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1.
Clin Simul Nurs ; 2022 Mar 14.
Article in English | MEDLINE | ID: covidwho-2178143

ABSTRACT

Coronavirus disease (COVID-19) required innovative training strategies for emergent aerosol generating procedures (AGPs) in intensive care units (ICUs). This manuscript summarizes institutional operationalization of COVID-specific training, standardized across four ICUs. An interdisciplinary team collaborated with the Simulator Program and OpenPediatrics refining logistics using process maps, walkthroughs and simulation. A multimodal approach to information dissemination, high-volume team training in modified resuscitation practices and technical skill acquisition included instructional videos, training superusers, small-group simulation using a flipped classroom approach with rapid cycle deliberate practice, interactive webinars, and cognitive aids. Institutional data on application of this model are presented. Success was founded in interdisciplinary collaboration, resource availability and institutional buy in.

2.
Sensors ; 23(1):456, 2023.
Article in English | ProQuest Central | ID: covidwho-2200664

ABSTRACT

Herein, we describe the design of a laboratory setup operating as a high-precision tribometer. The whole design procedure is presented, starting with a concept, followed by the creation of an exact 3D model and final assembly of all functional parts. The functional idea of the setup is based on a previously designed device that was used to perform more simple tasks. A series of experiments revealed certain disadvantages of the initial setup, for which pertinent solutions were found and implemented. Processing and correction of the data obtained from the device are demonstrated with an example involving backlash and signal drift errors. Correction of both linear and non-linear signal drift errors is considered. We also show that, depending on the research interests, the developed equipment can be further modified by alternating its peripheral parts without changing the main frame of the device.

3.
Microorganisms ; 10(12), 2022.
Article in English | Web of Science | ID: covidwho-2200528

ABSTRACT

Since influenza and coronaviruses are currently deadly and emerging threats worldwide, better treatment, remediation and prevention options are needed. In that regard, a basic understanding of severe acute respiratory syndrome (SARS)-CoV-2/COVID-19 (Betacoronaviridae) and other viral pathogen mechanisms of transmission are expected. Unfortunately, unprecedented, and growing distrust of vaccines and even masks or personal protective equipment (PPE) in the United States and elsewhere presents itself as an added challenge. We postulate that development of improved and highly effective prophylactic measures, together with new life-saving therapies that do inhibit or otherwise treat infection of SARS-CoV-2, influenza and other viral pathogens, could be an adjunct measure to globally protect vulnerable individuals from pandemic threats. In this review, we share what we learned from the past COVID experience to offer a multifactorial and improved approach to current and future pandemic infections or threats using low-cost means.

4.
Int J Environ Res Public Health ; 20(1), 2022.
Article in English | PubMed | ID: covidwho-2200060

ABSTRACT

While personal protective equipment (PPE) protects healthcare workers from viruses, it also increases the risk of heat stress. In this study, the effects of environmental heat stress, the insulation of the PPE inner-garment layer, and the personal cooling strategy on the physiological and perceptual responses of PPE-clad young college students were evaluated. Three levels of wet bulb globe temperatures (WBGT = 15 °C, 28 °C, and 32 °C) and two types of inner garments (0.37 clo and 0.75 clo) were chosen for this study. In an uncompensable heat stress environment (WBGT = 32 °C), the effects of two commercially available personal cooling systems, including a ventilation cooling system (VCS) and an ice pack cooling system (ICS) on the heat strain mitigation of PPE-clad participants were also assessed. At WBGT = 15 °C with 0.75 clo inner garments, mean skin temperatures were stabilized at 31.2 °C, H(skin) was 60-65%, and HR was about 75.5 bpm, indicating that the working scenario was on the cooler side. At WBGT = 28 °C, T(skin) plateaued at approximately 34.7 °C, and the participants reported "hot" thermal sensations. The insulation reduction in inner garments from 0.75 clo to 0.37 clo did not significantly improve the physiological thermal comfort of the participants. At WBGT = 32 °C, T(skin) was maintained at 35.2-35.7 °C, H(skin) was nearly 90% RH, T(core) exceeded 37.1 °C, and the mean HR was 91.9 bpm. These conditions indicated that such a working scenario was uncompensable, and personal cooling to mitigate heat stress was required. Relative to that in NCS (no cooling), the mean skin temperatures in ICS and VCS were reduced by 0.61 °C and 0.22 °C, respectively, and the heart rates were decreased by 10.7 and 8.5 bpm, respectively. Perceptual responses in ICS and VCS improved significantly throughout the entire field trials, with VCS outperforming ICS in the individual cooling effect.

5.
PLOS Water ; 1(3), 2022.
Article in English | ProQuest Central | ID: covidwho-2197190

ABSTRACT

Shared water facilities are widespread in resource-poor settings within low- and middle-income countries. Since gathering water is essential, shared water sites may act as an important COVID-19 transmission pathway, despite stay-at-home recommendations. This analysis explores conditions under which shared water facility utilization may influence COVID-19 transmission. We developed two SEIR transmission models to explore COVID-19 dynamics. The first describes an urban setting, where multiple water sites are shared within a community, and the second describes a rural setting, where a single water site is shared among communities. We explored COVID-19 mitigation strategies including social distancing and adding additional water sites. Increased water site availability and social distancing independently attenuate attack rate and peak outbreak size through density reduction. In combination, these conditions result in interactive risk reductions. When water sharing intensity is high, risks are high regardless of the degree of social distancing. Even moderate reductions in water sharing can enhance the effectiveness of social distancing. In rural contexts, we observe similar but weaker effects. Enforced social distancing and density reduction at shared water sites can be an effective and relatively inexpensive mitigation effort to reduce the risk of COVID-19 transmission. Building additional water sites is more expensive but can increase the effectiveness of social distancing efforts at the water sites. As respiratory pathogen outbreaks—and potentially novel pandemics—will continue, infrastructure planning should consider the health benefits associated with respiratory transmission reduction when prioritizing investments.

6.
Environ Health Prev Med ; 28:1, 2023.
Article in English | PubMed | ID: covidwho-2196744

ABSTRACT

BACKGROUND: Healthcare workers (HCWs) employed personal protective equipment (PPE) during the COVID-19 pandemic, crucial to protecting themselves from infection. To highlight the efficacy of PPE in preventing environmental infection among HCWs, a systematic review was conducted in line with PRISMA guidance. METHODS: A search of the PubMed and Web of Science databases was conducted from January 2019 to April 2021 using pre-defined search terms. Articles were screened by three researchers. The approved papers were read in full and included in this review if relevance was mutually agreed upon. Data were extracted by study design and types of PPEs. RESULTS: 47 of 108 identified studies met the inclusion criteria, with seven reviews and meta-analyses, seven cohort, nine case-control, fifteen cross-sectional studies, four before and after, four case series, and one modeling studies. Wearing PPE offered COVID-19 protection in HCWs but required adequate training. Wearing surgical masks provided improved protection over cloth masks, while the benefit of powered air-purifying respirators is less clear, as are individual gowns, gloves, and/or face shields. CONCLUSIONS: Wearing PPE, especially facial masks, is necessary among HCWs, while training in proper use of PPE is also important to prevent COVID-19 infection.

7.
BJPsych Open ; 9(1), 2023.
Article in English | ProQuest Central | ID: covidwho-2196609

ABSTRACT

BackgroundCOVID-19 has created many challenges for women in the perinatal phase. This stems from prolonged periods of lockdowns, restricted support networks and media panic, alongside altered healthcare provision.AimsWe aimed to review the evidence regarding the psychological impact on new and expecting mothers following changes to antenatal and postnatal service provision within the UK throughout the pandemic.MethodWe conducted a narrative literature search of major databases (PubMed, Medline, Google Scholar). The literature was critically reviewed by experts within the field of antenatal and perinatal mental health.ResultsChanges to service provision, including the introduction of telemedicine services, attendance of antenatal appointments without partners or loved ones, and lack of support during the intrapartum period, are associated with increased stress, depression and anxiety. Encouraging women and their partners to engage with aspects of positive psychology through newly introduced digital platforms and virtual service provision has the potential to improve access to holistic care and increase mental well-being. An online course, designed by Imperial College Healthcare NHS Trust in response to changes to service provision, focuses on postnatal recovery inspiration and support for motherhood (PRISM) through a 5-week programme. So far, the course has received positive feedback.ConclusionsThe pandemic has contributed to increased rates of mental illness among pregnant and new mothers in the UK. Although the long-term implications are largely unpredictable, it is important to anticipate increased prevalence and complexity of symptoms, which could be hugely detrimental to an already overburdened National Health Service.

8.
BMC Health Services Research ; 23:1-8, 2023.
Article in English | ProQuest Central | ID: covidwho-2196266

ABSTRACT

BackgroundPrimary care is the first point of contact for all acute health problems. As such, primary care was at the frontline in the COVID-19 pandemic, playing a significant role in clinical responses and information to the public. This study aimed to describe the variations in patient management strategies used in the out-of-hours services in different European countries during the first phase of the pandemic.MethodWe conducted a cross-sectional web-based survey in August 2020, selecting key informants from European countries using European networks. The questionnaire was developed in collaboration with researchers in the field of out-of-hours primary care. We performed descriptive analyses per region, structuring results into themes.ResultsKey informants from 38 regions in 20 European countries responded. Seven regions reported that their out-of-hours services had a pandemic preparedness plan, three had trained on the plan, and two had stockpiles of personal protection equipment before the outbreak. Extension of telephone triage lines and establishment of local infection-control teams and clinics were the main patient management strategies. Other strategies for patient contacts were also used in the regions, such as video-consultations (13 regions), electronic consultations (21 regions), patient's car as alternative waiting room (19 regions), outside tents for testing (24 regions), "drive-through” testing (26 regions), and separate departments for infected patients (14 regions).ConclusionFew out-of-hours services were well prepared for a pandemic, but all expanded and reorganized rapidly, adopting new strategies for patient management and treatment. The results could be useful for planning of organization preparedness of out-of-hours primary care service for future pandemics.

9.
BMC Medical Ethics ; 23:1-8, 2022.
Article in English | ProQuest Central | ID: covidwho-2196236

ABSTRACT

Healthcare cybersecurity is increasingly targeted by malicious hackers. This sector has many vulnerabilities and health data is very sensitive and valuable. Consequently, any damage caused by malicious intrusions is particularly alarming. The consequences of these attacks can be enormous and endanger patient care. Amongst the already-implemented cybersecurity measures and the ones that need to be further improved, this paper aims to demonstrate how penetration tests can greatly benefit healthcare cybersecurity. It is already proven that this approach has enforced cybersecurity in other sectors. However, it is not popular in healthcare since many prejudices still surround the hacking practice and there is a lack of education on hackers' categories and their ethics. The present analysis aims to comprehend what hacker ethics is and who ethical hackers are. Currently, hacker ethics has the status of personal ethics;however, to employ penetration testers in healthcare, it is recommended to draft an official code of ethics, comprising principles, standards, expectations, and best practices. Additionally, it is important to distinguish between malicious hackers and ethical hackers. Amongst the latter, penetration testers are only a sub-category. Acknowledging the subtle differences between ethical hackers and penetration testers allows to better understand why and how the latter can offer their services to healthcare facilities.

10.
Journal of intensive care medicine ; : 8850666221148645, 2023.
Article in English | EMBASE | ID: covidwho-2194965

ABSTRACT

BACKGROUND: Data regarding the risk of infection related to reusable bronchoscopes, the global drive toward disposable technology and the COVID-19 pandemic have led to an increase in the use and production of single use or disposable bronchoscopes. An in-depth comparison of all available devices has not been published. METHOD(S): A benchtop comparison of the AmbuaScopeTM, Boston Scientific EXALTTM Model B, the Surgical Company Broncoflex© Vortex, Pentax Medical ONE PulmoTM, and Vathin H-SteriscopeTM (all 2.8 mm inner dimension other than the Pentax single-use flexible bronchoscope (3 mm)) was undertaken including measurement of maximal flexion and extension angles, thumb force required and suction with and without biopsy forceps. Thereafter, preclinical assessment was performed with data collected including experience, gender, hand size, and scope preference. RESULT(S): The Vathin single-use flexible bronchoscope had the biggest range of tip movement from flexion to extension with and without forceps. The Boston single-use flexible bronchoscope required the maximal thumb force but had the least reduction of tip movement with forceps. The Boston single-use flexible bronchoscope significantly outperformed all other scopes including the standard Pentax scope and was the only scope capable of suctioning pseudo-mucus around the forceps. Although there was no significant difference in preference in the overall group, females and those with smaller hand size preferred the Pentax and males the Broncoflex single-use flexible bronchoscope. CONCLUSION(S): Currently available single-use flexible bronchoscopes differ in several factors other than scope sizes and monitor including suction, turning envelope, and handle size. Performance in the clinical setting will be key to their success.

11.
Measurement & Control ; 2022.
Article in English | Web of Science | ID: covidwho-2194683

ABSTRACT

A new way to measure the penetration efficiency of a face mask is introduced. It has a number of advantages over the currently used measurement systems in which a stationary mask is impacted with a moving aerosol during which the upstream and downstream particle concentrations are compared. The equivalent system described here instead moves a mask through a stationary aerosol in a closed chamber and compares the particle concentrations before and after the movement of the mask. This system provides many advantages, such as greater simplicity, greater accuracy, an exact constant aerosol flow speed through a mask, more easily made concentration measurements, more realistic impacts, more controlled averaging, the absence of the need for preliminary impacts during flow stabilization, and a lower cost. A laboratory prototype of the system has been fabricated and seen to perform as expected. Data obtained from this prototype are displayed, analyzed, and used to demonstrate the consistency and repeatability of the system. A portable fully-automated compact prototype has also been designed and fabricated. This device can be easily operated, and the total time required to test a mask, from material insertion to result display, is only a few minutes.

12.
Global Pediatric Health ; 10(no pagination), 2023.
Article in English | EMBASE | ID: covidwho-2194619

ABSTRACT

There has been limited review of the reported deployment of infusion pumps in low- and lower-middle-income countries. This paper aims to identify the current distribution of infusion pumps in low- and lower-middle-income countries (LLMICs) used to treat neonates. A rapid review was conducted using material sourced from ProQuest, Pubmed, Web of Science, and IEEE Xplore. Twenty-six search results met the inclusion criteria. Within these, 41 neonatal healthcare facilities were discussed with 17 of the facilities having infusion pumps available, 13 limited access, and 11 none. Infusion pump use remains limited in Sub-Saharan Africa so efforts should be made to deploy specialist neonatal care improvement packages, potentially including infusion pumps designed for LLMICs. The effects of COVID-19, to neonatal care LLMICs, should be accessed to ensure progress has not regressed. These proposals aim to aid in the continued improvement of neonatal care globally and reduce newborn mortalities. Copyright © The Author(s) 2023.

13.
9th IEEE International Conference on e-Learning in Industrial Electronics, ICELIE 2022 ; 2022.
Article in English | Scopus | ID: covidwho-2191843

ABSTRACT

Covid-19 pandemic hit a giant blow on in-person education. This was especially difficult when teaching laboratory related exercises. In this paper we show that we can treat this hardship as an opportunity, and engage students into creating tools that help their colleagues. In this particular case we present diploma projects that constituted equipment rental apps. We show that such form of diploma increases motivation and leads to nice results. © 2022 IEEE.

14.
International Journal of Lean Six Sigma ; 2022.
Article in English | Web of Science | ID: covidwho-2191419

ABSTRACT

PurposeWith the emergence of the COVID-19 pandemic, the production shortage of personal protective equipment (PPE), such as surgical masks, has become increasingly significant. It is vital to quickly provide high-quality, hygienic PPE during pandemic periods. This comprehensive case study aims to confirm that Kaizen and 5S applications reduce wastage rates and stoppages, which as a result, created a more efficient and sustainable workplace in a small-mediumenterprise (SME) producing PPE in Turkey. Design/methodology/approachThe method for this case is discussed with the help of a flowchart using the DMAIC cycle: D-define, M-measure, A-analyse, I-improve and C-control. FindingsThe total stoppages due to fishing line, gripper, piston and yarn welding have decreased by approximately 42.4%. As a result of eliminating wasted time and reduced changeovers, a total of 5,502 min have been saved per month. This increased production of approximately 10.55% per month, led to an addition of 506,184 units. Originality/valueThe use of lean manufacturing (LM), Six Sigma, Lean Six Sigma and continuous improvement methodologies are not common in textile SMEs. Based on the current literature reviewed, to the best of the authors' knowledge, this is the first comprehensive case study that combines statistical tools, such as hypothesis tests and LM practices, in the production process for a PPE company operating as a textile SME.

15.
Critical Care Medicine ; 51(1 Supplement):36, 2023.
Article in English | EMBASE | ID: covidwho-2190463

ABSTRACT

INTRODUCTION: The Covid-19 pandemic affected the operations of Global Health Missions. We describe the experience of providing critical care support internationally, finding alternatives for the Pediatric Fundamental Critical Care Support (PFCCS) course to adapt to these constraints. A group of PFCCS consultants, directors, and instructors from Pediatric Life-Saving Effort (PULSE) conducted courses in New York and Nigeria. METHOD(S): A pilot PFCCS course was scheduled for December 2021 at a registered center in NYC, USA, with the "online-hosted" option for the lectures. A "hybrid" (virtual and in-person) virtual modality on Zoom for the skills stations facilitated the training of pediatric residents and nurses from 2 community hospitals: 14 participants, 2 local, and 4 remote instructors. Two "break out" rooms were assigned for a specific skills station. The audio-visual display of the remote instructor was via a monitor screen augmented with an external microphone. Webcams were connected to the computer for remote instructors to visualize the skill station as a volunteer manipulated the vital sign simulator. We used the "side by side: speaker" option in the "view" feature to display the remote instructor simultaneously. Remote instructors used a chat application to advise changes on the digital monitors while following a scripted scenario. Local instructors acted as facilitators. This course was replicated in Nigeria to support a project spearheaded by Health Place for Children Initiative to establish the first PICU at The University of Nigeria Teaching Hospital. n candidates became PFCCS certified. Feedback from course experiences was gathered by email and standardized surveys. RESULT(S): Remote instructors in Italy, Mexico, and Texas effectively engaged virtually to conduct the skills stations. Their experience was similar to their vast experience conducting live skills stations. There was positive feedback about the quality of the skill stations. Their experience was similar to other scenarios of crisis resource management conducted regularly at TBHC. CONCLUSION(S): The pandemic significantly reduced PULSE's activity in international educational missions. The "hybrid" model of PFCCS courses can reduce the logistical and financial burden of international courses.

16.
Open Forum Infectious Diseases ; 9(Supplement 2):S757-S758, 2022.
Article in English | EMBASE | ID: covidwho-2189929

ABSTRACT

Background. To ensure an adequate supply of N95 respirators in response to the global shortages caused by the COVID-19 pandemic, we evaluated and implemented hydrogen peroxide vapor (HPV) to reprocess disposable N95 respirators. Previous work performed by our team showed that HPV was effective in eradicating viable viruses from experimentally contaminated N95 respirators and that they retained their breathability and filtering efficiency for 3 cycles of HPV disinfection. Methods. A multidisciplinary team worked by performing experiments and PDSA cycles to develop the ultimate process. Key processes and stakeholders were identified and engaged in operations decisions. Results. The respirator reprocessing program was successfully implemented. One of the critical components for its success was the implementation of a Personal Protective Equipment (PPE) liaison program which was developed to create a process and local, unit-level champion for the collection of used N95s and to educate the staff on the program and provide guidance per the hospitals' PPE policy. A courier system was implemented for the collection, transport and delivery of bulk containers of respirators between facilities. Facility Services designed and constructed a centralized respirator reprocessing center to include a receiving location, a negative pressure decontamination area to sort and stage the respirators on racks, two HPV reprocessing rooms and a clean room to receive the reprocessed N95s and to repackage and label for distribution. Standard operating procedures, staff training and competencies, and logs for documentation were created. Within 18 weeks (March 13, 2020 through July 2020), nearly 32,000 N95 respirators were reprocessed and packaged for redistribution utilizing the 2 HPV disinfection rooms and 5 full time employees. As built, there was capacity to reprocess 5,000 respirators per day and evaluated by the U. S. Food and Drug Administration (FDA) led to the issue of an Emergency Use Authorization. Conclusion. This scalable program enabled YNHHS to ensure an adequate supply of respirators for the safety of staff during the COVID-19 pandemic and global shortages of PPE. A multidisciplinary team and leadership commitment to provide resources for space and personnel were critical for program success.

17.
Open Forum Infectious Diseases ; 9(Supplement 2):S443, 2022.
Article in English | EMBASE | ID: covidwho-2189705

ABSTRACT

Background. Breath samples collected from patients infected with respiratory viruses are necessary for viral detection using breath analyzer devices. Given the highly transmissible nature of many of these illnesses, sample collection requires a multilayered approach to ensure the safety of the research staff responsible for obtaining and transporting these samples. Our team established a protocol to minimize exposure to and transmission of COVID-19 when collecting breath samples. Methods. We collected breath samples from 64 participants, of which 31 (48.4%) were positive for SARS-CoV-2 at the time of their visit. Before we started sample collection, biosafety inspection was conducted. We used a five-pronged approach to enhance safety and minimize transmission. First, we collected specimens in an outdoor space while the patients were seated in their vehicles. Second, we used a disposable mouthpiece and a one-way valve tofill a 1L TEDLAR bag. Third, patients were instructed to close the valve tightly before returning it to the staff. Fourth, we placed the bag in secondary containers which were placed in tertiary containers to minimize any contact with aerosols in the TEDLAR bag. In the last step, we placed a portable HEPAfilter near the indoor sample processing unit to minimize exposure and air contamination with the samples. Study staff donned all forms of necessary personal protective equipment, including gloves, gowns, N95 respirators, and protective eyewear, during sample collection and transportation. Results. A total of 64 breath samples were collected from 64 adult participants from February to March 2022. A total of 30 participants (46.9%) were within 7 days of their initial diagnosis. All participants were able to successfully collect samples without additional resources or attempts. All samples were able to be transported successfully into the lab. No staff contracted COVID-19 during the study period. Conclusion. Layered safety measures, including protective equipment, physical barriers, and well-ventilated environments mitigated the risks associated with breath sample collections from infected participants.

18.
Open Forum Infectious Diseases ; 9(Supplement 2):S296, 2022.
Article in English | EMBASE | ID: covidwho-2189660

ABSTRACT

Background. Limited availability of multiplex molecular tests in the near-patient setting can impact the rapid diagnosis and treatment of patients experiencing symptoms of respiratory tract infections, including pharyngitis. The BioFire Respiratory/ Sore Throat (R/ST) Panel (bioMerieux, Salt Lake City, UT), designed for use with the BioFire SpotFire System, is a PCR-based sample-to-answer diagnostic test that identifies four bacteria and 10 viruses (including SARS-CoV-2) from nasopharyngeal swab (NPS) or throat swab (TS) specimens in about 16 minutes. This study evaluated the performance of an Investigational Use Only (IUO) version of the BioFire R/ST Panel in the near patient setting. Methods. NPS and TS specimens were prospectively enrolled from symptomatic consented/assented volunteers of all ages, or obtained as residual leftover specimens. Enrollment was conducted between December 2020 and September 2021 at five study sites in the US and UK (adult and pediatric emergency departments or urgent care clinics) with testing performed by personnel representative of the intended users (non-laboratory professionals). Several analytes that were not circulating during the COVID-19 pandemic were supplemented with archived specimens of known analyte composition. Performance was determined for both sample types by comparison to FDA cleared multiplex PCR tests or culture and PCR followed by sequencing of isolates (Streptococcus from throat swabs). Results. A total of 1131 NPS and 452 TS prospectively collected specimens and 542 NPS and 128 TS archived specimens were tested with the BioFire R/ST Panel. For NPS specimens (prospective and archived) overall positive percent agreement (PPA) was 98.7% and negative percent agreement (NPA) was 99.1%, and for TS specimens (prospective and archived) overall PPA was 95.9% and NPA was 99.2%. Conclusion. The BioFire R/ST Panel is a sensitive, specific, and robust test for rapid detection of a wide range of organisms in NPS and TS specimens in the nearpatient setting. This test is expected to aid in the timely diagnosis and appropriate management of pharyngitis and other respiratory infections.

19.
European Heart Journal, Supplement ; 24(Supplement K):K99-K100, 2022.
Article in English | EMBASE | ID: covidwho-2188660

ABSTRACT

Introduction: Clinically relevant pulmonary embolism (PE) related to pacemaker leads is reported in up to 3.5% of cases of implantations. We reported a particular case of acute massive PE in a patient bearer of a Cardiac Resynchronization Therapy-Defibrillator (CRT-D). Case presentation: A 49-year-old man presented to our ER reporting dyspnea and localized pain to the left hemithorax. Past medical history included HFrEF due to idiopathic dilated cardiomyopathy complicated by apical thrombosis, CRT-D, Charcot-Marie-Tooth syndrome, dyslipidemia, and a hepatic nodule undergoing diagnosis. Recently, he reported COVID-19 and successive pleuropneumonia requiring hospitalization. At home, he was taking Acenocoumarin, Sacubitril/Valsartan 97/103mg bid, Carvedilol 6.25mg bid, Digoxin 0.0625mg, and Canrenon 50mg with questionable adherence. On physical examination, he was pyretic, mildly hypotensive and hypoxemic. An ECG showed atrio-guided biventricular stimulation at 110 bpm. A transthoracic echocardiogram (TTE) revealed biventricular disfunction and dilation, mitral and tricuspid regurgitation, PAPs 60 mmHg, and a thrombotic formation in the left ventricle apex. Blood tests found elevated D-Dimer and infection markers, INR 1.1. A CTangiography confirmed a bilateral acute massive PE associated with lung consolidations and left pleural effusion. We excluded deep vein thrombosis in the lower limbs. Patientwas admitted to CCU and treatedwith intravenous heparin, antibiotics, and support therapy. After one week, we performed a transesophageal echocardiogramthat confirmed the previous TTE except for a minor PAPs and unknown thrombotic formations on the atrial side of the tricuspid valve, adhering to CRT-D leads, pedunculated, highly mobile, the largest with an area of 1.9cm2. Cardiac surgery wasn't indicated;we excluded thrombophilia and thoracic cancer. Patient is still hospitalized, asymptomatic and with a precarious cardiovascular status. Discussion(s): The incidence of asymptomatic clot adhering to cardiac device's leads found by echocardiography is 1.4%, and thromboembolic complications are even rarer, especially after years from the implant. In our patient, the right atrium thrombosis is probably the cause of PE, and possible precipitating factors were pneumonia or unknown hepatic neoplasm. In the diagnostic workup, TTE probably wasn't sensitive enough to detect those thrombi. Conclusion(s): We presented a particular case of PE in a relatively young patient affected with HFrEF. Even if thrombosis related to pacemaker leads is rare, it should be considered as a possible cause of PE in a patient bearer of a cardiac stimulating device. (Figure Presented).

20.
IOP Conference Series Earth and Environmental Science ; 1123(1):012042, 2022.
Article in English | ProQuest Central | ID: covidwho-2188019

ABSTRACT

Energy building design today aims to ensure thermal comfort and indoor air quality;this concern has been increased, given the recent SARS-CoV-2 pandemic. The proposed work investigates the effect of increased natural ventilation on energy requirements, ensuring low CO2 levels and acceptable Indoor Air Quality (IAQ) in general. The case of hospitals was chosen because of the stringent IAQ requirements they raise as a result of the burdened (physical, chemical, biological) indoor environment, as well as the vulnerable health of the patients. The current energy analysis was carried out in patient wards, waiting rooms, and operating rooms. The proposed correlation between IAQ and energy is infrequent in the relevant literature, especially for the case of hospitals. Different scenarios regarding the ventilation mode are examined, including pure natural ventilation, natural ventilation combined with air cleaners, as well as mechanical ventilation. According to the results, improvement of the air quality leads to higher energy demand;this is the case of mechanical ventilation, noting that not properly designed natural ventilation techniques may lead to high energy consumption, without ensuring acceptable IAQ. Air cleaners can contribute towards better environment, potentially decreasing ventilation requirements;the issue of fresh air adequacy has to be examined though. The demonstrated methodological analysis and results can help the designer to investigate the efficiency of different ventilation modes, involving the effect of thermal envelope, geometrical and operation parameters, towards the energy requirements minimization and IAQ quality maximization.

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