Urgent Conditions Research Articles

Adaptive Resource Allocation for Diverse Safety Message Transmissions in Vehicular Networks

In this paper, we propose a two-level adaptive resource allocation (TARA) framework to support vehicular safety message transmissions. In particular, three types of safety messages are considered in urban vehicular networks, i.e., event-triggered messages for urgent condition warnings, periodic messages for vehicular status notifications, and messages for environmental perception. Roadside units are deployed for network management, and thus messages can be transmitted through either vehicle-to-infrastructure or vehicle-to-vehicle connections. To satisfy the requirements of different message transmissions, TARA framework consists of a group-level resource reservation module and a vehicle-level resource allocation module. Particularly, the resource reservation module is designed to allocate resources to support different types of message transmissions for each vehicle group at the first level. To learn the implicit relationship between the resource demand and message transmission requests, a supervised learning model is devised in the resource reservation module, where to obtain the training data we further propose a sequential resource allocation (SRA) scheme. Based on historical network information, SRA scheme offline optimizes the allocation of sensing resources, i.e., choosing vehicles to provide perception data, and communication resources. With resources reserved for each group, the vehicle-level resource allocation module is then devised to distribute specific resources for each vehicle to satisfy the differential requirements in real-time. Extensive simulation results demonstrate the effectiveness of TARA framework in terms of the high packet delivery ratio and low latency for message transmissions, and the high quality of collective environmental perception.

Patient-reported orofacial-dental pain severity and tele-triage decisions during COVID-19 pandemic: Does the severity of pain drive tele-triage decisions?

BackgroundGlobally, with the COVID-19 pandemic, dental services were limited to emergency/ urgent conditions and were provided only after tele-triage referral for face-to-face management. However, no previous research explored whether the pain severity (PS) drives the tele-triage decisions. The current study examined the association between PS and tele-triage decision of whether to manage the condition remotely or refer the caller for face-to-face management.MethodsThis retrospective cross-sectional study analyzed the PS reported by hotline callers, using numerical rating scale (NRS-11), during the first wave of COVID-19 lockdown (23 March–31 August 2020) and its association with tele-triage decision controlling for age, sex, history of chronic illness, and dental discipline needed. Binomial logistic regression assessed the association between the PS (exposure) and tele-triage decision (outcome). ANOVA compared PS across tele-triage categories, dental history and tentative diagnosis.ResultsPS was significantly associated with tele-triage decisions (p < 0.05). An increase in pain score by 1 unit was associated with 1.4 times increased odds of face-face referral (95% CI: 1.26–1.54). Pediatric/ adolescent patients (9–18 years) (odds ratio (OR) = 2.07; 95% CI: 1.07–4.02), history of chronic illness (OR = 2.12; 95% CI:1.28–3.51), need for surgical specialty (OR = 1.93; 95% CI: 1.22–3.04) and orthodontic specialty (OR = 7.02; 95% CI: 3.54–13.87) were independently associated with tele-triage decision. PS was highest for the emergency triage category (8.00 ± 2.83, P < 0.0001), dental history of tooth with cavity or filling (6.65 ± 2.024, P < 0.0001), and the tentative tele-diagnosis of cellulitis (7.75 ± 2.872, P < 0.0001).ConclusionsDuring COVID-19 pandemic, tele-triage decisions were significantly influenced by patient-reported PS, adjusting for a range of variables. Despite this, referral for face-to-face management was individualized and driven by the tripartite considerations of the reported pain, clinical judgement, and the high transmission characteristics of COVID-19.

Prompt intervention in large bowel obstruction management: A Nationwide Inpatient Sample analysis

BackgroundLarge bowel obstruction is an urgent condition which can progress to ischemia and perforation. The importance of prompt intervention has not been rigorously demonstrated. MethodsPatients with bowel obstruction who underwent stoma, stent, and/or colectomy in the Nationwide Inpatient Sample were used to study prompt intervention (defined as occurring within 2 days of admission). Outcomes were inpatient mortality, discharge to home, and length of stay in an adjusted analysis. ResultsAmong the 31,277 patients, prompt intervention occurred in 42.6%. In an adjusted analysis, prompt intervention was more likely in higher income patients and less likely in patients with comorbidities; among those with malignant obstruction, less likely in women, and among those with benign obstruction, less likely in Blacks. Inpatient mortality (6%) was not different between groups. Discharge home (71% vs 68%; p < 0.0001) and shorter LOS (−3 days) occurred in those managed promptly. ConclusionPrompt intervention in large bowel obstruction results in decreased LOS and greater likelihood of discharge to home, but not a mortality benefit. Female, Black and lower income patients were less likely to have prompt intervention.

Modern approaches to the therapy of urgent conditions (рlacenta praevia)

BACKGROUND: Obstetric bleeding associated with placental anomalies is a leading cause of massive bleeding and maternal mortality. Their relevance increases due to the increasing abdominal delivery frequency. Numerous proposed approaches and ways to stop such bleeding indicate the complexity and versatility of the problem, as well as its unresolved present stages.&#x0D; AIM: This study aimed to evaluate the effectiveness of a new method of bleeding control in placenta previa.&#x0D; MATERIALS AND METHODS: Herein presented the results of a prospective study that included 58 cases of bleeding control for placenta previa in patients who gave birth in 20172020 at G.G. Kuvatov Republican Clinical Hospital in Ufa. Two groups were formed depending on the method of bleeding control. The main group included 34 patients who used a new method for bleeding control. The control group included 24 patients who used traditional methods of bleeding control following the clinical protocol.&#x0D; RESULTS: The proposed method of bleeding control in placenta previa using drainage silicone tubes and a circular suture is used during cesarean section surgery for placenta previa without signs of placenta accreta spectrum. When separating the placenta and bleeding from the placental site in the region of the lower uterine segment and the internal uterine pharynx, drainage tubes were used that are placed in the internal pharynx area, the uterine body, and the vagina in the necessary amount to achieve tamponade of the internal pharynx.&#x0D; Further, the tubes were fixed by applying a circular suture tied in the lower uterine segment, which pressed the placental area to the tubes in a hard-to-reach place for stitching, located in the region of the lower uterine segment and internal uterine pharynx, with a mechanical vascular compression at the internal pharynx level without disturbing the outflow from the uterine cavity.&#x0D; CONCLUSION: The comparative study of methods for stopping the lower segment bleeding in patients with placenta previa shows the high effectiveness of the proposed method for reducing the surgical intervention time and the postoperative period course, as well as the ergonomics and simplicity of bleeding control for the surgeon.

Motivation as a complex algorithm of encouraging a person to engine in motional and recreational activity

The article considers the scheme of physical and recreational activities, as physical exercises in the growing hypo dynamics of modern man is an urgent need and condition for improving health. On the way to creating an effective and long-lasting motivational stimulus for exercise enthusiasts, there are many obstacles and killers of motivation that you need to know and be able to overcome. There are also different ways to strengthen motivation: reminding about the need and importance of physical activity, checking your physical condition every week, creating new habits and strengthening your motivations by actions, ranking the importance of your tasks, postponing what to expect, paying full attention to the most necessary. As a result of research of literature sources the scheme of structure of formation of motivation to motor activity in the general kind which is presented in drawing is developed. The presented conclusions show that the needs and motivation for physical activity are social needs that require special study, because in contrast to more important biological and social needs, they are not paramount, but on the contrary - must withstand the conflict with such enjoyable activities as recreation, visiting and watching movies, football, meeting friends, drinking alcohol, etc. The second conclusion states that the structure of motivation for motor activity is a complex multifactor algorithm that depends on many factors that are both generalized and individual, and develop and change in dynamics.

The Repatriation of Foreign Terrorist Fighters in Indonesia: Its Dilemma and Debates

ISIS (Islamic State in Iraq and Syria) has expanded its movement to Southeast Asia, including Indonesia which once got attacked by terrorist as the country becomes terrorists’ preferred place to travel and execute their plans in conflict zones. To tackle this problem, Indonesian government had issued a policy to avoid negative implications upon the return of Indonesian nationals linked to terrorism from abroad (Foreign Terrorist Fighters or FTF). The government was considering whether or not to repatriate FTF since this plan remains a debatable issue in Indonesia. The government was concerned with the possibility of them recruiting new members. On the other side, humanity becomes the opposite reason leading to the acceptance of the extremist repatriation policy. Due to the urgency of the rampant terrorist threats and the consequences, the Indonesian government has decided to implement the repatriation policy. The government ended up refusing the repatriation of Indonesian nationals linked to terrorism abroad to protect the national security. This article elaborates the radicalization mechanism, terrorist recruitment process based on the national security theory. This study also explains the urgent situation and condition that made the government apply refusal against repatriation. There are still considerable challenges regarding the repatriation policy that need to be addressed such as relevant infrastructure and effective regulations.

The Repatriation of Foreign Terrorist Fighters in Indonesia: Its Dilemma and Debates

ISIS (Islamic State in Iraq and Syria) has expanded its movement to Southeast Asia, including Indonesia which once got attacked by terrorist as the country becomes terrorists’ preferred place to travel and execute their plans in conflict zones. To tackle this problem, Indonesian government had issued a policy to avoid negative implications upon the return of Indonesian nationals linked to terrorism from abroad (Foreign Terrorist Fighters or FTF). The government was considering whether or not to repatriate FTF since this plan remains a debatable issue in Indonesia. The government was concerned with the possibility of them recruiting new members. On the other side, humanity becomes the opposite reason leading to the acceptance of the extremist repatriation policy. Due to the urgency of the rampant terrorist threats and the consequences, the Indonesian government has decided to implement the repatriation policy. The government ended up refusing the repatriation of Indonesian nationals linked to terrorism abroad to protect the national security. This article elaborates the radicalization mechanism, terrorist recruitment process based on the national security theory. This study also explains the urgent situation and condition that made the government apply refusal against repatriation. There are still considerable challenges regarding the repatriation policy that need to be addressed such as relevant infrastructure and effective regulations.

Emergency department triage and COVID‐19: Performance of the Interagency Integrated Triage Tool during a pandemic surge in Papua New Guinea

ObjectiveTo determine the sensitivity of the Interagency Integrated Triage Tool to identify severe and critical illness among adult patients with COVID‐19.MethodsA retrospective observational study conducted at Port Moresby General Hospital ED during a three‐month Delta surge.ResultsAmong 387 eligible patients with COVID‐19, 63 were diagnosed with severe or critical illness. Forty‐seven were allocated a high acuity triage category, equating to a sensitivity of 74.6% (95% CI 62.1–84.7) and a negative predictive value of 92.7% (95% CI 88.4–95.8).ConclusionIn a resource‐constrained context, the tool demonstrated reasonable sensitivity to detect severe and critical COVID‐19, comparable with its reported performance for other urgent conditions.

A case of surgical treatment of lobar emfysema in a newborn

Lobar emphysema still remains a significant issue of pediatric surgery. It accounts for 14% of all congenital anomalies of the respiratory system. The development of intra-thoracic tension syndrome leads to a critical oxygen supply disorder. The main method of treatment of congenital pathology in case of severe respiratory disorders is operative. However, an unrecognized anomaly of lung development leads to incorrect surgical tactics. A clinical case of surgical treatment of a newborn with lobar emphysema of the lung complicated by intra-thoracic tension syndrome is presented. Video-assisted thoracoscopic resection of the lower lobe of the left lung was performed. Six months after the intervention, a complete restoration of the function of external respiration was detected. Timely full-fledged surgical treatment contributed to the elimination of the cause of the development of an urgent condition in congenital lung abnormality, effective restoration of organ functions and favorable outcome.

Konsep al-Ḍarūrah Tentang Vaksin Astrazeneca Perspektif Majelis Ulama Indonesia

This study aims to comprehensively describe the general overview of al-ḍarūrah and the AstraZeneca vaccine, examine the analysis of fiqh principles regarding al-ḍarūrah in the use of the AstraZeneca vaccine by the MUI, and analyze the MUI fatwa Number 14 of 2021 concerning the Law on the Use of the Covid-19 Vaccine Product. AstraZeneca. This study uses a qualitative-descriptive research method with library research techniques. The results showed that al-ḍarūrah is a condition that threatens human life or part of its body. Al-ḍarūrah referred to in the use of the AstraZeneca vaccine is that there is an urgent need condition (al-ḥājah al-syar'iyyah) that occupies the condition of al-ḍarūrah. This is in line with the fiqh rule "al-ḥājah al-'āmmah wa al-khāssah tanzīlu manzilah al-ḍarūrah" namely general and special needs occupy the position of al-ḍarūrah. The MUI fatwa regarding the use of AstraZeneca's Covid-19 vaccine on the grounds of urgent need that occupies the position of al-ḍarūrah, can be categorized as al-ḍarūrah for treatment, where the Covid-19 vaccine of AstraZeneca product is in accordance with awābiṭ al-ḍarūrah, namely: first, al-arrah arūrah really happens instantly, not waiting for a deliberate al-ḍarūrah; second, there is no other solution except to violate the prohibition; and third, based on reliable expert testimony that there are no drugs other than those that are forbidden.

Impact of gastrectomy for incurable advanced gastric cancer in urgent situations in the elderly

BackgroundChemotherapy is the standard treatment for incurable advanced gastric cancer; however, its indications are limited in elderly patients. Furthermore, the efficacy of chemotherapy and surgery as well as the treatment strategy for incurable gastric cancer in elderly patients with urgent conditions are unclear. In these situations, palliative gastrectomy or gastrojejunostomy is often performed. Less invasive surgical procedures should be performed on elderly patients in consideration of their condition; however, gastrectomy may be preferable if it can improve the prognosis. Therefore, we investigated the significance of palliative gastrectomy in elderly patients with incurable advanced gastric cancer who underwent surgery due to stenosis or bleeding. MethodsFifty-six patients aged >80 years with stage IV incurable advanced gastric cancer who underwent surgery at our department between February 1992 and July 2021 were included in the study. The patients underwent gastrectomy (distal and total gastrectomy) or gastrojejunostomy. We examined the association between the clinicopathological factors and overall survival after surgery. ResultsThe subjects included 43 men and 13 women. Twenty-nine patients underwent distal gastrectomy or total gastrectomy, and 27 underwent gastrojejunostomy. The median follow-up duration for all patients was 297 days. The univariate analysis indicated significant differences in the surgical procedure and blood loss. Multivariate analysis showed a significant difference only in the surgical procedure (hazard ratio, 5.32; 95% confidence interval, 2.43–11.6; P < 0.001). ConclusionsGastrectomy as a palliative surgery for incurable advanced gastric cancer in elderly patients may improve their prognosis.

Nature and Extent of Physical Comorbidities Among Korean Patients With Mental Illnesses: Pairwise and Network Analysis Based on Health Insurance Claims Data.

Objective The nature of physical comorbidities in patients with mental illness may differ according to diagnosis and personal characteristics. We investigated this complexity by conventional logistic regression and network analysis. Methods A health insurance claims data in Korea was analyzed. For every combination of psychiatric and physical diagnoses, odds ratios were calculated adjusting age and sex. From the patient-diagnosis data, a network of diagnoses was constructed using Jaccard coefficient as the index of comorbidity. Results In 1,017,024 individuals, 77,447 (7.6%) were diagnosed with mental illnesses. The number of physical diagnoses among them was 11.2, which was 1.6 times higher than non-psychiatric groups. The most noticeable associations were 1) neurotic illnesses with gastrointestinal/pain disorders and 2) dementia with fracture, Parkinson’s disease, and cerebrovascular accidents. Unexpectedly, the diagnosis of metabolic syndrome was only scarcely found in patients with severe mental illnesses (SMIs). However, implicit associations between metabolic syndrome and SMIs were suggested in comorbidity networks. Conclusion Physical comorbidities in patients with mental illnesses were more extensive than those with other disease categories. However, the result raised questions as to whether the medical resources were being diverted to less serious conditions than more urgent conditions in patients with SMIs.

Analysis of risks and restrictions in hospitalization of urgent patients by ground transport

Relevance. Mortality from accidents, poisoning, acute diseases and injuries in Russia and the world remains high. For a number of urgent conditions, fast medical evacuation to a medical facility and prompt specialized care are critical. In a metropolis, there are a number of features that limit the work of ambulance ground teams (AGT). Intention. To analyze medical evacuation of patients to a hospital in a metropolis (the city of Moscow as an example) using ground transportation, with its shortcomings and limitations. Methodology. Patterns prehospital and early hospital mortality of patients in need of emergency medical care were analyzed, main reasons for the fastest possible transportation to a specialized hospital were determined. The statistics of road traffic accidents involving ambulances in Moscow for 2019-2020 were analyzed. Average traffic loads in Moscow for the period of 2017-2019 were estimated. Cases of rendering emergency medical care to Muscovites outside the city and in places without a road transport system were analyzed. Results and Discussion. The main causes of death before arrival of ambulance teams are blood loss of various origins (28 %), burn shock (6 %), poisoning with various substances (31 %), traumatic brain injury and stroke (12 %), acute coronary syndrome (7 %) and a number of other conditions. If resuscitation measures are required, risks of death increase by 10.7 % for every 10 minutes of waiting for an ambulance. One-day outcomes were influenced by time to hospital admission for cardiovascular diseases (26.9-30.1 % mortality rate ); diseases and injuries of the central nervous system, i.e. stroke, head injury (25.2-25.5 % mortality rate); internal bleeding (12.6-15.2 % mortality rate). In Moscow in 2019, an average of 2.8 ambulance vehicles got into road accidents daily. This probability amounted to 2.78 x10-3 and was 2.5 times higher than for other vehicles (1.11 x10-3). The main restrictions for ground transportation in a metropolis are as follows: unpredictable traffic conditions increase time to hospital admission, difficulty transporting patients from remote areas, including off-road locations. Conclusion. When urgent patients are admitted to a specialized hospital by road in a metropolis, there are a number of restrictions that must be taken into account when organizing emergency medical care. The main potential risks of increased time to hospital admission in Moscow is unpredictable road traffic.

Outcomes of a Short Course in Improving Eye Healthcare Knowledge and Skills Among Final-Year Medical Students.

BackgroundGlobally, at least, more than 2 billion people are either blind or visually impaired, the majority of whom live in low-income settings. Visually impaired people experience limitations in their daily activities in addition to the negative psychological impact. Ophthalmology is not a major focus in medical curricula, including in Sudan. The purpose of this study was to evaluate the effects of a short course in improving eye healthcare knowledge and skills among final-year medical students in a public university in Khartoum State, Sudan.MethodsA mixed-methods interventional study was conducted among 25 final-year medical students in Sudan. A short ophthalmology course was designed and conducted aiming to strengthen the knowledge and ability of the medical students to deal with common eye disorders, eye emergencies, prevention of blindness, and promotion for eye health. Data were collected using a closed-ended questionnaire at the start and 1 month after completion of the course. The quantitative data were analyzed using Excel, and the Fisher exact test was performed using Statistical Package for the Social Sciences (version 21.0) to examine any association between variables of interest. A p value of less than 0.05 was considered statistically significant. The quantitative data was supplemented by one focus group discussion that was conducted at the end of the course.ResultsThe average ophthalmology knowledge of participants improved from 52.6 to 86.6% (p < 0.001). Diagnostic skills improved from 57.3 to 93.6% (p < 0.001), and knowledge regarding the needed interventional actions improved from 58.6% to 94% (p < 0.001). Participants both enjoyed and learnt from this short course. Participants felt more confident and able to distinguish between simple, complicated, and urgent conditions. The majority of course content was new to them, but they suggested replacing some content with actual clinical work.ConclusionA well-designed short ophthalmology course significantly improves the levels of medical students’ knowledge and skills towards eye health. Implementing such a course as a standard component in the national medical curriculum has the potential to contribute towards the reduction of blindness in the long term.

COVID-19 outbreak and acute appendicitis: Does the lockdown has a influence on appendectomies?-A single center retrospective cohort study.

Healthcare systems have been negatively affected from COVID-19 pandemic worldwide. Elective surgical procedures were postponed and conservative treatment options were considered even in urgent conditions. This study aimed to explore the influence of the COVID-19 pandemic on urgent appendectomy in a pandemic hospital. Patients on whom appendectomy was performed between March 2020- June 2020 were included into the study (pandemic group). For comparison, control group patients were selected in the same period of 2019 (control group). Patients' demographics, laboratory and radiological findings, length of hospital stay, complications and histopathological findings of the groups were compared. Forty-six patients were included in pandemic group and and one hundred-one in the control group. Patient characteristics were similar in both groups. There were no significant differences in type of surgery, complications, laboratory and histopathological findings. In the control group, length of hospital stay was longer when compared with the pandemic group. Although the number of appendectomies performed decreased significantly during the COVID-19 pandemic, perioperative parameters were similar in both groups.

The effect of an occlusion-induced delay on braking behavior in critical situations: A driving simulator study.

To share results of an experiment that used visual occlusion for a new purpose: inducing a waiting time. Senders was a leading figure in human factors. In his research on the visual demands of driving, he used occlusion techniques. In a simulator experiment, we examined how drivers brake for different levels of urgency and different visual conditions. In three blocks (1 = brake lights, 2 = no brake lights, 3 = occlusion), drivers followed a vehicle at 13.4 or 33.4m distance. At certain moments, the lead vehicle decelerated moderately (1.7m/s2) or strongly (6.5m/s2). In the occlusion condition, the screens blanked for 0.4 s (if 6.5m/s2) or 2.0 s (if 1.7m/s2) when the lead vehicle started to decelerate. Participants were instructed to brake only after the occlusion ended. The lack of brake lights caused a delayed response. In the occlusion condition, drivers adapted to the instructed late braking by braking harder. However, adaptation was not always possible: In the most urgent condition, most participants collided with the lead vehicle because the ego-vehicle's deceleration limits were reached. In non-urgent conditions, some drivers braked unnecessarily hard. Furthermore, while waiting until the occlusion cleared, some drivers lightly touched the brake pedal. This experimental design demonstrates how drivers (sometimes fail to) adjust their braking behavior to the criticality of the situation. The phenomena of biomechanical readiness and (inappropriate) dosing of the brake pedal may be relevant to safety, traffic flow, and ADAS design.

The persistent challenges faced by vascular surgery services during the UK coronavirus pandemic: a snapshot qualitative survey.

The coronavirus (COVID-19) pandemic continues to affect the NHS. The Vascular and Endovascular Research Network (VERN) COvid Vascular sERvice (COVER) study has prospectively shown the significant global impact of the COVID-19 pandemic on vascular surgery. The aim of this study is to investigate the way in which this second wave has affected surgeons' ability to treat patients with urgent vascular conditions, using contemporaneous snapshot data from 30 UK vascular centres. This is a contemporary (18-28 January 2021) re-run of the Tier 1 COVER survey. This used closed and open questions, related to centres' provision of common vascular services, threshold for treatment, imaging, screening, staff and theatre availability, multidisciplinary team input, clinics, personal protective equipment, vaccination policies and case-backlogs. The survey was disseminated to clinicians via email. A service reduction score was calculated. Forty-two complete responses were received from 30 vascular centres (England, Northern Ireland, Scotland and Wales). Overall, 56.7% of units are performing only urgent procedures. The threshold for abdominal aortic aneurysm (AAA) repair has increased in the majority of UK centres (60%). One in six AAA screening programmes have stopped all screening activity: 30% having a significantly reduced programme and only half running as normal. Waiting lists are increasing for AAA, lower limb revascularisation and venous disease. Overall, these data suggest that vascular care in the NHS is facing unprecedented pressures due to COVID-19. Vascular stakeholders will have to urgently address these issues in the coming months. ISRCTN 80453162 (registered prospectively).

Off-hour presentation and outcomes for percutaneous coronary intervention in acute myocardial infarction with Killip III-IV.

Background/AimsAcute myocardial infarction (AMI) is conventionally recognized as an urgent medical condition requiring timely and effective reperfusion therapy. However, the results of studies on the clinical outcomes in AMI according to hospital visit timings are inconclusive. To explore the difference in long-term outcomes between off- and on-hour percutaneous coronary interventions (PCI) in patients with AMI of Killip functional classification III–IV (Killip III–IV AMI).MethodsData on the characteristics and clinical outcomes of 1,751 patients with Killip III–IV AMI between November 2011 and June 2015 from the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry were analyzed. All participants were allocated into two groups: off-hour (weekdays from 6:00 PM to 8:00 AM, weekends, and legal holidays) and on-hour (weekdays from 8:00 AM to 6:00 PM) groups. The incidence of major adverse cardiac and cerebrovascular events, defined as a composite of all-cause mortality, nonfatal myocardial infarction, any revascularization, cerebrovascular accident, and stent thrombosis, was the primary endpoint.ResultsAmong the 1,751 patients, 572 (39.1%) underwent PCI during on-hours and 892 (60.9%) during off-hours. At the 3-year follow-up, no significant difference was found in the clinical outcomes between the two groups in both the unadjusted and propensity-score weighing-adjusted analyses.ConclusionsThe outcomes of patients with Killip III–IV AMI admitted during off- and on-hours were similar.

Ultrasound-Guided vs. Landmark-Guided Lumbar Puncture for Obese Patients in Emergency Department.

ObjectiveEmergency patients are in severe and urgent condition. If the patient is obese, the traditional lumbar puncture method is more difficult. This study was to observe the comparison of ultrasound-guided and landmark-guided lumbar puncture for obese patients in the emergency department.MethodsSixty patients suspected of intracranial infection, subarachnoid hemorrhage, and intraventricular hemorrhage from January 2018 to June 2020 were selected in the Department of Emergency Medicine, Shengjing Hospital of China Medical University. They were randomly assigned to two groups according to the order of enrollment: Group A (Landmark-guided group, n = 30) and Group B (Ultrasound-guided group, n = 30). Follow-up assessments were performed to observe lumbar puncture time, the number of bloody CSF, Visual Analog Scale (VAS), the complications, and satisfaction.ResultsCompared with group A, group B had less lumbar puncture time, lower puncture attempts, and a higher first puncture success rate (P <0.05). In group B, the number of bloody CSF was less (P <0.05), postprocedural low back pain was less (P <0.05), intraprocedural sciatic nerve irritation and postprocedural paresthesia were less, but the difference was not statistically significant (P > 0.05). Compared with group A, the postprocedural VAS in group B was lower, and the difference was statistically significant (P <0.05). The total satisfaction of group A and group B was 60.0 and 86.7%, respectively. The total satisfaction of group B was higher than that of group A (P <0.05).DiscussionUltrasound-guided lumbar puncture can be used for obese patients with difficulty in the lumbar puncture. It is worthy of clinical application and promotion.

P063 Tracking down autoantibodies

Background/AimsVaccine-associated autoimmunity is not infrequent, pertaining to either the cross-reaction between antigens or the action of adjuvant. This issue is more inexplicable to the COVID-19 vaccine, because of nucleic acid formulation and the hastened development process inflicted by the urgent pandemic condition. Here we are presenting a young patient who developed a significant abnormal autoimmune profile immediately post covid vaccination.MethodsA 31-year-old IT engineer was referred to Rheumatology with post-vaccine arthralgia. He had a history of recent aortic root aneurysm repair after having chest pain on exertion. Echocardiography showed dilated aortic root with significant aortic regurgitation, CT aortogram confirmed spiral type A dissection. He underwent an emergency cardiothoracic surgery in October 2020, followed by an uneventful recovery.He received the first dose of Pfizer COVID-19 vaccine on 2nd February, the very next day he developed painful ankles, knees, left hip, and right shoulder.Blood tests showed elevated CRP of 45, ESR 34, rheumatoid factor positive at 92, anti-CCP >340, ANA 13, ds-DNA 202, U1RNP positive, anti-SM antibody positive, Ro and La antibodies positive, antiJo1 antibody positive, with normal complements.He denied any swelling of the joints. No history of hair loss, photosensitive skin rashes, Raynaud's, sicca symptoms, oro-genital ulceration, or cracking of the skin. There were no constitutional symptoms, chest pain, or bowel issues. He was previously labeled as asthmatic, which is stable after surgery. He doesn’t smoke or drinks alcohol. There was no family history of autoimmune conditions.On examination, he has tenderness across both hands and wrists with palmar erythema but no synovitis. He has painful right shoulder abduction with left hip pain on flexion and extension. Cardiovascular and GI examination was unremarkable apart from sternotomy scar and metallic valvular heart sounds. His dipstick urinalysis was negative for blood and protein. In recent x-rays hands and feet were normal.We agreed on a trial a tapering course of prednisolone started with 20mg daily. Three weeks later in follow-up, he reported partial response to steroids. His inflammatory markers were coming down. We have started azathioprine as a steroid-sparing agent.ResultsThis gentleman with negative autoimmune screening prior to cardiothoracic surgery expressed florid newly detected autoantibodies straightaway after the COVID-19 vaccine. This is suggestive of undifferentiated connective tissue disease with the likelihood of overlap syndrome between rheumatoid arthritis and SLE.ConclusionCOVID-19 vaccination showed a beacon of light to end the pandemic by achieving herd immunity. There is an excusable socioeconomic rush towards mass vaccination without long-term safety analysis, however, it is also crucial that any vaccine licensing process should entail meticulous scrutiny of the human proteome against vaccine peptide sequences. This will minimize the risks of acute autoimmune reactions to inoculation and future chronic autoimmune pathology.Disclosure R. Mazumder: None. K.S. Afridi: None.