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But, this intervention alongside other attachment behaviours such as touching the belly and talking to foetus could enhance MFA. Therefore, the best interventions to improve MFA might be combined ones implemented in the form of counselling and training sessions.

Some patients with coronavirus disease 2019 (COVID-19) develop pneumothorax. Tube thoracotomy and bulla resection could generate aerosols and cause virus transmission; the optimal treatment strategy remains unclear.

A 57-year-old male was transferred as a severe COVID-19 pneumonia case. On the 16th day after admission, the patient’s respiratory condition deteriorated, and the chest X-ray revealed the presence of severe right-sided pneumothorax. A chest drain was immediately inserted; however, a significant air leak continued, and severe ventilator settings were required. Thus, veno-venous extracorporeal membrane oxygenation (VV-ECMO) treatment was initiated to allow the lungs to rest. After 10days of lung-protective ventilation, the patient was weaned from ECMO and the chest drain was removed on the following day with no major comorbidities.

The combination of ECMO with lung rest strategy could be a treatment option for intractable pneumothorax with COVID-19 to avoid unnecessary surgical procedures and aerosol generation.

The combination of ECMO with lung rest strategy could be a treatment option for intractable pneumothorax with COVID-19 to avoid unnecessary surgical procedures and aerosol generation.

Among the influenza-associated encephalopathies, acute necrotizing encephalopathy (ANE) has a particularly poor prognosis. While it usually progresses within 48h, we encountered a rapidly evolving case with the patient falling into coma from lucidity within 10min.

A 71-year-old man was found unconscious after taking a 10-min bath and brought to the emergency room. The head computed tomography (HCT) was normal, and he was diagnosed with heatstroke as a complication of influenza A. Despite effective therapy to correct his temperature, his consciousness did not improve, and within 24h he progressed to multiple organ injury. Repeat HCT and subsequent magnetic resonance imaging revealed irreparably progressed ANE.

To effectively treat ANE, early recognition and diagnosis are critical. Our case suggests that ANE should be considered and added to the differential diagnosis for adult patients with rapid cognitive deterioration.

To effectively treat ANE, early recognition and diagnosis are critical. Our case suggests that ANE should be considered and added to the differential diagnosis for adult patients with rapid cognitive deterioration.

Early onset pneumonia (EOP) in patients with cardiac arrest treated with targeted temperature management is a recently debated issue. We assessed the association between C-reactive protein (CRP) levels and development of EOP in patients treated with extracorporeal cardiopulmonary resuscitation (ECPR).

We reviewed the data of all patients admitted to our hospital after out-of-hospital cardiac arrest treated with ECPR between April 2006 and April 2019 who survived for at least 48h. We collected demographic data, cardiac arrest characteristics, prophylactic antibiotic use, and neurologic outcomes. Diagnosis of EOP was made based on clinical, radiological, and microbiological criteria. The primary endpoint was the association between the incidence of EOP and CRP levels from day 1 to day 4. DOX inhibitor molecular weight A total of 55 patients were included, of which 20 developed EOP. CRP levels on days 3 and 4 were significantly elevated in patients who developed EOP (13.1 [11.8-21.1] mg/dL versus 11.6 [7.4-15.2] mg/dL, P=0.005; and 19.0 [16.9-27.1] mg/dL versus 14.7 [7.4-21.2] mg/dL, P=0.019, respectively). In the multivariable logistic regression model, the CRP level on day 3 was significantly associated with the development of EOP (odds ratio 1.22; 95% confidence interval 1.06-1.41; P=0.001).

Increased inflammation in acute phase was associated with development of EOP in patients treated with ECPR.

Increased inflammation in acute phase was associated with development of EOP in patients treated with ECPR.

The aim of this study was to better understand the usefulness of retrospective inspection of radiology reports of CT (computed tomography) or MRI (magnetic resonance imaging) by emergency doctors in the emergency room.

Between April 2018 and March 2019, patients who went home after CT or MRI who needed to change their treatment plans and subsequent corresponding procedures after inspection of radiology reports by emergency doctors were reviewed.

Among 7,661 CT or MRIs performed on 5,917 patients, there were 131 patients (133 CT or MRI or 1.7% among 7,661 examinations) who required a change in their treatment plans after inspection of radiology reports. Of the 133 CT or MRI performed, there were 51 (38.3% among 133 CT or MRI, 0.7% among 7,661 examinations) CT or MRI performed, which indicated findings to suspect a tumor (11.8% in the head, 41.2% in the chest, 35.3% in the abdomen, and 11.8% in others). With the need to make important changes in treatment plans, making appointments for outpatient clinics was necessary for 52 CT or MRI findings, and requiring the patients to return to the clinic or be admitted was necessary for 9 (totally 61; 0.8% among 7,661 examinations).

Data from this study suggest that inspection of radiology reports of CT or MRI by emergency doctors after patients went home is useful in finding characteristics suggestive of tumors in 0.7% of all radiology reports and is necessary to identify important changes that should be made in treatment plans in 0.8% of all radiology reports.

Data from this study suggest that inspection of radiology reports of CT or MRI by emergency doctors after patients went home is useful in finding characteristics suggestive of tumors in 0.7% of all radiology reports and is necessary to identify important changes that should be made in treatment plans in 0.8% of all radiology reports.We analyse the impact of total population containment on the evolution of the growth rate of confirmed cases of coronavirus disease 2019 (COVID-19) by controlling the results by the situation observed in a country that has not applied this measure. We conducted a study of four European countries, England, Belgium, France and Italy, taking Sweden as a control country that did not confine its population. To do so, we use the interrupted time series method. Comparisons of the postintervention linear trends of COVID-19 confirmed cases from England, Belgium and France with that of Sweden show no statistically significant difference. Comparison of the postintervention linear trends of COVID-19 confirmed cases from Italy with that from Sweden shows a positive and statistically significant difference. It reflects a dynamic in the growth rate of confirmed cases in Italy higher than that observed in Sweden despite the total containment of the population. The results obtained therefore lead to the conclusion that the measure of total population containment is ineffective in the countries sampled.