022 The Korean Society for Vascular Surgery.
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SESSION TITLE: Challenging Cases of Hemophagocytic Lymphohistiocytosis SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome involving pathologic immune activation that is often fatal. The link between the cytokine storm related to COVID-19 and development of HLH has been reported since the onset of the pandemic, but little is known about clinical manifestations of HLH, thereby delaying treatment. CASE PRESENTATION: A 50 year-old male presented with a several day history of progressive weakness in the setting of missed dialysis session. Medical history was significant for ESRD on dialysis and diastolic heart failure (EF 35%). Initial vitals were unremarkable. Physical exam was notable for peripheral edema bilaterally. Laboratory studies were consistent with hyperkalemia, elevated ferritin (28,383) and elevated liver function tests. COVID-19 PCR was positive upon admission. Chest x-ray, CTA chest and a right upper quadrant ultrasound were unremarkable. He was admitted to the medical ICU for emergent dialysis. Soon after arrival to the ICU, he became lethargic and confused with increasing oxygen requirements and a subsequent a code blue was called. Cardiopulmonary resuscitation was immediately initiated, with a first rhythm consistent with ventricular fibrillation. He was shocked and placed on an amiodarone infusion with return of spontaneous circulation. TTE revealed a severely reduced EF <10%. Despite initiation of advanced COVID-19 therapies with Solu-Medrol and tocilizumab he remained ventilator dependent. Due to hemodynamic instability and persistent metabolic acidosis, he was transitioned to continuous renal replacement. Further blood work showed worsening inflammatory markers (ferritin 33,500, LDH 6981). Because of the significantly elevated ferritin, there were concerns for possible HLH. Triglycerides and IL-2 receptor were 395 mg/dL and 9300 pg/mL respectively. Total NK cells were decreased to 1.2%. He remained persistently unstable despite aggressive measures. He suffered a second cardiopulmonary arrest, which was unable to achieve return of spontaneous circulation and he ultimately passed away. DISCUSSION: HLH is characterized by uncontrolled activation and proliferation of benign macrophages in reticuloendothelial organs. This results in histiocytic hemophagocytosis, worsening peripheral blood cytopenia(s), cytokine storm, and cytokine mediated biochemical alteration ultimately culminating in multiorgan dysfunction and disseminated intravascular coagulation. Although a distinctive constellation of features has been described for HLH, diagnosis remains challenging as patients have diverse presentations associated with a variety of triggers. CONCLUSIONS: As HLH is a medical emergency with poor prognosis, prompt recognition and early treatment is crucial for improving clinical outcomes. We hope this case will create increased awareness and timely diagnosis of cytokine storm syndromes in patients with severe COVID-19 infection. Reference #1: Meazza Prina M, Martini F, Bracchi F, Di Mauro D, Fargnoli A, Motta M, Giussani C, Gobbin G, Taverna M, D'Alessio A. Hemophagocytic syndrome secondary to SARS-Cov-2 infection: a case report. BMC Infect Dis. 2021 Aug 13;21(1):811. doi: 10.1186/s12879-021-06532-7. PMID: 34388982;PMCID: PMC8361241. Reference #2: Schnaubelt, Sebastian MDa,*;Tihanyi, Daniel MDb;Strassl, Robert MDc;Schmidt, Ralf MDc;Anders, Sonja MDb;Laggner, Anton N. MDa;Agis, Hermine MDd;Domanovits, Hans MDa Hemophagocytic lymphohistiocytosis in COVID-19, Medicine: March 26, 2021 - Volume 100 - Issue 12 - p e25170 doi: 10.1097/MD.0000000000025170 DISCLOSURES: No relevant relationships by Garrett Fiscus No relevant relationships by Niala Moallem No relevant relationships by Resham Pawar
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Coronavirus disease 2019 (Covid-19), a serious disease caused by the Severe Acute Res-piratory Syndrome-Corona Virus-2 (SARS-CoV-2), was firstly identified in the city of Wuhan of China in December 2019, which then spread and became a global issue due to its high transmission rate. To date, the outbreak of COVID-19 has resulted in infection to 230,868,745 people and the death of 4,732,669 patients. It has paralyzed the economy of all the countries worldwide. Considering the possible mutations of SARS-CoV-2, the current medical emergency requires a longer time for drug design and vaccine development. Drug repurposing is a promising option for potent therapeutics against the pandemic. The present review encompasses various drugs or appropriate combinations of already FDA-approved antimalarial, antiviral, anticancer, anti-inflammatory, and antibiotic therapeu-tic candidates for use in the clinical trials as a ray of hope against COVID-19. It is expected to deliver better clinical and laboratory outcomes of drugs as a prevention strategy for the eradication of the dis-ease.
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Background: Physiotherapeutic intervention body positioning have been observed to increase oxygen saturation. In COVID-19 patients, we intended to investigate how the prone position worked in conjunction with conventional respiratory physiotherapy. The objective was to determine the effect of prone position along with conventional respiratory physiotherapy on SpO2 of COVID-19 patients in Aurobindo hospital, Indore district. Methods: The Ministry of Health, Government of India, authorized the rules for collecting data from infected patients. In this study, 400 patients between the ages of 20 and 80 years old were recruited from Sri Aurobindo Hospital in the Indore district, all of them had a confirmed diagnosis of COVID-19 and required oxygen treatment. SpO2 data was collected as a baseline. Patients were helped into the prone position after baseline data collection and conventional respiratory physiotherapy. Clinical data was obtained again after using the prone posture in conjunction with conventional respiratory physiotherapy. To demonstrate the various prone variations, a patient information sheet was supplied. At 0 and 60 minutes after the exercise, oxygen saturation was measured. Results: Between April 2020 to June 2020, we assessed SpO2 of 400 Patients pre and post prone position along with conventional respiratory physiotherapy. Prone positioning was feasible. Oxygenation was significantly improved from supine to prone position. The data were processed for mean and standard deviation. It was analyzed that there was difference in pre to post value of mean, from 95.685 to 98.123 with standard deviation from 1.645to 1.445. The result shows significant improvement in SpO2 after applying prone positioning in patients infected with COVID-19. The findings suggest that prone positioning is both possible and beneficial in increasing blood oxygenation in awake COVID-19 patients. Further study is needed to find the technique's potential value in terms of enhancing overall respiratory and global outcomes. Conclusion: The difference between the saturation of the two position was significant.
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Aim: Winter pressures along with the COVID-19 pandemic, have caused cancellation of elective services, prolonged waiting times, patient dissatisfaction and financial implications. Length of stay (LOS) following joint replacements is variable. The availability of ring-fenced beds and enhanced recovery protocol (ERP) can improve these outcomes. The performance of a stand-alone arthroplasty unit in an acute NHS Trust was assessed regarding safety, LOS and complications. Method: Patient data was collected for total hip & knee replacements (TJAs) between the months of December to March of 2018-19 and 2019- 20. Demographics, ASA, transfusion rates, LOS and 90-day reattendance was analysed. Modified ERP implemented in late 2019 included changes in analgesia and early post-operative mobilisation. The performance was then compared with DGHs within the region. Results: In 2019-20, of 280 TJAs performed, there was a mean LOS of 43 hours. This shows a reduction compared with LOS of 69 hours in 2018-19, where 288 TJAs were performed. In 2019-20, 74% of cases had early discharge within 36 hours of surgery, versus 24% in 2018-19. This accumulates to 333 inpatient days saved. Note that following ERP modification, 6 patients were discharged on the day of surgery. Surgery related complications within 3 months which required reattendance, were seen in only 2 patients. This unit performed an average of 335 TJA's in these winter months, the highest average in comparison to other DGHs in the East Midlands region, which had an overall average of 165 cases. Conclusions: A ring-fenced arthroplasty service with adherence to ERP significantly decreases LOS and increases productivity.
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TOPIC: Sleep Disorders TYPE: Medical Student/Resident Case Reports INTRODUCTION: Excessive dynamic airway collapse (EDAC) and Obstructive Sleep Apnea (OSA) are two entities which could cause significant negative intrathoracic pressure with resulting pulmonary edema. We present a case of obese patient with Down syndrome, severe OSA and EDAC who developed noncardiogenic pulmonary edema. CASE PRESENTATION: A 22-year-old male with a past medical history of Down syndrome, morbid obesity (BMI 44) and severe OSA not on CPAP, was admitted for shortness of breath and an episode of emesis. He was reportedly sleeping at home when suddenly started vomiting and developed severe shortness of breath. On exam, bilateral wheezing and a dry cough were present. He was hemodynamically stable, afebrile, hypoxic with saturation to 80%, requiring supplemental oxygen through a high flow delivery circuit. Labs were significant for WBC 16.1, a negative COVID-19 test, a negative procalcitonin, normal lactate and normal BNP, blood culture negative. Chest X-ray (CXR) showed bilateral pulmonary congestion, and CT of the chest confirmed bilateral diffuse pulmonary edema and showed dynamic tracheal collapse. The patient was aggressively diuresed and was quickly weaned off of supplemental oxygen with aggressive diuresis and was discharged home with recommendations to follow up with his primary pulmonologist for further investigation into the high suspicion for EDAC and for evaluation for CPAP therapy. DISCUSSION: EDAC occurs when there is a greater than 50% reduction of the sagittal diameter of the trachea in forced expiration or while coughing that results in an excessive collapse of the posterior membranous trachea towards the lumen without a collapse of cartilage. EDAC may present with coughing, difficulty clearing secretions, dyspnea, and stridor and often is mislabeled as COPD, asthma, or laryngeal edema. The diagnosis of EDAC can be made through dynamic bronchoscopy or dynamic radiologic imaging, like dynamic CT. An association between OSA and EDAC is theorized to exist, as repeated tension during inspiration against an occluded glottis during sleep may promote the development of EDAC. Moreover, an elevation in dynamic intra-thoracic central airway collapse may be associated with increasingly severe OSA, measured by obstructive respiratory events and degree of hypoxia. Ultimately, pulmonary edema may develop due to the effects of severe hypoxemia and/or extreme negative intrathoracic pressure which may result from severe OSA, with the possibility of EDAC playing a role in certain patient populations. CONCLUSIONS: EDAC is an underrecognized entity that may result in mild symptoms including cough and wheezing, to outright pulmonary edema and respiratory failure. OSA is theorized to be associated with EDAC, but additional research is needed to provide more definitive evidence of the relationship between the two conditions. REFERENCE #1: MURGU, Septimiu D., and Henri G. COLT. "Tracheobronchomalacia and Excessive Dynamic Airway Collapse." Wiley Online Library, John Wiley & Sons, Ltd, 31 May 2006, onlinelibrary.wiley.com/doi/10.1111/j.1440-1843.2006.00862.x. REFERENCE #2: Park, Jisoo, et al. "Successful High Flow Nasal Oxygen Therapy for Excessive Dynamic Airway Collapse: A Case Report." Tuberculosis and Respiratory Diseases, The Korean Academy of Tuberculosis and Respiratory Diseases, Oct. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4620351/. REFERENCE #3: Crowhurst, Thomas David, et al. "Obstructive Sleep Apnoea Is Associated with Dynamic Intra-Thoracic Central Airway Collapse: Results of a 10-Year Multi-Centre Retrospective Analysis." Sleep Science and Practice, BioMed Central, 16 June 2020, sleep.biomedcentral.com/articles/10.1186/s41606-020-00045-z. DISCLOSURES: No relevant relationships by Kamran Manzoor, source=Web Response No relevant relationships by Resham Pawar, source=Web Response No relevant relationships by Nikola Perosevic, source=Web Response No relevant relationships by Meher Singha, source=Web Response No relevant relationships by Evan Wasserman, source=Web Response