The main features of medical units participating in UN peacekeeping operations

The article is devoted to the organization of medical support for UN peacekeeping operations in modern conditions. Special attention is paid to the levels of medical care for military observers in UN missions. The main tasks of medical units, their composition of forces and means, as well as their state of the material and technical base located in missions and participating in the medical support of armed conflicts are disclosed. The main performance indicators of the medical unit based on the results of the work of 2017-2018 are analyzed.

The case for wearable proximity devices to inform physical distancing among healthcare workers

Objective Despite the importance of physical distancing in reducing SARS-CoV-2 transmission, this practice is challenging in healthcare. We piloted use of wearable proximity beacons among healthcare workers (HCWs) in an inpatient unit to highlight considerations for future use of trackable technologies in healthcare settings. Materials and Methods We performed a feasibility pilot study in a non-COVID adult medical unit from September 28 to October 28, 2020. HCWs wore wearable proximity beacons, and interactions defined as <6 feet for ≥5 s were recorded. Validation was performed using direct observations. Results A total of 6172 close proximity interactions were recorded, and with the removal of 2033 false-positive interactions, 4139 remained. The highest proportion of interactions occurred between 7:00 Am–9:00 Am. Direct observations of HCWs substantiated these findings. Discussion This pilot study showed that wearable beacons can be used to monitor and quantify HCW interactions in inpatient settings. Conclusion Technology can be used to track HCW physical distancing.

ANALYSIS OF THE SPECIFIC FEATURES OF THE USE OF PHYSIOTHERAPEUTIC METHODS IN PATIENTS WHO UNDERWENT ARTHROSCOPIC OPERATIONS ON THE KNEE JOINT IN 2018–2019 AT THE MEDICAL UNIT OF THE MINISTRY OF INTERNAL AFFAIRS OF RUSSIA IN THE REPUBLIC OF TATARSTAN

Background. Diseases of the musculoskeletal system are the most common cause of disability in the modern world, and the prevalence of these diseases is increasing at an alarming rate. Currently, various types of arthroscopic operations on the knee joint are performed – for meniscus damage (including meniscus suture), instability of the knee joint, damage to the cruciate complex, articular cartilage, patellar instability, free joint bodies, pathological folds, synovitis, knee arthrosis, and rheumatoid arthritis. Medical rehabilitation after arthroscopic surgery traditionally includes administration of nonsteroidal anti-inflammatory drugs, opioids, local anesthetics, therapeutic exercise using isometric active exercises, hydrokinesis therapy, and various physical therapy methods. Aim. Study of the use of physiotherapeutic methods in the treatment of patients who underwent atroscopic surgery on the knee joint in the physiotherapy department at the Ministry of Internal Affairs of Russia for the Republic of Tatarstan Clinical Hospital in 2018–2019. Material and methods. The frequency of prescription of therapeutic physical factors for patients who underwent arthroscopic surgeries on the knee joint at the physiotherapy department at the Medical Unit of Ministry of Internal Affairs of Russia for the Republic of Tatarstan Clinical Hospital in 2018–2019 was investigated. The patients were accordingly divided into two groups: in 2018, 37 patients were prescribed physiotherapeutic procedures, in 2019 there were 48 patients. The age of the patients in 2018 was (33,9±9,4) years, in 2019 it was (34,2±9,1) years. Statistica 6 software package by StatSoft was used for statistical processing. Differences were considered statistically significant at p<0,05. Results and discussion. Paraffin therapy, treatment using Nuga-Best bed, amplipulse therapy, UHF therapy, cryotherapy, oxygen cocktails containing medicinal herbs were prescribed with less frequency in the treatment of patients operated for knee joint injuries in 2018 than in 2019. Despite the proven effectiveness of whirlpool baths and darsonvalization in treating musculoskeletal disorders were not prescribed for the rehabilitation of patients who underwent atroscopic surgeries at the physiotherapy department of Medical Unit of Ministry of Internal Affairs of Russia for the Republic of Tatarstan Clinical Hospital in 2019. Conclusion. When rehabilitating patients who have undergone arthroscopic intervention on the knee joint, it is advisable to thoroughly consider the use of therapeutic physical factors to improve the operation of the physiotherapy department.

P006 Initiation of Continuous Positive Airway Pressure as an inpatient in Patients with Obesity Hypoventilation Syndrome admitted to General Medical Unit

Background With higher rates of obesity in regional and rural Australian population, there will be higher rates of Obesity Hypoventilation Syndrome (OHS). The cornerstone of the treatment of OHS is Positive Airways Pressure. We studied the initiation of Continuous Positive Airways Pressure (CPAP) in an inpatient setting in patients with OHS in the regional population of Ballarat and subsequent impact on their hospital stay/readmission. Methods We performed a retrospective study of 22 patients with OHS during the 6-month study period (01/07/2021–31/12/2021) admitted into General Medical Unit at Ballarat Base Hospital. Progress Complete Outcome/Impact The mean age in the cohort was 60 with average weight of 139.5 kg. The mean pCO2 and pH were 68.1 and 7.33 respectively. CPAP was initiated in 9 of 22 patients (40.1%) with mean of 7.3 days. Mean days of oxygen use was 4.7 days with mean length of hospital stay 10 days. We did not find any statistical difference in length of hospital stay, ICU stay, supplemental oxygen use or readmission rates between CPAP and non-CPAP group. Subgroup analysis showed that CPAP group had higher rates of COPD (44.4% vs 30.8%) and diabetes (44.4% vs 30.8%) with trend to lower FEV1 (mean FEV1 47.6% vs 57.2%). There were 4 deaths (16.7%), 3 of them did not have CPAP initiated. The longer duration to CPAP initiation is likely to explain the non-significant difference between the groups. Proactive measures to increase initiation of CPAP is likely to improve patient outcome in terms of their morbidity and mortality.

Folie a Deux: Shared Psychotic Disorder in a Medical Unit

Introduction. A shared psychotic disorder is a system of delusions shared by two or more individuals. Shared psychotic disorders typically develop in pairs or groups with a close relationship who are socially isolated. The function and affect of those inflicted with shared psychotic disorders usually remain intact. For these reasons, a shared psychotic disorder is seldom identified, diagnosed, and treated. This case describes a shared psychotic disorder incidentally discovered in a medical unit. Case. The patient was a 47-year-old woman with no known past psychiatric history who had been medically admitted for gastroenteritis. On the day of discharge, a psychiatric consult was requested for “paranoia and bizarre behavior.” The patient was seen making statements that she needed security and the FBI to escort her as she left the hospital. Another person in the patient’s room was discovered to be the patient’s mother who had been staying with her in the hospital. Evaluation of the patient along with observation of her mother revealed that the two shared a complex system of delusions revealing a diagnosis of shared psychotic disorder. Discussion. A shared psychotic disorder is a unique psychiatric diagnosis. It may be even rarer to diagnose in the inpatient medical setting because multiple individuals from a shared system are typically not seen. In this case, the patient and her mother had multiple clinical characteristics of a shared psychotic disorder, including an enmeshed relationship and social isolation. The treatment for shared psychotic disorders involves separation of the individuals and pharmacotherapy with antipsychotics. This case also presented a unique ethical dilemma as the psychiatric team was called to evaluate a patient and found a patient and another individual to have symptoms. Conclusion. A shared psychotic disorder is important to consider on the differential when cases of psychosis with delusional systems are seen on medical floors.

Sort and Sieve: Pre-Triage Screening of Patients with Suspected COVID-19 in the Emergency Department

Introduction. To reduce the risk of nosocomial transmission, suspected COVID-19 patients entering the Emergency Department (ED) were assigned to a high-risk (ED) or low-risk (acute medical unit, AMU) area based on symptoms, travel and contact history. The objective of this study was to evaluate the performance of our pre-triage screening method and to analyse the characteristics of initially undetected COVID-19 patients. Methods. This was a retrospective, observational, single centre study. Patients ≥ 18 years visiting the AMU-ED between 17 March and 17 April 2020 were included. Primary outcome was the (correct) number of COVID-19 patients assigned to the AMU or ED. Results. In total, 1287 patients visited the AMU-ED: 525 (40.8%) AMU, 762 (59.2%) ED. Within the ED group, 304 (64.3%) of 473 tested patients were COVID-19 positive, compared to 13 (46.4%) of 28 tested patients in the AMU group. Our pre-triage screening accuracy was 63.7%. Of the 13 COVID-19 patients who were initially assigned to the AMU, all patients were ≥65 years of age and the majority presented with gastro-intestinal or non-specific symptoms. Conclusion. Older COVID-19 patients presenting with non-specific symptoms were more likely to remain undetected. ED screening protocols should therefore also include non-specific symptoms, particularly in older patients.

Neurological symptoms and axonal damage in COVID-19 survivors: are there sequelae?

The persistence of neurological symptoms after SARS-CoV-2 infection, as well as the presence of late axonal damage, is still unknown. We performed extensive systemic and neurological follow-up evaluations in 107 out of 193 consecutive patients admitted to the COVID-19 medical unit, University Hospital of Verona, Italy between March and June 2020. We analysed serum neurofilament light chain (NfL) levels in all cases including a subgroup (n = 29) of patients with available onset samples. Comparisons between clinical and biomarker data were then performed. Neurological symptoms were still present in a significant number (n = 49) of patients over the follow-up. The most common reported symptoms were hyposmia (n = 11), fatigue (n = 28), myalgia (n = 14), and impaired memory (n = 11) and were more common in cases with severe acute COVID-19. Follow-up serum NfL values (15.2 pg/mL, range 2.4–62.4) were within normal range in all except 5 patients and did not differentiate patients with vs without persistent neurological symptoms. In patients with available onset and follow-up samples, a significant (p < 0.001) decrease of NfL levels was observed and was more evident in patients with a severe acute disease. Despite the common persistence of neurological symptoms, COVID-19 survivors do not show active axonal damage, which seems a peculiar feature of acute SARS-CoV-2 infection.

Effects of Combination Therapy of Methotrexate with Sulfasalazine and Hydroxychloroquine: Comparative Clinical Trial

Aims: To study the role of two combination therapies in the treatment of rheumatoid arthritis. Study Design: This an open-label, randomized 180-days clinical trial. Place and Duration of Study: This study was conducted in the Department of Pharmacology and Therapeutics, BMSI and Medical unit ward 6. Methodology: Eighty-nine patients were enrolled (69 women, 20 men; age range 28-62 years). A and B were the groups assigned to the patients. MTX 7.5-20 mg/ week orally and SSZ 10-20 mg / day orally as maximally tolerated were prescribed to the 55 patients of group A. MTX 7.5-20 mg/ week orally and HCQ 200 mg twice daily were prescribed to the 54 patients of group B.. Results: When we compared group A with group B, group A showed major progress in mean swollen joint count (1.9 ± 0.97) as compared to group B (2.7 ± 1.78). Group B showed major progress in mean physician’s global assessment (2.7 ± 0.92) as compared to group A (3.8 ± 1.22). For that reason, our study showed that patients receiving both the combinations responded equally in terms of efficacy but the combination of MTX and HCQ is better tolerated than the combination of MTX and SSZ. Conclusion: Both combinations of MTX & SSZ and MTX & HCQ were equally effective but the combination of MTX & HCQ was superior in terms of tolerability than the combination of MTX and SSZ.