Life-threatening Situations Research Articles

The sense of social security of Ukrainian refugees in Poland

Social security is a relatively new area of research in security sciences. In a life-threatening situation, any of us would try to escape. The example of refugees from Ukraine allows us to indicate a number of threats resulting from forced migration caused by war. What does social security mean to of Ukrainian emigrants in Poland? Since security is defined as a state of peace, a state of certainty and a guarantee of one’s behavior, the sense of security is a state of anxiety and lack of confidence. In order to better understand and assess this threat, it is necessary to explain what social security is. Social security is a concept that is viewed from many directions and there is no adopted definition that describes this social phenomenon. For the purposes of this article, the following definition has been adopted: Social security is associated with the probability of undesirable social phenomena (problems) and the limitation of risks related to survival and quality of life in the economic and cultural spheres. Moreover, the level of social security adjusts to social challenges and risks and such is the increased number of refugees in Poland.

Correction: La Sala et al. New Fast Acting Glucagon for Recovery from Hypoglycemia, a Life-Threatening Situation: Nasal Powder and Injected Stable Solutions. Int. J. Mol. Sci. 2021, 22, 10643

The authors would like to make corrections to the reference citations in the original article [...].

Therapeutic Plasma Exchange for the Treatment of Hyperthyroidism: Approach to the Patient with Thyrotoxicosis or Antithyroid-Drugs Induced Agranulocytosis.

Primary hyperthyroidism is an endocrine disorder characterized by excessive thyroid hormone synthesis and secretion by the thyroid gland. Clinical manifestations of hyperthyroidism can vary from subclinical to overt forms. In rare cases, hyperthyroidism may represent a clinical emergency, requiring admission to an intensive care unit due to an acute and severe exacerbation of thyrotoxicosis, known as a thyroid storm. First-line treatment of hyperthyroidism is almost always based on medical therapy (with thioamides, beta-adrenergic blocking agents, glucocorticoids), radioactive iodine or total thyroidectomy, tailored to the patient's diagnosis. In cases of failure/intolerance/adverse events or contraindication to these therapies, as well as in life-threatening situations, including a thyroid storm, it is necessary to consider an alternative treatment with extracorporeal systems, such as therapeutic plasma exchange (TPE). This approach can promptly resolve severe conditions by removing circulating thyroid hormones. Here we described two different applications of TPE in clinical practice: the first case is an example of thyrotoxicosis due to amiodarone treatment, while the second one is an example of a severe adverse event to antithyroid drugs (agranulocytosis induced by methimazole).

Living and leaving a life of coercion: a qualitative interview study of patients with anorexia nervosa and multiple involuntary treatment events

BackgroundA small but significant group of patients with anorexia nervosa (AN) undergo multiple involuntary treatment (IT) events. To enhance our understanding of IT and potentially inform treatment, we explored experiences and perspectives on IT of these patients.MethodsWe designed a qualitative semi-structured interview study and used reflexive thematic analysis. Participants were at least 18 years of age, had multiple past IT events (≥ 5) related to AN over a period of at least one month of which the last IT event happened within the preceding five years. Participants had no current IT, intellectual disability, acute psychosis, or severe developmental disorder. We adopted an inductive approach and constructed meaning-based themes.ResultsWe interviewed seven participants. The data portrayed a process of living and leaving a life of coercion with a timeline covering three broad themes: living with internal coercion, coercive treatment, and leaving coercion; and five subthemes: helping an internal battle, augmenting suffering, feeling trapped, a lasting imprint, and changing perspectives. We highlighted that patients with AN and multiple IT events usually experienced internal coercion from the AN prior to external coercion from the health care system. IT evoked significant negative affect when experienced, and often left an adverse imprint. Moreover, IT could help an internal battle against AN and perspectives on IT could change over time.ConclusionsOur study suggests that feeling internally coerced by AN itself sets the stage for IT. Clinicians should be conscious of the potential iatrogenic effects of IT, and reserve IT for potentially life-threatening situations.

Exploring family caregiver challenges in caring for patients with COVID-19 in intensive care units.

Families of individuals hospitalized in an intensive care unit (ICU) with severe illnesses, such as COVID-19, are experiencing a range of physical and emotional stressors. Identifying the challenges faced by family members and providing support to loved ones battling life-threatening diseases can lead to improved treatment and care for the said family members in a healthcare setting. The current study was conducted to explore and understand the experiences of family caregivers caring for their loved ones battling COVID-19 in an ICU. This descriptive qualitative study was conducted from January 2021 to February 2022, based on the experiences of 12 family caregivers of patients with COVID-19 hospitalized in the ICU. Data collection was conducted through purposeful sampling using semi-structured interviews. MAXQDA10 software was used for data management, and conventional content analysis was used for qualitative data analysis. The present study conducted interviews with caregivers to understand their experiences while caring for a loved one in an ICU. Three main themes emerged from the analysis of these interviews: hardship of care trajectory, pre-loss mourning, and contributing factors in resolving family health crises. The first theme, the hardship of care trajectories, encompasses categories such as immersion in the unknown, lack of care facilities, negligence in care, neglect of families by healthcare providers, self-ignorance, and perceived stigma. The second these was pre-loss mourning that included some categories such as emotional and psychological turmoil, witnessing the exhaustion of loved ones, separation suffering, the fearing of loss, anticipatory grief, blame related to the disease causative agents, and perceived helplessness and despair. The third theme was contributing factors in resolving family health crises that included categories of the critical role of family caregivers in health engagement, the role of healthcare professionals in health engagement, and the role of interpersonal factors in health engagement. A total of 80 subcategories were also obtained based on the experiences of the family caregivers. This study's findings indicate that families can play an important role in resolving their loved ones' health problems in life-threatening situations such as the COVID-19 pandemic. Moreover, healthcare providers must recognize and prioritize family-based care and trust the families' ability to effectively manage health crises. Healthcare providers should also be attentive to the needs of both the patient and their family members.

Rising global incidence of invasive group A streptococcus infection and scarlet fever in the COVID-19 era – our knowledge thus far

Rising global incidence of invasive group A streptococcus infection and scarlet fever in the COVID-19 era – our knowledge thus far

Blood types and antibody profiles of Straight Egyptian Arabian horses in Qatar: Preliminary results.

The characterization of the blood groups, antibody profiles, and its distribution pattern among different horse breeds and geographic locations, can be very useful in life-threatening situations where a blood transfusion is needed, and compatibility tests are not readily available. This study estimated the distribution of blood types and antibody profiles in Straight Egyptian Arabian horses from Qatar. A total of 20 Straight Egyptian Arabian horses, from multiple origins and genetic background were included. Venous blood from each horse was typed and screened for anti-red blood cell (RBC) hemolytic and agglutinating antibodies. Descriptive statistical analysis and Fisher Exact test were applied, considering 95% confidence interval (95% CI). All included horses (100%) had Aa and Ca blood types (95% CI: 83.2%-100.0%). Other blood types found less frequently included Ua (50%), Qc (45%), Pa (40%), Qb (25%) and Qa (5%). Only horses withtravel history developed anti-RBC antibodies (6 out of 9), however, no horse carried more than one type of anti-RBC antibodies, supporting the premise that environmental factors may influence the development of alloantibodies. Although pre-transfusion testing regardless the circumstances should be prioritized, even considering a small population of horses, our findings suggest that Straight Egyptian Arabian horses in Qatar could be safely used as blood donors, due to the apparent omnivalence of Aa and Ca blood types and lower incidence of alloantibodies, important in emergency situations where pre-transfusion testing is unavailable.

In state we trust: Evidence from Poland on why we undersave for retirement

ABSTRACT With a possible decline in public pension benefits, private savings will become critical for maintaining desired living standards, yet most people undersave. We focus on one of the possible explanations for this: trust in the state. Using data from a dedicated survey and applying structural equation modeling, this study demonstrates that Polish citizens cherish the unconditional, albeit subconscious, belief in the state as a potential rescuer of last resort in life-threatening situations. This trust plays an essential role in people’s propensity to save for the future. We discuss potential explanations of this phenomenon and its consequences for social policymaking.

Fetal and Perinatal Nephrology: Small but Mighty.

Fetal and Perinatal Nephrology: Small but Mighty.

Deep Multimodal Habit Tracking System: A User-adaptive Approach for Low-power Embedded Systems

The pace of population ageing is increasing and is currently becoming one of the challenges our society faces. The introduction of Cyber-Physical Systems (CPS) has fostered the development of e-Health solutions that ease the associated economic and social burden. In this work, a CPS-based solution is presented to partially tackle the problem: a Deep Multimodal Habit Tracking system. The aim is to monitor daily life activities to alert in case of life-threatening situations improving their autonomy and supporting healthy lifestyles while living alone at home. Our approach combines video and heart rate cues to accurately identify indoor actions, running the processing locally in embedded edge nodes. Local processing provides inherent protection of data privacy since no image or vital signs are transmitted to the network, and reduces data bandwidth usage. Our solution achieves an accuracy of more than 80% in average, reaching up to a 95% for specific subjects after adapting the system. Adding heart-rate information improves F1-score by 2.4%. Additionally, the precision and recall for critical actions such as falls reaches up to 93.75%. Critical action detection is crucial due to their dramatic consequences, it helps to reduce false alarms, leading to building trust in the system and reducing economic cost. Also, the model is optimized and integrated in a Nvidia Jetson Nano embedded device, reaching real-time performance below 3.75 Watts. Finally, a dataset specifically designed for indoor action recognition using synchronized video and heart rate pulses has been collected.

The compatibility of oxytocin and tranexamic acid injection products when mixed for co-administration by infusion for the treatment of postpartum haemorrhage: An in vitro investigation.

To investigate the compatibility of oxytocin and tranexamic acid injection products when mixed for the purpose of co-administration by intravenous infusion. Compatibility testing. Hospitals taking part in a multicentre postpartum haemorrhage treatment (E-MOTIVE) trial in Kenya, Nigeria, Tanzania and South Africa. Oxytocin and tranexamic acid products. The compatibility of two sentinel products of oxytocin injection and tranexamic acid injection in 200-mL infusion bags of both 0.9%w/v saline and Ringer's lactate solution was assessed. We analysed all tranexamic acid-oxytocin combinations, and each evaluation was conducted for up to 3h. Subsequently, the compatibility of multiple tranexamic acid products with reference oxytocin products when mixed in 0.9%w/v saline over a period of 1h was investigated. Concentration of oxytocin over time after mixing with tranexamic acid products. We found significant interaction between certain oxytocin and tranexamic acid products after mixing them in vitro and observing for 1 h. The interaction substantially impacted oxytocin content leading to reduction in concentration (14.8%-29.0%) immediately on mixing (t= 0min). In some combinations, the concentration continued to decline throughout the stability assessment period. Oxytocin loss was observed in 7 out of 22 (32%) of combinations tested. In a clinical setting, mixing certain oxytocin and tranexamic acid products before administration may result in an underdosing of oxytocin, compromising care in an emergency life-threatening situation. The mixing of oxytocin and tranexamic acid injection products for co-administration with intravenous infusion fluids should be avoided until the exact nature of the observed interaction and its implications are understood.

Aging Out-of-Place: Perceptions of Successful Aging Among Aging Burundian Refugees in the United States.

Refugees flee their home countries due to life-threatening situations and are resettled in countries such as the United States. For older refugees, their cultural background and forced migration experience may affect how they perceive successful aging in their host countries. As such, it is important to understand how aging refugees perceive aging well to enhance their well-being in the host communities. Thus, the present study explores perceptions of successful aging among refugees in the United States. Twenty-one Burundian refugees, aged 50-67, were recruited from an upper Midwest community to participate in interviews on their perceptions of successful aging. The qualitative interviews were analyzed using thematic content analysis. Emergent themes showed that aging refugees' perceptions of successful aging were in some ways consistent with perceptions among other nonrefugee aging populations, such as perceptions related to physical functioning and health. Yet, in many ways, refugees' unique background and experiences seemed to lead to unique aging perceptions, such as perceiving an earlier onset of aging and expressing surprise and appreciation to experience old age. Study findings suggest important future directions and potential implications for refugee host regions and communities on how they can better support aging refugees as well as develop effective interventions to promote well-being.

Is There a High Risk for GI Bleeding Complications in Patients Undergoing Abdominal Surgery?

Gastrointestinal bleeding (GIB) can cause life-threatening situations. Here, endoscopy is the first-line diagnostic and therapeutic mode in patients with GIB among further therapeutic approaches such as embolization or medical treatment. Although GIB is considered the most common indication for emergency endoscopy in clinical practice, data on GIB in abdominal surgical patients are still scarce. For the present study, all emergency endoscopies performed on hospitalized abdominal surgical patients over a 2-year period (1 July 2017-30 June2019) were retrospectively analyzed. Primary endpoint was 30-day mortality. Secondary endpoints were length of hospital stay, cause of bleeding, and therapeutic success of endoscopic intervention. During the study period, bleeding events with an indication for emergency endoscopy occurred in 2.0% (129/6455) of all surgical inhouse patients, of whom 83.7% (n = 108) underwent a surgical procedure. In relation to the total number of respective surgical procedures during the study period, the bleeding incidence was 8.9% after hepatobiliary surgery, 7.7% after resections in the upper gastrointestinal tract, and 1.1% after colonic resections. Signs of active or past bleeding in the anastomosis area were detected in ten patients (6.9%). The overall 30-day mortality was 7.75%. The incidence of relevant gastrointestinal bleeding events in visceral surgical inpatients was overall rare. However, our data call for critical peri-operative vigilance for bleeding events and underscore the importance of interdisciplinary emergency algorithms.

Emergency hemodialysis in the Joseph Raseta Befelatanana hospital, Antananarivo, Madagascar

Initiation of emergency dialysis is a critical situation responsible for high morbidity and mortality. This study describes the characteristics of emergency hemodialysis patients in a hospital in Madagascar. It is a descriptive study over a period of 7 months, from September 1, 2018 to March 31, 2019, on emergency hemodialysis patients in the hemodialysis department of the University Hospital of Joseph Raseta Befelatanana, Antananarivo. Emergency hemodialysis was defined as dialysis performed immediately or within the first 48 hours of hospitalisation in a life-threatening situation. Among 124 haemodialysis patients, 52 patients (41.93%) had started dialysis as an emergency. The mean age of patients was 50.5 years and the sex ratio (male/female) was 1.08. Hypertension (51.92%) and diabetes (34.61%) were the main comorbidities. Chronic kidney disease was found in 82.7%. The majority of patients were unprepared and had initiated dialysis with a central venous catheter. The most frequent indication was Kussmaul's breathing (32.6%) followed by anuria (28.84%). The mortality rate was 23.08% and the prognosis was influenced by their condition on arrival. The predominance of chronic kidney disease and the absence of a permanent vascular approach can be explained by the late referral to nephrologists of patients with chronic kidney disease. Efforts need to be made to increase the proportion of scheduled dialysis patients with a permanent approach.

The Integration of Live Video Tools to Help Bystanders During an Emergency Call: Protocol for a Mixed Methods Simulation Study

Early action by bystanders is particularly important for the survival of individuals in need of emergency care, especially those experiencing a cardiac arrest or an airway obstruction. However, only a few bystanders are willing to perform cardiopulmonary resuscitation. The use of a live video during emergency calls appears to have a positive effect on the number of cardiopulmonary resuscitations performed by bystanders. The objective of this study is to propose and evaluate the relevance of a living lab methodology involving video calls in simulated life-threatening emergency situations. The first study aimed at analyzing the process of dealing with out-of-hospital cardiac arrest at a dispatch center and identifying the needs of the dispatchers. The second study is a pretest of a living lab. The third study focuses on a living lab in which 16 situations of cardiac arrest and airway obstruction are simulated. The simulation includes both a live video and transmission of a video demonstration of emergency procedures. The measures focus on 3 areas: the impact of video tools, development of collaboration within the community, and evaluation of the method. The results of the first study show that dispatchers have an interest in visualizing the scene with live video and in broadcasting a live demonstration video when possible. The initial results also show that collaboration within the community is enhanced by the shared simulation and debriefing experiences, clarifying regulation procedures, and improving communication. Finally, an iterative development based on the lessons learned, expectations, and constraints of each previous study promotes the existence of a living lab that aims to determine the place of live video tools in the sequence of care performed by dispatchers. Living labs offer the opportunity to grasp previously undetected insights and refine the use of the applications while potentially developing a sense of community among the stakeholders. DERR1-10.2196/40699.

Informed consent and compulsory treatment on individuals with severe eating disorders: a bio-ethical and juridical problem.

The problem concerning the activation of the measure of Compulsory Health Treatment (CHT) for subjects suffering from Eating Disorders (ED) represents a legal paradox that places health professionals in the position of frequently doubting the real usefulness of the measure within the hospital context. This issue is mainly related to anorexia nervosa, which puts the subject in a higher life-threatening situation than other EDs. To outline the current state of the art, the most recent national and international scientific publications concerning informed consent and CHT in EDs were searched. In addition, Italian rulings in various degrees of judgement were evaluated with the suggestion of a possible resolution of these issues. The analysis of the literature showed that although a multitude of psychometric instruments has been created to identify the ability to give informed consent, there are still not all the elements necessary to identify the actual degree of disease awareness of ED subjects. An important factor could be the exploration of the person's interception, which has been seen to be very high in individuals with AN who are known not to experience the sensation of hunger. At present, reviews of the bibliography and judgments have shown that the measurement of CHT remains crucial if it is intended as a life-saving treatment. However, it is evident that in terms of BMI, CHT is not a definitive intervention and therefore the adoption of this practice is necessary with extreme caution taking into account the person's actual ability to consent. Future studies will have the task of determining the psychic factors necessary to better understand the state of the person in his or her physical and mental wholeness, giving due weight to these characteristics and orienting knowledge in a practical sense to more profitable direct treatment for individuals with ED.

An extremely rare phenomenon: Angina bullosa hemorrhagica

Introduction:Angina bullosa hemorrhagica is a disease without a concomitant hematological or vesiculobullous disorder characterized by painless hemorrhagic bullae in the oral mucosa; it is rarely seen and has a good course.Case presentation:A 45‐year‐old female patient was admitted to the emergency department with a painless hemorrhagic bulla that suddenly appeared on the soft palate. A blister, 2 cm in diameter and dark red in color, was seen extending from the hard palate's posterior to the soft palate. Nasolaryngoscopic evaluation was performed, and no additional hemorrhagic bulla was detected. She was discharged with the recommendation of oral mouthwash.Discussion:Solitary hemorrhagic bulla, suddenly occurring on the soft palate, is diagnostic for angina bullosa hemorrhagica. Some authors have reported that blisters in the posterior pharynx may progress to acute upper airway obstruction.Conclusion:Early nasolaryngoscopic evaluation in angina bullosa hemorrhagica is an excellent option to be considered by the emergency physician to prevent life‐threatening situations.

The Tactical Athlete: Definitions, Cardiovascular Assessment, and Management, and "Fit for Duty" Standards.

Tactical athletes are individuals in the military, law enforcement, and other professions whose occupations have significant physical fitness requirements coupled with the potential for exposure to life-threatening situations. Such exposures can have varied hemodynamic effects on the cardiovascular system. It is crucial that their clinical evaluation is inclusive of specific occupational requirements. Safety protocols regarding medical clearance are relatively more stringent for this population than for competitive athletes due to the increased impact to the tactical athlete, their team, and the population they aim to serve and protect should they experience a cardiovascular event on the job.

A RARE CASE OF MOREL LAVELLEE LESION

Introduction: Morel-Lavallée lesions are post-traumatic, closed degloving injuries occurring deep to subcutaneous plane due to disruption of capillaries resulting in an effusion containing hemo-lymph and necrotic fat. It is an uncommon condition that results from a shearing force, causing a gloving injury which may get infected and lead to a life-threatening situation. Case Presentation: A 28 year old female patient presented to the emergency department with a history to Road trafc accident and sustained minor lacerations to the left lower limb and a contusion over the lateral aspect of the left thigh. The patient was found to have MLL upon ultrasound over the contused area, which was then incised and drained. The wound healed well over 3 weeks and split skin grafting was done which was successfully taken up. MLL's are rare forms of closed degloving Discussion: injuries which may be missed upon initial examination and mis-diagnosed as a contusion. If not treated promptly, it may lead to infection of the collected blood and overwhelming sepsis. It is important for clinicians to be Conclusion: aware of Morel Lavellee lesions as the diagnosis is more reliable on clinical examination and prompt diagnosis may prevent life-threatening complications in trauma patients

Outcomes of Open Versus Laparoscopic Surgery for Colorectal Cancer in the Emergency Setting

Aim: The study aim is to do the comparison of oncological and short-term results of open and laparoscopic surgery for colorectal cancer in emergency setting. Study Design: This retrospective cohort research was held in the Department of Surgery, Civil Hospital, Karachi and Sheikh Zayed Medical College/ Hospital, Rahim Yar Khan for two-years duration from January 2020 to December 2021. Patients and Methods: after approval of this study and an informed consent agreement was signed by each participant. We performed an emergency analysis on 55 consecutive patients who received emergency open (n=40) or laparoscopic (n=15) resection for colorectal cancer. Results: The gender, age, BMI, American Society of Anesthesiologists (ASA) score, tumor location and prior abdominal surgery history were not significantly different between the laparoscopic and open groups. The T4 pathological tumors were more frequent in the open surgery group (50% vs. 13.3%; p=0.031) than in the laparoscopic group. The open surgery group also experienced high proportion of perforation (42.5% vs. 33.3%) and obstruction (47.5% vs. 26.7%) cases. In the laparoscopic group, bleeding or anemia were much common (33.3% vs. 7.5%; p=0.032). The laparoscopic group did not experience any open conversions. The open surgery group had a high pervasiveness of Hartmann's surgery (35%), whereas the laparoscopic group had high pervasiveness of low anterior resection (26.7%; p=0.064). The complication ration at 30-days for laparoscopy (37.5%) and open surgery (33.3%) was comparable (p=0.900). Conclusions: In some individuals with colorectal cancer, emergency laparoscopic surgery has advantages in relation of short-term and oncologic outcomes. As a result, skilled laparoscopic surgeons may actively consider using laparoscopy in life-threatening situations. Keywords: Laparoscopy, colorectal cancer, and emergency.