SELECTING THE HEAT-REFLECTING SCREEN WHILE THE FORMATION OF CONDENSATE IS AVOIDED

This article deals with the problem of choosing the thickness of the heat-refl ecting screen behind the heating radiator, in which the conditions for the formation of condensate on the wall are not achieved. Based on the analysis of the results obtained, the maximum thickness of the screen is established, using the example of penofol, at the calculated temperature diff erence in the conditions of a cold fi ve-day period, and the heat losses and the economic eff ect of this energy-saving measure are determined already during the heating period. Calculations were carried out for a wall made of reinforced concrete, covered with plaster on the outside. This technique can be used for other cases of enclosing structures and various materials of the heat-refl ecting screen.

Acetaminophen Intoxication with Fulminant Hepatic Failure Salvaged by Plasmapheresis

Introduction Acetaminophen-induced liver injury is the most common cause of acute liver failure, where multiple ingestions or a delay in the presentation may lead to a poor prognosis. N-acetylcysteine (NAC) is the conventional antidote used to treat acute acetaminophen toxicity, and plasmapheresis can be used as an adjunct, though there are no systematic studies to prove its effectivity. Case Presentation An 18-year-old girl was admitted with reduced responsiveness for one day with a few episodes of diarrhea. On admission, she was febrile and had a GCS of 10/15, otherwise normal neurology. She had marked right hypochodrial tenderness, deep icterus, and a pulse of 120 beats per minute, with a blood pressure of 80/50 mmHg; fluid resuscitation with inotropic support was done. Initial investigations revealed severe metabolic acidosis, hemoglobin of 9.5 g/dL, white blood cell count 13,500/mm3, and platelet 119,000 per µL. The prothrombin time (PT) international normalized ratio (INR) was 4.7, and the activated partial thromboplastin time (APTT) was 38.6. The alanine aminotransferase (ALT) level was 8118 U/L, and aspartate aminotransferase (AST) was 3883 U/L with a total bilirubin of 107 µmol/L. The diagnosis of acute liver failure following acetaminophen intoxication was made and managed with intravenous NAC, pantoprazole cover, intravenous ceftriaxone, metronidazole, thiamine, and vitamin K. Fresh frozen plasma and platelets were given for severe coagulopathy. She was started with plasmapheresis at the intensive care unit (ICU), where she had a significant improvement, though she developed hospital-acquired pneumonia, which was successfully managed. Subsequently, her liver functions returned to the baseline, and she was discharged after a psychiatric assessment. Conclusion A high degree of suspicion needs to be adopted to diagnose acetaminophen-induced acute liver failure when a patient presents with hepatic encephalopathy, and plasmapheresis can be considered a life-saving measure adjunct to the NAC.

EP.FRI.4 Cholecystostomy presents as a viable option in acute biliary sepsis during the COVID-19 pandemic

Aim To audit and evaluate gallstone related admissions during the COVID-19 pandemic and assess cholecystostomy as an interim and potentially life-saving measure in acute biliary sepsis Methods Patients attending with gallstone disease related complaints from January to September 2020 were assessed, along with data collection on ‘hot’ gallbladder operations, elective cholecystectomies and cholecystostomies performed. Data was assessed on a month by month basis Results There were 306 gallstone related acute admissions in this audit time period. August had the highest number of admissions with 42 (14%) and March the lowest with 21 (7%). Despite 15 hot cholecystectomies (94%) being performed from January to March, only 1 was performed from April to September (6%). 116 elective cholecystectomies were performed during the time period, with 94 (81%) occurring from January to March. 15 cholecystostomies (9 radiologically, 6 surgically) were performed in the period, with 12 (80%) occurring from March onwards. All cholecystostomy patients have been subsequently listed for laparoscopic cholecystectomy. Conclusions This study demonstrates a drop in elective surgery from March 2020 onwards consistent with the COVID-19 pandemic peak. Furthermore, acute admissions related to gallstones decreased over a similar timeframe. Cholecystostomy proved itself to be a viable and potentially life-saving option in dealing with acute biliary sepsis during the COVID-19 pandemic

Where Did the Pericardial Effusion Go? A Case of Cardiopulmonary Resuscitation Acting as Treatment for Pericardial Tamponade

Pericardial tamponade results in multiple organ dysfunction and can lead to cardiac arrest. Cardiopulmonary resuscitation (CPR), a life-saving measure performed on patients in cardiac arrest, can lead to thoracic organ damage. However, CPR rarely acts as a therapeutic treatment for pericardial tamponade. Our case describes a patient admitted with pericardial tamponade in whom CPR provided therapeutic treatment with pericardial rupture and resolution of the tamponade.

Life-saving with a vaginal condom catheter in postpartum haemorrhage due to vaginal lacerations in a low-resource setting

Postpartum haemorrhage (PPH) due to multiple vaginal lacerations is difficult to manage and tamponade is used as a life-saving measure. Condom catheter with stay sutures at the vaginal introitus for this purpose has not been reported. We describe successfully managing PPH due to multiple vaginal lacerations following a forceps delivery using a condom tied to an 18 FG Foley catheter. The device was introduced to the vagina, inflated with 700 mL of normal saline and was held in situ by sealing the vaginal introitus with interrupted nylon stitches running between the labia minora. Condom catheter is cheap and freely available in low-resource settings. The preparation and application can be done by a less experienced operator.

The Voices of Black South African Men on Renal Dialysis at a Tertiary Hospital: A Phenomenological Inquiry

The study explored the psychosocial experiences of rural black South African men undergoing renal dialysis in a tertiary hospital. Twenty men aged between 20 and 59 years ( Meanage = 40.65 yrs; SD = 12.52) participated in the study. Participants were recruited purposefully. Data were collected over a period of 4 months through in-depth face-to-face interviews and analyzed using the Interpretative Phenomenological Analytical method. The following three key themes were extracted from the interviews: (a) the emotional pain and fear of death following a diagnosis of ESRD; (b) living on dialysis interferes with the management and handling of “manly” responsibilities and duties and, (c) dialysis as a challenging yet life-saving measure. The findings further suggest that renal dialysis has an impact on men’s sense of masculinity and has the potential to complicate the management of renal failure. The paper concludes by recommending that cultural and community factors be taken into account when considering interventions to manage the health of men living with renal conditions.

Facial Ulcer: A Harbinger of Post-COVID-19 Mucormycosis, a Case Report

: Facial ulcers may be the manifestation of a wide variety of disorders with infective, inflammatory, granulomatous, or malignant etiopathogenesis, leading to challenges in differential diagnosis and management. Mucormycosis is an angio-invasive, rapidly spreading, and potentially fatal fungal infection beginning from the nose and paranasal sinuses after the inhalation of fungal spores, manifesting with cutaneous necrotic eschar. The rhinomaxillary region is the commonest site involved, particularly in immunocompromised individuals. Mucormycosis incidence in people with coronavirus disease 2019 (COVID-19) is on the rise, especially in India during the second wave. Diabetes mellitus is an independent risk factor for severe COVID-19 infection, as well as for mucormycosis. We report an elderly gentleman with uncontrolled diabetes, treated for the COVID-19 infection, who presented with an ulcer over the left nasal ala. This case report highlights the importance of high-index suspicion and prompt and aggressive multidisciplinary management of mucormycosis, as a life-saving measure.

Aeromedical evacuation of a COVID-19 patient from a zonal hospital: A case report

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has affected the whole world including many healthcare workers. In this era of ongoing global pandemic, the patient surge for aeromedical evacuation is going to increase. Case Details: A 54-year, male healthcare worker with no known co-morbidities, presented with complains of fever, myalgia, and sore throat at a zonal hospital of Indian Air Force in the northeast part of India. He was diagnosed with COVID-19 related bilateral extensive pneumonia. Despite of standard treatment, his condition deteriorated. An aeromedical evacuation of the patient was carried out to a tertiary healthcare centre at Delhi which involved 4-h of flying time. The Airborne Rescue Pod for Isolated Transportation (ARPIT) isolation pod was used to minimize the risk of contamination. Discussion: This was the first time that a COVID-19 patient was air evacuated in an isolation pod in Indian Armed Forces to the best of our knowledge. Based on our experience, we recommend that air evacuation of such a patient may be resorted to only as a life saving measure. The use of an isolation pod remains an unsettled issue; whereas, it gives absolute containment to spread of infection, it poses unique challenges in terms of handling the patient in case of an in-flight emergency. Certain modifications in the isolation pod have been recommended.

Insinuating cocktailed components in biocompatible-nanoparticles could act as an impressive neo-adjuvant strategy to combat COVID-19

The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) spread rapidly worldwide, freezes all sectors, and was declared a life-threatening disease by the World Health Organization on Jan 30, 2020. So far, no specific drugs are identified or approved for treating SARS-CoV-2. In the past few years, nanomaterials are in the limelight for their ability to deliver the drugs effectively and selectively to target like siRNA, the prime infection sites, and benefiting us to visualize the particular regions, treatment reactions via non-intruding imaging techniques. As intranasal delivery interacts directly to the infection site with minimal side effects on the healthy cell, we postulate to administer a mixture of few polyherbal formulations like the golden spice curcumin, sitopaladi churna (SPC), and kaempferol in zein-chitosan nanoparticles as a life-saving measure for treating Coronavirus disease (COVID-19) cases. This viewpoint will shed light on the antiviral role of curcumin, SPC, and kaempferol zein-chitosan nanoparticle to modulate immune responses and observe its curative approach to the current pandemic COVID.

Analyzing the Development and Implementation Posibility of the Robotic Ambulance for COVID Pacients

During Covid pandemic, the automation, robotization and digitization were accelerated, but the results do not meet all expectations. Telecommunications have undeniable successes, but in other sectors the benefits of technological advancement are still missing. The "online school" and the "online procedures" of some institutions have been partially upgraded, but things have been as well in other activities which were less suitable for automation, robotization and digitization. The healthcare sector was highly stressed in the context of COVID-19 crisis, but it has not fully benefited from the advantages of the robotic vehicles. Life and death during COVID-19 crisis has affected most people, either as victims or actors in a reality that took them unprepared. Ambulances have been challenged by events which were not always managed successfully. They must respond promptly to save the lives of those who call for help. Staff in this sector are often overworked and highly stressed. The simultaneous existence of robotic ambulances that can take over some of the victims who need medical services could be both a good idea and a life-saving measure. The paper proposes implementation of existing technology for optimizing ambulance services with robotic tools and suitable for digitization. In this way, complementary solutions can be generated for increasing the quality of life, respectively for mitigating the emotional and physical stress when it comes to near death experiences. When on-site complex resuscitation and first aid maneuvers are not necessary, being required only the lifting and transportation procedures by a medical robot, the ​​use of a robotic vehicle mitigates the ambulance’s personnel from stresses. These solutions are complementary, leading to an improvement in life’s quality.