Background: Groups of children swimming during summer camp or child care are generally monitored by a small number of lifeguards and staff. The high child-to-staff ratio can make pool monitoring less effective, increasing drowning risk. The aim of this study is to evaluate novel drowning detection technology that could supplement pool monitoring. Methods: The WAVE^™ Drowning Detection System was deployed at a camp pool for 8 weeks. The WAVE^™ Drowning Detection System entails headbands worn by swimmers that send alerts to vibrating staff bracelets and audible alarms when submerged for a period of time. Data on the number of alerts were collected, and staff were surveyed. Results: One or two alerts were initiated every hour. Staff reported that risky underwater play and exiting the pool area were top reasons for alerts. Staff found the awareness brought to risky pool behavior useful and had a neutral attitude about false alarms. Staff found the system easy to learn and use but suggested headband fit and comfort could be improved. Staff believed the system could help save someone's life. Conclusions: The WAVE system is low-risk, easy-to-use technology that may supplement lifeguard monitoring of large groups of children in pools.

Background: Delirium occurs frequently in intensive care unit (ICU) patients; however, there are limited data evaluating its impact on critically ill hematology-oncology patients. We aimed to determine the incidence and risk factors for early-onset delirium development in hematology-oncology patients admitted to the ICU. Methods: This single-center, retrospective cohort study evaluated the primary outcome of incident delirium within 7 days of ICU admission in adults admitted to the hematology-oncology medical or surgical ICU. Patients with delirium (DEL) were compared to those without (No-DEL) for evaluation of secondary endpoints including hospital mortality, ICU, and hospital length of stay (LOS). Multivariable logistic regression modeling was performed to identify independent risk factors for delirium. Results: Delirium occurred in 125 (51.2%) of 244 patients. Inhospital mortality was significantly higher in the DEL vs. No-DEL group (32.8% vs. 15.1%, P = 0.002). Median (1^st and 3^rd quartiles) ICU and hospital LOS were significantly longer in the delirium group, respectively (6 [4–10] days vs. 3 [2–5] days, P < 0.001, and 21 [14–36] days vs. 12 [8–22] days, P < 0.001). Higher Sequential Organ Failure Assessment score, high-dose corticosteroids, mechanical ventilation (MV), and brain metastases were each independently, associated with an increased delirium risk. Conclusion: Hematology-oncology patients admitted to the ICU frequently develop delirium. Consistent with literature in nonhematology-oncology critically ill patients, identified independent risk factors for delirium were MV and organ dysfunction. Risk factors unique to the critically ill hematology-oncology patient population include high-dose corticosteroids and brain metastases. Further research is needed to evaluate strategies to mitigate delirium development in this population based on risk assessment.

Background: Coronavirus disease 2019 (COVID-19) pneumonia with severe acute respiratory distress syndrome (ARDS) is often associated with a progressive respiratory failure that is refractory to maximal ventilatory support and other ARDS strategies. Studies show evidence of a hypercoagulable state in COVID-19 patients, including capillary thrombosis and alveolar fibrin deposits which impede normal gas exchange. In this context, thrombolysis is considered as a salvage therapy to rescue critically hypoxemic patients. Methods: In this retrospective observational study, the efficacy of thrombolysis on outcome of COVID-19 ARDS with respiratory failure was analyzed. Patients with severe ARDS and d-dimer levels of 5 μg/ml or above were initiated on alteplase, as a 25 mg bolus followed by a 25 mg infusion over 22 h. Primary outcome was intensive care unit (ICU) mortality and secondary outcomes were change in PaO2/FiO2 24 h after thrombolysis, avoidance of intubation, ventilator free days (VFD), and ICU and hospital length-of-stay (LOS). Results: Thirteen out of 34 patients with severe COVID ARDS underwent thrombolysis. They had lower ICU mortality than non-thrombolysed patients (23.1% vs. 71.4%, P = 0.006), greater percentage improvement in PaO2/FiO2 (116% vs. 31.5%, P = 0.002), more VFDs (13 days vs. 0 day, P = 0.004), and lesser requirement for intubation (23.1% vs. 76.2%, P = 0.004). ICU and hospital LOS were similar. Conclusion: Thrombolysis can be considered as a rescue therapy for nonintubated COVID-19 ARDS patients with severe hypoxemic respiratory failure, who show evidence of a procoagulant state. Larger studies are needed before inclusion into the regular treatment protocol for COVID-19 patients.

Background: Acute respiratory distress syndrome (ARDS) is one of the manifestations of severe coronavirus disease 2019 (COVID-19) with low respiratory compliance and poor oxygenation as main characteristics and mortality rate of 50%–94%. Surfactants, including surfactant protein D (SP-D), have a role in maintaining respiratory compliance. This study aimed to analyze the relationship between serum SP-D levels with respiratory compliance and ARDS in patients with critically ill COVID-19 pneumonia. Methods: This study was a cross-sectional study. Subjects were adult reverse transcription–polymerase chain reaction-confirmed COVID-19 patients who had ARDS treated with invasive mechanical ventilation. All data were obtained from medical records. Statistical analysis was done using Spearman test, Mann–Whitney test, and receiver operating characteristic curve. Results: Serum level of SP-D was significantly correlated with static respiratory compliance (P = 0.009; correlation coefficient [rs] = 0.467). Serum SP-D levels correlated with ARDS severity (P < 0.001). SP-D levels had a very strong diagnostic value for ARDS severity, with an optimal cutoff value of 44.24 ng/mL (sensitivity 92.3%; specificity 94.1%). ARDS severity also correlated significantly with respiratory compliance (P = 0.005; correlation coefficient 0.496). Conclusion: Higher serum SP-D levels were associated with lower respiratory compliance, ARDS severity, and may be utilized diagnostically to identify patients with severe ARDS.

Background: We investigated the prognosis, sequelae, and related factors of severe coronavirus disease (COVID-19) patients who required invasive mechanical ventilation 6 months after discharge from the hospital. Methods: COVID-19 patients admitted to Kishiwada Tokusyukai Hospital between April 1, 2020, and May 31, 2021, and treated with an invasive mechanical ventilator were included in this study. We conducted a telephone visit 6 months after discharge to confirm survival and asked questions about sequelae. Results: The mortality rate 6 months after discharge was 7.4%. Tracheostomy (odds ratio [OR], 0.03; 95% confidence interval [CI], 0.003–0.26), high Acute Physiology and Chronic Health Evaluation II score (16.0 [interquartile range [IQR], 11.5–17.2] vs. 11.0 [IQR, 8.0–14.0]), prolonged hospital stay (17.0 [IQR, 12.7–24.5] vs. 10.0 [IQR, 8.0–13.0]), and prolonged ventilation duration (12.5 [IQR, 10.7–20.0] vs. 8.0 [IQR, 6.0–11.0]) were associated with the risk of death. Moreover, 49% of the patients had residual disability. The most common sequelae were hoarseness, respiratory distress on exertion (31% of symptomatic patients), and muscle weakness (22%). The prone positioning therapy (OR, 5.55; 95% CI, 1.35–32.97) was associated with hoarseness, and the use of muscle relaxants (OR, infinity; 95% CI, 1.14–infinity) was a risk factor for muscle weakness. Conclusion: Although the mortality rate after the acute phase of COVID-19 was not high, many patients experienced sequelae. Careful treatment should be continued after the end of acute treatment for patients with prolonged respiratory failure due to COVID-19. Muscle relaxants and prone positioning therapy may cause sequelae and should be performed carefully.

Background: Carbapenem-resistant Enterobacteriaceae, especially Klebsiella pneumonia, have become a severe global problem with a significant threat to public health, but few studies have investigated the risk factors and epidemiology of carbapenem-resistant K. pneumonia (CRKP) infections in India. Methods: We performed a retrospective observational study of 224 participants with K. pneumoniae who were admitted to the medical intensive care unit (ICU) of Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India, between January 1 and December 30, 2020. Antibiotic susceptibility testing was done by automated broth microdilution VITEK^® 2 (BioMerieux, Inc., Hazelwood, USA). The Clinical and Laboratory Standards Institute document M100-S22 (January 2020) was used to interpret antimicrobial susceptibility testing. Data were obtained from paper medical records. Results: Two hundred and twenty-four subjects with culture-positive for K. pneumonia were retrieved during the study period, out of which 108 had CRKP. The risk factors for univariate analysis were Acute Physiology and Chronic Health Evaluation II, ICU length of stay (LOS), invasive mechanical ventilator days, central venous catheter days, and arterial line days. The multivariate analysis showed invasive mechanical ventilation and ICU LOS were independent risk factors for CRKP infection. Mortality in the CRKP group was 48 (44%) compared to 27 (23%) in the carbapenem-sensitive K. pneumonia (CSKP) group, which was statistically significant (P < 0.01). Conclusion: Infection due to CRKP in the ICU was associated with 1.9 times higher mortality as compared to CSKP. Invasive mechanical ventilation and ICU LOS were found to be independent risk factors for CRKP infection.

Background: The Acute Physiologic and Chronic Health Evaluation II (APACHE-II), Sequential Organ Failure Assessment (SOFA), and Model for End-Stage Liver Disease modified for Sodium concentration (MELD-Na) scores are validated to predict disease mortality. We studied the prognostic utility of these scoring systems in critically ill coronavirus disease 2019 (COVID-19) patients with liver injury. Methods: This was a retrospective study of 291 confirmed COVID-19 and liver injury patients requiring intensive care unit level of care. These patients required supplemental oxygen requirement with fraction of inspired oxygen >55% and/or the use of vasopressor. MELD-Na, SOFA, and APACHE-II scores were adjusted. Outcomes were mortality and length of stay (LOS). Results: SOFA (odds ratio: 0.78, 95% confidence interval: 0.63–0.98, P < 0.05) was associated with decreased odds for mortality. APACHE-II and MELD-Na were not associated with mortality or LOS. Conclusions: We suggest that the novel nature of COVID-19 necessitates new scoring systems to predict outcomes in critically ill COVID-19 patients with liver injury.

Background: Injuries of lower genital tract are commonly seen in obstetrics patients during labor and delivery. Nonobstetric genital injuries are seen less commonly. Research on injuries to the lower genital tract from nonobstetric trauma is therefore scant. The purpose of this study was to document causes, treatment, and outcomes among patients of lower genital tract injuries visiting to B. R. D. Medical College and Nehru hospital, Gorakhpur, U.P. Methods: Admission and operation theater registers of the department of obstetrics and gynecology during 1 year were scrutinized for cases admitted with the diagnosis of genital trauma. Bed-head tickets of patients were scrutinized with the help of a data abstraction form, and information regarding age, cause of injury, site, size and pattern of injuries, treatment, and short-term outcome were recorded. Results: Of a total of 43 cases of traumatic genital tract injuries, 39 women received treatment. Maximum cases were seen in girls aged 6–10 years. Three women were pregnant at the time of injury. Noncoital injuries predominated over coital injuries, i.e., 59% versus 38.4%. Among the noncoital injuries, fall was the most common cause accounting for 75% of the cases. Coital injuries following consensual sex occurred more commonly in women who were sexually active, lactating, or postmenopause. The chief presenting complaint was vaginal bleeding. Vaginal wall laceration/tear was the most common injury reported. Multiple injuries were seen in 40% (17/39) of the cases. Twenty-one cases of laceration/tear (53.8%) were repaired surgically of which seven required examination and repair under anesthesia. Vulvar hematomas were managed by incision and drainage. There was no major morbidity or mortality. Conclusions: The results of this study from eastern Uttar Pradesh, India, support those from other developing nations. Noncoital injuries were found to be the most predominant cause of non-obstetric genital trauma, though, contrary to others, children were seen to be at the greatest risk. It is important to teach children about playing safely and following safety measures while on the road. We must also make them aware so that they do not become victims of rape.

Coronavirus disease 2019 (COVID-19) has been associated with respiratory failure and high mortality. Hypercoagulability and thromboembolic complications have been found in a high percentage of patients amongst which, pulmonary embolism (PE) is the most common. Currently, there are no guidelines on using thrombolysis therapy in COVID-19 patients who developed PE. We present five survivors aged 30–75 years old with confirmed COVID-19. All cases were proven by computed tomography pulmonary angiogram (CTPA) to have PE treated with low-dose recombinant tissue plasminogen activator (rtPA). PE should be suspected in all COVID-19 patients with rapid worsening of dyspnea, desaturation, unexplained shock, and increased level of D-dimer and fibrinogen. In our cases, PE developed despite preventative anticoagulation regimens with low molecular weight heparin. After thrombolytic therapy, all patients showed improvement in partial-arterial-oxygen-pressure to inspired oxygen-fraction ratio (arterial partial pressure of oxygen/inspired oxygen fraction ratio). D-dimer showed elevation after thrombolytic therapy and decreased in the following days. Fibrinogen levels decreased following thrombolytic therapy. Current anticoagulation regimens seem insufficient to halt the course of thrombosis, and thrombolytic therapy may be beneficial for patients with severe COVID-19 and PE. Systemic thrombolysis therapy is a double-edged sword, and clinicians must balance between benefit and risk of bleeding.

Liver disease in pregnancy can be classified into pregnancy-related, liver disease coincident with pregnancy or preexisting liver disease. Acute fatty liver of pregnancy (AFLP) is a rare liver disorder that is caused by defects in mitochondrial beta (β) oxidation of fatty acids. In view of its fulminant presentation and rapid progression to multiple organ failure (MOF), AFLP carries high maternal and fetal mortality. These patients are commonly present in the third trimester of pregnancy with gastrointestinal symptoms and complications such as hypoglycemia, lactic acidosis, hyperammonemia, leukocytosis, liver dysfunction, coagulopathy, and renal dysfunction. Diagnosis is mostly based on the Swansea diagnostic criteria and by excluding other etiologies of liver dysfunction. Liver biopsy is rarely performed owing to underlying coagulopathy and thrombocytopenia. In this case series, we intend to share our experience of managing four cases of AFLP that were admitted to the intensive care unit with fetal demise and MOF.