Novel, Inexpensive Portable Respiratory Protection Unit (PRPU) for Healthcare Workers

Introduction: Given concern for increased aerosolization during intubation of patients with severe acute respiratory syndrome coronavirus, we sought to create a portable, inexpensive, and easily constructed device to help protect healthcare workers.Methods: A respiratory protection unit can be constructed in approximately 30 minutes and for less than 50 United States dollars in materials, using polyvinylchloride pipe and automobile collision wrap.Conclusion: This device provides possible increased protection during video laryngoscopy and can easily be replicated

Endometriosis: An Unusual Cause of Bilateral Pneumothoraces

A 27-year-old female presented to the emergency department with sudden onset shortness of breath. A diagnosis of bilateral catamenial pneumothoraces was made following chest radiograph. Catamenial pneumothorax is a recurrent spontaneous pneumothorax that occurs in 90% of affected women 24-48 hours after the onset of their menstruation; 30-50% of cases have associated pelvic endometriosis. Symptoms can be as simple as chest pain or as severe as the presentation of this patient who was initially found to be in significant respiratory distress

A Full Uterus: Hematometra from Cervical Scarring

A 29-year-old female presented with abdominal pain, nausea, and vomiting. She reported no menstrual period for one year. She did report monthly episodes of severe cramping. A loop electrosurgical excision procedure was performed approximately 10 months prior. On pelvic exam, a smooth cervix with scarring over the os was visualized with no evidence of cervical opening. A pelvic ultrasound showed an enlarged uterus with contents within the endometrial cavity likely representing hemorrhage of different ages and ongoing bleeding. Gynecology was consulted and performed an incisional opening of the cervix. The patient was diagnosed with hematometra from scarred cervical os

The oxidation of carbon monoxide using a tin oxide catalyst

This paper outlines some of the steps involved in the development by the United Kingdom Atomic Energy Authority (UKAEA) of a catalytic device for the recombination of carbon monoxide and oxygen in a CO2 laser system. It contrasts the differences between CO oxidation for air purification and for laser environmental control, but indicates that there are similarities between the physical specifications. The principal features of catalytic devices are outlined and some experimental work described. This includes measurements concerning the structure and mechanical properties of the artifact, the preparation of the catalyst coating and its interaction with the gaseous environment. The paper concludes with some speculation about the method by which the reaction actually occurs

Optimising the cost-effectiveness of risk-based screening for diabetic retinopathy

Publicly provided health screening programmes tend to offer standardised screening for a fixed eligible population. Recently, the development of risk calculation engines has introduced the potential for the stratification of screening based on individuals' risks of disease onset. This possibility raises practical, methodological, and ethical challenges. To date, no such programme has been the subject of an economic evaluation. In this thesis we present reason and basis for the allocation of screening based on individual risk. The research is conducted in the context of screening for diabetic eye disease in the UK. Diabetic retinopathy is a common complication of diabetes that can lead to blindness, substantial detriments to quality of life, and significant health care resource use. Our study is linked to a programme of research that includes a cohort study and randomised controlled trial in the city of Liverpool. We review and further develop the evidence base to inform the evaluation of a risk-based screening programme for diabetic eye disease. Specifically, we generate new evidence on the costs and health outcomes associated with the screening and treatment of diabetic retinopathy. We report on a cross-sectional study of health-related quality of life for people attending screening for diabetic retinopathy and find that people with pre-symptomatic disease tend to report poorer quality of life than people with no disease, with EQ-5D-5L index values of 0.733 on average compared with 0.787 for people with no disease. A meta-analysis of published health state utility values for diabetic eye disease shows a negative impact on health-related quality of life before progression to blindness. Our meta-regression found a utility index decrement of 0.024 for people with proliferative retinopathy. The costs of screening are low at the individual level, estimated to be £32.03 in our costing study. But the overall budget impact of changes in the frequency of screening can be significant. We analyse a large data set of hospital and community screening activity to identify key treatment pathways for diabetic eye disease. We find that these have changed in recent years, with the introduction of more expensive interventions. The evidence generated by our work is used to inform the development of a decision analytic model. The model is designed to estimate the cost-effectiveness of risk-based screening for diabetic eye disease, compared with current practice. We find that risk-based screening is likely to be more cost-effective than standardised screening programmes. Evaluating a programme that allocates screening according to individuals' levels of risk raises theoretical and ethical challenges. To this end, we develop a simple framework for individualised cost-effectiveness analysis that can be used to inform the design of a risk-based screening programme. We also explore the ethics of risk-based screening, developing the notion of screening need as distinct from treatment need. Risk-based screening is likely to be cost-effective in the context of diabetic eye disease. The evidence presented in this thesis can be used to support the evaluation of new programmes, which can be designed in order to optimise cost-effectiveness using the methods that we describe. Such an approach is consistent with equitable policy objectives

Delayed-onset angioedema following a snakebite in a patient on ACE inhibitors: A case report

INTRODUCTION: Angiotensin converting enzyme inhibitors (ACEI) are a common class of medications prescribed to patients for hypertension. Anti-hypertensive use is not normally considered an important factor when treating patients with crotalid envenomations; however, in combination with the venom in this patient, it may have resulted in angioedema. CASE REPORT: A 65-year-old male on ACEI presented to his community emergency department following a snake envenomation to his thumb. Six vials of Crotalidae polyvalent immune fab were administered, and he was transferred to a referral center. Approximately 18 hours after the envenomation, the patient complained of tongue swelling and difficulty speaking. There was evidence of angioedema, with the right side of the tongue significantly enlarged compared to the left. He was intubated for airway protection and remained on a ventilator for three days. CONCLUSION: Angiotensin converting enzyme inhibitors may potentiate the effects of exogenous bradykinin as some snake venom has naturally occurring bradykinin, which may further amplify its effects. Extra vigilance may be warranted for the development of angioedema in patients receiving ACEI

Real-Time Analysis of Drosophila Post-Embryonic Haemocyte Behaviour

BACKGROUND: The larval stage of the model organism Drosophila is frequently used to study host-pathogen interactions. During embryogenesis the cellular arm of the immune response, consisting of macrophage-like cells known as plasmatocytes, is extremely motile and functions to phagocytise pathogens and apoptotic bodies, as well as produce extracellular matrix. The cellular branch of the larval (post-embryonic) innate immune system consists of three cell types-plasmatocytes, crystal cells and lamellocytes-which are involved in the phagocytosis, encapsulation and melanisation of invading pathogens. Post-embryonic haemocyte motility is poorly understood thus further characterisation is required, for the purpose of standardisation. METHODOLOGY: In order to examine post-embryonic haemocyte cytoskeletal dynamics or migration, the most commonly used system is in vitro cell lines. The current study employs an ex vivo system (an adaptation of in vitro cell incubation using primary cells), in which primary larval or pre-pupal haemocytes are isolated for short term analysis, in order to discover various aspects of their behaviour during events requiring cytoskeleton dynamics. SIGNIFICANCE: The ex vivo method allows for real-time analysis and manipulation of primary post-embryonic haemocytes. This technique was used to characterise, and potentially standardised, larval and pre-pupal haemocyte cytoskeleton dynamics, assayed on different extracellular matrices. Using this method it was determined that, while larval haemocytes are unable to migrate, haemocytes recovered from pre-pupae are capable of migration