Role of computed tomography (CT) in identifying foreign body ingestion in an individual with autism - A case report.

Foreign body ingestions are quite common and most often will uneventfully pass in stool, however, some ingestions, can lead to complications such as obstruction. If left untreated, this can lead to perforation and fistula formation. Hence, threshold for intervention should be low and diagnostic imaging can assist with treatment decisions. We present to you a case of 17-year-old male with non-verbal autism with an unusual hollow foreign body ingestion leading to small bowel obstruction.

The impact of a barrier enclosure on time to tracheal intubation: a randomized controlled trial.

PURPOSE: Novel devices such as the barrier enclosure were developed in hopes of improving provider safety by limiting SARS-CoV-2 transmission during tracheal intubation. Nevertheless, concerns arose regarding a lack of rigorous efficacy and safety data for these devices. We conducted a randomized controlled trial to evaluate the impact of the barrier enclosure on time to tracheal intubation. METHOD: After Research Ethics Board approval, elective surgical patients with normal airway predictors were randomly allocated 1:1 to tracheal intubation with or without a barrier enclosure. The primary outcome was time to tracheal intubation. Secondary outcomes included first-pass success rate, total time of airway manipulation, anesthesiologists' perception of intubation difficulty, likelihood of use in SARS-CoV-2-positive patients, and patients' perception of comfort and acceptability. RESULTS: There were 48 participants in the barrier enclosure group and 46 participants in the control group. The mean (standard deviation [SD]) time to tracheal intubation was 62 (29) sec with barrier closure and 53 (27) sec without barrier enclosure (mean difference, 9 sec; 95% confidence interval, - 3 to 20; P = 0.14). Anesthesiologists rated the difficulty of intubation higher with barrier enclosure (mean [SD] visual analogue scale score, 27 [26] mm vs 9 [17] mm; P < 0.001). There were no significant differences in other secondary outcomes. CONCLUSION: In healthy surgical patients with normal airway predictors, the use of a barrier enclosure during tracheal intubation did not significantly prolong time to intubation or decrease first-pass intubation success. Nevertheless, there was an increase in difficulty of intubation perceived by the anesthesiologists with use of a barrier enclosure. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT04366141); registered 28 April 2020.

RéSUMé: OBJECTIF: De nouveaux dispositifs tels que des boîtes de protection ont été mis au point dans l'espoir d'améliorer la sécurité des fournisseurs de soins en limitant la transmission du SRAS-CoV-2 pendant l'intubation endotrachéale. Néanmoins, des inquiétudes ont été soulevées au sujet d'un manque de données rigoureuses sur l'efficacité et l'innocuité de ces dispositifs. Nous avons réalisé une étude randomisée contrôlée afin d'évaluer l'impact d'une boîte de protection sur le temps de l'intubation endotrachéale. MéTHODE: Après avoir reçu l'approbation du Comité d'éthique de la recherche, des patients de chirurgie élective présentant des prédicteurs des voies aériennes normales ont été aléatoirement répartis à un ratio de 1:1 pour une intubation endotrachéale avec ou sans boîte de protection. Le critère d'évaluation principal était le temps nécessaire à l'intubation endotrachéale. Les critères d'évaluation secondaires comprenaient le taux de réussite à la première tentative, le temps total de manipulation des voies aériennes, la perception par les anesthésiologistes de la difficulté d'intubation, la probabilité d'utilisation chez les patients atteints du SRAS-CoV-2, et la perception de confort et d'acceptabilité des patients. RéSULTATS: Il y avait 48 participants dans le groupe avec boîte et 46 participants dans le groupe témoin. Le temps moyen (écart type [ÉT]) pour l'intubation endotrachéale était de 62 (29) sec avec la boîte et de 53 (27) sec sans la boîte (différence moyenne, 9 sec; intervalle de confiance de 95 %, − 3 à 20; P = 0,14). Les anesthésiologistes ont estimé que la difficulté d'intubation était plus élevée avec une boîte de protection (score moyen sur l'échelle visuelle analogique [ÉT], 27 [26] mm vs 9 [17] mm; P < 0,001). Il n'y avait pas de différences pour les autres critères d'évaluation secondaires. CONCLUSION: Chez les patients chirurgicaux en bonne santé avec des prédicteurs de voies aériennes normales, l'utilisation d'une boîte de protection pendant l'intubation endotrachéale n'a pas prolongé de manière significative le temps d'intubation ni réduit le taux de réussite de l'intubation à la première tentative. Néanmoins, il y avait une augmentation de la difficulté d'intubation perçue par les anesthésiologistes avec l'utilisation d'une boîte de protection. ENREGISTREMENT DE L'éTUDE: www.clinicaltrials.gov (NCT04366141); enregistrée le 28 avril 2020.

The COSMIC Bubble Helmet: A Non-Invasive Positive Pressure Ventilation System for COVID-19.

Goal: COSMIC Medical, a Vancouver-based open-source volunteer initiative, has designed an accessible, affordable, and aerosol-confining non-invasive positive-pressure ventilator (NIPPV) device, known as the COSMIC Bubble Helmet (CBH). This device is intended for COVID-19 patients with mild-to-moderate acute respiratory distress syndrome. System Design: CBH is composed of thermoplastic polyurethane, which creates a flexible neck seal and transparent hood. This device can be connected to wall oxygen, NIPPVs including Continuous Positive Airway Pressure and Bi-level Positive Airway Pressure, and mechanical ventilators. Discussion: Justification of CBH design components relied on several factors, predominantly the safety and comfort of patients and healthcare providers. Conclusion: CBH has implications within and outside of the pandemic, as an alternative to invasive mechanical ventilation methods. We have experimentally verified that CBH is effective in minimizing aerosolization risks and performs at specified clinical requirements.

Topical tranexamic acid inhibits fibrinolysis more effectively when formulated with self-propelling particles.

BACKGROUND: Endogenous fibrinolytic activation contributes to coagulopathy and mortality after trauma. Administering tranexamic acid (TXA), an antifibrinolytic agent, is one strategy to reduce bleeding; however, it must be given soon after injury to be effective and minimize adverse effects. Administering TXA topically to a wound site would decrease the time to treatment and could enable both local and systemic delivery if a suitable formulation existed to deliver the drug deep into wounds adequately. OBJECTIVES: To determine whether self-propelling particles could increase the efficacy of TXA. METHODS: Using previously developed self-propelling particles, which consist of calcium carbonate and generate CO2 gas, TXA was formulated to disperse in blood and wounds. The antifibrinolytic properties were assessed in vitro and in a murine tail bleeding assay. Self-propelled TXA was also tested in a swine model of junctional hemorrhage consisting of femoral arteriotomy without compression. RESULTS: Self-propelled TXA was more effective than non-propelled formulations in stabilizing clots from lysis in vitro and reducing blood loss in mice. It was well tolerated when administered subcutaneously in mice up to 300 to 1000 mg/kg. When it was incorporated in gauze, four of six pigs treated after a femoral arteriotomy and without compression survived, and systemic concentrations of TXA reached approximately 6 mg/L within the first hour. CONCLUSIONS: A formulation of TXA that disperses the drug in blood and wounds was effective in several models. It may have several advantages, including supporting local clot stabilization, reducing blood loss from wounds, and providing systemic delivery of TXA. This approach could both improve and simplify prehospital trauma care for penetrating injury.

Impact of a CXCL12/CXCR4 Antagonist in Bleomycin (BLM) Induced Pulmonary Fibrosis and Carbon Tetrachloride (CCl4) Induced Hepatic Fibrosis in Mice.

Modulation of chemokine CXCL12 and its receptor CXCR4 has been implicated in attenuation of bleomycin (BLM)-induced pulmonary fibrosis and carbon tetrachloride (CCl4)-induced hepatic injury. In pulmonary fibrosis, published reports suggest that collagen production in the injured lung is derived from fibrocytes recruited from the circulation in response to release of pulmonary CXCL12. Conversely, in hepatic fibrosis, resident hepatic stellate cells (HSC), the key cell type in progression of fibrosis, upregulate CXCR4 expression in response to activation. Further, CXCL12 induces HSC proliferation and subsequent production of collagen I. In the current study, we evaluated AMD070, an orally bioavailable inhibitor of CXCL12/CXCR4 in alleviating BLM-induced pulmonary and CCl4-induced hepatic fibrosis in mice. Similar to other CXCR4 antagonists, treatment with AMD070 significantly increased leukocyte mobilization. However, in these two models of fibrosis, AMD070 had a negligible impact on extracellular matrix deposition. Interestingly, our results indicated that CXCL12/CXCR4 signaling has a role in improving mortality associated with BLM induced pulmonary injury, likely through dampening an early inflammatory response and/or vascular leakage. Together, these findings indicate that the CXCL12-CXCR4 signaling axis is not an effective target for reducing fibrosis.

Assessing the oral bioavailability of difluorosialic acid prodrugs, potent viral neuraminidase inhibitors, using a snapshot PK screening assay.

Difluorosialic acids (DFSAs) are potent inhibitors of viral neuraminidase that demonstrate activity against oseltamivir- and zanamivir-resistant strains of influenza. Unfortunately, low oral bioavailability precludes their development as second generation neuraminidase inhibitors for treating influenza as this leaves them unsuitable for use in an oral formulation. Herein is described the preparation of a series of DFSA prodrugs designed to increase oral bioavailability. These prodrugs were evaluated using a snapshot PK screen and stability tests, with successful candidates being further assessed with a full pharmacokinetic workup. These new prodrugs increased oral bioavailability by up to three times that seen for the parent DFSAs.