The assessment, management, and treatment of the entrapped victim are critical skills needed to ensure a successful outcome. Individuals have been trapped in the "rubble" for even short periods of time only to succumb to predictable consequences of muscle compression injury. The clinician should be prepared to address issues of crush syndrome (including compartment syndrome) proactively and aggressively. The history of this disease is clear and well documented both in the military literature and in the earthquake rescue reviews. The key to management is managing and predicting clinical conditions before they present themselves. The potential exists in the urban environment (with the potential of building collapses) to have patients with crush syndrome that far exceed local medical capabilities should be part of modern disaster planning. This article reviews the various body systems and presents management and assessment strategies for the clinician.

A nylon flocked swab/universal transport medium collection method developed for bacterial sexually transmitted infections was adapted to detect respiratory viruses in infants and toddlers. This method significantly outperformed the traditional use of nasal aspirates in terms of PCR-based virus detection (P ‫؍‬ 0.016), and the samples were easier for clinicians to evaluate, store, and transport.Collection of nasal secretions from infants and toddlers for viral testing is typically performed using the nasal saline aspirate (NA) technique described by Hall and Douglas in 1975 (7). This technique is less invasive and performs similarly to nasopharyngeal aspirates for its most common indication, respiratory syncytial virus (RSV) testing (1). However, NA sampling tends to be highly variable in terms of the volume and material collected and is prone to rapid viral RNA degradation. This method is further complicated by the need to divide specimens into aliquots and freeze them to Ϫ70°C when immediate PCR analysis is not available. This additional manipulation, coupled with the need for dry ice shipping, adds extra costs and may potentially increase the number of false-negative results, thereby decreasing the usefulness of PCR-based testing and compromising clinical decision-making.Nylon flocked swabs (NFS), in combination with universal transport medium for room temperature storage and shipping (UTM-RT; Copan Diagnostics, Inc., Murrieta, CA), are a proven collection and transport method for bacteria responsible for sexually transmitted infections. This method also allows for room temperature storage and shipping (3). RSV remains viable in UTM-RT for up to 96 h (2) and, in this regard, has been reported as superior to other transport media (9). Adapting the NFS/UTM-RT collection method to nasal secretion sampling would provide a better method of nasal secretion sampling.Our primary hypothesis was that nasal secretions collected using NFS stored in UTM-RT would lead to a higher PCR

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Cattle tick infestations constitute a major problem for the cattle industry in tropical and subtropical regions of the world. Traditional control methods have been only partially successful, hampered by the selection of chemical-resistant tick populations. The Boophilus microplus Bm86 protein was isolated from tick gut epithelial cells and shown to induce a protective response against tick infestations in vaccinated cattle. Vaccine preparations including the recombinant Bm86 are used to control cattle tick infestations in the field as an alternative measure to reduce the losses produced by this ectoparasite. The principle for the immunological control of tick infestations relies on a polyclonal antibody response against the target antigen and, therefore, should be difficult to select for tick-resistant populations. However, sequence variations in the Bm86 locus, among other factors, could affect the effectiveness of Bm86-containing vaccines. In the present study we have addressed this issue, employing data obtained with B. microplus strains from Australia, Mexico, Cuba, Argentina and Venezuela. The results showed a tendency in the inverse correlation between the efficacy of the vaccination with Bm86 and the sequence variations in the Bm86 locus (R2 = 0.7). The mutation fixation index in the Bm86 locus was calculated and shown to be between 0.02 and 0.1 amino acids per year. Possible implications of these findings for the immunoprotection of cattle against tick infestations employing the Bm86 antigen are discussed.

Chronic pulmonary infection is a hallmark of lung disease in cystic fibrosis (CF). Infections dominated by non-fermentative Gram-negative bacilli are particularly difficult to treat and highlight an urgent need for the development of new class of agents to combat these infections. In this work, a small library comprising thiourea and guanidine derivatives with low molecular weight was designed; these derivatives were studied as antimicrobial agents against Gram-positive, Gram-negative, and a panel of drug-resistant clinical isolates recovered from patients with CF. One novel compound, a guanidine derivative bearing adamantane-1-carbonyl and 2-bromo-4,6-difluouro-phenyl substituents (H-BDF), showed potent bactericidal activity against the strains tested, at levels generally higher than those exhibited by tobramycin, ceftazimide and meropenem. The role that different substituents exert in the antimicrobial activity has been determined, highlighting the importance of the halo-phenyl group in the guanidine moiety. The new compound displays low levels of cytotoxicity against THP-1 and A549 cells with a selective index (SI) > 8 (patent application PCT/IB2017/054870, August 2017). Taken together, our results indicate that H-BDF can be considered as a promising antimicrobial agent.

The FDNY-START system may allow providers to prioritize casualties using an intermediate category (Orange) more properly aligned to meet patient needs, and as such, may reduce the rates of over-triage compared with START. The FDNY-START system decreases the variability in patient sorting while maintaining high field utility without needing computer assistance or extensive retraining. Comparison of triage algorithms at actual MCIs is needed; however, initial feedback is promising, suggesting that FDNY-START can improve triage with minimal additional training and cost.

Antimicrobial resistance to antibiotic treatment has significantly increased during recent years, causing this to become a worldwide public health problem. More than 70% of pathogenic bacteria are resistant to at least one of the currently used antibiotics. Polymyxin E (colistin) has recently been used as a “last line” therapy when treating Gram-negative multi-resistant bacteria. However, little is known about these molecules’ pharmacological use as they have been discontinued because of their high toxicity. Recent research has been focused on determining colistimethate sodium’s pharmacokinetic parameters to find the optimal dose for maintaining a suitable benefit–risk balance. This review has thus been aimed at describing the use of colistin on patients infected by multi-drug resistant bacteria and the importance of measuring this drug’s plasma levels in such patients.

Objective To determine if oxygen saturation (out‐of‐hospital SpO2), measured by New York City (NYC) 9‐1‐1 Emergency Medical Services (EMS), was an independent predictor of coronavirus disease 2019 (COVID‐19) in‐hospital mortality and length of stay, after controlling for the competing risk of death. If so, out‐of‐hospital SpO2 could be useful for initial triage. Methods A population‐based longitudinal study of adult patients transported by EMS to emergency departments (ED) between March 5 and April 30, 2020 (the NYC COVID‐19 peak period). Inclusion required EMS prehospital SpO2 measurement while breathing room air, transport to emergency department, and a positive severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) reverse transcription polymerase chain reaction test. Multivariable logistic regression modeled mortality as a function of prehospital SpO2, controlling for covariates (age, sex, race/ethnicity, and comorbidities). A competing risk model also was performed to estimate the absolute risks of out‐of‐hospital SpO2 on the cumulative incidence of being discharged from the hospital alive. Results In 1673 patients, out‐of‐hospital SpO2 and age were independent predictors of in‐hospital mortality and length of stay, after controlling for the competing risk of death. Among patients ≥66 years old, the probability of death was 26% with an out‐of‐hospital SpO2 >90% versus 54% with an out‐of‐hospital SpO2 ≤90%. Among patients <66 years old, the probability of death was 11.5% with an out‐of‐hospital SpO2 >90% versus 31% with an out‐of‐hospital SpO2 ≤ 90%. An out‐of‐hospital SpO2 level ≤90% was associated with over 50% decreased likelihood of being discharged alive, regardless of age. Conclusions Out‐of‐hospital SpO2 and age predicted in‐hospital mortality and length of stay: An out‐of‐hospital SpO2 ≤90% strongly supports a triage decision for immediate hospital admission. For out‐of‐hospital SpO2 >90%, the decision to admit depends on multiple factors, including age, resource availability (outpatient vs inpatient), and the potential impact of new treatments.