A Trilogy of Submassive Pulmonary Embolism, Non-Small Cell Lung Cancer with Brain Metastasis, Kartagener's Syndrome and its Management with Aspiration Thrombectomy.

Venous thromboembolism is a common cause of morbidity and mortality in cancer patients. Given the bleeding risks, determining treatment for malignancy-related thrombosis is challenging, especially in the case of submassive pulmonary embolism (PE) because the risk-benefit ratio in terms of bleeding risk is uncertain. Here we discuss the case of a 53-year-old man with Kartagener syndrome with situs inversus totalis and stage IV non-small cell lung cancer with a recent brain mass resection, presenting with dyspnoea and palpitations. The patient was diagnosed with a submassive PE and only underwent suction thrombectomy through the left internal jugular vein with excellent response. In conclusion, when treating submassive PE, aspiration thrombectomy without thrombolysis is preferable to thrombolysis, which may be contraindicated due to the higher risk of bleeding. LEARNING POINTS: Anticoagulation and thrombolysis should be started after carefully weighing the risks and benefits in cancer patients.In some patients with submassive pulmonary embolism (PE), thrombolysis may be contraindicated due to the increased risk of bleeding, but aspiration thrombectomy can be a preferred treatment modality.Further research evaluating the risks and benefits of different therapeutic approaches for submassive PE could aid in determining the best course of action and establishing treatment guidelines.

Language in a Time of COVID-19: Literacy Bias Ethnic Minorities Face During COVID-19 from Online Information in the UK.

OBJECTIVES: To investigate the readability and presence of translated online information readily available to the British public during COVID-19. DESIGN: A cross-sectional study was performed. The terms "Coronavirus", "COVID-19", "Lockdown", "Social Distancing", "Handwashing", "Furlough Scheme" and "Sick pay" were inputted into the popular search engine, Google. Websites were categorised by their source (i.e. Government, Non-Governmental Organisation, NHS and Commercial) and theme (i.e. general COVID-19 information, population practise and employment rulings). Reliable calculators for assessing readability (Simple Measure of Gobbledygook, Gunning Fog Index, Flesch-Kincaid Grade Level, Coleman-Liau Index and Automated Readability Index) were used. MAIN OUTCOME MEASURES: The median scores with the interquartile range from each calculator of the pooled data were observed. The presence of accompanying translated material and graphic information was also counted and presented as counts and percentages. The number of readable websites (i.e. a score ≤ 8) for each source and theme category were also recorded. SETTING: UK Internet servers. RESULTS: The median scores of the pooled data (n = 148) had shown that the majority of websites were unreadable to the average British reader according to each calculator used (SMOG 1.3%; GF 6.8%; FK 35.8%; CL 2.6%; ARI 40%). Only 3.4% and 6.8% of the pooled websites had readily available translated material and accompanying graphic material, respectively. CONCLUSION: Readability of COVID-19 information is below national standards and that there is a lack of accompanying translated and graphics-based material online. This may lead to an amplified level of misunderstanding in BAME populations about the COVID-19 pandemic and the rulings put in place.

COVID-19 patients in a tertiary US hospital: Assessment of clinical course and predictors of the disease severity.

INTRODUCTION: Patients with severe COVID-19 can develop ventilator-dependent acute hypoxic respiratory failure (VDAHRF), which is associated with a higher mortality rate. We evaluated the clinical course of hospitalized COVID-19 patients and compared them with the patients who received invasive mechanical ventilation. Characteristics of intubated patients who were successfully weaned from the ventilator were compared with the patients who failed to be extubated or died in the hospital. OBJECTIVE: To investigate the clinical course of hospitalized COVID-19 patients, and assess the possible predictors of the disease severity leading to VDAHRF. METHODS: This is a single-center, retrospective study. The first 129 patients (18 years or older) with COVID-19 admitted to Monmouth Medical Center from March 1st to April 25th, 2020 were included. RESULTS: Out of 129 patients, 23.25% (n = 30) required invasive mechanical ventilation, and of those, six patients were successfully weaned from the ventilator. Multivariable logistic regression analysis showed increased odds of intubation associated with hypoxemia (odds ratio 17.23, 95% CI 5.206-57.088; p < 0.0001), elevated d-dimer by one unit mg/L of FEU (odds ratio 1.515, 95% CI 5.206-57.088; p = 0.0430) and elevated ferritin by one unit ng/ml (odds ratio 1.001, 95% CI 1.000-1.001, p = 0.0051) on admission, adjusted for other covariates. CONCLUSIONS: Patients who required invasive mechanical ventilation were more likely to have older age, male gender, coronary artery disease, diabetes, and obesity. The patients who were successfully weaned from the ventilator were more likely to be younger in age, and none of them had heart failure or CAD.

Effect of body mass index on the incidence of perineal trauma.

OBJECTIVE: To investigate the association between perineal trauma at childbirth and maternal body mass index (BMI), and estimate the risk of perineal trauma among different BMI groups. METHODS: Data were retrospectively assessed from all vaginal deliveries in a UK tertiary maternity unit between 1999 and 2014. Associations between BMI at booking and first- and second-degree tears (minor perineal trauma), third- and fourth-degree tears (obstetric anal sphincter injuries [OASIS]), and frequency of instrumental deliveries were assessed. Multivariate logistic regression included the factors BMI (weight in kilograms divided by the square of height in meters), age, ethnicity, smoking, parity, pregnancy length, episiotomies, instrumental delivery, and birth weight. RESULTS: Data from 45 557 deliveries were used. Compared with women with a normal BMI (<25), odds of minor perineal trauma were significantly reduced among women with obesity (BMI 30 to <35; odds ratio [OR] 0.91, 95% confidence interval [CI] 0.84-0.99) or severe obesity (BMI ≥35; OR 0.87, 95% CI 0.77-0.98). OASIS was not significantly associated with BMI. Instrumental delivery rates were higher among women with normal BMI (5936/27 107; 22.0%) than among those with severe obesity (284/2032; 14.0%). CONCLUSION: Increased BMI at booking was associated with a reduced incidence of minor perineal trauma at delivery, but was not associated with OASIS.

Critical Care Admissions following Total Laryngectomy: Is It Time to Change Our Practice?

Critical Care Unit (CCU) beds are a limited resource and in increasing demand. Studies have shown that complex head and neck patients can be safely managed on a ward setting given the appropriate staffing and support. This retrospective case series aims to quantify the CCU care received by patients following total laryngectomy (TL) at a District General Hospital (DGH) and compare patient outcomes in an attempt to inform current practice. Data relating to TL were collected over a 5-year period from 1st January 2010 to 31st December 2015. A total of 22 patients were included. All patients were admitted to CCU postoperatively for an average length of stay of 25.5 hours. 95% of these patients were admitted to CCU for the purpose of close monitoring only, not requiring any active treatment prior to discharge to the ward. 73% of total complications were encountered after the first 24 hours postoperatively at which point patients had been stepped down to ward care. Avoiding the use of CCU beds and instead providing the appropriate level of care on the ward would result in a potential cost saving of approximately £8,000 with no influence on patient morbidity and mortality.

Injuries in elite Taekwondo Poomsae athletes.

Poomsae is the only non-contact and no opponent form of Taekwondo. The purpose of this descriptive study was to determine the type and rate of injuries in elite Canadian Poomsae athletes. Strain and joint dysfunction were the most common types of injuries in Poomsae. Lower limb and back were the most common area of injury in females and males respectively. Females with a lower rank in experience level (DAN≤ 3) were more likely to suffer from chronic overuse injuries compared to their male counterparts, who reported more acute injuries. Athletes ≤40 years of age were more prone to acute injuries compared to athletes over 40. As result of reflection on this study a Poomsae Injury Report Form was developed.

Poomsae est la seule forme de Taekwondo contre un adversaire imaginaire. Le but de cette étude descriptive était de déterminer le genre et la fréquence de blessures chez les athlètes canadiens de Poomsae de haut niveau. Le claquage et le dysfonctionnement articulaire étaient les genres de blessures les plus courants dans le Poomsae. Les blessures des membres inférieurs et du dos étaient les plus fréquentes respectivement chez les athlètes féminins et masculins. Les athlètes féminins ayant un niveau d'expérience (DAN ≤ 3) inférieur étaient plus susceptibles de souffrir de blessures chroniques dues à un surentraînement que leurs homologues masculins qui, eux, ont signalé des blessures plus graves. Les athlètes âgés de moins de 40 ans étaient plus prédisposés à des blessures graves que les athlètes de plus de 40 ans. Les résultats de cette étude ont permis de préparer un formulaire de rapport sur les blessures dans le Poomsae.

A review of the health effects of smoking shisha.

There is emerging evidence, although at early stages, of various detrimental health effects after smoking shisha. With regard to the cardiovascular system, there is a significant acute rise in cardiovascular markers, such as heart rate and blood pressure. The long-term effects on the cardiovascular system are yet to be established. Shisha smoking has also been significantly associated with lung cancer. Various other forms of cancer have also been documented, but have not reached statistical significance and require further research. Finally, shisha smoking increases the risk of infection and has been associated with outbreaks in the Middle East. Therefore, with the increasing consumption of shisha in Europe, especially in the UK, more research is required to tackle this potential public health threat.

Measuring the acute cardiovascular effects of shisha smoking: a cross-sectional study.

OBJECTIVES: To investigate the acute cardiovascular effects of smoking shisha. DESIGN: A cross-sectional study was carried out in six shisha cafes. Participants smoked shisha for a period between 45 min (minimum) and 90 min (maximum). The same brand of tobacco and coal was used. SETTING: London, UK. PARTICIPANTS: Participants were those who had ordered a shisha to smoke and consented to have their blood pressure, heart rate and carbon monoxide levels measured. Excluded subjects were those who had smoked shisha in the previous 24 h, who smoke cigarettes or who suffered from cardiorespiratory problems. MAIN OUTCOME MEASURES: Blood pressure was measured using a sphygmomanometer. Pulse was measured by palpation of the radial artery. Carbon monoxide levels were obtained via a carbon monoxide monitor. These indices were measured before the participants began to smoke shisha and after they finished or when the maximum 90 min time period was reached. RESULTS: Mean arterial blood pressure increased from 96 mmHg to 108 mmHg (p < 0.001). Heart rate increased from 77 to 91 bpm (p < 0.001). Carbon monoxide increased from an average of 3 to 35 ppm (p < 0.001). A correlation analysis showed no relationship between carbon monoxide and the other indices measured. CONCLUSION: The acute heart rate, blood pressure and carbon monoxide levels were seen to rise significantly after smoking shisha. The weak correlation between carbon monoxide levels and the other variables suggests that carbon monoxide levels had not contributed to their significant increase.

Short-term complications of percutaneous tracheostomy: experience of a district general hospital--otolaryngology department.

Percutaneous tracheostomy is a procedure frequently carried out in a critical care setting. It is performed in the majority of cases by anaesthetists in the United Kingdom. The ENT surgeon is only called in situations where it is deemed by the intensivist that percutanous tracheostomy would prove too great a risk. In this situation the patient was taken to the operating theatre for a surgical tracheostomy. In our paper, a retrospective analysis was performed of all percutaneous tracheostomies carried out by ENT surgeons in the Royal Glamorgan Hospital, during a two-year period from July 1999 to July 2001, to assess whether percutaneous tracheostomy is a feasible option as a first line procedure in all elective tracheostomies. Thirty-six patients were included in the study. The mean age was 60.2 years. Haemorrhage was noted to be a problem in only one patient and two patients developed postoperative wound infection that was treated with systemic antibiotics. No other complications were encountered. We propose that all ENT surgeons should be trained in performing percutaneous tracheostomy and that it should be used as the gold standard in elective tracheostomy insertion. In cases where difficulties are likely to be anticipated, percutaneous tracheostomy can still be considered as the first option. This can be performed in the operating theatre setting with the knowledge that if any complication should occur then conversion to surgical tracheostomy can be done without delay.