Staff and patient experience of the implementation and delivery of a virtual health care home monitoring service for COVID-19 in Melbourne, Australia.

BACKGROUND: Provision of virtual health care (VHC) home monitoring for patients who are experiencing mild to moderate COVID-19 illness is emerging as a central strategy for reducing pressure on acute health systems. Understanding the enablers and challenges in implementation and delivery of these programs is important for future implementation and re-design. The aim of this study was to explore the perspectives of staff involved with the implementation and delivery, and the experience of patients managed by, a VHC monitoring service in Melbourne, Australia during the COVID-19 pandemic. METHODS: A descriptive qualitative approach informed by naturalist inquiry was used. Staff interviews were analysed using the Consolidated Framework for Implementation Research (CFIR). Patient experience was captured using a survey and descriptive statistics were used to describe categorical responses while content analysis was used to analyse free text responses as they related to the CFIR. Finally, data from the interviews and patient experience were triangulated to see if patient experience validated data from staff interviews. RESULTS: All 15 staff were interviewed, and 271 patients were surveyed (42%). A total of four final overarching themes emerged: service implementation enablers, service delivery benefits for patients, fragmentation of care, and workforce strengths. 19 subthemes aligned with 18 CFIR constructs from staff and patient data. CONCLUSION: Rapid implementation was enabled through shared resources, dividing implementation tasks between senior personnel, engaging furloughed healthcare staff in design and delivery, and having a flexible approach that allowed for ongoing improvements. Benefits for patients included early identification of COVID-19 deterioration, as well as provision of accurate and trustworthy information to isolate safely at home. The main challenges were the multiple agencies involved in patient monitoring, which may be addressed in the future by attributing responsibility for monitoring to a single agency.

Spontaneous Pneumothorax in Patients of COVID 19 Pneumonia.

COVID 19 pandemic has put a massive strain on healthcare all over the world. Every day new data is getting released and various complications are being reported in patients of COVID 19 Pneumonia. One such complication is pneumothorax and pneumomediastinum. Both these conditions can lead to an increase in mortality and morbidity in patients with COVID 19 pneumonia. We studied 476 patients of COVID 19 pneumonia at our hospital, out of which 18 (3.78%) had developed pneumothorax and/or pneumomediastinum. While most of these patients were on some form of positive pressure ventilation (invasive/non-invasive), some of them had a HRCT Chest suggestive of either air trapping and/or cyst formation. Three patients had developed bilateral pneumothorax while on non-invasive ventilator. Nine of the 18 patients expired and nine were discharged.Through this article, we would like to emphasize that an acute deterioration in hypoxemia in a COVID-19 patient could indicate a pneumothorax. Pneumothorax as well as pulmonary thromboembolism are reported complications in COVID-19 and clinician vigilance is required during assessment of patients, as both share the common symptom of breathlessness and therefore can mimic each other.

Bilateral Fungus Ball: An Uncommon Complication Post Severe COVID 19 Infection.

COVID 19 is one of the world's worst hit pandemics. WHO first learned of this new virus on 31 December 2019, following a report of cluster of cases of 'viral pneumonia' in Wuhan, China. Covid 19 causes systemic infection but it worst hits the lungs and can cause ARDS ( 5%). Bilateral lung fibrosis is a commonly observed sequela after severe Covid 19 infection. Covid 19 pneumonia also acts as a nidus for superadded bacterial and fungal infections. However we haven't come across fibrocavitation and fungus ball as post Covid 19 sequelae.brbrWe here present a case report of a patient who was diagnosed as ARDS due to SARS CoV2, was treated as per standard Covid 19 protocols, required NIV and discharged on home oxygen. The HRCT on discharge showed bilateral fibrosis. The follow up HRCT after 45 days of discharge showed evidence of Bilateral cavities with Fungus ball.

Licorice-induced apparent mineralocorticoid excess causing persistent hypertension and hypokalemia.

Chronic ingestion of licorice is known to cause numerous metabolic and electrolyte disturbances. Severe hyponatremia, hypertension, and hypokalemia as well as metabolic alkalosis are amongst the most common consequences of chronic ingestion resulting in an apparent mineralocorticoid excess (AME). Treatment predominantly consists of cessation of licorice ingestion, potassium replenishment and aldosterone antagonists. Given the potentially lethal effects of chronic licorice ingestion, clinicians should be made aware of the presentation of AME and the proper management. We present the rare case of a 62-year-old male with licorice-induced apparent mineralocorticoid excess secondary to excessive licorice tea intake. Initial presentation included severe hypokalemia of 2.2mmol/L and hypertension of 180/110mmHg, while eunatremic (Na, 144meq/L).

Impact of single and mixed infections with Escherichia coli and Mycoplasma gallisepticum on Newcastle disease virus vaccine performance in broiler chickens: an in vivo perspective.

AIMS: This study was designed to investigate, in an in vivo setting, the effects of single and combined infections with either Mycoplasma gallisepticum (MG) and/or Escherichia coli on the chicken immune response induced by Newcastle disease virus (NDV) vaccine. METHODS AND RESULTS: Humoral immunity was measured through detection of NDV antibody and anti-NDV IgG titres using haemagglutination-inhibition test and enzyme-linked immunosorbent assay, respectively. In addition, the expression levels of pro-inflammatory cytokines' genes (interleukin (IL) 6, IL4 and interferon (IFN) γ) were analysed using quantitative reverse transcription PCR. Significant (P < 0·05) results in all immunological parameters were detected in the vaccinated noninfected chicken group in comparison with those in groups exposed to bacterial infections. Bacterial infection along with vaccination hampered the NDV antibodies production and reduced the vaccine upregulated cytokine genes. The vaccinated mixed infection group reported lower antibody titres and cytokines expression levels compared to those in the single infection groups. All the previously enhanced immunological parameters reflected the maximum protection post challenge with velogenic viscerotropic NDV in the vaccinated noninfected chicken group. CONCLUSIONS: These findings provide novel insights into the immunosuppression activities of MG and E. coli infection in chickens vaccinated against NDV. SIGNIFICANCE AND IMPACT OF THE STUDY: This study hopes to provide a better insight to the immunosuppressive action of bacterial pathogens in chickens. This will help to improve biosecurity strategies during NDV vaccination in the future.

Diagnoses and management of adult cough: An Indian Environmental Medical Association (EMA) position paper.

BACKGROUND: Cough is a common yet distressing symptom that results in significant health care costs from outpatient visits and related consultations. OBJECTIVE: The understanding of the pathobiology of cough in recent times has undergone an evolution with Cough hypersensitivity syndrome (CHS) being suggested in most cases of dry cough. However, in the case of productive cough, ancillary mechanisms including impaired Mucociliary clearance, in addition to hypermucosecretory bronchospastic conditions of Smoker's cough, asthma-COPD overlap, bronchiectasis, and allergic bronchopulmonary aspergillosis, need to be critically addressed while optimizing patient care with symptomatic therapy in outpatient settings of India. METHODS: In this review, evidence-based graded recommendations on use of antitussives - & protussives as a Position Paper were developed based on the Level and Quality of Scientific evidence as per Agency for Health Care and Quality (AHRQ) criteria listing and Expert opinions offered by a multidisciplinary EMA panel in India. RESULTS: Management of acute or chronic cough involves addressing common issues of environmental exposures and patient concerns before instituting supportive therapy with antitussives or bronchodilatory cough formulations containing mucoactives, anti-inflammatory, or short-acting beta-2 agonist agents. CONCLUSION: The analyses provides a real world approach to the management of acute or chronic cough in various clinical conditions with pro- or antitussive agents while avoiding their misuse in empirical settings.

Injuries due to motorcycle accidents amongst Saudi women. Are we waiting for a new epidemic?

Full text is available as a scanned copy of the original print version.

Pediatric inguinal hernia: Outcome of repair.

Full text is available as a scanned copy of the original print version.

Diaphragmatic injury. A clinical review.

OBJECTIVE: Recent experience at King Fahad Hospital of the University, Al-Khobar University, Kingdom of Saudi Arabia was reviewed to identify the pitfalls in the diagnosis of diaphragmatic injuries, and attempt to develop a scheme by which early diagnosis is achieved in order to avoid the sequelae of delayed presentations. METHODS: A retrospective chart review of patients admitted to the surgical service, with the diagnosis of diaphragmatic injury was undertaken during the period June 1994 through to June 1999. RESULTS: The total number was 8 patients, and the age ranged between 6-71 years. Of these patients 5 were diagnosed immediately post-traumatic, 2 with delayed presentation, and one with recurrent post-traumatic repair. This case was excluded. Six patients presented following blunt and one after penetrating trauma. Rupture occurred mainly on the left dome of the diaphragm in 5 patients and on the right in 2. Complications ranged from mild chest symptoms to severe respiratory and multi-system involvement. CONCLUSION: Diaphragmatic injuries occurred in 2%-5% of multiple trauma victims. It is considered a predictor of serious associated injuries, However, as many as 10%-30% are missed during the initial evaluation. A high index of suspicion is required, and judicious use of diagnostic aids should be employed to reach early diagnosis to avoid the sequelae of missed injuries.

Bioassays guided isolation of compounds from Chaetomium globosum.

The aim of the present study was to evaluate different biological activities of the fungus Chaetomium globosum (family Chaetomiaceae). The evaluation was done through testing its antimicrobial, antioxidant and anticancer effects. C. globosum was isolated from the Cucumber soil (rhizosphere) and caused inhibition of the mycelial growth of Fusarium solani, Rhizoctonia solani and Sclerotium rolfsii in the biculture test. Petroleum ether and ethyl acetate extracts of the liquid culture of C. globosum showed potent in vitro antioxidant activity. C. globosum proved potent antibacterial activity against Bacillus subtilis, Escherichia coli and Pseudomonas fluorescens. It also recorded significant antifungal activity against Candida albicans, F. solani, Fusarium oxysporum, R. solani and Pythium ultimum. It exerted cytotoxic effect on human hepatocellular carcinoma cell line (HepG2). Unsaponifiable and saponifiable matters of the petroleum ether extract showed the presence of hydrocarbons, sterols and fatty acids. The ethyl acetate extract showed the presence of prenisatin, chrysophanol, chrysazin, chaetoviridin A and B. The isolated secondary metabolites proved significant antioxidant and antimicrobial activity on B. subtilis, E. coli and R. solani. In conclusion, this fungus showed different biological activities. Further studies must be done to apply its use in the agricultural and medicinal field.

Maternal lipopolysaccharide alters the newborn oxidative stress and C-reactive protein levels in response to an inflammatory stress.

Maternal infection is associated with oxidative stress (OS) and inflammatory responses. We have previously shown that maternal exposure to lipopolysaccharide (LPS) at E18 alters the subsequent offspring immune response. As immune responses are mediated, in part, by OS, we sought to determine if maternal inflammation during pregnancy programs offspring OS and C-reactive protein (CRP) levels. Pregnant Sprague-Dawley rats received intraperitoneal (i.p.) injections of saline or LPS at 18 days' gestation (n = 4), and pups delivered spontaneously at term. At postnatal day 24, male and female offspring received i.p. injection of LPS. Serum lipid peroxides formation (PD) and CRP levels were determined before and at 4 h following the LPS injection. Pups of LPS-exposed dams had significantly higher basal OS (PD 29.4 ± 5.4 v. 10.1 ± 4.8 nmol/ml) compared with controls. In response to LPS, CRP levels (20.4 ± 2.8 v. 5.7 ± 1.0 ng/ml) were significantly higher among pups of LPS-exposed dams than controls. Prenatal maternal exposure to LPS increases baseline OS levels in neonates and CRP levels in response to LPS. These results suggest that maternal inflammation during the antenatal period may induce long-term sequelae in the offspring that may predispose to adult disease.

Biologically active steroid from the green alga Ulva lactuca.

The marine green alga, Ulva lactuca, was shown to contain 3-O-beta-D glucopyranosyl-stigmasta-5,25-dien. The structure of the compound was established on the basis of its spectroscopic data and it was extracted for the first time from this alga. The topical antiinflammatory activity of this compound was examined using the mouse ear oedema assay as an experimental model of topical inflammation. Also, the antimicrobial activity of the isolated compound was tested against 10 various microorganisms (G+, G-, fungi and yeast strains).

Effect of octreotide on the prevention of hyperamylasemia after ERCP in Saudi Arabia: a prospective study.

BACKGROUND AND OBJECTIVES: Acute pancreatitis is a serious complication of ERCP. Octreotide as prophylaxis against ERCP-induced hyperamylasemia has produced conflicting results. A review article has called for additional controlled studies. This work was undertaken to see the effect of octreotide in ERCP-induced enzyme changes in a predominantly Saudi population. SUBJECTS & METHODS: The setting was a university teaching hospital, Eastern Saudi Arabia. The study was prospective, randomized and controlled and the subjects were 50 consecutive adult in-patients. Octreotide, 200 tg subcutaneous, was used in the study group (27 patients). Levels of serum amylase and lipase were estimated three times post-ERCP; mean values were compared with the control group (23 patients) using student t test. RESULTS: A total of 50 patients were studied. Their mean age was 43 (range 19 to 70); 30 were female, a male:female ratio of 1:1.5. The two groups were comparable in terms of age, sex and nationality as well as clinical, haematological and biochemical variables. In both groups, the serum levels of amylase and lipase 4 hours post-ERCP were significantly higher compared with base line levels. However, there were no statistical differences between the mean post-ERCP values within as well as between the two groups of patient studied. However, the pattern of response appeared to be different when amylase was compared with lipase. CONCLUSION: Prophylactic octreotide, in the regimen used in this study, does not protect against post-ERCP hyperamylasemia and hyperlipasemia. The observed apparent difference in the pattern of serum amylase and lipase remains to be confirmed.

Seasonal variation of the lipoidal matters and hypolipidaemic activity of the red alga Corallina officinalis L.

The lipoidal matters of Corallina officinalis L. showed a seasonal nonsignificant quantitative variation. However, the fatty acids revealed a relative increase in the summer and winter, while unsaponifiable matter exhibited a slight increase in the spring. The GC/MS analysis of saponifiable and unsaponifiable matter of the algal samples collected in different seasons revealed that samples collected in the spring contained a low cholesterol content and high steroidal compounds as well as high polyunsaturated fatty acids. The alcohol extract, hexane extract and fatty acid fraction of this algal sample exhibited a significant hypolipidaemic activity. Also, two biologically active fractions of hydrocarbons were isolated by CC technique from the hexane fraction of C. officinalis L. and identified by GC/MS.

In vitro contractile responses of detrusor to carbachol and neurokinin A, in children with recurrent urinary tract infection or day wetting.

OBJECTIVE: To investigate whether a history of recurrent urinary tract infection (UTI) and/or the presence of day-wetting/urge symptoms might influence the contractile responses to the cholinergic agonist carbachol or to the sensory neuropeptide neurokinin A (NKA) in the urinary bladder in children. PATIENTS AND METHODS: Small detrusor strips were taken from the margin of the cystotomy incision of the bladder dome during surgery to correct vesico-ureteric reflux (VUR) in 62 children (aged 4 months to 12 years) or for unrelated bladder conditions in five controls (aged 3 months to 13 years). Concentration-response curves to carbachol and NKA were constructed using organ-bath techniques, and results compared for age, sex, weight of the detrusor strip, UTI history or day-wetting syndrome. RESULTS: The contractile responses to NKA were no different for any of the features investigated. The contractile response to carbachol and NKA in detrusor from control and VUR patients was not significantly different. The children with a history of UTI were significantly older than those without. The contractility in response to carbachol was greater in older girls (aged 4-12 years) than younger girls (< 4 years) and than in all boys (< 4 years and 4-12 years; ANOVA P = 0.013). The mean (SEM) maximum contractile response to carbachol in the group of 20 young children (4-30 months) with previous UTI was 3.0 (0.3) g, whereas the maximum response in the age-matched group of 11 without UTI was 1.8 (0.3) g (P = 0.046). There were no significant differences in maximum responses between those with day-wetting and those without (aged > 4 years), although there was a significant difference in pD2 value, at 6.19 (0.13) and 5.58 (0.14), respectively (P = 0.018). CONCLUSION: Carbachol produced a larger contractile response in detrusor from children with a history of UTI than from those without, indicating possible alterations in muscarinic receptor characteristics. An increased sensitivity to muscarinic stimulation in day-wetting children was also suggested, whereas NKA is unlikely to be involved in any of these pathophysiological conditions.

Abdominal tuberculosis in Saudi Arabia: a clinicopathological study of 65 cases.

The clinical and pathological features of 65 patients with abdominal tuberculosis obtained during a 7-yr period were analyzed and the diagnostic procedures critically evaluated. The diagnosis was histologically confirmed in 59 patients. In two more patients, the diagnosis was based solely on a positive ascitic fluid culture for tubercle bacilli. The remaining four patients responded dramatically to anti-tuberculous chemotherapy given on suspected laparoscopic findings in cases in which no biopsy was taken. Laparoscopy was found to be safer and superior to laparatomy and is recommended as an initial investigation in the diagnostic work-up of patients in whom tuberculous peritonitis is suspected. Furthermore, the finding of granulomatous inflammation in peritoneal biopsy is a justification for immediate therapy in such patients. This is particularly valid in endemic areas if one considers the risks of delaying treatment of these patients.