Constant Vigilance Research Articles

Weight stigma after bariatric surgery: A qualitative study with Brazilian women.

Prior studies suggest that one anticipated benefit of bariatric surgery is the achievement of a thinner body, one that is less subject to perceived negative judgment and condemnation by others. However, additional analyses also indicate that stigma may persist even with significant post-surgery weight loss. To investigate the stigma-related perceptions and experiences of women who have undergone bariatric surgery and the resulting body transformations, we conducted individual, semi-structured interviews with thirty Brazilian women (15 aged 33-59 and 15 aged 63-72). The resulting text was then analyzed using thematic analysis. We found that some form of weight stigma persisted for our participants, regardless of weight loss. Ongoing experiences of stigma were also evidenced by the constant internal and external vigilance reported by the women, as well as their articulated efforts to distance themselves from their previous bodies. Additionally, participants reported being judged for choosing an "easy way out" to lose weight. Those in the older group reported that weight stigma was entangled with ageism: older participants received mixed messages underscoring the ways that weight and age may interact in doubly stigmatizing ways. Family and close peers were especially powerful sources of stigma experiences. Collectively, these results show that weight stigma persists even when people undergo a procedure to lose substantive weight and that the degree and types of stigma experiences are influenced by gender and age. Our study suggest future research should explore whether a targeted approach might be more effective, for example, an approach that would emphasize the importance of developing coping strategies with respect to experiences of stigma and discrimination after surgery.

Vaccination against COVID-19 in patients with allergy: experience of the allergological center in Dnipro

Vaccination against COVID-19 is the main global preventive measure in the fight against SARS-CoV-2. As the COVID-19 vaccine will be administered to billions of individuals worldwide during the pandemic, there exists a reasonable fear of severe adverse reactions requiring constant vigilance and careful treatment, particularly in individuals with a history of severe allergy. The aim of our study was to develop and implement an algorithm for the safe vaccination against COVID-19 in patients with pathology associated with hypersensitivity reactions. From January to June 2022, after signing the informed consent, 126 adult patients with relevant diseases in remission were included in a prospective single-center study. Complaints and case histories were collected from all patients, including comorbidity and medications received, anthropometric data were studied, a standard clinical examination was performed, tryptase in venous blood was measured, the level of control was additionally assessed in patients with asthma using the asthma control test and spirography. According to the results of the study, it was proven that vaccination against COVID-19 in patients with pathology associated with hypersensitivity reactions is safe, on condition of prior consultation with an allergist and performing vaccination in a medical institution. The algorithm developed for preparing for vaccination in the mentioned above persons consists of a careful collection of case history; assessment and, in case of absence – achieving control of the underlying disease; analysis and correction of therapy with temporary replacement of medications that are potential cofactors of anaphylaxis; determination of blood tryptase level. For safe vaccination in patients with severe allergic anamnesis, administration of 20 mg of desloratadine before each dose of the vaccine with observation after vaccination within 30 minutes is suggested.

#6612 ACUTE KIDNEY INJURY ASSOCIATED WITH IMMUNE CHECKPOINT INHIBITOR THERAPY: REPORT OF 4 CASES

Abstract Background and Aims Immunotherapy using immune check point inhibitors (ICIs) is the cornerstone of modern cancer therapy. Despite significant clinical benefits, ICIs are associated with remarkable adverse events of autoimmune nature involving various organs. Acute Kidney Injury (AKI) occurs more rarely, mainly with the appearance of acute interstitial nephritis. We present a series of patients with AKI after administration of immunotherapy with ICIs. Method Patient 1 with metastatic small cell lung cancer on immunotherapy with atezolizumab presented with purpura on the trunk and lower extremities, AKI, microscopic glomerular hematuria, and proteinuria. Patient 2 with esophageal malignancy on immunotherapy with pembrolizumab and worsening renal function. Patient 3 with endometrial malignancy on immunotherapy with pembrolizumab developed AKI, nephrotic syndrome and microscopic hematuria. Patient 4 with melanoma on immunotherapy with pembrolizumab presented with microscopic hematuria and rash. Results A kidney biopsy was performed in all 4 patients unreavealling the following; Patient 1: pauci-immune necrotizing glomerulonephritis with fibrinoid necrosis and inflammation in the wall of a vessel. Patient 2: acute interstitial nephritis with intense inflammation. Patient 3: findings consistent with focal segmental glomerulosclerosis (FSGS, NOS), without evidence of immune complex disease. Patient 4: focal segmental glomerulosclerosis, moderate interstitial fibrosis and interstitial nephritis in remission. The patient had already been treated with glucocorticoid. In all 4 patients immunotherapy was temporarily discontinued and they were treated with intravenous pulses of methyl-prednisolone followed by oral glucocorticoids, with significant improvement of kidney function and resolution of all extra renal manifestation i.e skin rash etc. Escalation of immunosuppressive therapy with the addition of another agent was avoided in order not to cause relapse of the malignancy. Conclusion AKI is a rare but potentially serious complication of ICIs. Temporal discontinuation of the implicated agent is of major importance while treatment with glucocorticoids may be critical for kindey function. Yet, constant vigilance and sustained collaboration among medical specialists are becoming essential in the increasing use of immunotherapy.

Towards pre-emptive resilience in military supply chains: A compromise decision support model-based approach

ABSTRACT The complex and dynamic nature of military supply chains (MSC) requires constant vigilance to sense potential vulnerabilities. Several studies have employed decision support models for the optimization of their operations. These models are often limited to a best single-point solution unsuitable for complex MSC constellations. In this article, the authors present a novel approach based on decision support models to explore a range of satisficing solutions against disruptions in MSCs using a compromise Decision Support Problem (cDSP) construct and Decision Support in the Design of Engineered Systems (DSIDES). Two cases were evaluated: (1) a baseline scenario with no disruption and (2) with disruption to achieve target values of three goals: (1) minimizing lead time, (2) maximizing demand fulfilment and (3) maximizing vehicle utilization. The results obtained in Case 1 identified a more stable solution space with minimal deviations from the target value, while in Case 2 the solution space was unstable with deviations from the target values

Auto Triggerring Weapon System for Border Security using Internet of Things

Border surveillance is the utmost essential responsibility in the realm of national defense and security. It is imperative to maintain constant vigilance over a nation's borders to uphold tranquility and ensure the safety of its populace. Safeguarding border areas rigorously from such activities is particularly critical in the present climate, where terrorist infiltrations and illicit movements of both animate and inanimate entities have become commonplace due to technological advancements. Offering uninterrupted surveillance is the minimum action required to prevent such incidents in border regions. At present, the manual monitoring of borders is carried out by the border security forces responsible for this task.Due to the vast distances between the borders and the harsh terrain and climate, it requires a lot of people and resources. Designing it is therefore analytically critical to create an automatic weapon system that could also complete even without monitoring task requirement for human involvement. Implementing this system eliminates the need to continuously deploy personnel in hazardous situations. Moreover, the system should possess the ability to make appropriate decisions and take necessary actions while also notifying human controllers when suspicious activities are detected. Central control rooms can be located away from the border region. Once an alert is sent, humans must determine the subsequent course of action. When implemented effectively, this approach helps conserve resources and reduces risks to human life. Full automation of border monitoring is not currently viable due to safety concerns, but such technologies can certainly assist and work in conjunction with armed forces to protect a nation's borders

Securing IoT Networks for Detection of Cyber Attacks using Automated Machine Learning

Cybercriminals are always developing innovative strategies to confound and frustrate their victims. Therefore, maintaining constant vigilance is essential if one wishes to protect the availability, confidentiality, and integrity of digital systems. Machine learning (ML) is becoming an increasingly powerful technique for doing intelligent cyber analysis, which enables proactive defenses. Machine learning (ML) has the potential to thwart future assaults by studying the recurring patterns that have already been successful. Nevertheless, there are two significant drawbacks associated with the utilization of ML in security analysis. To begin, the most advanced machine learning systems have significant problems with their computing overheads. Because of this constraint, firms are unable to completely embrace ML-based cyber strategies. Second, in order for security analysts to make advantage of ML for a wide variety of applications, they will need to develop specialized frameworks. In this study, we aim to put a numerical value on the degree to which a hub can improve the safety of an ecosystem. Typical cyberattacks were carried out on an Internet of Things (IoT) network located within a smart house in order to validate the hub. Further investigation of the intrusion detection system's (IDS) resistance to adversarial machine learning (AML) assaults was carried out. In this method, models can be attacked by supplying adversarial samples that attempt to take advantage of the defects in the detector that are present in the pre-trained model.

Pneumococcal Cerebrospinal Meningitis: A Rare Complication of Pediatric Temporal Bone Fracture

Meningitis is a rare and potentially serious complication in children with temporal bone fractures. We present an unusual case of a 7-year-old girl with pneumococcal meningitis complicated by cerebrospinal fluid (CSF) leakage following transverse fracture in the left temporal bone. She had an otorrhea resolved spontaneously in the early stage of hospitalization. At 4 days post-discharge, the patient returned with headache, fever, neck stiffness, voiding difficulty, and bilateral abducens nerve palsy. Magnetic resonance images demonstrated an intense uniform contrast enhancement in the cerebral cisterns and the sacral nerve roots. Laboratory analysis and culture diagnosed meningitis caused by <i>Streptococcus pneumonia</i>. She was discharged home after getting intravenous ceftriaxone for 5 weeks. Follow-up for the patient required constant vigilance and included a multidisciplinary approach. At 7 months after head trauma, the child was well with no neurological and auditory deficits. This case illustrates a previously unreported complication in pediatric patient of temporal bone fracture associated with CSF otorrhea.

5613475 ADVERSE REACTIONS TO RBC TRANSFUSION: A SINGLE THALASSEMIA AND SICKLE CELL DISEASE DEPARTMENT’S EXPERIENCE

Background: Thalassemia and Sickle Cell Disease patients require regular blood transfusions and iron chelation treatment for the entirety of their lives. Several patients had transfusion-related side effects as a result of frequent and chronic transfusions. Methods: In this study, we analysed the frequency of transfusion reactions and the methods used to address them by reviewing the medical records of 95 patients who received multiple transfusions on a regular basis during a 20-year period. All demographics and charactiristics are in TABLE 1. Table 1: - The Demographics and Characteristics Compared TYPE OF HEMOGLOBINOPATHY β-Thalassemia (51.3%) α-Thalassemia (2.6%) Sickle Cell Disease (12.8%) β-thal/SCD (15.4%) AGE AT THE ONSET OF TRANSFUSIONS < 2 years old (45.7%) > 20 years old (11.4%) > 30 years old (34.3%) occasionally (8.6%) TRANSFUSION FREQUENCY weekly (2.7%) every 15-20 days (54.1%) monthly (34.3%) exchange transfusions (2.7%) Results: Over a 20-year period, 42 percent (42,1%) of the 95 patients who received repeated transfusions reported at least one adverse event during the transfusion (about two per year reported). Our unit’s usual clinical practice is to transfuse patients with Leukoreduced RBC to prevent HLA alloimmunization, CMV transmission, and fever nonhemolytic transfusion reactions.Fever (48.1%), chills (18.5%), anaphylaxis/urticaria (11.2%), swelling (3.7%), hemolysis (11.2%), yersinia enterocolitica (3.7%), and alloimmunization (3.7%) were the most common side effects reported by patients experiencing a transfusion reaction (image 1).In each case, the transfusion was discontinued and the reaction was treated according to local clinical practice. Antibiotic therapy was used to manage infectious complications. Extended blood type matching (ABO, CcDEe, Kell, Duffy, Kidd, MNS,Lewis, Lutheran, etc) has been used in clinical practice as a prophylactic intervention in the case of hemolysis or alloimmunization. Before receiving washed red blood cells in future transfusions, some patients with fever or allergic responses were administered premedication with antihistamines or antipyretics. Nine patients (22.5%) of patients those who had experienced a previously adverse reaction reported a second episode with the following symptoms: allergic reaction/urticaria (44.5%), fever (33.5%), and alloimmunization (22.5%). Patients who developed alloimmunization during the second adverse transfusion event had no history of alloimmunization previously. Conclusions: In the studied population, there was no high prevalence of serious or fatal transfusion adverse effects. Every transfusion requires constant vigilance for the occurrence of transfusion reactions, especially in patients who have received multiple transfusions.

Listeria outbreaks cause maternal and perinatal mortality and morbidity: we must do better.

Listeria outbreaks cause maternal and perinatal mortality and morbidity: we must do better.

Experimental performance of smart IoT-enabled drip irrigation system using and controlled through web-based applications

The water requirements in irrigation have been growing and the accurate quantity of water can be produced by a smart irrigation system. Considering this kind of need, this paper aims to develop an Internet of Things (IoT) enabled smart drip irrigation system by applying Web/Android applications that will provide a solution for continuous monitoring and controlling the drip irrigation system to avoid the problems of constant human vigilance and waste of water. It also facilitates prevention by giving automatic water to plants relying on water necessities. It can also convince be capable in Agricultural fields, Parks, Lawns, etc. With the advancement of technology, there are always reducing risks and making work simpler. The embedded system provides a solution for solving this kind of problem. In this paper, a smart drip irrigation system is established which is driven by IoT and web-based applications. The web application is also designed for taking appropriate action for the user during drip irrigation. This application provides the appropriate amount of water from the pump for gardening. It can be accomplished by incorporating different sensors within the system to observe the humidity, temperature, and soil moisture conditions which transmit the data to the micro-controller for proper estimating the water needs of the plants. This kind of system can be controlled and visualized in the android mobile phone through a web application anywhere.

ANALYSIS OF APPROACHES OF INDIVIDUAL ASIAN COUNTRIES TO ASSESS BIOLOGICAL RISKS

Оver the past decade, the increase in outbreaks of infectious diseases such as COVID-19, monkeypox, etc. has forced us to reconsider the approach to assessing biological risks in ensuring biological safety. The rapid global spread of these diseases is putting enormous pressure on governments and international agencies to diagnose, treat and control outbreaks. In this regard, it is necessary to study their potential in the field of biosecurity, including the diagnosis, treatment, and research of infectious diseases and improve the rules and guidelines for biodefense. An analysis of foreign experience, including China, Pakistan, Kyrgyzstan, Tajikistan and Kazakhstan was carried out on biological risk assessment, which requires constant monitoring and assessment of emerging threats and evolving risks. Monitoring includes conducting regular infectious disease surveillance, analyzing trends and patterns of disease transmission, and evaluating the effectiveness of prevention and control measures. Countries can adapt their approaches and strategies to address new and emerging threats by continuously monitoring and reassessing biological risks. In conclusion, the experience of foreign countries in biological risk assessment provides valuable information on best practices, strategies and technologies that can help improve global biological risk management and mitigation efforts. This review article highlights the importance of reliable surveillance systems, effective communication and cooperation, investment in research and development, constant vigilance and preparedness for biological threats.

Multi-trauma care in the Intensive Care Unit and the role of the nurse: A literature review

Introduction: Multiple traumas occupy a significant part of the staff in the Intensive Care Unit (ICU), as multi-injured patients almost always require intensive care. These patients are distinguished, depending on the cause and type of injuries, in specific categories such as injuries, bleeding etc. During their stay in the ICU they may experience complications that need immediate treatment. The role of the nurse is mainly focused on the constant vigilance and the correct hierarchy of interventions. Aim: The purpose of this literature review is to investigate the care of the multi-injured in ICU and the role of the nurse on it. Method: A bibliographic review was performed on the sites 'PubMed', 'google scholar', 'Scopus' and 'open-archives', with the keywords: 'multi-injured', 'multi-injured in ICU', 'multi-injured care in ICU' , "the role of the nurse in ICU" and "patient with trauma in ICU", for the years 2007-21. A total of 28 articles were used, in English and Greek language. Results: An observational study in Greece (2011) showed that the most common cause of admission to ICUs was road accidents, while a study in China (2014-15) showed that acute intracerebral hemorrhage and brain injury were the most common causes of death. A study in South Korea (2010-15) found that the most common complication in multiple injuries in ICU was respiratory-related pneumonia (VAP), while in another study in the Netherlands (2013-18) 24.6% developed delirium/confusion within the ICU. Meta-analyses in China (2018) and Australia (2016) and a literature review in Canada (2016) showed that early enteral nutrition reduces complications, mortality, and length of stay in the ICU. According to a cohort study in USA (2012), early mobilization of the multi-injured also contributes to the reduction of complications. An observational study in England (2012-15) showed that surgery reduces mortality, while in a prospective study in Brazil (2010-11) the workload of nurses in ICUs with multiple injuries was high and correlated with various factors. Finally, in a contemporary study in Greece (2019) it was observed that 80% of patients in the ICU had experienced positive experiences from the nursing staff. Conclusions: In recent years, studies have been conducted internationally on the prevention, treatment and care of multiple injuries in ICUs. It is proposed to further strengthen the role of nurses, mainly through the institutionalization of protocols and training programs, to improve patient prognosis and reduce health costs in hospitals.

A rare cause of hypoglycemia in adults

The aim of the study was to describe a clinical case of noninsulinoma pancreatogenous hypoglycemia (NIPH).Materials and methods. Patient R. 42 years old, woman, was admitted with complaints on spastic abdominal pain, heartburn, flatulence, bloating. The patient had a history of cramping pains in the upper abdomen, episodes of hypoglycemia up to once a day, periodically diarrhea with undigested food up to 3 times a day, and frequent weakness during last 9 years. In 2013, she was diagnosed with a neuroendocrine tumor of the pancreas, and therefore distal pancreatectomy was performed that year. According to histological and immuno-histochemical studies, foci of islet-cell hyperplasia (nesidioblastosis) were noted in the tail of the pancreas against the background of tissue fibrosis. Non-insulinoma pancreatogenous hypoglycemia of adults (NIPH) was diagnosed, enzyme replacement therapy and Octreotide-depo were prescribed. Relapses were noted twice. Two weeks before admission, the patient noted episodes of hypoglycemia. Upon admission, the patient had state of moderate severity, irregular stools up to 3–4 times a day. Antibacterial treatment was carried out, enzyme replacement therapy, octreotide was continued.Results. On the 7th day of hospitalization, the patient was stabilized: the level of glycemia was 4.5–4.9 mmol / l, the frequency and consistency of stool normalized. No data for decompensation of the disease has been received. The patient was discharged in a satisfactory condition.Conclusion. This clinical case demonstrates the influence of NIPH on the patient’s quality of life and the need for constant vigilance against the recurrence of hypoglycemic episodes, despite the treatment. This case can improve the awareness about this rare but important disease.

FEATURES OF DIAGNOSIS AND TREATMENT OF CROHN’S DISEASE (CLINICAL CASE)

The exact reason for the occurrence of Crohn’s disease remains unknown. It is believed that pathology can be carried out by infectious and viral pathogens, deviations from the norm of natural balance of the microflora of the gastrointestinal tract (hereinafter – the gastrointestinal tract). Many researchers indicate an abnormal autoimmune response of the body on food stimuli – in favor of such an assertion indicates the systematic impression of the internal organs. However, for the emergence and development of this disease, there are significant impacts with harmful habits, such as: smoking, alcoholic beverages and medicines, unbalanced nutrition and the presence of chronic inflammatory gastroids. The inflammatory process begins in the mucous membrane, gradually affects all layers of the wall of the gastrointestinal wall, leads to its destruction and fibrosis and the formation of fistish and stenoses. Therefore, early diagnosis and timely treatment prevents the development of complications, including such severe such as bleeding, perforation of the intestinal wall, intra-abdominal abscesses, internal and external fists, adhesions of the intestine with the development of obstruction. Purpose: on the basis of a specific case of HC to investigate and analyze the features of diagnosis and treatment of these patients using an analytical method and a systematic approach. Materials and methods: The material was a clinical case of HC, methods of instrumental diagnosis and objective analysis. The results: The concrete case of HC is investigated, features of inspection and diagnostics are defined. Conclusions: A feature of the diagnosis and treatment of patients with HC is a constant vigilance about the occurrence of complications, the key to the prevention of which is a multidisciplinary approach in the tactics of diagnosis and treatment of these patients. Key words: Crohn’s disease, features of examination and diagnosis.

Advancing Folkloristics

Advancing Folkloristics

Supplemental Material for Constant Vigilance: The Impact of Weight Stigma, Vigilance, and Internalization on Maladaptive Eating Behaviors

Supplemental Material for Constant Vigilance: The Impact of Weight Stigma, Vigilance, and Internalization on Maladaptive Eating Behaviors

SARS-CoV-2 emerging Omicron subvariants with a special focus on BF.7 and XBB.1.5 recently posing fears of rising cases amid ongoing COVID-19 pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron versions have been the sole one circulating for quite some time. Subvariants BA.1, BA.2, BA.3, BA.4, and BA.5 of the Omicron emerged over time and through mutation, with BA.1 responsible for the most severe global pandemic between December 2021 and January 2022. Other Omicron subvariants such as BQ.1, BQ.1.1, BA.4.6, BF.7, BA.2.75.2, XBB.1 appeared recently and could cause a new wave of increased cases amid the ongoing COVID-19 pandemic. There is evidence that certain Omicron subvariants have increased transmissibility, extra spike mutations, and ability to overcome protective effects of COVID-19 neutralizing antibodies through immunological evasion. In recent months, the Omicron BF.7 subvariant has been in the news due to its spread in China and a small number of other countries, raising concerns about a possible rebound in COVID-19 cases. More recently, the Omicron XBB.1.5 subvariant has captured international attention due to an increase in cases in the United States. As a highly transmissible sublineage of Omicron BA.5, as well as having a shorter incubation time and the potential to reinfect or infect immune population, BF.7 has stronger infection ability. It appears that the regional immunological landscape is affected by the amount and timing of previous Omicron waves, as well as the COVID-19 vaccination coverage, which in turn determines whether the increased immune escape of BF.7 and XBB.1.5 subvariants is sufficient to drive new infection waves. Expanding our understanding of the transmission and efficacy of vaccines, immunotherapeutics, and antiviral drugs against newly emerging Omicron subvariants and lineages, as well as bolstering genomic facilities for tracking their spread and maintaining a constant vigilance, and shedding more light on their evolution and mutational events, would help in the development of effective mitigation strategies. Importantly, reducing the occurrence of mutations and recombination in the virus can be aided by bolstering One health approach and emphasizing its significance in combating zoonosis and reversal zoonosis linked with COVID-19. This article provides a brief overview on Omicron variant, its recently emerging lineages and subvairants with a special focus on BF.7 and XBB.1.5 as much more infectious and highly transmissible variations that may once again threaten a sharp increase in COVID-19 cases globally amid the currently ongoing pandemic, along with presenting salient mitigation measures.

When “Nice” Isn’t: Confronting Niceness and Whiteness to Center Equity in Teacher Education

ABSTRACT Niceness is a socialized disposition, particularly amongst white women, that prioritizes comfort and neutrality while preventing resistance against oppressive systems. Given the demographics of teachers and teacher educators, niceness and whiteness are deeply embedded in programs and institutions. As eight white, female teacher educators, we drew on the power of cross-institutional collaboration to form a self-study community of practice with the purpose of interrogating and dismantling the ways niceness and whiteness function in our teaching and teacher institutions and create barriers to centering equity and justice. Findings indicated that collaboration helped us identify how niceness shaped and continues to shape our teaching and teacher identities, particularly how we navigate difficult conversations, think about our roles as teacher educators, and imagine literacy curricula. Findings also indicated that despite efforts to recognize and interrupt niceness and whiteness, our growth was nonlinear, and we find that constant vigilance and reflection is necessary. Implications for the broader field of education include the power of self-study for disrupting niceness and whiteness in teacher education and orienting the community toward action through mutual support and accountability, while also recognizing the ways in which niceness continues to function as a barrier for enacting change for social justice.

An (Un)Expected Threat for a Regionally Near-Threatened Species: A Predation Case of a Persian Squirrel on an Insular Ecosystem

One of the most successful predators on island ecosystems is the domestic cat, which is considered responsible for the decline of numerous species' populations. This can be estimated by the analysis of cats' dietary habits, yet prey identification is not always possible, and thus, in cases where precise prey identification is required, one of the most accurate methods derives from observing the hunting process. However, the cryptic nature of the feral cats and the constant vigilance of the species that are preyed upon make the observation process difficult, especially when the prey has a low population density. Here, we report for the first time such a case: a feral cat that has ambushed, killed, and consumed a regionally near-threatened species, the Persian squirrel. This incidental observation happened in the squirrel's westernmost end of its distribution, the island of Lesvos, Greece. Due to the unexpectedness of the event, in the following days, we estimated both the squirrels' and cats' population density. Results showed that while the density of the squirrels is moderate, the population density of the feral cats is almost fifteen times higher. For this reason, management actions need to be taken in an effort to minimize the impacts of feral cats on the native species of the island.

HME filters: a boon or bane?

Heat and moisture exchange filters (HMEFs) have been a controversial yet widely used adjunct to breathing circuit. Here we discuss a case scenario where clogging of HMEF with moisture presented as elevated peak airway pressures. Apart from stressing the importance of monitoring airway pressure, we discuss about the judicious use of HMEFs, problems associated with their use and measures to overcome the same. Being a ubiquitous adjunct, a thorough knowledge of its functioning and constant vigilance during its use is of paramount importance