Future Smart Connected Communities to Fight COVID-19 Outbreak.

Internet of Things (IoT) has grown rapidly in the last decade and continues to develop in terms of dimension and complexity, offering a wide range of devices to support a diverse set of applications. With ubiquitous Internet, connected sensors and actuators, networking and communication technology along with artificial intelligence (AI), smart cyber-physical systems (CPS) provide services rendering assistance and convenience to humans in their daily lives. However, the recent outbreak of COVID-19 (also known as coronavirus) pandemic has exposed and highlighted the limitations of contemporary technological deployments especially to contain the widespread of this disease. IoT and smart connected technologies together with data-driven applications can play a crucial role not only in the prevention, mitigation, or continuous remote monitoring of patients, but also enable prompt enforcement of guidelines, rules, and administrative orders to contain such future outbreaks. In this paper, we envision an IoT and data-supported connected ecosystem designed for intelligent monitoring, pro-active prevention and control, and mitigation of COVID-19 and similar epidemics. We propose a gamut of synergistic applications and technology systems for various smart infrastructures including E-Health, smart home, supply chain management, transportation, and city, which will work in convergence to develop 'pandemic-proof' future smart communities. We also present a generalized cloud-enabled IoT implementation framework along with scientific solutions, which can be adapted and extended to deploy smart connected ecosystem scenarios using widely used Amazon Web Services (AWS) cloud infrastructures. In addition, we also implement an E-Health RPM use case scenario to demonstrate the need and practicality for smart connected communities. Finally, we highlight challenges and research directions that need thoughtful consideration and across the board cooperation among stakeholders to build resilient communities against future pandemics.

A Lethal Complication of Endoscopic Therapy: Duodenal Intramural Hematoma.

Duodenal intramural hematoma (DIH) usually occurs in childhood and young adults following blunt abdominal trauma. It may also develop in the presence of coagulation disorders and may rarely be an iatrogenic outcome of endoscopic procedures. Management of DIH is usually a conservative approach. A case of intramural duodenal hematoma that developed following endoscopic epinephrine sclerotherapy and/or argon plasma coagulation and that was nonresponsive to conservative therapy in a patient with chronic renal failure who died from sepsis is being discussed in this report. Clinicians should be aware of such possible complications after endoscopic hemostasis in patients with coagulation disorders.

The role of inferior vena cava diameter in volume status monitoring; the best sonographic measurement method?

OBJECTIVES: This study aims to determine the site of and the best sonographic method for measurement of inferior vena cava (IVC) diameter in volume status monitoring. METHODS: This observational before-and-after study was performed at the intensive care unit of the emergency department. It included hypotensive adult patients with suspected sepsis who were recommended to receive at least 20 mg/kg fluid replacement by the emergency physician. The patients were fluid replaced at a rate of 1000 mL/h, and maximum and minimum IVC diameters were measured and the Caval index calculated sonographically via both B-mode and M-mode. Hence, IVC's volume response was assessed by a total of 6 parameters, 3 each in M-mode and B-mode. Freidman test was used to assess the change in IVC diameter with fluid replacement. Wilcoxon test with Bonferroni correction was used to determine which measurement method more sensitively measured IVC diameter change. RESULTS: Twenty-eight patients with a mean age of 71.3 were included in the final analysis.The IVC diameter change was significant with all 6 methods (P < .001). The IVC minimum diameter change measured on M-mode during inspiration (M-mode i) was the only measurement method that significantly showed diameter change with each 500-mL fluid replacements. The initial and the subsequent M-mode i values after each 500 mL of fluid were 5.65 ± 3.34; 8.05 ± 3.66; 10.16 ± 3.61, and 11.21 ± 2.94, respectively (P < .001, P < .002, and P < .003, respectively). CONCLUSION: Inferior vena cava diameter was changed by fluid administration. The M-mode i method that most sensitively measures that change may be the most successful method in volume status monitoring.

The role of inferior vena cava diameter in the differential diagnosis of dyspneic patients; best sonographic measurement method?

STUDY OBJECTIVE: We aimed to determine the role of inferior vena cava (IVC) diameter in making a differentiation between dyspnea of cardiac (acute heart failure [AHF]) and pulmonary origin. We also attempted to determine the best sonographic method for the measurement of IVC diameter. METHODS: This prospective observational study was conducted at the intensive care unit of the emergency department of a training and research hospital. This study enrolled patients with the main symptom of dyspnea who were categorized into 2 groups, cardiac dyspnea and pulmonary dyspnea groups, based on the final diagnosis. All patients underwent sonographic measurement of minimum and maximum diameters of IVC, and the caval index (CI) was calculated in both M-mode and B-mode. The sensitivity, specificity, and likelihood ratios (LR) of the IVC values for the differentiation of the 2 groups were calculated. RESULTS: This study included a total of 74 patients with a mean age of 72.8 years. Thirty-two patients had dyspnea of cardiac origin, and 42 patients had dyspnea of pulmonary origin. The IVC diameter measured with B-mode during inspiration (B-mode i) was the most successful method for differentiation of the 2 groups. B-mode i values greater than 9 mm predicted dyspnea of cardiac origin with a sensitivity of 84.4% and a specificity of 92.9% (+LR: 11.8, LR: 0.16). CONCLUSION: Sonographic assessment of the IVC diameter may be used as a rapid, readily, nonexpensive, complication-free, and reproducible technique for the differentiation of cardiac and pulmonary causes of dyspnea. B-mode i measurement may be more successful in the differentiation of dyspnea compared with other IVC diameters and calculations.

Atypical Presentation of Posterior Reversible Encephalopathy Syndrome in a Patient Diagnosed with Postpartum Gestational Hypertension.

Hypertensive disorders of pregnancy are a major cause of maternal mortality and morbidity. Preeclampsia and eclampsia are among the most common causes of posterior reversible encephalopathy syndrome (PRES). Clinically, PRES is characterised by visual disturbances, headache, nausea, change in mental status and seizure. Although treatment of the underlying cause provides clinical and radiological healing, a delay in the diagnosis and treatment can result in permanent brain damage and death. The exact incidence of new-onset postpartum hypertension is difficult to ascertain. Women with mild hypertension are usually asymptomatic; therefore, patients either can not be diagnosed or are diagnosed with late complications. With this case, we would like to present a patient who had no diagnosis of maternal hypertension or preeclampsia-eclampsia during pregnancy but, after a postpartum seizure, was diagnosed with PRES.