The Recovery of Equipment for Capacity building OVERseas (RECOVER) initiative at Rutgers New Jersey Medical School involves collection and donation of clean and unused medical supplies that would otherwise be discarded to those desperately in need of those supplies abroad. RECOVER has recently responded to the aftermath of the Ebola crisis and the even more recent mudslide natural disaster in Freetown, Sierra Leone, which had resulted in a considerable diminishing of the local medical supplies. The goal of this study was to assess the match between donated supplies and local needs by using a post-donation survey. In December 2016, we conducted a pre-donation survey inquiring which of the supplies available from RECOVER were needed by four hospitals in Freetown. The survey also asked about specific barriers to keeping such supplies in stock. After each hospital received a shipment of supplies, we administered an online Qualtrics (Qualtrics, Provo, UT) follow-up survey intending to assess the appropriateness of the donated supplies. The survey asked about which wards used what supplies, most useful items, ability to sterilize, and whether the donation provided supplies that would otherwise need to be bought. Recipient hospitals reported the use of 90% of donated supplies. The most useful supplies were gowns, scalpels, gloves, and drapes; All recipients reported the ability to sterilize donated goods. Supplies were used in operating rooms, emergency rooms, and medical wards. Donated supplies provided hospitals with supplies that would typically need to be bought or that were unavailable in the region. No adverse events were reported related to the use of donated supplies. At first glance, our donations appear usable and appropriate for the recipients. We hope to provide a framework for an objective measure of need for hospitals in other low-income countries, using the Freetown post-Ebola crisis as a pilot for the assessment of medical supply donations and the longitudinal impact it can have on global health and surgery overseas. More studies are required to further explore the possible implications of our program including those relating to medical waste management and environmental considerations when donating and shipping disposable supplies to a developing country.

Eosinophilic ascites is a rare type of exudative ascites most commonly caused by eosinophilic gastroenteritis. Here, a 57-year-old man presents with sudden-onset abdominal distension associated with nausea, vomiting and decreased appetite for 10 days. Physical examination revealed significant abdominal distention and fluid wave. Initial labs showed leucocytosis and mild peripheral eosinophilia. Imaging of his abdomen revealed severe ascites, no features of cirrhosis and diffuse inflammatory changes involving the jejunum and ileum. Diagnostic paracentesis showed exudative, ascitic fluid with predominant eosinophilia. Cytology of the ascitic fluid and blind biopsies taken during oesophagogastroduodenoscopy and enteroscopy were both negative for malignancy. The ascites reaccumulated rapidly, requiring five rounds of large-volume paracentesis during hospitalisation. Empiric treatment for suspected eosinophilic gastroenteritis with intravenous steroids improved and stabilised the patient’s ascites for discharge. Parasitic workup resulted positively for Toxocara antibodies on ELISA. On 2-week outpatient follow-up, a course of albendazole resolved all gastrointestinal symptoms.

Obstructive sleep apnea (OSA) is an independent risk factor for many diseases. While there is a known association between OSA and cardiovascular disease, the association with intravascular or thrombotic events such as deep vein thrombosis (DVT), pulmonary embolism (PE), and cerebrovascular accidents (CVA) is less understood. This study looks at the distribution of significant comorbidities, vascular events, and outcomes among patients with and without OSA.METHODS: Data from the National Inpatient Sample (NIS) database for 2015-2016 was used to assess the prevalence of hypercoagulable events in patients with and without OSA. Using propensity score matching, patients with OSA were matched to a cohort of those without OSA using a 1:5 ratio and was adjusted for age and gender. Adjusted chi square analysis and multivariate logistic regression, was also performed.RESULTS: There were 24,980 patients with OSA matched with 149,880 patients without OSA (mean age 60.09 years; 44.9% female) with 83.5% of between 40 and 60 years of age. Those with OSA were found to have 18.2% more DVTs, 14.3% more PEs, and 25.0% more CVAs than the non-OSA group. Of those with OSA, incidence of the following events were more common in males: PE (25.8%), DVT (61.3%), cerebral hemorrhage (71.1%), cerebral ischemic event (73.0%). However, females with OSA were approximately 3.7 more likely than males with OSA to have in-hospital mortality (OR 3.71; 95% CI 2.68-5.14). For both males and females, there was an increased risk of coagulable events in those with underlying pulmonary artery hypertension (PAH) (OR 4.11; 95% CI 3.36-5.02), emphysema (OR 3.04; 95% CI 2.02-4.57,) asthma (OR 1.17; 95% CI 1.02-1.35), and hypertension (OR 1.23; 95% CI 1.10-1.38) but not heart failure (OR 0.82; 95% CI 0.68-0.98), alcohol use disorder (OR 0.46; 95% CI 0.29-0.72), or cirrhosis (OR 0.35; 95% CI 0.19-0.65). The average length of stay for those with OSA was 4.57 days, 4.1% longer than those without OSA, and when comparing total hospital charges, the average cost for those with OSA was 19% more. The average length of hospital say for males and females with OSA were 4.60 and 4.47 days, respectively. CONCLUSIONS: Even when adjusted for age, sex, and various comorbidities, the presence of vascular events was significant in the OSA group and was associated with higher length of stays and hospital charges. Males had a higher frequency of coagulable events however, females were more likely to have in-hospital mortality, especially those with concomitant pulmonary disease.CLINICAL IMPLICATIONS: Although OSA is widely recognized as a risk factor for cardiovascular and cerebrovascular diseases, there is limited data on the thrombotic events associated with this disease, the distribution of significant comorbidities as well as clinical outcomes. Our findings add to the growing evidence that OSA represents a major risk factor for vascular events in hospitalized patients.