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Rationale: The aerosolized solid, liquid, mix-phased particles are the Particulate Matter or PM having serious health impacts. In the recent years with the unprecedented situation of COVID-19 pandemic, it became a necessity that the scientific world comes forward with an objective of developing more equipment for air purification with novel technology to combat airborne pathogen, aeroallergen and viruses. We have applied AFLPCO Nanotechnology to build equipment and mask. Methods: We built a fiberglass chamber to evaluate the capacity of the AFL-Mask to prevent entry of particulate matters and pathogens. To evaluate the air in the chamber, we used a LightHouse Handheld Particle Counter to sample airborne particles. We have recorded the particle concentrations at time-intervals to determine the percentage of particles entering the other chamber with the mask placed in the junction dividing the chamber. Results: This mask involves a 4-stage filtration system designed to combat all forms of airborne pathogens including bacteria, viruses, mold spores and harmful VOCs. We found that the AFL-Mask was efficient in preventing any particulate matter including PM2.5, PM10, bacterial and fungal spores and VOCs. Conclusions: The AFL-Mask and AFLPCO air purifiers built for long-term use to improve the inhaled air quality. The ergonomic design with padded lining and straps and improved filtration technology made the AFL-Mask a superior mask that provides a continuous airflow to prevent suffocation, troubled breathing and fluctuating blood pressure, especially pertaining to patients with cardiovascular or pulmonary issues. AFLPCO airpurifers were efficient in improving IAQ.
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Background: Since the onset of coronavirus disease 2019 (COVID-19) in the world, healthcare workers have been exposed to this virus due to their important roles and responsibilities in the care and treatment of patients with COVID-19. In this regard, doing risk assessments in healthcare centres helps significantly to control and reduce COVID-19. Therefore, this study aimed to assess COVID-19 risk and its association with clinical symptoms among healthcare workers in Neyshabur. Method(s): This cross-sectional study was conducted among 483 healthcare workers of Neyshabur medical centres in 2020. In order to collect the data, a checklist consisting of three sections of demographic variables, risk assessment and clinical symptoms was used. Statistical analyses were performed by using the STATA software version 14. The significance level was set at P<0.05. Result(s): The mean +/- standard deviation age of the study population was 34.2 +/- 8.4 years. Out of 483 participants, 55 (11.4%) were identified as high-risk exposure category, 52 (10.8%) as medium-risk category and 77 (15.9%) as low-risk category. According to multiple logistic regression models, it was observed that cough (odds ratio (OR)=2.2;P=0.001), running nose (OR=3.3;P<0.001), suffocation (OR=3.2;P<0.001), shivering (OR=3.4;P=0.001), nausea (OR=3.3;P=0.001), vomiting (OR=7.2;P=0.025), diarrhoea (OR=3.0;P=0.001), muscular pain (OR=2.1;P=0.005), joint pain (OR=2.2;P=0.005) and fatigue (OR=2.1;P=0.003) were significantly associated with risk assessment. Conclusion(s): The findings showed that more than one-fifth of studied healthcare workers were at high or medium-risk exposure of COVID-19. Cough and fatigue had the most frequencies in healthcare workers with high or medium-risk exposure, and also, vomiting and shivering had a stronger association with risk assessment status. Copyright © The Author(s) 2021.
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TYPE: Late Breaking TOPIC: Chest Infections INTRODUCTION: The gold standard for the definite diagnosis of opportunistic infections in the respiratory system is represented by the bronchial biopsy accompanied by the histopathological examination, thus eliminating the suspicion of other diseases at this level. CASE PRESENTATION: In January of this year, a 59-year-old patient presented to the pulmonology department, accusing the sensation of suffocation in supine position, accentuated during the evening, retrosternal embarrassment and epigastric pain. From the patient’s history we remember SARS-COV2 infection, sarcoidosis and cardiac pathology, with outpatient backgroung treatment. The objective examination shows pale, cold skin, sound chest, no bronchial rales. From laboratory data we note slight inflammation, mild neutropenia and anemia. Functional respiratory tests are normal. The sputum examination doesn’t show the pathogenic flora, the Galactomannan antigen is negative. Thus, fibrobronchoscopy with biopsy is performed, the cytohistological result highlighting septate hyphae with sharp-angled branches, conidia and metules of the genus Aspergillus Spp. The evolution during the hospitalization period is favorable under the antibiotic and symptomatic treatment, subsequently following the outpatient antifungal treatment. DISCUSSION: We are facing a case in which establishing an early diagnosis of pulmonary aspergillosis is a challenge, being known that a proper therapy can prevent further complications. CONCLUSIONS: Patients with pre-existing lung disease may contract various infections and the response of the immune system depends on the degree of damage. DISCLOSURE: No significant relationships. KEYWORD: pulmonary aspergillosis
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BACKGROUND: Mental health problems were heterogeÂneously increased among the population groups during the COVID 19 pandemic.1 The pandemic promoted existAîng suicide risk factors such as illicit drugs and alcohol use, access to lethal means, and social disconnectedness.2 According to the CDC, 40% of US adults reported sympÂtoms of depression, anxiety, or increased substance use during COVID-19, and 10.7% of the participants reported suicidal ideation.3 OBJECTIVE: This study aimed to compare suicide rates among adult population (18-64 years old) in Marion County, Indiana in 2019 and 2020. METHODS: Data for 2019 and 2020 was ed from coroners' records in Marion County, Indiana. In 2019 and 2020, a cumulative total of 130 and 157 suicide cases were reported, respectively. We identified 104 adult suicide cases in 2019 and 116 adult suicide cases in 2020 with age range of 18 to 64 years. We analyzed the data for age, race, genÂder, job, marital status and the method of suicide. RESULTS: From 2019 to 2020, adult suicides increased by 11.5%, from 104 to 116 cases. In 2019, cases were highest during the month of January (14.4%). Most cases were white (79.8%). The average age was 39.6 years old and male to female ratio was 3.9:1.1. Almost half of the cases (49%) were unemÂployed and 36.5% were employed. Regarding marital status, 47.1% of those died by suicide were never marÂried, 27.8% were married and 19.2% were divorced. Regarding the method of suicide, gunshot wound was the most common method (58.6%), followed by hangAîng (32.6%), drug toxicity, asphyxiation, and sharp force trauma with 1.9% each. In 2020, cases were highest in January (12%) and December (11.2%). In 2019, most cases were white (76.72%). The average age was 35.7 years old and male to female was 8.6:3. About one third of cases (33.6%) were unemployed and 43.1% were employed. Regarding mariÂtal status, the majority (58.6%) were never married, while 23.2% and 13.7% were married and divorced respectively. The most common method of suicide was gunshot wound (63.7%), followed by hanging (24.1%), drug toxicity (4.3%), and asphyxiation (4.3%). CONCLUSION: Suicide rates among adults increased by 11.5% in Marion County, Indiana. While white males had the highest suicide rates during both years, female suicides increased from 20% in 2019 to 26% in 2020. Average age of those who died by suicide was younger in 2020. A rise in suicide was seen in unmarried and employed individuals. Suicide by gunshot wounds and drug toxicity also increased. Our findings echoed the CDC findings.3 Public health measures which target certain population groups such can mitigate suicide rates during a global pandemic.
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Purpose of Study Sleep-related deaths account for 18.2% of all infant mortalities in Tennessee. In 2019, Shelby County had the highest number of infant sleep-related deaths in the state of Tennessee with 23 cases (22% of all infant deaths in the county). Most occur while in an unsafe sleep environment, including co-sleeping or from suffocation items in the crib. A committee was formed at our tertiary care children's hospital to implement and model safe sleep practices. The purpose of this study is to evaluate the effectiveness of our safe sleep interventions by comparing type and proportion of unsafe sleep practices before and after implementation of a safe sleep policy and staff education. Methods Used Residents and medical students assessed infant (less than 6 months old) sleep practices with a 6-question survey evaluating sleep location, position, and presence of suffocation items. ICU and NICU patients were excluded. Baseline data was collected from May 2019 to January 2020, with the following interventions implemented thereafter: crib cards explaining safe sleep, [ASLR1] recommendations for removal of extra blankets and other items from the crib, an updated hospital policy based on American Academy of Pediatrics guidelines, and online training for staff. Follow up data was collected from May 2020 to October 2020. Further data collection was limited due to the COVID-19 pandemic until February 2021. Summary of Results Data was collected for 105 infants in the baseline group and only 29.5% were sleeping safely: 87.6% were in a safe position, 90.5% were in a safe location, but only 30.5% had no suffocation items in the crib. After safe sleep interventions were implemented, data from May to October 2020 in 46 infants showed a slight decline in safe sleep to 23.9%: 84.8% in a safe position, 89.1% in a safe location, and 26.1% with no suffocation items in the crib. Among 116 infants evaluated from February to August 2021, only 13% were sleeping safely: 83% in a safe position, 77% in a safe location, and 30% with no suffocation items in the crib. Conclusions Overall, infants tend to sleep in safe positions and locations in our hospital, but many continue to have suffocation items in the cribs. Differences in results of the two periods of follow up data could be related to a stricter definition of 'overall safe sleep' for survey responses. Due to lack of improvement after initial safe sleep policy implementation, new interventions, including requirement for a physician order for head of bed elevation, involvement of nursing staff as 'Safe Sleep Champions', and additional education on suffocation items are planned in order to improve safe sleep in our hospital.
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Case report-IntroductionGranulomatosis with Polyangiitis (GPA) is a rare small-to medium-vessel vasculitis associated with anti-neutrophil cytoplasmic autoantibody (ANCA). Its multi-systemic features include pulmonary, ear, nose, and throat (ENT), renal, and neurological manifestations. Its incidence is estimated to be 10.2 cases per million population. It is challenging to diagnose when its symptoms are treated in isolation from one another. This case highlights the difficulty in diagnosing GPA in a patient with respiratory symptoms during the Coronavirus Disease 2019 (COVID-19) pandemic and describes the challenges of managing it in the context of a subsequent COVID-19 infection as the mainstay of treatment remains immunosuppression.Case report-Case descriptionA 78-year-old female non-smoker with a history of leg ulcers developed a 3-month history of cough and haemoptysis and was treated in primary care for suspected sinus and chest infections. She then presented to Accident and Emergency twice for the same symptoms and was discharged after having her antibiotics changed.2 weeks later, she presented for the third time with cough, ongoing haemoptysis, conjunctivitis in the right eye, pain over the right side of her head, and discharge from her right ear. She was admitted as she was pyrexical, tachycardic and her CRP was 60. COVID-19 swabs were negative. ENT team recommended IV ceftriaxone and metronidazole for suspected orbital cellulitis. Blood cultures remained negative. CT sinuses with contrast showed right sided thrombosis of transverse sinus and bilateral mastoid effusion of the middle ear. Following neurology review, she was anticoagulated with dalteparin. A day later, she was transferred to the Respiratory ward and dropped her Haemoglobin level to 70. Her chest radiograph showed diffuse alveolar haemorrhage and CT images showed widespread bilateral peri-hilar consolidation.A rheumatology opinion was sought and vasculitic screen showed ANCA 268, and PR3 >177. Her urinary protein/creatinine ratio was elevated at 90. Rheumatology team confirmed multi-systemic GPA and recommended starting oral Prednisolone 60 mg daily. After the renal team was consulted, she was moved to a side-room and started on IV Methylprednisolone (pulsed with three doses), along with cyclophosphamide and rituximab. Dalteparin was discontinued.2 days later, she desaturated, and became pyrexical. Repeat COVID-19 swabs were positive.Three Consultants agreed that Plasma Exchange and Non-Invasive Ventilation (NIV) would be inappropriate. A Do Not Attempt Resuscitation form was signed, and prognosis was discussed with the patient and her 78-year-old husband who requested to visit. Patient deteriorated and unfortunately died 6 days later.Case report-DiscussionThis case is interesting because it highlights the diagnostic challenge of GPA. Retrospectively, it may be noted that doctors persisted in treating suspected infection although the patient continued to deteriorate. However, a diagnosis should be re-considered if the patient does not respond to treatment and it is important to consider vasculitis as a cause of haemoptysis.Anticoagulation was started since the benefits were considered to outweigh the risks as her haemoptysis was of small volume. The patient soon developed pulmonary haemorrhage, so the risks of anticoagulation should not be underestimated in vasculitis.The Rheumatology team's cautious approach to immunosuppression was in stark contrast to the renal team's aggressive approach. The Renal team believed that concerns about protecting the patient from COVID-19 when she was negative from this infection should not take precedence over appropriate immunosuppression from a potentially fatal vasculitis.The patient was admitted at the start of the COVID-19 pandemic and was negative for COVID-19 on admission. She was nursed in a bay on the Respiratory ward where she later became COVID-19 positive. This raises questions about whether the earlier test was a false negative result or whether her infection was hospital-acquired. Infection cont ol guidelines were changing rapidly at the start of the COVID-19 pandemic.The decision to avoid plasma exchange was based on the findings of the PEXIVAS trial. NIV was avoided as it required a full-face mask to minimize particle dispersion but would pose an asphyxiation risk as patient was coughing up blood.Finally, the team learnt to be flexible in these extraordinary circumstances when dealing with the end-of-life decisions of the COVID-19 positive patient. Although her husband was a vulnerable person because of his age, he was given the opportunity to visit while wearing Personal Protective Equipment and agreed to self-isolate for two weeks.Case report-Key learning pointsThis case helped me appreciate the complexity of deciding to immunosuppress an already severely ill patient in the context of the COVID-19 pandemic. I recognised that the patient had a poor prognosis with or without immunosuppression and our role as healthcare professionals was to give her the best chance of recovery. The conference will allow me to interact with other colleagues and discuss what they would do in this situation as our Rheumatology and Renal teams had different approaches.After further reading on false negative results, we found that Johns Hopkins researchers found that testing people for SARS-CoV2 too early in the course of infection is likely to result in a false negative test even though they may eventually test positive for the virus.I have also learnt about the PEXIVAS trial which found that the addition of plasma exchange to standard therapy does not reduce the risk for all-cause mortality among patients with severe ANCA-associated vasculitis. Moreover, a reduced-dose regimen of glucocorticoids is non-inferior to a standard-dose protocol, while reducing the risk for serious infections.Diffuse alveolar haemorrhage (DAH) is not treatable with arterial embolization or bronchoscopic methods due to the diffuse nature of the bleeding. Extracorporeal membrane oxygenation (ECMO) has been used to support patients with DAH but the use of ECMO is controversial due to the need for anticoagulation.The conference will help me deepen my understanding of epidemic rheumatology which will be useful for my clinical practice going forward, especially if there is a second wave of the COVID-19 pandemic. I am keen to use this event to engage with other clinicians on immunosuppression in the context of infection so that I may confidently manage similarly complex cases in the future.
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Owing to COVID-19 pandemic, wearing personal protective equipment (PPE) and N95 mask inside an operation theatre has become a common practice. Subjective symptoms of suffocation, headache, dizziness, and lack of concentration while on PPE may at times become significant enough requiring oxygen therapy, removal of mask, or even doffing of PPE, which may increase the risk of being infected and at the same time compromising patient care. The reason behind such subjective symptoms may be multifactorial. We report here a 52-years-old anesthetist with a high body mass index, wearing PPE for a prolonged duration inside an operation theatre during a high-risk surgery encountered a similar episode. Being the lone anesthetist, he decided to oxygenate himself in an innovative way, thus, avoiding doffing and any undesirable event. With pandemic expanding rapidly such scenarios may be encountered often, identifying factors predicting such events and finding methods of oxygenation while wearing PPE may be extremely beneficial.