An Applied Research Impact Case: U-Trap Refill Design for Preventing Transmission of COVID-19 and Other Infectious Diseases

COVID-19 has sparked a rise in creative inventions to help people adjust to the new normal. To reduce the risk of coronavirus spreading from entering the indoor areas through drainage pipes, a team from the Engineering Discipline of the Hong Kong Institute of Vocational Education has developed the U-trap Refill Automator to assist residents in monitoring the water level in common U-shaped trap drainage pipes while refilling water automatically when the water contained in the U-trap is insufficient. The practice of research-led teaching and research-informed teaching for the benefits of students is substantial in the project. The team practices research-led teaching by sharing the relevant research findings with colleagues and encouraging critique. On the other hand, the research-informed teaching is actualized by the relevant professional development, constructive feedback and guided design. The project is an interplay between research and teaching in that building synergies between research and teaching should be a central element of excellence. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Marginal Artery of Drummond Pseudoaneurysm Masquerading as Fistulous Tract Resulting in Recurrent Lower Gastrointestinal Bleeding

Introduction: The mortality rate of patients hospitalized with a lower gastrointestinal bleed has been reported at 1.1% in the United States from 2005 to 2014. Pseudoaneurysms, typically associated with pancreatitis, have been described in case reports as a rare condition with a small subset presenting as gastrointestinal bleeding. Our study describes a rare case of recurrent lower gastrointestinal bleeding diagnosed as a pseudoaneurysm by endoscopy and angiography. Case Description/Methods: A 38-year-old male presented to our facility from a long-term care facility with hematochezia and blood clots per gastrostomy-jejunostomy. He had recently been hospitalized for severe coronavirus disease 2019 with a complicated hospital course in the intensive care unit including necrotizing pancreatitis with an abdominal drain, multiple secondary infections, tracheostomy, and percutaneous endoscopic gastrostomy-jejunostomy. On previous hospitalization, he was found to have a small pseudoaneurysm of the gastroduodenal artery and received embolization of the gastroduodenal and gastroepiploic arteries at that time. During transport to our hospital, he was noted to have tachycardia, hypotension requiring norepinephrine, and was transfused one unit of red blood cells. Hemoglobin at this time was 7.5 g/dl after transfusion. Esophagogastroduodenoscopy was completed and showed a gastrojejunostomy tube in the expected location but was noted to be tight to the mucosa, which was pale in appearance. Flexible sigmoidoscopy revealed localized areas of edematous and erythematous mucosa with some associated oozing throughout the sigmoid colon. Repeat evaluation was completed one week later due to recurrent hematochezia. Colonoscopy was performed with identification of an apparent fistulous tract in the sigmoid colon located at 35 cm. Computed tomography angiography localized a pseudoaneurysm arising from the marginal artery of Drummond just proximal to its anastomosis with the ascending branch of the left colic artery and was successfully embolized. Discussion(s): Pseudoaneurysms, such as the one described in this case, have been shown to be associated with pancreatitis and can result if a pseudocyst involves adjacent vasculature. Gastrointestinal bleeding is a rare presentation of this condition. However, this case highlights the importance of repeat colonoscopy and angiography in the setting of a lower gastrointestinal bleed of unknown etiology.

Does rapid discharge after breast cancer surgery have an impact on wound healing and complications? COVID-19 pandemic experience.

The COVID-19 pandemic has challenged the health systems worldwide. Because of high volume of COVID-19 patients, all hospitals in our region were re-configured as COVID-19 centres and elective surgery procedures were cancelled. Our clinic was the only active centre in the region and grave increase in our patient volume urged our clinic to modify our discharge protocol. This retrospective study included all breast cancer patients underwent mastectomy and/or axillary dissection, in the Breast Surgery Clinic of Kocaeli State Hospital, a regional pandemic hospital, between December 2020 and January 2021. Patients were mostly discharged the day of surgery with drains because of congestion, while some of the patients had traditional stay, when beds were available. The patients were evaluated postoperatively (the first 30 days) in terms of wound complications, Clavien-Dindo classification grade, satisfaction, presence of pain and nausea, and treatment costs during the follow-up period of the study. Outcomes were compared between early discharged patients and patients who had traditional long stay. Compared with long-stay patients, in the early discharged group, postoperative wound complications was significantly lower (P < .01) with significant cost savings. There were no significant changes in variables such as surgery type, ASA class, satisfaction, need for additional medication and Clavien-Dindo between the groups. Adaptation to an early discharge protocol for breast cancer surgeries may be an efficient way of practicing surgery in a pandemic. Early discharge with drains may be beneficial for patients.

Our ‘Pacific family'. Heroes, guests, workers or a precariat?

Australia launched a Seasonal Worker Programme (SWP) in 2012, shortly after a similar scheme in New Zealand, to bring seasonal workers from Pacific Island Countries (PICS) to work in agriculture. The scheme was seen as a potential ‘Triple Win' with sending and receiving countries, and workers' households, benefiting. Workers' remittances contributed to welfare, especially housing and education, and small business establishment, but there were social costs associated with repeated absences. In 2018, Australia introduced the Pacific Labour Scheme (PLS) to extend guestwork opportunities into other areas of non-seasonal labour shortage such as aged care, tourism and meat processing. The shortage of local labour during COVID-19 demonstrated that Pacific guestworkers were invaluable to Australia, and in 2022 the schemes were revamped and expanded further as the PALM (Pacific Australia Labour Mobility) Scheme. Concern over a Chinese threat in the region gave further support for the expansion. PICs expressed concerns about exploitative practices, while higher rates of participation increased the potential for an incipient brain drain from the PICs, with wages roughly four times those at home, as migrants now left non-agricultural jobs. The expanded scheme continues to favour Australian employers leaving questions over, equity, uneven development and the future of the PICs.

An Evaluation of the Impact of 0.05% Chlorhexidine on the Prevalence of Surgical Site Infections in Aesthetic Breast Surgery

Purpose of Study Surgical site infections (SSI) burden U.S. hospitals with around $1.5 billion annually. To reduce SSI, irrigating the incision with an antimicrobial solution before closure is recommended. Hence, we evaluate the impact of Irrisept, a form of diluted chlorohexidine 0.05%, on reducing the prevalence of SSI in a high-risk breast cosmetic surgery population. Methods Used We conducted a retrospective cohort study using data in the electronic medical record for breast implant exchange patients in one practice and analyzed infection rates between 42 patients from July 2018-June 2019 that did not receive Irrisept irrigation (control group) with 16 patients from July 2019-July2020 that received Irrisept irrigation (experimental group;significantly less due to Covid-19). We executed descriptive analyses, independent T test, ANOVA (for 3 types of incision location), and Chi-squared to assess comorbidities and intraoperative factors. Summary of Results Among the control group (n=42), 4 patients had a postoperative infection;in the experimental group (n=16), 0 had an infection (9.52% vs. 0%;p=0.04) suggesting the use of Irrisept significantly decreases SSI. The p values from the T test and ANOVA (p<0.05=significant) showed no significant differences in breast cancer (0.84), previous radiation (0.32), history of chemotherapy (0.57), obesity (0.40), renal failure (0.32), smoker/previous smoker (0.41), type of implant (0.32), incision location (0.68), acellular dermal matrix use (0.32), or drain use (0.58) between two groups. The only significant comorbidity was diabetes (p=0.04) with 9.52% (control) vs. 0% (experimental). However, greater percentage of experimental group were obese (25% vs.14.29%) and had a history of smoking (25% vs. 9.52%). Conclusions A concern regarding the implementation of Irrisept irrigation is associated costs. However, the results show the use of Irrisept decreases the infection rates, ultimately relieving the financial burden of postoperative infections. Therefore, we recommend irrigating the incisions of breast surgery patients with Irrisept as both a preventative and economic measure.

The Virtual Brain Drain in Turkey: A Qualitative Research on Remote Employees' Experiences in Foreign Firms

The virtual brain drain is an outcome of the strategies global companies have pursued around the world to gain a competitive advantage and reach more qualified employees, mostly with regard to better economical conditions. Virtual brain drain is a situation that occurs with no geographical displacement when considered in terms of cause-and-effect factors and is becoming more common in the world. Although the prevalence of a virtual brain drain has been associated with COVID-19 in consideration of its impact factors, this brain drain is also said to have started before COVID-19. In addition to the pandemic, however, employees' search for flexibility and the desire to meet their different expectations, especially with regard to economic status, have gradually enlarged and strengthened this phenomenon. This study aims to provide a framework for understanding virtual brain drain relevant researchers and policymakers by focusing on the experiences of employees working remotely for foreign companies. The research uses the qualitative methodology and collects data from 11 participants in six different Turkish cities through the e-interview technique. The study analyzes the obtained data using the descriptive analysis technique. According to the results obtained from the study, employees' job searches were observed to have been shaped around economic factors, flexibility, and issues arising from companies, with the factors affecting the work-life balance being expressed more frequently and having a guiding effect with regard to the virtual brain drain.

Recurrent intussusception with ileal perforation as a complication of Blue Rubber Bleb Nevus Syndrome in a pediatric patient

Blue rubber bleb nevus syndrome (BRBNS) is a rare congenital condition, characterized by multiple venous malformations that may involve any organ system, most commonly the skin or the gastrointestinal tract. These lesions are often responsible for chronic blood loss and secondary anemia, and in rare situations may cause severe complications such as intussusception, volvulus, and intestinal infarction. Intussusception as a complication of BRBNS, although a known complication of the disease, has rarely been reported, especially in the Philippines. In the Philippine Society for Orphan Disorders, only 2 cases of BRBNS are currently included in the organization, including the patient presented in the case report. The treatment of BRBNS that involves the gastrointestinal tract depends on the extent of intestinal involvement and severity of the disease. The treatment aims to preserve the GI tract as much as possible due to the high recurrence in the disease. In this case report, we present a 13 year-old male with BRBNS with previous history of intussusception, successfully managed conservatively;however, upon recurrence, underwent exploratory laparotomy wherein a subcentimeter perforation in the antimesenteric border of the proximal ileum was noted, together with a gangrenous intussuscipiens, and multiple mulberry-like formations on the antimesenteric border of the small bowels. Histopathological findings of the resected bowels showed multiple cavernous hemangiomas consistent with BRBNS. The postoperative course of the patient was unremarkable.Copyright © 2023 The Authors

The use of monopolar diathermy in laparoscopic appendectomy, Is it really safe?

Background: There have been numerous techniques used in laparoscopic appendectomy (LA) to divide the mesoappendix, including LigaSure, Harmonic scalpel, clips, endoloop ligatures, Endo GIA staplers, and bipolar coagulation. However, few studies have investigated monopolar diathermy for mesoappendix division. Therefore, this study aimed to assess both its safety and efficacy in LA. Method(s): In this prospective non-randomized study, patients (n = 87) who underwent LA for acute appendicitis were included. The bipolar electrocautery was used for mesoappendix division in the first 33 patients (BC group), while the monopolar electrocautery was used in the next 54 patients (MC group). Result(s): The median operative time was significantly shorter in the MC group (42 min. vs 47 min. in BE group, p = 0.01). One patient converted to open surgery in the MC group due to uncontrollable bleeding. There were no significant differences between both groups regarding postoperative complications and hospital stay (p = 0.91, p = 0.13, respectively). Conclusion(s): Monopolar electrocautery is safe and effective for mesoappendix division in LP in comparison to bipolar electrocautery. However, larger and multicentric studies are required to validate our results.Copyright © 2023 The Authors

Radiologic and Endoscopic Treatment for a Disconnected Pancreatic Duct Syndrome Associated to Percutaneous Pancreatic Fistula: Achieving the "Internalization of the Fistula"

Background and aim: A 40-year-old male was referred to our institute for the management of a percutaneous pancreatic fistula after acute pancreatitis due to SARS-COV2 infection. He developed a peripancreatic collection(PPC) which was percutaneously drained due to infection. After the resolution of PPC, a percutaneous leakage of the main pancreatic duct (MPD) was observed, so he underwent Endoscopic Retrograde ColangioPancreatography(ERCP) with biliary plus pancreatic sphincterotomy and placement of both pancreatic and biliary stent without resolution of the leak. Material(s) and Method(s): Then he was referred to our institution, where initial management included ERCP with placement of two trans-papillary pancreatic stents and the removal of percutaneous catheter, but the fistula kept to drain. Result(s): A multidisciplinary-board decided to perform a rendezvous with interventional radiology to facilitate an endoscopic ultrasound(EUS) trans-gastric drainage of the pancreatic area draining in the percutaneous fistula. Conclusion(s): The procedure included an initial ERCP with replacement of the two pancreatic stents while the radiologist places percutaneously a guidewire through the fistula to the pancreatic point of leakage into MPD. After that, EUS identified the point in which the percutaneous guidewire was getting into the MPD and a trans-gastric EUS-guided insertion of a guidewire achieved the MPD through a 19-Gauge needle. The latter guidewire crossed the percutaneous fistula and came out. At that point, a dilation up to 10 mm was performed to create a trans-gastric pancreatic fistula. The next step was to insert percutaneously a double pigtail(10 Fr) releasing the distal side into the stomach and the proximal side into the main pancreatic duct in order to stabilize the neo-fistula. Another trans-gastric plastic stent was endoscopically placed through the pancreato-gastric neo-fistula. At the end, injection of contrast dye through the percutaneous fistula showed a complete drainage into stomach. In conclusion, the procedure achieved the complete exclusion and resolution of the pancreatic-cutaneous fistula.Copyright © 2023. Editrice Gastroenterologica Italiana S.r.l.

Idiopathic anomalous congenital band causing small intestinal obstruction in a 5-month-old dog

A 5-month-old, intact male, yellow Labrador retriever was presented with a 24-hour history of anorexia and vomiting. Abdominal imaging revealed the presence of a mechanical obstruction in the jejunum and peritoneal effusion. Cytologic evaluation and culture of the effusion prior to surgery identified a suppurative exudate with bacteria consistent with septic peritonitis and suspected to be related to the intestinal lesion. An exploratory laparotomy was performed, and a segment of jejunum was circumferentially severely constricted by an off-white, fibrous band of tissue. Resection and anastomosis of the strangulated segment of jejunum and excision of the constricting band provided resolution of the clinical signs. The dog made a complete recovery. Histologic evaluation revealed the band to be composed of fibrovascular and smooth muscle tissue, consistent with an idiopathic anomalous congenital band. No other gastrointestinal lesions were observed, either grossly at surgery or histologically in the resected segment of intestine. To our knowledge, a similar structure has not been reported in the veterinary literature.Copyright © 2022 Canadian Veterinary Medical Association. All rights reserved.

How Does Servant Leadership Nurture Nurses' Job Embeddedness? Uncovering Sequential Mediation of Psychological Contract Fulfillment and Psychological Ownership

Aim. This research aimed to explore how servant leadership nurtures nurses' job embeddedness by uncovering the sequential mediation of psychological contract fulfillment and psychological ownership. Background. The healthcare of Pakistan is undergoing an acute shortage of 1.3 million nurses. The gap is widening due to unprecedented natural uncertainties (floods, earthquakes, COVID-19, dengue, polio, and monkeypox) and the large-scale brain drain of nurses. Therefore, exploring the underlying factors that could facilitate nurses' job embeddedness is imperative. Methods. A cross-sectional research design was employed, wherein data were gathered in three rounds, two months apart, from 587 nurses employed in public hospitals in Pakistan, and analysis was performed with Smart-PLS. Results. Servant leadership positively influences nurses' job embeddedness and psychological contract fulfillment. Besides, psychological contract fulfillment positively affects psychological ownership, and psychological ownership enhances nurses' job embeddedness. Finally, psychological contract fulfillment and psychological ownership sequentially mediate the relationship between servant leadership and job embeddedness. Conclusions. This research emphasized the vitality of servant leadership in nurturing nurses' job embeddedness. Implications for Nursing Management. Healthcare authorities should keenly focus on promoting servant leadership that shapes the positive perception of nurses about their psychological contract fulfillment and psychological ownership, which are essential resources to cherish nurses' job embeddedness.

Air leak in Covid 19: experience from a DGH in the UK

Introduction: We have previously described pneumothorax (PTX) and pneumomediastinum (PM) in COVID-19. Incidence is approx. 1%, and usually associated with a poor prognosis. Method(s): With Caldicott approval, all patients with Covid-19 with PTX and PM are flagged to the pleural service for ongoing analysis. Demographics and outcomes are collected. Result(s): 46 were identified (Total: 4506, 01/03/20-02/01/22): mean age 57.5 years (range 19-91). 37 (82%) male, 45 white Caucasian, 1 South East Asian, 20 ex-smokers, 8 never smokers, 1 current smoker & the rest unknown. Respiratory comorbidity was most commonly COPD (12), asthma (4), combined pulmonary fibrosis and emphysema (1), previous TB (1), & active lung cancer (1). Average estimated frailty score was 2 (range 1-6). Mean BMI was 28 (range 18.5-46.7), mean height 1.72m (range 1.55-1.84). Average number of days to air leaks is 13.29 patients had PTX [16 isolated PTX (including 6 bilateral)] & 22 had PM (4 isolated PNM). 18 patients had concurrent surgical emphysema. 10 patients were intubated at the time of air leak, 16 on CPAP or HFNC, 13 on oxygen, the rest on air. 32 were managed conservatively. Others had a variety of small, large bore and subcutaneous drains and 1 was transferred for ECMO. There were 10 deaths with 1 directly due to PTX in a 91 yr old, CFS of 6 and intercurrent stroke. 1 was associated with PM, CFS 2 & lung cancer, 1 85 yr old with CFS 4 & COPD, 1 82 yr old with CFS 3 on CPAP & the rest were on mechanical ventilation). Conclusion(s): Inpatient incidence of PTX and PM is still approximately 1%. Survival is better as overall Covid19 survival improves(direct mortality from air leak approx. 21 %) with mortality due to other factors rather than the air leak.

Streptococcus Pneumoniae Purulent Pericarditis

Background Bacterial pericarditis represents < 1 % of all cases of pericarditis in the United States. Most cases of bacterial pericarditis are from contiguous spread from underlying pneumonia or mediastinitis. We present a case of pneumococcal pericarditis in a patient with untreated pneumonia. Case A 54-year-old male with a past medical history of recent COVID-19 pneumonia presented with worsening dyspnea for the past 3 weeks. Vitals were T 99.3, BP 122/93, HR 159 BPM, O2 sat 94% on 3 L NC. ECG demonstrated atrial flutter with 2:1 block. CT scan demonstrated a pericardial effusion and bilateral pleural effusions. Decision-making In the ED, he became hypotensive and bedside echo demonstrated large pericardial effusion with RV collapse. Emergent pericardiocentesis produced 750 cc of purulent fluid. Streptococcus pneumoniae was isolated from the initial fluid aspirate. Right thoracostomy tube was placed with pleural fluid gram stain and culture without bacterial growth. Due to continued purulent drainage from the pericardial drain, repeat CT scan demonstrated persistent pericardial effusion and loculated right sided pleural effusion. He underwent video-assisted thoracoscopic surgery with pericardial wash out and window. He improved and was discharged with 6 weeks of Ceftriaxone. Conclusion Purulent pericarditis is typically a fulminant disease associated with high mortality and rapid progression. Prompt identification and management is critical for patient survival. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Cardiac Angiosarcoma Presenting as Recurrent Pericardial Effusion and Constrictive Pericarditis

Background Malignancy accounts for 15-20% of moderate to large pericardial effusions. Among these, cardiac angiosarcomas are extremely rare. Case A 30-year-old male presented with dyspnea and fatigue, 9 months after COVID-19 infection. He had sinus tachycardia (117 beat/min). Chest X-ray showed cardiomegaly. Echocardiogram demonstrated a large circumferential pericardial effusion with right ventricular collapse. Decision-making Pericardiocentesis yielded 850 ml of bloody fluid, with symptomatic relief. He was discharged on colchicine and indomethacin with a presumptive diagnosis of post-viral pericarditis. A month later, he had recurrent symptoms and re-accumulation of large circumferential effusion. CT chest revealed multiple pulmonary nodules and bilateral pleural effusions. He underwent subxiphoid pericardial window and pleural biopsy. Fluid analysis and biopsy results were inconclusive. Over 3 weeks, he had worsening symptoms, despite a daily pericardial drain output of ~200 ml. Repeat echocardiogram showed loculation of the effusion with signs of constrictive pericarditis. He underwent pericardiectomy. Pathology revealed cardiac angiosarcoma. FDG PET scan showed thoracic metastasis. Anakinra was initiated. Conclusion Idiopathic and post-viral etiologies are the most common causes of pericardial effusion. Although rare, cardiac angiosarcoma should be on the differential diagnosis for recurrent pericardial effusion. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Risk Perception and Level of Perceived Work Stress among Sanitation Workers: A Cross Sectional Study

Background: The COVID-19 pandemic increased the workload of municipal and garbage collectors, increasing their levels of exposure to health hazards. Hence, we aimed to assess the risk perception and level of perceived work stress among sanitation workers during of COVID 19 pandemic. Method(s): This cross-sectional descriptive study was conducted among domestic waste collectors and cleaners of Oulgaret Municipality, Puducherry, during January-February 2021. Convenient sampling was used. Workers engaged garbage collection, street sweeping, cleaning of drains and public toilets were included. Telephonic interviews were carried out using a structured questionnaire. Result(s): A total of 120 workers were interviewed. The mean (SD) age of the male participants (N= 36) was 45.4 (9.8) years;and 46.4(8.5) years for females (N=84). All the workers reported adherence to hand hygiene practices and wearing masks and gloves. 26.6% felt that public non-compliance to solid waste management rules was a major risk. The participants (24.1%) found the public to be abusive and fault finding and 20.8% of workers mentioned that the public were empathetic, cooperative, and generous. Almost one-third (32.5%) worked without holidays, and 21.6% reported the supply of PPE was irregular post lockdown. Although the Municipality arranged transport for the majority of the workers to commute to and from work during the lockdown, a small number (13.3%) had traveled to work on their own. 58.3% had anxiety with regards to contracting the infection, and 25.8% had a fear of spreading infection to family and children. Eagerness to learn more about the pandemic was expressed by 47.5%. Conclusion(s): Public non-compliance to solid waste management rules was perceived as a major risk, and more than half of the workers expressed anxiety during the Covid pandemic lockdown. Strengthening the Municipal workers' social security schemes to compensate and protect them in areas of high levels of exposure needs immediate attention.

A Case Report of Normal Pressure Hydrocephalus Developing After COVID-19 Infection.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) has been reported to cause significant injury to the central nervous system (CNS). Herein, we describe the case of a 48-year-old male with a past medical history of attention-deficit/hyperactivity disorder (ADHD), hypertension, and hyperlipidemia who developed typical symptomatology of normal pressure hydrocephalus (NPH) with cognitive impairment, gait dysfunction, and urinary incontinence after a mild coronavirus disease (COVID-19) infection. The diagnosis was confirmed by imaging and lumbar puncture (LP). The patient was treated with a ventriculoperitoneal (VP) shunt placed by neurosurgery and had a complete recovery. Despite increasing reports of neurological manifestations of COVID-19 infection, the mechanism of such pathology is still not well understood. Hypotheses include viral invasion of the CNS either through the nasopharynx and olfactory epithelium or directly through the blood brain barrier.

The COVID-19 pandemic and health workforce brain drain in Nigeria.

Over the years, the Nigerian healthcare workforce, including doctors, nurses, and pharmacists have always been known to emigrate to developed countries to practice. However, the recent dramatic increase in this trend is worrisome. There has been a mass emigration of Nigerian healthcare workers to developed countries during the COVID-19 pandemic. While the push factors have been found to include the inadequate provision of personal protective equipment, low monthly hazard allowance, and inconsistent payment of COVID-19 inducement allowance on top of worsening insecurity, the pull factors are higher salaries as well as a safe and healthy working environment. We also discuss how healthcare workers can be retained in Nigeria through increment in remunerations and prompt payment of allowances, and how the brain drain can be turned into a brain gain via the use of electronic data collection tools for Nigerian health workers abroad, implementation of the Bhagwati's tax system, and establishment of a global skill partnership with developed countries.

Research on the relationship between architectural features in northeast China and vertical aerosol transmission of COVID-19.

During the COVID-19 pandemic, many buildings in northeast China have had clusters of infected cases in the vertical layout. There is speculation that vertical aerosol transmission occurs. The houses in northeast China are airtight, and range hoods may be used for a long period of time when cooking. The pathway and factors influencing vertical aerosol transmission are worth studying. To elucidate a viral aerosol transmission pathway, we selected a multistory apartment and a high-rise building in Changchun city, Jilin province, China, to conduct an in-depth investigation and on-site simulation experiments. According to epidemiological investigation information on infected cases, building structures, drainage, ventilation, etc., we used fluorescent microspheres to simulate the behaviors of infected people, such as breathing and flushing the toilet after defecation, to discharge simulated viruses and track and monitor them. The field simulation experiment confirmed the transmission of fluorescent microsphere aerosols to other rooms in two types of buildings using a vertical aerosol transmission pathway of toilet flush-sewage pipe-floor drain without a water seal. Our study showed that, in the absence of a U-shaped trap or floor drain water seal whether in a multistory apartment or high-rise residential building, there is a transmission pathway of "excretion of virus through feces-toilet flushing-sewage pipe-floor drain without water seal," which will cause the vertical transmission of viral aerosol across floors during the COVID-19 pandemic. Moreover, the negative pressure generated by turning on the range hood when closing doors and windows increase aerosol transmission. Based on this negative pressure, prevention and control measures for residential buildings in northeast China during the COVID-19 pandemic were proposed.

Spotting the Needle Amongst the Haystack - When Asthma Isn't Asthma

Introduction/Background: Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss Syndrome, is a rare, small to medium vessel ANCA associated vasculitis. Hallmarks of EGPA include asthma, chronic rhinosinusitis, and peripheral neuropathy. EGPA is characterized by a prodrome of asthma and allergic rhinitis, followed by peripheral blood hyper-eosinophilia and accumulation of extravascular eosinophils, and finally systemic vasculitis. Extrapulmonary involvement is common, sometimes with fatal outcomes. The onset of EPGA is typically between 25-50 years;however, EGPA also occurs during childhood and has a significant morbidity and mortality. Description/Method: Our patient presented to the emergency department with a 2-week history of lethargy, wheeze and left sided neck swelling. After testing COVID-19 positive eight months prior to this, she developed wheezy episodes and was subsequently diagnosed with asthma which was managed with bronchodilators as required. She was reviewed by an allergist who confirmed a dust mite allergy and prescribed Montelukast. She remained well during the summer months however during winter she had 3 distinctive episodes of wheeze and cough which were managed by antibiotics and prednisolone. In the emergency department, an echocardiogram was performed which showed a cardiac tamponade. She was transferred to CICU where she had a pericardial drain inserted. The fluid was abundant with inflammatory cells. Multiple investigations were performed as follows: Hb: 135g/L, wbc: 20.30 x 10 9/L, Eosinophils: 12.77 x 10 9/L, CRP: 51 mg/L, ESR: 75 mm/hr, LDH: 1188 IU/L, IgE: 8000 UI/ml, ANA, ANCA: negative. CT chest showed mediastinal lymphadenopathy and patchy bilateral infiltrate and cardiac MRI showed myopericarditis and LV fibrosis. BMA showed no malignant cells and sinusitis was confirmed by CT. On examination, she was underweight. Her nasal mucosa looked inflamed. Otherwise systemic examination was unremarkable. In the context of poor ejection fraction (20%) with LV fibrosis, urgent MDT was arranged and concluded that our working diagnosis was EGPA. The decision was made to start IV methylprednisolone 10mg/kg/day for 3 days and Ivermectin. That night our patient had a VF arrest which required a single shock conversion 4J/kg. There was 7-minute downtime. Treatment was escalated to include cyclophosphamide, rituximab and plasmapheresis. The patient made a remarkable recovery, extubated and transferred to a normal ward. Her eosinophils count and inflammatory markers improved dramatically following treatment. However, she developed severe neuropathic left leg pain and NCS confirmed peripheral neuropathy Discussion/Results: EGPA is a very rare disease and diagnosis can be challenging especially with the absence of histopathology diagnosis. Early empirical treatment especially in a very ill child in intensive care unit can save lives and divert the progress of the disease. This patient has fulfilled the American College of Rheumatology criteria to diagnose EGPA including asthma, eosinophil count > 10% of upper normal, peripheral neuropathy, pulmonary infiltrates on CT thorax and paranasal sinuses abnormalities. Cardiac biopsy of the fibrotic mass may be a useful tool for diagnosis;however, this invasive procedure may expose this patient with high risk of fatal arrhythmias. Since other causes of eosinophilia were ruled out including parasitic infections, lymphoproliferative disorders, and rare primary immunodeficiency syndromes (hyper-IgE syndrome due to STAT3 or DOCK8 deficiency and Omenn syndrome) and the patient responded well to treatment, the diagnosis of EGPA was supported. Key learning points/Conclusion: Asthma not responding to bronchodilator could be another diagnosis Eosinophilia should be interpreted with caution. Defer the need for histopathology diagnosis in critically ill children Cardiac involvement is a life-threatening marker Early diagnosis prevents life threatening complications.