Preventing transfusion associated hyperkalemia in pediatric cardiac surgery : Measure The Levels of Potassium in Packed Red Blood Cells Before Using – invited Commentary

The authors present an revolutionary study aiming to evaluate the effect of alterations in potassium concentrations in transfused packed red blood cells (PRBC) on neonate and infant potassium levels after congenital cardiac surgery. By establishing a strict protocol which restricts the rate of transfusion, the age of the transfused PRBC, and not transfusing a PRBC with a potassium level above 15 mmol/L, they accomplished to suggest a safe and easy way for preventing transfusion associated hyperkalemia.

LMA PROSEAL: AN ALTERNATIVE TO ENDOTRACHEAL IN- TUBATION IN OPEN APPENDECTOMY OPERATION.' IN THE DEPARTMENT OF ANESTHESIOLOGY, MEDICAL COLLEGE, KOLKATA

INTRODUCTION One of the important responsibilities of an Anaesthesiologist is to maintain a patent airway during any surgical procedure. Since the early days of Anaesthesia, various efforts have been made to dispel the problem of airway maintenance. AIMS AND OBJECTIVES The study entitled “LMAProSeal: An alternative to endotracheal intubation in open appendicectomy operation” was conducted with the aims to compare the efcacy of LMA ProSeal and Endotracheal Tube in patients undergoing Open Appendectomy under General Anaesthesia. MATERIALAND METHODS Study Area: This study was conducted in Medical College, Kolkata (West Bengal), under the department of Anaesthesiology in General Surgery Operation Theatre (C. B. Top OT/ Green OTComplex), after clearance from the Hospital ethical committee, during the period from 1st may 2013 to 31st January 2014. Awritten informed consent was taken from all patients included in the study. StudyPopulation:Patients postedforopenAppendicectomyoperationwithBMIbetween18.50–24.99kg/m2andbodyweightbetween30—60kg. Sample Size: 100 RESULTS AND OBSERVATIONS The effects were observed by monitoring heart rate, blood pressure and SPO2 preoperatively (as baseline), after intubation or placement of LMAProSeal at 1 min, 3 mins, 5mins and every 5 mins thereafter till the reading at removal of the device. For both the groups baseline ETCO2 was taken from connection of ETCO2 cable following placement of airway devices. SUMMARY AND CONCLUSION The study revealed that both the airway devices (ET tube and LMA ProSeal) were successful in operative procedure (open appendicectomy) in all the patients without any signicant complication. In experienced hands and following a strict protocol of insertion, the LMA ProSeal can prove to be an efcient and safe alternative to endotracheal tube for airway management of elective patients undergoing laparotomy procedure like open appendicectomy.

Successful Resumption of Football Competition With Spectators During the Active Phase of COVID-19 Pandemic: Experiences From A Rapidly Developing Country

Background: COVID-19 has interrupted professional sporting activities for more than a year and sent shockwaves across the society. Objectives: To evaluate the resumption of professional football event with fans and the likely spread of COVID-19 infections. Design: A retrospective observational studyMethods: The study involved football players, match officials, local organizing committee (LOC) members, working in close coordination, and over 16,000 spectators in the state of Qatar. We examined data from the Amir Cup final (December 18th , 2020), which was played under a strict protocol that included extensive SARS-CoV-2 RT-PCR testing for players and match officials, as well as the utility of COVID-19 rapid antigen testing and antibody testing as a tool for screening spectators to ensure their safe return to the stadiums. In addition, we reviewed the guidelines and protocols that were put in place to organize Qatar's Amir Cup Football Final, which drew over 16,000 fans in the stadium.Results: A total of 16171 spectators undertook rapid antigen and antibody tests for the Amir cup final (From Dec16-Dec18, 2020). Fifteen Spectators (n=15) returned with a positive result for COVID-19 infection during the final event (Positivity rate =0.12%). All players underwent RT-PCR testing 48 hours before the match. None of the players tested positive for Covid-19 infections. 1311 individuals reported having symptoms related to COVID-19 post final of Amir Cup. These spectators were tested for COVID-19 RT-PCR with an overall positivity rate (positive/reactive) to be 0.42% (69/16171).Conclusion: This report shows a meagre incidence rate of COVID-19 infections during and post-Amir Cup final, and based on this, it appears that during the ongoing COVID-19 pandemic, the supervised and controlled resumption of football matches with spectators can be carried out safely following a strict testing and tracing protocol.

Should the Endoscopic Restrictions during COVID-19 Pandemic Remain Unchanged?

(Background) Endoscopic procedures are interventions that have been defined as carrying a high-risk of infection with COVID-19. Most endoscopy units restrict their activity based on pre-endoscopic diagnosis. (Objective) To determine the consequences of endoscopic restrictions as a result of the COVID-19 pandemic and their impact on digestive cancer diagnosis. (Design) A comparison of upper digestive endoscopies and colonoscopies with gastrointestinal cancers diagnosed between three endoscopic centers, two of which restricted their procedures and one that did not but performed the procedures under a strict protocol. (Setting) A retrospective analysis was performed collecting data between 15 March 2019 and 15 August 2020. Two-factor ANOVA and a Tukey’s a posteriori test were used as statistical tests. (Main outcome measures) There was variation in gastrointestinal cancer diagnosis between 2019 and 2020, considering the endoscopic procedures performed each year. (Result) There was a significant decrease in the total endoscopic procedures performed between 2019 and 2020 (p < 0.001), the result of reduced testing at the two centers (p < 0.001) with pre-endoscopic restrictions, which was not compensated for by a slight increase in procedures at the center without restrictions (p = 0.139). Regarding the total cancers diagnosed, while a significant decrease was observed for the two centers with pre-endoscopic restrictions (p = 0.007), a significant increase was registered in the center that maintained its endoscopic productivity (p < 0.001). After 851 procedures (537 upper digestive endoscopies and 314 colonoscopies) there was no evidence of COVID-19 infection in the endoscopic staff. (Conclusion) Endoscopic restrictions based on pre-endoscopic diagnosis should be reassessed in consideration of local pandemic situations, and a balance should be sought between COVID-19 infection risk and the detrimental delay of potential cancer diagnosis.

757 Does Increased Sampling of Cerebrospinal Fluid from External Ventricular Drains Lead to Increased Rates of Infection?

Introduction External ventricular drains (EVDs) are commonly used in the management of acute hydrocephalus after subarachnoid haemorrhage (SAH). Infection is the most common complication. There remains controversy over whether frequent sampling is associated with increased risk of infection. Method Two cohorts of patients requiring EVD after SAH were retrospectively analysed for suspected and proven CSF infection. The first clinical cohort was of 50 consecutive patients with twice weekly sampling. The second group had alternate daily sampling as part of a prospective research study. Results Female to male ratio were (32:18) and (29:15) in clinical vs research group respectively. Average age of both groups was 59. Average length of treatment with EVD in both groups was 10 days. 16/50 (32%) patients had a suspected infection vs 13/44 (30%) and 8/50 (16%) had a proven infection compared to 6/44 (14%) in clinical and research groups, respectively. There was no statistically significant difference between the two groups (suspected infections p = 0.7 and proven infections p = 0.7) Conclusions Increased rates in CSF sampling in the research cohort did not result in higher rates of CSF infection. This suggests that rate of sampling, if done following a strict protocol, is not associated with increased risk of infection.

Journey so far with COVID 19 – a comprehensive review

Introduction. The occurrence of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has emerged as a global pandemic with huge death tolls. Coronavirus disease 2019 (COVID-19) may progress from minimal infection to serious respiratory failure mandating treatment for a continuum of developed disease condition. Aim. The purpose of this review is to summarize the findings related to epidemiology, clinical manifestations, modes of transmission, diagnosis and the treatment modalities (both experimental and repurposed) for COVID-19. Material and methods. Literature were searched using various search engines like PubMed, SCOPUS, EMBASE, J-Gate, Google Scholar to look for review articles, randomized controlled trial results, prospective studies and, retrospective studies done on COVID-19 for the purpose of this comprehensive review. Analysis of the literature. The transmission seems to be occurring through droplet, fomite and aerosols (rarely). Currently there is no specific/targeted vaccine available. Priority is highly placed to identify possible treatment approaches to circumvention this disease. Conclusion. Till we find a vaccine, we have to strategize to optimally use the existing evidence of the indirect effects of these various available drugs for therapy and maintain a strict protocol for prevention and we must use triage system to admit only those critically ill or having severe disease.

Disaster Risk Communication and the Zero-Casualty Goal of Albay Province, Philippines

The province of Albay in the Philippines is highly vulnerable to climatic and geologic hazards, but it has largely achieved its zero-casualty goal for the past two decades. In recognition of this achievement, the province has garnered numerous awards from international and national organizations. Past studies have identified Albay's success factors, but the role of communication has been overlooked. Thus, this research discusses the communication projects and protocols of Albay on disaster management. Data were obtained from interviews of key informants and examination of official documents. Results showed that the province's communication activities are assigned to specific persons, embedded in an early warning system, enacted using multiple media, supported by multiple stakeholders, and implemented under a strict protocol. These make Albay's disaster communication practices effective in attaining its zero-casualty goal during disasters.

Nasal Nalbuphine Analgesia in Prehospital Trauma Management by First-Responder Personnel on Ski Slopes in Switzerland

Background Pain is one of the major symptoms complained about by patients in the prehospital setting, especially in trauma. Due to the mountainous topography, there may be a time delay between injury and arrival of professional rescuers, in particular on ski slopes. Administration of a safe opioid by first responders (FR) may improve overall treatment. We therefore assessed the use of nasally administered Nalbuphine as analgesic treatment in trauma patients by FR at various skis resort in Switzerland.Methods This observational study examined a cohort of 267 patients given Nalbuphine by FR in various ski resorts in Switzerland. All FR were instructed how to administer Nalbuphine before treating patients. A treatment algorithm was developed and distributed to assure that Nalbuphine was only administered following a strict protocol. Data regarding pain scores and pain reduction after administration of Nalbuphine were collected on-site. Refills were handed out with each completed questionnaire.Results Nalbuphine decreased the level of pain statistically significant and clinically relevant by a median of 3 units on the NRS for pain. The multivariate regression model showed that pain reduction was more pronounced in patients with higher initial pain level. Nalbuphine was less effective in patients aged 20-60 years compared to the adolescent population. No major side effects were observed.Conclusion Nasal Nalbuphine by FR was a noninvasive pain management strategy that provided safe and effective analgesia in prehospital, acute­ly injured patients. This may be an alternative method especially in circumstances of severe pain and prolonged time between arrival of the FR and arrival of EMS / HEMS personnel on scene.