Contribution of Live Video to Physicians' Remote Assessment of Suspected COVID-19 Patients in an Emergency Medical Communication Centre: A Retrospective Study and Web-Based Survey.

The COVID-19 pandemic had a major impact on emergency medical communication centres (EMCC). A live video facility was made available to second-line physicians in an EMCC with a first-line paramedic to receive emergency calls. The objective of this study was to measure the contribution of live video to remote medical triage. The single-centre retrospective study included all telephone assessments of patients with suspected COVID-19 symptoms from 01.04.2020 to 30.04.2021 in Geneva, Switzerland. The organisation of the EMCC and the characteristics of patients who called the two emergency lines (official emergency number and COVID-19 number) with suspected COVID-19 symptoms were described. A prospective web-based survey of physicians was conducted during the same period to measure the indications, limitations and impact of live video on their decisions. A total of 8957 patients were included, and 2157 (48.0%) of the 4493 patients assessed on the official emergency number had dyspnoea, 4045 (90.6%) of 4464 patients assessed on the COVID-19 number had flu-like symptoms and 1798 (20.1%) patients were reassessed remotely by a physician, including 405 (22.5%) with live video, successfully in 315 (77.8%) attempts. The web-based survey (107 forms) showed that physicians used live video to assess mainly the breathing (81.3%) and general condition (78.5%) of patients. They felt that their decision was modified in 75.7% (n = 81) of cases and caught 7 (7.7%) patients in a life-threatening emergency. Medical triage decisions for suspected COVID-19 patients are strongly influenced by the use of live video.

Effects of Prolonged Exposure to Hypobaric Hypoxia on Oxidative Stress: Overwintering in Antarctic Concordia Station.

Concordia Station is the permanent, research station on the Antarctic Plateau at 3230 m. During the eleventh winter-over campaign (DC11-2015; February 2015 to November 2015) at Antarctic Concordia Station, 13 healthy team members were studied and blood samples were collected at six different time points: baseline measurements (T0), performed at sea level before the departure, and during the campaign at 3, 7, 20, 90, and 300 days after arrival at Concordia Station. Reducing the partial pressure of O2 as barometric pressure falls, hypobaric hypoxia (HH) triggers several physiological adaptations. Among the others, increased oxidative stress and enhanced generation of reactive oxygen/nitrogen species (ROS/RNS), resulting in severe oxidative damage, were observed, which can share potential physiopathological mechanisms associated with many diseases. This study characterized the extent and time-course changes after acute and chronic HH exposure, elucidating possible fundamental mechanisms of adaptation. ROS, oxidative stress biomarkers, nitric oxide, and proinflammatory cytokines significantly increased (range 24-135%) during acute and chronic hypoxia exposure (peak 20th day) with a decrease in antioxidant capacity (peak 90th day: -52%). Results suggest that the adaptive response of oxidative stress balance to HH requires a relatively long time, more than 300th days, as all the observed variables do not return to the preexposition level. These findings may also be relevant to patients in whom oxygen availability is limited through disease (i.e., chronic heart and lung and/or kidney disease) and/or during long-duration space missions.

Genomic and physiological resilience in extreme environments are associated with a secure attachment style.

Understanding individual capability to adjust to protracted confinement and isolation may inform adaptive plasticity and disease vulnerability/resilience, and may have long-term implications for operations requiring prolonged presence in distant and restricted environments. Individual coping depends on many different factors encompassing psychological dispositional traits, endocrine reactivity and their underlying molecular mechanisms (e.g. gene expression). A positive view of self and others (secure attachment style) has been proposed to promote individual resilience under extreme environmental conditions. Here, we tested this hypothesis and investigated the underlying molecular mechanisms in 13 healthy volunteers confined and isolated for 12 months in a research station located 1670 km away from the south geographic pole on the Antarctic Plateau at 3233 m above sea level. Study participants, stratified for attachment style, were characterised longitudinally (before, during and after confinement) for their psychological appraisal of the stressful nature of the expedition, diurnal fluctuations in endocrine stress reactivity, and gene expression profiling (transcriptomics). Predictably, a secure attachment style was associated with reduced psychological distress and endocrine vulnerability to stress. In addition, while prolonged confinement and isolation remarkably altered overall patterns of gene expression, such alteration was largely reduced in individuals characterised by a secure attachment style. Furthermore, increased resilience was associated with a reduced expression of genes involved in energy metabolism (mitochondrial function and oxidative phosphorylation). Ultimately, our data indicate that a secure attachment style may favour individual resilience in extreme environments and that such resilience can be mapped onto identifiable molecular substrates.

Author Correction: Lack of acclimatization to chronic hypoxia in humans in the Antarctica.

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Lack of acclimatization to chronic hypoxia in humans in the Antarctica.

The study was carried out at Concordia Station (Antarctic Plateau). The aim was to investigate the respiratory and haematological responses to hypoxia in healthy subjects living at constant altitude. Thirteen men and women (34.1 ± 3.1 years) were exposed for 10 months to hypobaric hypoxia (oxygen level equivalent to 3800 m asl). These unique conditions enable a greater accuracy of monitoring human responses to chronic hypoxia than can be achieved elsewhere. Blood haemoglobin and erythropoietin concentrations were determined at sea level (Pre), and after 3, 7, 20, 90 and 300 days at altitude. Blood gas analysis, base excess and arterial oxygen saturation were measured at Pre, and after 150 and 300 days at altitude. Erythropoietin returned quickly to baseline level after a transient increase in the first days. Blood haemoglobin concentration started increasing at day 7 and remained markedly higher for the entire duration of the mission. At day 150 the blood carbon dioxide partial pressure was markedly reduced, and consequently blood pH remained higher at negative base excess until day 300. The arterial oxygen saturation remained lower than Pre throughout. In conclusion, humans display little capacity of hypoxia acclimatization even after ten months of constant exposure to low oxygen partial pressure.

Does vascular injury affect the outcome of open tibial fractures?

BACKGROUND: Consensus on the definition of a Gustilo grade IIIC injury was sought, and the influence of vascular injuries on outcome of severe open tibial fractures was investigated. METHODS: Three thousand three hundred fifty-one plastic and orthopedic surgeons were sent questionnaires to determine their interpretation of Gustilo grade IIIC injuries. Notes of patients with severe open tibial injuries reconstructed at Frenchay orthoplastic center with free tissue transfer between 2006 and 2010 were reviewed. Data were collected on patient demographics and vascular integrity. Outcome was measured using the Enneking score. RESULTS: Four hundred seventy-six plastic surgeons and 2875 orthopedic surgeons were contacted. Seven hundred fifty-three responses (22.5 percent) were received; 46.2 percent thought a grade IIIC injury was a devascularized limb, 24.2 percent felt it was a one- or two-vessel injury, 6.9 percent thought it represented any vascular injury, and 22.7 percent had no definite answer. Sixty-eight patients (50 men and 18 women; mean age, 42.7 years) were identified. Fifty had normal angiograms and 18 sustained vascular injuries. Forty-two percent of vascular injuries were to the anterior tibial artery, 37 percent were to the posterior tibial, and 27 percent were to the peroneal. Mean follow-up was 11.2 months. Mean Enneking score for patients without and with vascular injury was 29.8 and 24.4, respectively (p = 0.004). CONCLUSIONS: Vascular injury independently influences long-term limb function. The authors suggest a modification to the current classification to improve communication among surgeons, and advocate the use of preoperative angiography before free soft-tissue reconstruction of severe open tibial fractures.