Notes

Record-breaking aerosol amounts described simply by light up injection to the stratosphere.
•The CDC's cumulative funding for Public Health, Prevention, and Emergency Preparedness decreased over the course of 2011-2020, however, NIH funding dedicated to Prevention displayed an overall increase from 2008 to 2019.•The Hospital Preparedness Program (HPP) is the only source of federal funding for healthcare system readiness, yet their budget exhibited consistent reductions from 2003 to 2018.•Public health emergencies like the COVID-19 pandemic have demonstrated more significant consequences than other diseases that receive greater funding.•Allocating additional funding towards CDC health prevention in addition to expanding the Public Health Preparedness Response Fund (PHPR) and Prevention and Public Health Fund (PPHF) may improve future prevention and preparedness measures.The COID-19 pandemic has forced people into a new way of adaptation with virtual meetings using videoconferencing apps.This study aims to report experiences of using a multiscreen to screen platform for sharing experiences in the form of Live Lecture and beyond. An observational study on distant CME events using multiscreen to screen webinar model was conducted from December 2019 - April 2020. Efficacy of the content delivery was measured using MCQs as pre- and post-test or by key questions. The videoconference was combined with a game platform to plant key points of the lecture. Among 68 webinars, there were 21 organied using multiscreen to screen platform, including 14 live lectures, 3 half-day webinars and 4 panel discussions. Only two live lectures were conducted with pre- and post-test. Six live lectures were added with key questions and game sessions. Time preference to oin the webinar session was at 9-10AM on the participants side; however, participations came from across the continents regardless the preference. Web-conference based activities become a new normal way of scientific meetings. A shorter event gets more participation and fewer number of participants leaving half-way through the event. 5HT Key questions and game sessions appear to be more interesting to the participants rather than pre- and post-test.
The breast cancer treatment paradigm has shifted to neoadjuvant treatment. There are many advantages to neoadjuvant treatment, such as tumor downsizing,
tumor biology testing, treating micrometastasis, and achieving complete pathological response (a surrogate marker for overall survival). However, in the post neoadjuvant settings, sentinel lymph node biopsy can be done using a dual staining technique to decrease the false-negative rate (FNR) and increase the detection rate. However, many hospitals are not equipped to use radioisotopes. Here we investigate the detection rate and accuracy of sentinel lymph node biopsy in post neoadjuvant treatment breast cancer, comparing radioisotope, isosulfan blue, and indocyanine green (ICG) approaches.

This prospective study includes breast cancer patients (T2-4, N1-2) who had received neoadjuvant treatment. Carcinomas were confirmed by tissue pathology. Patients who had previous surgical biopsy or surgery involving the axillary regions, and those with a history of e 19.05% with ICG, 21.43% with isosulfan blue, and 18.03% with a radioisotope. However, the FNR was less than 10% when ICG, isosulfan blue, and a radioisotope were combined.

We can perform sentinel lymph node biopsy by combining blue dye with ICG as an optional modality and achieve a comparable outcome with combine radioisotope in locally advanced breast cancer after neoadjuvant treatment.
We can perform sentinel lymph node biopsy by combining blue dye with ICG as an optional modality and achieve a comparable outcome with combine radioisotope in locally advanced breast cancer after neoadjuvant treatment.
Inguinal bladder hernia (IBH) is a rare condition representing less than 5% of all inguinal hernias. Most cases occur in elderly overweight men. Patients may present with variable symptoms such as urinary symptoms, inguinal swelling, or pain; however, most of them are asymptomatic and only less than 7% are diagnosed pre-operatively. Different radiological studies can be used if IBH suspected preoperatively including ultrasound, computed tomography scan; however, cystography is the most sensitive test for diagnosis of IBH. Open reduction and hernia repair are the standard treatment of IBH.

We report a rare case of an-83-year-old male who presented with left inguinal pain associated with lower urinary tract symptoms including dysuria, nocturia, post-voidal dribbling, and urinary frequency. Laboratory studies showed acute kidney injury (AKI), and computed tomography (CT) of abdomen and pelvis without contrast CT revealed a herniation of 80% of the bladder through the left inguinal canal into the left scrotalt for IBH as we accomplished in our case.
Perioperative goal-directed haemodynamic therapy (GDHT), defined as the administration of fluids with or without inotropes or vasoactive agents against explicit measured goals to augment blood flow, has been evaluated in many randomised controlled trials (RCTs) over the past four decades. Reported post-operative pulmonary complications commonly include chest infection or pneumonia, atelectasis, acute respiratory distress syndrome or acute lung injury, aspiration pneumonitis, pulmonary embolism, and pulmonary oedema. Despite the substantial clinical literature in this area, it remains unclear whether their incidence is reduced by GDHT. This systematic review aims to determine the effect of GDHT on the respiratory outcomes listed above, in surgical patients.

We searched the Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, EMBASE, and clinical trial registries up until January 2020. We included all RCTs reporting pulmonary outcomes. The primary outcome was post-operative pulmonary complicat from fluids alone. Overall, the GDHT group received more colloid (+280 ml) and less crystalloid (-375 ml) solutions than the control group. Due to clinical and statistical heterogeneity, we downgraded this evidence to moderate.

This systematic review and meta-analysis suggests that the use of GDHT using fluids with inotropes and/or vasopressors, but not fluids alone, reduces the development of post-operative pulmonary infections and pulmonary oedema in general, abdominal and cardiothoracic surgical patients. This evidence was graded as moderate.PROSPERO registry reference CRD42020170361.
This systematic review and meta-analysis suggests that the use of GDHT using fluids with inotropes and/or vasopressors, but not fluids alone, reduces the development of post-operative pulmonary infections and pulmonary oedema in general, abdominal and cardiothoracic surgical patients. This evidence was graded as moderate.PROSPERO registry reference CRD42020170361.
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