Needle Decompression of Tension Pneumoperitoneum: A Case Report

Introduction: Tension pneumoperitoneum is rarely encountered in the emergency department but can have disastrous effects on the body when it is. However, an emergency physician has skills that can be readily applied to needle decompress the abdomen for rapid stabilization. Case Report: A 42-year-old male arrived via ambulance after a likely overdose with mental status improvement following naloxone administration. He was found to be in respiratory distress due to a rigid, distended abdomen that required intubation for stabilization. Computed tomography imaging showed significant pneumoperitoneum with tension physiology. Surgery consultation was unable to intervene immediately, and needle decompression with an angiocatheter was performed at the bedside with immediate ventilatory improvement. Conclusion: Tension pneumoperitoneum is a rare but potentially disastrous consequence of overdose secondary to emesis and rupture of the gastric wall. Needle decompression is a skillset already in the emergency physician’s toolbox and can be applied for emergency stabilization of a tension pneumoperitoneum with proper forethought and technique.

Characterization of a clinical Enterobacter hormaechei strain belonging to epidemic clone ST418 co-carrying blaNDM-1, blaIMP-4 and mcr-9.1

An Enterobacter hormaechei isolate (ECL-90) simultaneously harboring blaNDM-1, blaIMP-4 and mcr-9.1 was recovered from the secretion specimen of a 24-year-old male patient in a tertiary hospital in China. The whole genome sequencing of this isolate was complete, and 4 circular plasmids with variable sizes were detected. MLST analysis assigned the isolate to ST418, known as a carbapenemase-producing epidemic clone in China. blaIMP-4 and mcr-9.1 genes were co-carried on an IncHI2/2A plasmid (pECL-90-2) and blaNDM-1 was harbored by an IncX3 plasmid (pECL-90-3). The genetic context of mcr-9.1 was identified as a prevalent structure, “rcnR-rcnA-pcoE-pcoS-IS903-mcr-9-wbuC”, which is a relatively unitary model involved in the mobilization of mcr-9. Meanwhile, blaNDM-1 gene was detected within a globally widespread structure known as NDM-GE-U.S (“ISAba125– blaNDM-1–blaMBL”). Our study warrants that the convergence of genes mediating resistance to last-resort antibiotics in epidemic clones would largely facilitate their widespread in clinical settings, thus representing a potential challenge to clinical treatment and public health.ImportanceCarbapenemase-producing Enterobacteriaceae (CPE) spread at a high rate and colistin is the last-resort therapeutic for the infection caused by CPE. However, the emergence of plasmid-borne mcr genes highly facilitates the wide dissemination of colistin resistance, thus largely threatens the clinical use of colistin. Here, we for the first time characterized a clinical Enterobacter hormaechei strain co-producing blaNDM-1, blaIMP-4 and mcr-9.1 belonging to an epidemic clone (ST418). The accumulation of genes mediating resistance to last-resort antibiotics in epidemic clones would largely facilitate their widespread in clinical settings, which may cause disastrous consequence with respect to antimicrobial resistance. Understanding how resistance genes were accumulated in a single strain could help us to track the evolutionary trajectory of drug resistance. Our finding highlights the importance of surveillance on the epidemic potential of colistin-resistant CPE, and effective infection control measures to prevent the resistance dissemination.

SIMULATION-BASED ANALYSIS OF EARTHEN HERITAGE ARCHITECTURE AS RESPONSIVE REFUGEE SHELTERS (CASE STUDY: DOMES OF NORTHERN SYRIA)

Syria has been struggling through a continuous conflict for more than nine years so far. This conflict has had a disastrous consequence, for not only Syria urban areas but also its world heritage and historical sites. Moreover, the ongoing conflict resulted in the displacement of over 13 million people that is more than half the population; including more than 6.1 million internally displaced. This long-term encampment is a growing aspect of a growing refugee crisis. The Syrian refugees have to face another crisis in the camps due to a significant shortage of resources and support. One solution was using earthen buildings that have been a traditional architectural style in Syria for 11 thousand years. As a part of the cultural heritage, it depends on community participation and achieves environmental and economic efficiency in addition to preserving memory and identity of the place. This paper discusses the creation of sustainable shelters through the revival of heritage vernacular earthen architecture in northern Syria. A comparative analysis was conducted between the humanitarian agencies shelters (HAS) and different historical vernacular dwellings (HDS) from the same region with an arid steppe climate (hot summer and a short cold winter); they were modelled in numerical thermal simulations framework as a means to assess the shelters’ building energy demand and indoor comfort quality. The comparison resulted in the superiority of the heritage dwelling. The paper is concluded with passive approach optimization to the different historical earthen domes with consideration of the historical characteristics and background.

Numerical Analysis of Disastrous Effect of Reopening Too Soon in Georgia, USA

ABSTRACTSocial distancing restrictions were lifted in Georgia, USA before the daily new Covid-19 cases were significantly reduced below the peak. In this paper we show through numerical analysis the disastrous consequence of this action resulting in a second peak of daily cases which caused additional fatalities.

An Exploration to Develop Concrete Walls Using MnxZn1-xFe2O4 Ferrite as Absorbing Material to Provide Defense against Electromagnetic Pollution

Concern regarding the shielding effectiveness (SE) of building materials is gaining more response nowadays due to the awareness on the electromagnetic pollution (EMP) that is believed to results in disastrous consequence. A pure concrete inherently providing certain level of SE but it is not enough. Hence additional shielding and absorbing additives are added into the concrete. In this work MnxZn1-xFe2O4will be added into the pure concrete to enhance its SE performance. The effect of microstructure, compositions, grain sizes, homogeneity, mixture volume of the MnxZn1-xFe2O4will be considered for the optimization in this mixture. The key component to determine the SE of concrete is their electrical characteristic (relative permittivity and relative permeability). The parallel plate which is proposed previously will be used to determine the electrical characteristic of material and it will also be used for SE measurement.

Legal Safeguard from Intellectual Property Rights of Cultural Creative Industry

Just over twelve years ago, United Nations Educational, Scientific and Cultural Organization (UNESCO) published the Culture, trade and globalization: questions and answers. In the book, the first ever definition of ‘cultural industries’ is applied to ‘those industries that combine the creation, production and commercialization of contents that are intangible and cultural in nature. These contents are typically protected by copyright and they can take the form of goods or services.’ Cultural creations need guiding and checking on, and that is the reason why there is art director or creative director, so-called the ‘gate-keeper’, controlling over the quality of creations. If a gate-keeper builds a safeguard in the cultural creative behavior, lacking the check on the legal protection in the cultural creative industries, and whether the information of cultural industry element has touched on the question of the intellectual property rights infringement, then it will result in a disastrous consequence. This is the topic which the article researches on.