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Background: Spondyloptosis is caused by high force trauma. The vast majority of cases occur in the sagittal plane and at transition points where ridged sections meet more flexible regions. Lateral thoracic spondyloptosis is extremely rare and there is no current consensus on the optimal treatment plan. Case Description: Here we present a case of a previously physically healthy 24-year-old polytrauma patient after he was struck as a pedestrian by a motor vehicle. Of note the patient was found to have lateral spondyloptosis between T9-10 with complete spinal cord transection. The patient also sustained multi-ligamentous left knee injury, pelvic fractures, open comminuted left tibia and fibular fracture, lacerated liver, bilateral renal lacerations, ischemic bowel, and an aortic arch pseudoaneurysm. Conclusion(s): Lateral thoracic spondyloptosis is a devastating injury with an extreme rate of persistent neurologic deficits. There is no unanimously accepted treatment because of the rarity if the injury and the poor outcomes that patients face. Additionally, patients who experience high level trauma often develop severe psychiatric illness, and the importance of identifying risk factors and implementing care early may improve patient outcomes.Copyright © AME Medical Journal.
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Objective: Lateral femoral cutaneous neuropathy or meralgia paresthetica (MP) occurs for various reasons. MP developing after spine surgery is not uncommon and is mostly due to the prone position during surgery or iliac graft harvesting. However, it is usually overlooked due to mild symptoms and a self-limiting course. The purpose of this study was to present a case series of five patients who were followed up with conservative treatment for vertebral fractures and developed MP after prolonged use of lumbar braces. Materials and Methods: The sample comprised five patients with thoracolumbar fractures who did not meet the surgical criteria of the Thoracolumbar Injury Classification and Severity score and who were advised to use lumbar braces for 8 weeks and to return to the outpatient department. These patients did not present for follow-up due to the coronavirus disease-2019 (COVID-19) pandemic and continued to use the lumbar brace for more than the advised 8 weeks. A retrospective evaluation of age, sex, body mass index (BMI), comorbidities, and duration of brace use was conducted. Results: Three of the five patients were male with an average age of 61±18 years, average BMI of 29.3±4.8 kg/m2, (after excluding the young and normal-weight patient, the average age and BMI increased to 70±5 years and 31.6±1.5 kg/m2, respectively), and an average brace use duration of 18.4±3.2 weeks. Three patients presented with MP on the left side. Conclusion: Although tight-fitting pants/corsets/belts/body armor can cause MP, no cases of MP caused by lumbar braces used for conservative treatment of vertebral fractures have been reported. This case series arose from the effects of COVID-19, as the patients wanted to stay home. ©Copyright 2021 by the Turkish Spine Society / The Journal of Turkish Spinal Surgery published by Galenos Publishing House.
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Background: Recently, the COVID-19 spread has been drastically increasing worldwide at a breakneck pace. It has resulted in an unparalleled trial in education. Mostly, all educational institutes have announced their closure to adhere to the government guidelines and have adopted the online learning and teaching mechanism. To look at the optimistic side of this epidemic, we see that people have come up with advanced skills and technologies, new modes of learning, contemporary perspectives, and countless new trends to provide seamless educational services even during this crisis for a better tomorrow. Objective(s): Survey school and college students after online education and adhere to the government guide-lines. Method(s): We directed questionnaires and conducted surveys by 4 members using online mode by Google form, and the data were analysed using mean and percentage. Result(s): This survey started on 1st June 2021. During the lockdown period, most students responded through online mode, while some gave their responses in off-line mode, which effectively limited the research. Students are more likely to be interested in self-study than virtual studies. During virtual study hours, which schools and colleges provide, students use social media on different tabs and pay the least attention to what is tutored. However, due to online exams, they have access to all websites and even their books, so there is a lesser drop in their grades, making them believe in more unrealistic things in life. Students learn to become dishonest, but some parents continue supporting them in their treacherous behavior just for the sake of grades. Therefore, the major belief of students is that online exams are useless. Scarcely any learner who gives an honest exam gets intimidated as the results are biased and hence em-braces the pathway of bypass. However, amidst all of these, post-COVID-19 currents may allow us to visualize new learning techniques in India and make people more aware of the foreseeable future. In this research, we include school as well as college students. We have received 3120 responses from students. Conclusion(s): This article discusses that during the COVID-19 crisis, students adopted the learning mode and what is the impact of COVID-19 on the education system.Copyright © 2022 Bentham Science Publishers.
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Case Diagnosis: Critical Illness Polyneuropathy following COVID-19 Infection Case Description or Program Description: A 58-yearold female presented to PM&R clinic following a prolonged hospitalization for COVID-19, after which she developed bilateral wrist and foot drop. Prior to her hospitalization, she ambulated independently. At the time of evaluation, she was wheelchair bound. Physical exam demonstrated bilateral wrist and foot drop, with bilateral foot numbness. EMG demonstrated bilateral common peroneal incomplete axonal neuropathy, with bilateral incomplete axonal brachial plexopathy affecting mainly the lower trunk on the left side and the middle cord on the right side. Setting(s): Tertiary-care teaching hospital Assessment/Results: Outpatient physical and occupational therapy were initiated and she was prescribed bilateral ankle foot orthoses. She was referred to neurology, with diagnosis of multifocal axonal neuropathy, with critical illness polyneuropathy, post viral (COVID) immune axonopathy with mononeuritis multiplex. Repeat EMG obtained 8 months later demonstrated mild improvement on the needle study with decreased denervation potentials of the muscles tested however, NCS remained unchanged. Over a 1-year span of therapy, her strength, function and numbness improved. She progressed to ambulate independently without an assistive device. Discussion (relevance): Critical illness polyneuropathy (CIP) is a neurologic manifestation of systemic inflammatory response syndrome, causing axonal injury by unclear mechanism. It is suspected that distal nerve microcirculation causes ischemia and axonal degeneration. There are increasing reports of polyneuropathy following COVID-19 infection. Diagnosis involves EMG, which demonstrates axonal loss without demyelinating features, with NCS showing decreased amplitude of SNAPs. CIP treatment includes reduction of dose and duration of steroids and neuromuscular blocking agents, rehabilitation programs, and careful extremity positioning. Conclusion(s): Our patient experienced functional improvement with conservative management, including outpatient physical and occupational therapy with bracing. As the COVID-19 pandemic continues, CIP must be considered in patients with weakness and a history of COVID-19 infection, particularly in those with severe infection and ICU stay.
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Case Diagnosis: Covid-19 Pneumonia with Guillain Barre Syndrome. Case Description or Program Description: A 53-year-old female with history of tobacco use presented to the ED after a week of bilateral leg weakness, ascending to the arms, and difficulty swallowing. Covid test was incidentally positive. She had 1+ upper extremity and absent lower extremity reflexes, and was admitted with clinical diagnosis of Guillain Barre Syndrome (GBS). Patient was pre-medicated with lorazepam and diphenhydramine prior to initiation of IVIG. Ten minutes into the infusion, she became acutely and persistently hypoxemic, requiring transfer to ICU with intubation and proning. CT Chest showed bilateral aspiration with collapse of posterior lobes. Thus, respiratory failure attributed to bulbar weakness. GBS was later confirmed by LP, EMG, and MRI Spine. Setting(s): Tertiary to inpatient rehabilitation hospital. Assessment/Results: Patient completed 5 day course of IVIG, and empiric treatment with Dexamethasone and Remdesivir. Her course was complicated by two bacterial pneumoniae and failed extubation requiring tracheostomy. At time of transfer to inpatient rehab, she received her first Covid vaccine and experienced only commonly reported side effects. She was successfully decannulated. Patient made excellent progress with PT and OT, progressing from Moderate Assistance to Independent levels. She had residual right plantarflexion weakness that benefited from a posterior leaf spring (PLS) brace. She ultimately discharged home with family. Discussion (relevance): Development of GBS with a Covid-19 infection or post-vaccination has been described in the literature, but as this case demonstrates, temporal association does not imply causation. Furthermore in this case, decreased mental status due to sedating medications in the setting of dysphagia led to massive aspiration, leading to a prolonged hospital course. Conclusion(s): In Covid patients with concurrent GBS, heightened vigilance is required for rapidly weakening swallowing and respiratory muscle dysfunction, compromising Covid-infected lungs. Special attention is necessary for the medical care and rehabilitation of these dual diagnosis patients.
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BACKGROUND: In 2020, no consensus or guidance existed for managing COVID-19. Many PCP offices were forced to close. CANO kept clinics fully staffed and open, and published two articles on best practices for treating COVID-19 (5,6). CANO is a PCP network caring for underserved Medicare Advantage (MA). Growing from a single clinic (1) to ∼130 centers in < 6Y, CANO focused on 'treatable' gaps in: chronic disease management, HEDIS measures, and clinical inertia. CANO results have been extraordinary (2-6). Here we describe initiatives and strategies to navigate care delivery through the pandemic. METHODS: Tracking COVID-19 Cases-Bracing for Surges. A dedicated CANO COVID Task Force (CTF) collected data on 38,193 patients. Detection of 'surges' reliably predicted need to restock COVID-19 medicines, allocate staff, and communicate updates to staff and patients. The CTF collected data on COVID-19 infections, admissions, ER visits, patient deaths, etc. RESULTS: Staff Retention. The CTF performed much of COVID-related care and research, PCPs provided routine care with little interruption. Development of Published COVID-19 Treatment Algorithm. Data came directly from CANO EMR (5) and literature review (6). Application of the treatment algorithm led to a 60% lower outpatient COVID-19 mortality vs national average (P < .05) (7). At-Home COVID Care. Televisits;in home visits including testing, vaccination, treatment;home delivery of pulse oximeters, prescriptions and oxygen. Vaccination Program. A telephone campaign resulted in a vaccination rate of 83.8% vs. Florida average 74.9% as of Dec 31, 2021(7). Resumption of In-Person Clinic Visits. Dedicated Retention Team drove the return to in-clinic visits from 6% in April, 2020 to >90% by December, 2021. Impact of Real time monitoring. The collection and monitoring of data by the CTF through CANO's proprietary population health platform, Cano Panorama (R), facilated strategic planning and allocation of resources. Repurposing of staff. Associates were repurposed due to reduced in office visits to various teams. These teams included dedicated CTF call center, retention team, CANO at Home staff. CONCLUSIONS: Key Lessons for Dissemination: CANO platforms have served well during the crisis presented by the pandemic as in routine care. CANO has quickly put into systems and platforms that place highly effective and reproducible strategies to reduce the burden of COVID-19, improve disease course and survival, and, renormalize care.
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Objective: To determine patient concerns and anxiety regarding orthodontic treatment and appointments during COVID-19 Pandemic Methodology: After approval from Sharif Medical Research Center (SMRC) and the Ethics Committee of Sharif Medical City Hospital (SMCH), 247 orthodontic patients were selected from the Orthodontics Department of SMCH, Lahore, who had ongoing orthodontic treatment. The total duration of the study was two and a half months from 12th March to 30th May 2021. Data was analyzed by IBM SPSS version 25. Percentages of the responses in each domain of the questionnaire were calculated. Chi-square test, one-way ANOVA and Pearson’s correlation coefficient were applied where applicable to determine the significance of associations between different variables, with p<0.05 taken as significant. Results: Two hundred and forty seven patients were sent the questionnaire links, while 213 patients responded, out of which 132 were females and 81 were males, with mean age 22.81±2.93 years. Anxiety about the coronavirus pandemic ranged from 5.32 ±2.30. Patients were particularly concerned about the length of time it would take to complete their orthodontic treatment as a result of quarantine (55.9 percent). 5.68±2.15 was the mean anxiety level. Conclusion: The quarantine recommended due to the COVID-19 pandemic impacted orthodontic appointments and patients' anxieties and anxiety, since a statistically significant correlation was established between quarantine and coronavirus sentiments and orthodontic appointment willingness. Males were more willing to get braces than females. Delay in treatment end, bracket breaking, and growing malocclusion were patients' top concerns. Patients said the most critical precaution in orthodontics was changing the dentists' disposable lab coats after every visit to avoid cross-contamination.
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STUDY DESIGN: Observational Cohort study. OBJECTIVES: We aim to document the abandon and irregular compliance rate towards brace treatment during the COVID-19 pandemic and its impact on AIS progression. METHODS: We reviewed a database of AIS patients recruited between March and September 2020. We included AIS patients under brace treatment according to SRS criteria. The patients were divided in 2 cohorts: those with self-reported Good-Compliance (GC) to treatment and those who had a Bad-Compliance (BC). Data analysis included biometric and radiographic data at first visit and last follow-up and percentage of progression. Unpaired student-t tests and Chi2 were used for comparison. RESULTS: 152 patients met inclusion criteria. 89 patients (age:12.1y.o.±1.4) reported good adherence to treatment, while 63 patients (age:12.7y.o.±1.8) were not compliant. Within the BC group, 18 patients reported irregular brace wear, while 45 had completely abandoned treatment (abandon rate of 29%). The GC cohort started treatment with a mean main thoracic (MT) curve of 26° and finished with 27°. The mean difference between measurements was +.65°±7.5; mean progression rate was -4.6%. However, the BC cohort started with a mean MT curve of 27° and finished with 32°, with a mean increase of +5°±8 and a mean progression rate of -13%. The differences between the 2 cohorts were statistically significant (P = .0002). Six patients from the BC group progressed and were offered surgery. CONCLUSION: The abandon rate of brace treatment in AIS significantly increased during the first wave of COVID-19 pandemic. Patients who voluntarily discontinued treatment had significant increases in curve progression and surgical indication rates. LEVEL OF EVIDENCE: III.
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Methods: An experienced yoga therapist and chiropractor collaborated to develop a manualized series of 4 virtual combination yoga and chiropractic classes tailored to the needs of primarily older veterans with chronic back pain. The sessions emphasized education about spine health with practical exercises and other self-care strategies to decrease back pain. Over 4 onehour sessions, a cohort of two to six veterans practiced these chiropractic principles (e.g. postural correction, abdominal bracing, spine sparing strategies), gentle yoga postures, and relaxation and mindfulness exercises, each class building on the one before. Results: Four veteran cohorts were conducted from February 2021 through August 2021. Veterans reported feeling better equipped to manage their back pain and were more active after engaging in these classes. Delivering the classes via telehealth not only facilitated veterans' participation during COVID-19, but also allowed for the inclusion of some rural veterans who often lack access to integrative pain management resources. Other veterans struggled to participate virtually however due to lack of comfort with technology, or not having adequate equipment, or bandwidth. Background: The COVID-19 pandemic has severely limited patients' access to in-person manual (e.g. chiropractic) and complementary and integrative therapies, such as yoga, to manage chronic back pain. We sought to pilot a series of virtual classes combining yoga therapy with education and exercises to improve spine health and increase veterans' selfmanagement of chronic back pain. Conclusion: Challenges in providing in-person spine care during COVID-19 have been overcome by this novel collaboration between chiropractic care and yoga therapy, emphasizing patient education, active care strategies and empowerment of veterans. Future courses will need to consider recruitment efforts as well as providing enhanced technical support to help close the digital divide.
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Purpose: Knee Osteoarthritis (KOA) is a leading cause of physical disability worldwide. Individuals who suffer from KOA experience pain, reduced mobility, and lower quality of life. Considering the upward trend in KOA diagnoses, the economic burden of knee replacement, and the surgical backlog from COVID-19, the need for alternative conservative treatments is pressing. Bracing is an economical and accessible form of conservative treatment. Traditional KOA braces only offload one knee compartment. However, over 50% of the KOA population suffers from cartilage damage in multiple compartments. The Levitation™ “Tri-Compartment Offloader” (TCO) knee brace contains embedded liquid springs that provide flexion support and extension assist to simultaneously offload joint forces in all three knee compartments. Similar to the effect of weight loss, biomechanical studies have demonstrated that the TCO provides clinically relevant reductions in tibiofemoral and patellofemoral joint contact forces ranging between 30-50%. However, there is a need to validate whether the TCO improves real world outcomes in KOA patients. Therefore, the current objective is to examine the influence of a TCO brace on knee pain and function in a population suffering from KOA. Methods: Individuals with KOA who purchased the TCO are being enrolled in the ongoing study following informed consent (n=113). Participants receive 4 online surveys administered using Qualtrics (USA). The first survey is completed before brace wear commences (0-months), and follow-up surveys are scheduled after 1-month, 3-months and 9-months of TCO brace wear. The surveys contain validated questionnaires including the Visual Analog Scale (VAS) for pain, Knee Injury and Osteoarthritis Outcome Score (KOOS), EuroQol 5D-5L, International Physical Activity Questionnaire, Orthotics and Prosthetics Users Survey;as well as custom questionnaires to collect demographic information. This preliminary analysis includes 54 participants who completed the 1-month and 3-months surveys (mean age 55.7±9.1 yrs;43 male). Variables of interest include knee pain (VAS) and function (KOOS). Pain was assessed during four common activities: 1) walking on a flat surface (Flat Walking);2) rising from seated (Sit & Stand);3) going up and down stairs (Stairs);and 4) Squatting. A VAS pain score of 0 represents no pain, and 100 represents the worst pain imaginable. KOOS domains included: 1) Pain;2) Symptoms;3) function in activities of daily living (ADL);4) function in sport and recreation (S&R);and 5) knee-related quality of life (QoL). A KOOS score of 0 represents severe problems, and 100 represents no problems. Statistical analysis was conducted using SPSS (IBM, USA). Pain (VAS score) between timepoints was assessed using four one-way repeated measures ANOVAs with Bonferroni correction for multiple comparisons (α = 0.0125). Post-hoc analyses were used to compare timepoints. Effects of TCO use on knee function were assessed using Wilcoxon's signed-rank test with Bonferroni correction (α = 0.01). Results: Participants wore the TCO for an average of 5.1±3.4 hours/day, and 5.2±1.8 days/week at 1-month and 5.0±3.1 hours/day and 4.9±1.7 days/week at 3-months. One participant did not complete the 1-month survey. Further, two participants did not provide complete VAS responses (Table 1) and a number of participants did not provide answers to all KOOS domains (Table 2). Significant effects of TCO use on pain were observed during all activities (p<0.001) (Figure 1, Table 1). Post-hoc analyses indicated significantly decreased pain for all activities at 1-month (p <0.001) and 3-months (p-value range 0.001-0.01) compared to baseline (0-months). There were no significant differences in pain between 1-month and 3-months of TCO use (p-value range 0.318-1). The scores for all 5 domains of KOOS increased after 1-month and 3-months of TCO brace wear compared to baseline. TCO use resulted in a significant increase in ADL (0-1 months: p<0.001;0-3 months: p<0.001), Pain (0-1 months: p<0.001), and S&am ;R (0-1 months: p<0.002) (Figure 2, Table 2). [Formula presented] [Formula presented] [Formula presented] [Formula presented] Conclusions: This study demonstrates that the TCO brace significantly decreased knee pain for KOA patients when worn during common daily activities. The mean difference in pain scores after 1-month of TCO wear was greater than the minimally clinically important difference (-19.9mm) for all activities suggesting a clinically significant improvement in pain. These significant reductions in pain were maintained after 3-months of TCO wear, demonstrating continued pain management benefits at 3-months. This suggests that the TCO is an effective conservative treatment option over a moderate period of time. Brace usage data indicated good compliance and consistent duration of brace wear between 1-month and 3-months, which could be a result of the continued reduction in knee pain. An improvement in all 5 dimensions of KOOS was also observed, with significant improvements in Pain, ADL, and S&R after 1-month of wearing the TCO. These findings indicate that the Levitation™ TCO brace has a strong potential to manage pain and improve knee function for patients suffering from KOA. Future work includes continued data collection and investigating the effects of the TCO on pain and function in the KOA population over a longer time period.
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Introduction: Schaaf-Yang-Syndrome (SYS, OMIM # 615547) is caused by truncating variants of the paternal allele of the maternally imprinted, paternally expressed gene MAGEL2 in the Prader-Willi critical region 15q11–15q13. Prader-Willi syndrome (PWS) and SYS share several phenotypic features, including muscular hypotonia, developmental delay/intellectual disability, and short stature. Evidence exists that similar to PWS, Growth Hormone (GH) deficiency is also a feature of SYS. Since 2000, GH therapy has been approved by the Federal Drug Agency (FDA) for PWS, which poses the question if GH therapy is a suitable treatment for children with SYS. Objective: To assess the prevalence of GH therapy in SYS children, its effect on the clinical endpoints height and body mass index (BMI), possible side effects and parents’ perception of changes during the therapy. Methods: Twenty-eight individuals diagnosed with SYS were recruited through CP Schaaf and the closed Facebook group for SYS. Patients were sent a consent form, a clinical questionnaire, and asked for growth charts of the affected children. Feedback on muscle strength, endurance and satisfaction was measured on a 5-level Likert scale. Height and BMI Z Scores (defined as the standard deviation of average height or BMI compared to children of the same sex and age) were calculated using WHO/CDC data and the PedZ calculator. The effect size of GH therapy was assessed by calculating the change in Height and BMI Z Scoreover the first 6 months of treatment. Data was(figure presented)(figure presented)linearly interpolated if no measurement on exactly 90 and 180 days after treatment start was taken. Results: Of the 28 individuals enrolled, 14 were on GH therapy. Thirteen of the 14 patient families provided feedback for the changes during therapy. Detailed growth charts were available for 8 patients with GH therapy, as well as for 5 patients without GH therapy. GH treatment was initiated at an average age of 2.6 years (range: 5 months up to 8 years). No patient has had to discontinue or interrupt GH therapy. Parental perception of changes after the onset of treatment was unanimously positive: All families noted either an increase (7 patients) or strong increase (6 patients) in muscle strength. For endurance, feedback was exactly the same. Overall, general satisfaction with the treatment was high, with 8 families stating they were very satisfied, 3 families stating they were satisfied and 2 families being neutral. Additional reported benefits were improved cognitive and social skills (6 patients) and improved motor development (5 patients). Negative side effects included worsening of sleep apnea in one individual which did not require further treatment or intervention, and worsening of scoliosis/kyphosis in further two individuals. In both cases of scoliosis, treatment start coincided with local Covid19 restrictions, and physical therapy and new back braces were no longer accessible for both patients.After three months of GH treatment, Height Z Score of the treated group increased on average by +0.70. After six months of treatment, the average increase in Height Z Score was +0.99 (Fig. 1A and 1B). The BMI Z Score of the treated group decreased by −0.48 after three months and by −0.71 after six months of treatment, on average (Fig. 2A and 2B). We calculated Height Z Scores and BMI Z Scores of the treated and nontreated groups, which revealed average Height Z Scores of −1.1 in the treated group, and −3.5 in the non-treated group (Fig. 1C). The average BMI Z Score in the treated group was +0.47, while the average BMI Z Score in the untreated group was +0.93 (Fig. 2C). Conclusion: We present a retrospective, questionnaire-based assessment of GH treatment in individuals with SYS. Our findings suggest that GH therapy should be considered as treatment for SYS. In this cohort, it led to an increase of body height and parental reports suggested an improvement of endurance and muscle strength. Furthermore, several families also noted additional beneficial sideeffects like im roved cognition and motor development. These data pave the way for a prospective clinical trial of GH therapy for individuals with SYS.
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INTRODUCTION/HYPOTHESIS: As the world braces itself against new variants of SARS-CoV-2, less resource-rich facilities must consider what to do when the surge of critically ill COVID-19 patients requiring mechanical ventilation outnumbers the supply of ventilators. One solution is multiplex ventilation, where a single ventilator supports two patients. Previously proposed scenarios sacrifice volume control for pressure control in the name of safety. However, volume control ventilation, low tidal volumes, high positive endexpiratory pressure (PEEP) and high respiratory rate are key for Acute Respiratory Distress Syndrome (ARDS) ventilator management. We offer a proof of concept for an accessible multiplex ventilation model with volume protective settings. METHODS: Using one parent ventilator, two daughter circuits were improved with a 3D-printed splitter fitted with laser-cut mechanical flowmeters. Resistance valves connected to each flowmeter outflow port attach to the inspiratory limb of the daughter circuit. At the patient wye, a Luer lock attaches a dry arterial line transducer and an end-tidal CO2 monitor. A one-way check valve connects each daughter circuit expiratory limb to a T-piece at the expiratory port of the ventilator. Test lungs were used to assess whether lung-protective settings can be maintained and adjusted by measuring plateau and driving pressures with varying lung compliance. RESULTS: The improved sub-circuit flowmeters and valves allowed monitoring and manipulation of flow to correct tidal volume shifts with changes in patient lung compliance. Dry arterial line transducers reliably measured peak pressure, PEEP, stress index and plateau pressure on a GE monitor. One-way valves prevented expiratory gas rebreathing by the more compliant lungs. CONCLUSIONS: We concede that two patients on one ventilator is not a good idea, but as the COVID-19 pandemic rages on, resource-poor facilities will run out of good ideas quickly. With our solution, volume control ventilation can be employed, pressures measured, alarms set, and volumes calculated and adjusted for each patient. In the spirit of Roosevelt's call to “do what you can, with what you've got, where you are”, we submit that this is a relatively low-tech, inexpensive model that allows ARDS settings with just a few simple parts, anywhere in the world.
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The coronavirus disease (COVID) pandemic has impacted the health sector in massive proportions. Perhaps the worst affected aspect is that of oncological care. Cancer patients continue to suffer silently due to nonavailability of consultations and shortage of operating rooms. We need to brace ourselves for the impact of this backlog of nearly 18 months of neglected care of such patients.