An affordable, intelligent, and fully functional smart ventilator system

Because of the coronavirus disease (COVID-19) pandemic scenario that the world is going through right now, there has been a surge in the requirement for emergency life support systems like ventilators. Conventional ventilators used in intensive care units (ICUs) tend to be bulky and expensive and demand high power consumption and trained experts to operate. The aim of the project is to deliver a solution for the growing demand for portable ventilators and a viable replacement for nurse assisted artificial resuscitation. Mechanical ventilation is the process of supplying scheduled breaths to a patient who lacks the ability to do the work of breathing (WOB) himself/herself. The pattern of breathing for every patient is identified using sensor(s) and the required volume of air is supplied by compressing a bag valve mask (BVM) device. A machine learning algorithm learns the pattern of breathing and adjusts the pressure and volume controls specific to every patient. All operations and control mode switching for the device can be done using an Android app, hence making it user friendly. Copyright © 2022 Inderscience Enterprises Ltd.

Spirulina: A daily support to our immune system

In recent years, the various health benefits of Cyanobacteria microalgae - such as Arthrospira platensis, commonly called Spirulina, an edible blue-green algae - have attracted scientific attention including micro-level examinations of its bioactive components. As a whole food and nutritional supplement, it serves as a plant protein source, which has shown positive effects across a wide range of human health concerns, from malnutrition to metabolic syndrome. Spirulina bioactives, such as essential amino acids, phycocyanin, polysaccharides, carotenoids, and chlorophyll, and essential vitamins and trace minerals, are responsible for its holistic actions against oxidative stress and inflammation, and its antiviral, antibacterial, and immune-modulating effects. Various in vitro, in vivo, and ex vivo experiments have established Spirulina's mechanism of action and its effect on immunity as a proof of concept. The phenolic compounds and extracellular metabolites released from Spirulina whole food after digestion are postulated to strengthen the epithelial lining with antibacterial effects against pathogenic bacteria, adding to its prebiotic effect on the gut microbiota (like Bifidobacterium and Lactobacillus) due to its fiber content. In this study, the digestibility of Spirulina was assessed by the determination of free amino acids and peptide release during the each phase of digestion in a simulated static digestive model system. The hypothesis bridging poor gut health to low-level inflammation and metabolic syndrome, and the potential to address those issues with nutritional supplementation, such as with Spirulina, could also be beneficial in the long run to reduce comorbid illnesses, such as those associated with the currently prevailing coronavirus disease 2019 pandemic.

ATYPICAL PRESENTATION OF LEGIONNAIRES DISEASE WITH DIVERTICULITIS IN IMMUNOSUPPRESSED PATIENT

CASE: A 69-year-old male smoker with stage 3b prostate cancer managed with abiraterone and prednisone, prior severe COVID-19 pneumonia requiring mechanical ventilation, and history of perforated sigmoid diverticulitis presented with 3 days of anorexia, watery diarrhea, and left lower abdominal pain. Two weeks earlier he developed a mild dry cough without fever, dyspnea, or chest pain. There were no sick contacts or recent travel. He was afebrile, and initial routine chemistries and a complete blood count were unremarkable. An abdomino-pelvic CT revealed acute diverticulitis of the distal descending and sigmoid colon. A consolidation at the right lung base was also incidentally noted. Follow up imaging confirmed a multifocal pneumonia on chest Xray. Legionella antigen was detected in the urine. Metronidazole and levofloxacin were initiated with clinical improvement and the patient was discharged home to complete a 10-day course of antibiotics IMPACT/DISCUSSION: Legionella bacteria are gram negative organisms found widespread in soil and bodies of water including lakes, streams, and artificial reservoirs. Transmission is via inhalation of aerosols and a high innoculum is typically needed to cause infection. Host risk factors for infection include older age, impaired cellular immunity, smoking, male sex, and medical co-morbidities such as diabetes mellitus, renal, lung and cardiovascular disease. The two most commonly known syndromes associated with Legionella infection are Legionnaire's disease, a pneumonia occurring typically in the late summer or early autumn months (as in our patient), and Pontiac fever, an acute self- limited febrile illness. The mortality rate for hospitalized Legionnaire's is up to 10%. Extra-pulmonary manifestations are rare and can include skin and soft tissue infections, septic arthritis, endocarditis, myocarditis, peritonitis, pyelonephritis, meningitis, brain abscesses, and surgical site infections. The diagnosis of extra-pulmonary disease requires detection of Legionella at the affected site by culture or polymerase chain reaction. In the absence of a known local Legionella outbreak, our patient's age, sex, smoking status, and underlying immune suppression most likely increased his risk for this sporadic infection. We postulate that the acute diarrhea associated with Legionnaire's disease may have triggered inflammation of his diverticula or the acute diverticulitis was an extra-pulmonary manifestation. To our knowledge, we are the first to report a case of Legionnaire's disease presenting as acute diverticulitis. CONCLUSION: Legionnaire's is a typical disease with many atypical and extra-pulmonary presentations. We present a case of Legionnaire's disease masquerading as acute diverticulitis and urge timely consideration and testing for Legionella in at-risk patients presenting with predominantly GI symptoms and subtle or no respiratory complaints, as it can be life-saving.

Safety of emergency, elective and day case operating during the winter period at East Suffolk and North Essex NHS Foundation Trust: lessons from the outcomes of 4,254 surgical patients from the first COVID-19 wave.

BACKGROUND: There is limited evidence on perioperative outcomes of surgical patients during the COVID-19 pandemic to inform continued operating into the winter period. METHODS: We retrospectively analysed the rate of 30-day COVID-19 transmission and mortality of all surgical patients in the three hospitals in our trust in the East of England during the first lockdown in March 2020. All patients who underwent a swab were swabbed on or 24 hours prior to admission. RESULTS: There were 4,254 patients and an overall 30-day mortality of 0.99%. The excess surgical mortality in our region was 0.29%. There were 39 patients who were COVID-19 positive within 30 days of admission, 12 of whom died. All 12 were emergency admissions with a length of stay longer than 24 hours. There were three deaths among those who underwent day case surgery, one of whom was COVID-19 negative, and the other two were not swabbed but not suspected to have COVID-19. There were two COVID-19 positive elective cases and none in day case elective or emergency surgery. There were no COVID-19 positive deaths in elective or day case surgery. CONCLUSIONS: There was a low rate of COVID-19 transmission and mortality in elective and day case operations. Our data have allowed us to guide patients in the consent process and provided the evidence base to restart elective and day case operating with precautions and regular review. A number of regions will be similarly affected and should perform a review of their data for the winter period and beyond.

Safety and feasibility of performing pocus during the COVID-19 pandemic

Rationale: Point-of-care ultrasonography (POCUS) has a well-established role in the diagnosis and management of patients with cardiopulmonary failure and is recommended as an important frontline tool in the triage and diagnosis of patients with COVID-19. POCUS has been shown to be a safe modality for imaging patients in highly infectious settings such as Ebola, but there is limited published data on the safety and feasibility of POCUS use during periods of ICU strain in the COVID-19 pandemic. We describe our experience with POCUS in a hospital in New York City from March to May, 2020. Methods: POCUS was performed and interpreted by a competent critical care attending or fellow and primarily performed during the initial daily bedside assessment to limit number of entries and minimize exposure. POCUS exams were performed based on clinical indication and operators were encouraged to archive videos and images for documentation. Appropriate infection control procedures were followed, including hand sterilization, donning and doffing of personal protective equipment (disposable gown, gloves, N95 mask, eye shield) when entering a negative pressure room. Ultrasound machines were cleaned twice with hydrogen peroxide, both prior to and after exiting the room. We also evaluated the exposure to our intensivists after May 30th to evaluate for nosocomial transmission by means of COVID-19 antibody testing. Results: We were able to secure a dedicated portable ultrasound machine for each ICU, including newly opened surge ICUs. The consult service used a handheld ultrasound machine. Eighty-eight critically ill patients with COVID-19 disease had archived POCUS exams during this period. These patients had a median of 2 (range, 1-10) POCUS exams archived during their hospitalization. Infection control protocols were followed and a survey of all intensivists who performed said POCUS exams revealed that there was no known transmission of SARS-CoV2. Conclusions: We describe the practical aspects of incorporating POCUS in a safe and feasible manner in a critical care setting during a period of extreme strain and complex infection control requirements. Utilization of POCUS likely limited the need for further studies that might have increased risk of exposure to other healthcare personnel. There are limitations to this study, including barriers to archiving and documenting POCUS findings, likely due to operator error, time limitation, and technical issues with the machine or network connectivity. Future studies should focus on identifying barriers to POCUS archiving and documentation, description of clinical indications, findings, and change in management, if any.