Fire and Explosion Hazards Due to Medical Oxygen Handling During Coronavirus Pandemic

With the continued outbreak of the coronavirus and the increase in the need for medical oxygen, it became necessary to take all measures for the safe handling of gas. Oxygen is very reactive and behaves differently to air, compressed air, nitrogen and other inert gases. Medical oxygen, at high pressure, from a cylinder, can react violently with hydrocarbons such as oil and grease which may be used mistakenly in cylinder valve or regulator. The oxidation products are a potentially explosive hydroperoxide. Nearly all materials including rubber, textiles, and metals will burn vigorously in the presence of oxygen. Atmospheric air contains nitrogen 78%, oxygen about 21% and with 1% remaining including a variety of other gases like carbon dioxide and argon. Even a small increase in the oxygen level in the air to about 24% can create a dangerous situation. It becomes easier to start a fire, which will then burn hotter and more fiercely than in atmospheric air and may be impossible to put the fire out. Increase the concentration of oxygen due to leaking valve or hose in a poorly ventilated room or in confined space can quickly create a dangerous level.

Use of Topical Nitroglycerine in the Neonatal Population Following Peripheral Tissue Ischaemia: Case Report and Updates about Safety Concerns

Neonatal thrombosis is a well-described morbidity occurring in the neonatal intensive care unit. Critically ill neonates are most vulnerable to developing thrombosis with serious complications. Fingers and toes ischaemia secondary to vascular occlusion following central lines insertion remains an uncommon occurrence. The therapeutic approach for peripheral tissue injury using local warming, anticoagulants, thrombolytics or topical hyaluronidase showed limited benefits and potential side effects. Here we report an unusual case of finger ischaemia treated successfully using topical nitroglycerine. This complements previous reports confirming the efficacy and safety of this drug and highlighting its potential benefit in neonates.

Hip Pain: Relation to Anatomical Location and Underlying Pathology

The purpose of this article is to provide a synopsis of the current medical understanding of hip pain highlighting its relation to anatomical location and underlying pathology. We describe the i) mechanism of the hip joint, ii) classification of hip pain, iii) prevalence of hip pain, iv) purported causes, v) associated risk factors, vi) clinical presentation, vii) diagnosis and classification, and viii) treatment options. A quiz serves to assist readers in their understanding of the presented material.

Advanced Trainee-Led Physician Clinical Examination Workshop: Improving Training and Culture

Background: Near-to-peer teaching involves more experienced learners acting as tutors for junior colleagues and has significant theoretical benefits for both teachers and learners [1-3]. Aim: Development, implementation, and assessment of a weekend examination preparation workshop by Royal Australasian College of Physicians Advanced Trainees (ATs) for Basic Physician Trainees (BPTs), using a near-to-peer framework. Methods: A two-day offsite course was designed by ATs. Day 1 - subspecialty short-case demonstrations, followed by small-group examination practice. Shared downtime was organized for the evening. Day 2 - two exemplar long-case presentations by ATs with consultant examiner feedback, followed by interactive small-group sessions focusing on presenting long-cases. Results: A post-course survey was completed by 72% of BPTs (13/18) and 88% of ATs (8/9). Responses demonstrated that all BPTs would recommend this workshop to peers. 84% (11/13) found the course material very useful. 62% (5/8) ATs felt their leadership and teaching skills had significantly improved. BPTs reported that the AT long-case demonstrations were highly useful. Negative feedback included the venue, course timing, and lack of patients with clinical signs. Conclusion: This innovative AT-led examination preparation workshop significantly enhanced training culture and candidate well-being. ATs benefited with increased confidence in their ability to lead and teach.

Neurological and Gastrointestinal Manifestations of Novel Corona Virus Disease 2019 (COVID-19): Radiologist Prospective

Gastrointestinal and neurological symptoms can precede or be isolated manifestations of COVID-19 infection, therefore health care professionals must be aware of presentations, which can help in identification and appropriate isolation of such cases.

Uveitis Among Children Living with HIV / AIDS in Kinshasa, RD Congo: A Case Series

Purpose: To report the clinical features of a series of children living with HIV / AIDS (CLWHA) with uveitis. Methods: This was a case series of CLWHA and who had a diagnosis of uveitis examined from November 2010 to April 2011 in five sanitary structures in Kinshasa. For each child, anamnestic elements were collected. Each child underwent an ophthalmological examination including visual acuity measurement, slit lamp examination and fundus examination after dilation. Results: 15 CLWAH presented with uveitis out of a series of 100 CLWHA examined. Fourteen of the children with uveitis were already on treatment and had normal immune status, the only child who had not yet started treatment had a severe immune deficiency. Retinal vasculitis was the most common disorder in 8 children. It was asymptomatic and mainly concerned the veins on the peripheral retina. Four children presented with chorioretinal scars of unknown etiology. HIV-related microangiopathy was found in 2 children. Unilateral anterior uveitis was the only symptomatic involvement, found in the child who were not on treatment. Conclusion: Uveitis is common in African CLWHA. Retinal vasculitis of unknown etiology appears to be the most common clinical manifestation in this population. Antiretroviral therapy seems to decrease the frequency of sight-threatening conditions.

Incidentally Detected Asymptomatic Thrombus in the Inferior Vena Cava Thought to be Caused by Central Venous Catheterization for an Oral Surgical Procedure

Central venous catheterization (CVC) is a common procedure in the perioperative period, and thrombosis is one of the well-known complications of CVC. If the thrombus comes free from the vascular wall, it may cause serious problems such as pulmonary embolism. However, in some cases of inferior vena cava thrombosis, the patient has no symptoms, and thrombus is detected accidentally. A case in which asymptomatic thrombus in the inferior vena cava was incidentally detected following removal of the CV catheter after an oral surgical procedure is described.

Microbiota Against SARS CoV-2: Case Reports and a Model for Stopping the COVID-19 Pandemic

Background: The aim of this work is to present two case reports of successful prevention and treatment of the COVID-19 and to propose a model for stopping the COVID-19 pandemic with probiotics. Material and Methods: We present two case reports during the COVID-19 epidemic in Serbia in which probiotics were used for the prevention and treatment of the COVID-19. Based on the biological plausibility we propose a model for stopping the COVID-19 pandemic with probiotics. Results: In Case 1, a female (75), chain smoker, asthmatic, gets a fever (38.5ºC), and a pronounced weakness. Treated at home with paracetamol. The next morning fever (39.0ºC), more pronounced weakness. We advise to stop with paracetamol and to take a probiotic, 3x1 tablet (4x10exp9 CFU Lactobacillus and Bifidobacterium spec.) during a meal. The same night temperature falls and remains at 36.9ºC, weakness disappears. Feeling healthy and strong ever since. Negative on the ELISA test for the COVID-19. In Case 2, a male, (63), hypertensive, has got infected from a colleague at work who was treated for the COVID-19 in a hospital. Did not take probiotics as prevention. Treated at home with a symptomatic therapy for two weeks, with the symptoms of fever, dry cough, and pronounced weakness. Positive on the ELISA test for the COVID-19. His wife (57), who had been taking one probiotic daily regularly, has felt healthy ever since, although they have slept together. We propose a model for stopping the COVID-19 pandemic. Advice the whole population to take one capsule of probiotics Lactobacillus and Bifidobacterium, during a meal. Those with COVID-19 one capsule three times daily. Those who are on mechanical ventilation- two capsules three times daily. Conclusion: Based on case reports and the biological plausibility we propose a model for stopping the COVID-19 pandemic with probiotics.

Subcutaneous Implantable Cardioverter Defibrillator and LifeVest Saving Lives in Challenging Scenarios

Introduction: According to guidelines, ICD should be implanted in selected patients for primary or secondary prevention. The increasing number of procedures leads to a growth of infective complications. Case Summary: We report two cases of ICD implantation complicated with severe infections. The first procedure was complicated by endocarditis and septic shock, the second one by septic shock. After antibiotics and ICD explantation, a wearable cardioverter defibrillator (WCD) was used as a bridge to subcutaneous ICD (S-ICD). Conclusion: These two cases demonstrate the benefits of the S-ICD, but also the chance to treat high-risk patients with WCD as bridge-to-procedure, allowing full recovery before a new implantation.