COVID-19 Surge Capacity Solutions: Our Experience of Converting a Concert Hall into a Temporary Hospital for Mild and Moderate COVID-19 Patients.

The 2019 coronavirus disease (COVID-19) pandemic has stressed the health care system in Italy as well as around the world, with hospitals implementing their surge capacity to increase the number of available beds for patients positive to the virus.At the end of March, the Piemonte (Northern Italy) Government decided to build a temporary rapid-assembly emergency hospital for the treatment of mild and moderate COVID-19 patients, converting an existing concert hall in the city of Turin. The decision was prompted not only by the urgent need of hospital beds, but also by a forward-looking approach for the months immediately after the emergency, when it will be essential for conventional hospitals to return to a normal configuration.This paper documents the temporary hospital project, describing the site, the layout and the equipment, the idea behind structural choices, and the staff involved. The aim of the work is to share the experience and to provide some practical recommendations to other professionals who are fighting the COVID-19 pandemic worldwide.

Improving Oxygen Capacity at ITBP Referral Hospital During the Second Wave of COVID-19 Infections in Greater Noida, India: An Operative Targeted Intervention.

OBJECTIVES: Due to factors that still remain under debate, both social and virological, the coronavirus disease 2019 (COVID-19) pandemic has continued to flare up in India, particularly in northern and western areas. This has led to an incidence of approximately 350,000 cases per day and a daily death toll of around 4000 in the weeks between May 1 and 14, 2021. The current pandemic is testing the adaptability of the oxygen distribution and consumption. METHODS: Following India's request for support, the European Union (EU) Civil Protection Mechanism coordinated the response agreed by EU Member States providing shipments of oxygen and equipment. In this scenario, our Emergency Medical Team (EMT)-2, based in Italy, organized a cargo and a 12-member team of technicians and medical professionals with the main objective of installing a novel source of oxygen. RESULTS: The installation of a Pressure Swing Adsorption (PSA) oxygen plant provided the Indo-Tibetan Border Police (ITBP) hospital in Greater Noida, India, with a sustainable solution to combat oxygen shortage in less than 48 h. CONCLUSIONS: The supply of oxygen could not be deemed a successful intervention without a proper plan to guarantee the rational use of the source so additional training was carried out. Our EMT were among the first responders in mitigating this public health crisis.

Predictivity of Clinical Findings and Doppler Ultrasound in Pediatric Acute Scrotum.

PURPOSE: To evaluate the role of Doppler ultrasonography (DUS) in diagnosing pediatric testicular torsion (TT), and its diagnostic accuracy, and helping clinicians increase specificity and decrease negative exploration rates. MATERIALS AND METHODS: We performed a retrospective study of all consecutive patients with acute testicular symptoms referring to our pediatric emergency department (ED) from January 2010 to December 2013. RESULTS: We analyzed 1091 patients, with a mean age of 9 years. DUS was performed in 498 patients (40.8%); 107 patients (8.8%) underwent surgery and 41 patients (3.3%) had a TT. The following clinical findings were collected: presence of scrotal pain, erythema and swelling, spermatic cord pain and abnormal cremasteric reflex. The clinical findings significantly associated with TT were spermatic cord pain (OR = 37, 95% CI: 11.9-111.1, P < .001) and abnormal cremasteric reflex (OR = 47.6, 95% CI: 13.5-166.6, P < .001); the presence of swelling resulted confounding (OR = 2.3, 95% CI: 0.7-8.4, P < .001). Scrotal pain was not significantly associated with TT (P = .9), while erythema made TT unlikely (OR = 0.22, 95% CI: 0.07-0.7, P = .0445). In all cases the DUS significantly increased the predictivity. CONCLUSION: TT was present in 3.3% of patients presenting with testicular symptoms. The predictivity based on clinical findings resulted high and the negative exploration rate for TT was 62%. DUS increased the predictivity in all patients. .

Successful medical treatment for ranula in children.

OBJECTIVES: We compare the outcome of medical treatment for ranula versus surgery in children. STUDY DESIGN: Multicentric cohort study. METHODS: The case series includes 37 children with ranulas (diameter 2.7 ± 1.5 cm). Eighteen patients, including 3 who had relapsed after either simple marsupialization or ranula removal alone, received oral nickel gluconate, mercurius heel, and glandula submandibularis suis D10/D30/D200. Fifteen cases underwent marsupialization with packing, and 2 underwent sublingual gland and ranula en-bloc excision. Two patients who recovered spontaneously shortly after diagnosis were excluded. RESULTS: No recurrences occurred among medical patients. Of the 17 surgical patients, 3 treated with marsupialization with packing relapsed. With the 3 surgical failures from other centers a total of 6 of 20 relapses were considered. Swelling or tension was common in surgical cases but unusual in medical patients. CONCLUSIONS: In this case series oral medical treatment for ranula was very effective and more effective than marsupialization with packing.

Cardiopulmonary anatomy and function in long-term survivors of mild to moderate congenital diaphragmatic hernia.

BACKGROUND/PURPOSE: In the last decades, several studies regarding cardiopulmonary sequelae in survivors of congenital diaphragmatic hernia (CDH) have been published, but results often are conflicting, and controversies still exist. The aim of this study was to assess cardiopulmonary anatomic and functional outcome in a group of long-term survivors of CDH of mild to moderate degree. METHODS: Twenty-four children aged 8.15 +/- 2.80 years underwent clinical examination with growth assessment, chest radiographs, echocardiography, pulmonary perfusion scintigraphy, static lung volumes measurement, and spirometry. RESULTS: Mean Z scores of weight for age and height for age were within normal values. Echocardiography showed normal anatomy and function in all but 3 patients with isolated CDH, in whom minor alterations were detected. Mean perfusion to the affected side was significantly lower (45.16 +/- 5.30%; P <.0001) but still within normal range. Four children showed a substantial impairment of perfusion to the hernia side. The mean spirometric values and pulmonary volumes were normal. However, a mild restrictive pattern was evident in 6 children (27.3%), an obstructive pattern in 3 (13.6%), and a mixed obstructive and restrictive impairment in 1. CONCLUSIONS: Hypoplastic lungs of mild to moderate CDH survivors continue to cause pulmonary morbidity in some children many years after the correction of the defect. In particular, lung perfusion appears to be impaired in 20% of the patients and pulmonary function in 45%, without any significant cardiac or developmental sequelae. The negative correlation between FEV1 and duration of ventilation at presentation (r = -0.49; P =.026) may be caused by the consequences of lung hypoplasia, but initial ventilatory management may contribute to increased pulmonary morbidity. Relationship between perfusion and FEF25-75 (r = 0.61; p = 0.004) could reflect an equivalent degree of reduction in the caliber of distal airways and pulmonary vascular tree.