We present a case of a 78-year-old African-American man with a history of hypertension, and with no prior history of seizure. The patient presented with hypertensive urgency as well as stroke such as symptoms of confusion, seizure, postictal confusion, left hemianopsia and hyponatraemia. MRI findings were suggestive of posterior reversible encephalopathy syndrome (PRES). The patient was treated with appropriate medications with the resolution of his stroke-like symptoms. This case report discusses a patient with PRES, in the setting of hyponatraemia, and how prompt recognition may prevent permanent neurological sequela such as epilepsy.

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Influenza like pandemics are a severe threat to any established health care system as many thousands of patients would need emergency ventilator support during the acute respiratory failure stage, and this quickly overloads the existing facilities. The present article addresses the design and development of a human breathing assist machine (ventilator) prototype for use by qualified medical professionals in the emergency room, as well as in other locations, where a regular ventilator machine cannot be made available. The ventilator has been designed using readily available locally sourced materials, which can be assembled in a short time. This ensures the minimum required features to ventilate a patient in emergency conditions. The popular crank-rocker mechanism has been used to meet some of the vital design requirements of the emergency ventilator. The size of the links has been chosen to maintain a fixed inspiratory-to-expiratory (I:E) time ratio of 1:2. The kinematic linkage design has been kept modular by introducing a feature to adjust the location of the rocker tip to control the tidal volume from 100 ml to 600 ml of oxygenated air per breath. A virtual CAD model, based on the above-mentioned linkage design, has been designed to assess the variation of the position and velocity with time. Finally, a working prototype has been made, and it was observed that the I:E time ratio of 1:2 was achieved satisfactorily.

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INTRODUCTION: COVID-19 mortality has disproportionately impacted racial and ethnic minorities in the United States. This disparity is particularly notable in Washington D.C. where African Americans make up 44% of the population, but 51% of COVID-19 infections and 75% of COVID-19 mortalities. Anecdotally, we saw high numbers of severe COVID-19 cases among young Hispanic adults and decided to explore this phenomenon by analyzing demographic characteristics for all COVID-19 patients who received VV-ECMO in Washington D.C. RESULTS:We performed a multicenter retrospective chart review of all COVID-19 patients who received VV-ECMO support from March 2020 to March 2021 at the two hospitals that provide ECMO in Washington D.C. Patient selection was uniform across both institutions, with basis in the original CESAR and EOLIA selection criteria. To future explore socioeconomic status (SES) as a corollary to ECMO cannulation, we merged patient zip codes with zip code median household income from the American Community Survey. There were 38 patients with COVID-19 who received VV-ECMO in Washington DC. Median age was 45 years and ages ranged from 28 to 65 years. 61% of patients were male and 71% were single. 57.9% of patients were Hispanic and 29.0% were non-Hispanic Black. 44.7% of patients were insured through Medicaid and another 13.2% were insured through a locally-funded public insurance designed for low-income persons ineligible for Medicaid. 63% of patients lacked primary care physicians. 94.7% were from D.C. area. 83.3% of patients from the D.C. area lived in zip codes with a median household income that is below the median household income for the city ($85,203).DISCUSSION: Only 11% of adults in Washington D.C. identify as Hispanic. Hispanics made up 19% of COVID infections in the city, but 58% of COVID-19 VV-ECMO cases. This suggests that, in our region, Hispanics may be over-represented among young and middle-aged adults with severe COVID-19 infections, which is why they are more likely to require ECMO support. These data highlight the great need to focus on this vulnerable population, with continued efforts to combat misinformation about the vaccines and partner with trusted persons in the community.