We present a case of a critically ill patient with severe Legionella pneumonia complicated by morbid obesity (BMI ≥ 40 kg/m²) who was successfully treated with early initiation of veno-venous ECMO (V-V-ECMO) without any sequelae. The patient, a 48-year-old male, initially presented with symptoms of a sore throat, fever, significant fatigue, and decreased appetite. Upon diagnosis of severe pneumonia complicated by morbid obesity, he was transferred to our hospital for further management. Upon admission, he was promptly intubated and placed on mechanical ventilation. Due to a positive urinary Legionella antigen test indicating a risk of deterioration, V-V ECMO was initiated immediately after intubation. During ECMO support, the patient received Levofloxacin Hydrate at 500 mg/day and Prednisolone Sodium Succinate at 100 mg/day. He was successfully weaned off ECMO after 12 days and transferred back to the referring hospital on day 20. While ECMO therapy for morbidly obese patients was traditionally considered relatively contraindicated, this case suggest that obesity alone is not a contraindication to initiating ECMO.

Introduction: Health-related quality of life in patients undergoing dialysis decreases over time, not only due to the treatment of the disease but also due to the reduction of physiological, psychological and social well-being. Aim: The aim of this research is to study social support and nursing care that patients with dialysis receive, their levels of fatigue and their quality of life. In addition, the effect of social support and nursing care on the patients'' levels of quality of life is examined. Methodology: A quantitative cross-sectional study was conducted using the questionnaires “Multidimensional Scale of Perceived Social Support”, Fatigue Assessment Scale (FAS), Missoula-VITAS Quality of Life Index and nursing care. The study involved 69 patients on dialysis. Results: Interpersonal relationships were associated with social support (p <0.01). Quality of life was associated with social support (p <0.05). Conclusions: It seems that there is a strong association between social support and quality of life in patients on dialysis.

Objective: The effects of muscle fatigue appear to elicit a transient means of postural instability; however, the recovery of postural stability after fatiguing exercise has not been extensively studied. This study aimed to determine the immediate effect of local vibration applied to fatigued plantar flexor muscles on postural stability in healthy young adults. Design: True Experimental (pre-test - post test design with a control group). Setting: A tertiary care centre. Participations: 42 healthy young adults. Intervention: Fatigue of plantar flexors muscles was induced by repeated dynamic contractions performed to maximum exhaustion. Experimental group (n= 21) received local vibration to fatigued muscles with a handheld vibrator whereas the control group (n = 21) received no intervention (rest). Postural stability was assessed using one leg stance test (OLST) under three different conditions viz. pre-fatigue, post-fatigue and post rest/vibration. Results: Comparative analysis of postural stability within the group was done pre-fatigue, post-fatigue and post rest/vibration condition using Kruskal-Wallis test. A significant decrease from pre-fatigue to post-fatigue condition (p-value < 0.001); and a significant increase from post-fatigue to post rest/vibration condition (p-value < 0.001) was observed in OLST in both - control group and experimental group. However, further comparison of OLST between the groups (using unpaired t test) showed a significant difference in post-fatigue condition versus post rest/vibration condition in favour of the experimental group. Conclusion: Plantar flexors fatigue significantly affects one leg stance time in healthy young adults. Results of this study show that there is an immediate effect of vibration to fatigued muscles on recovery of postural stability in healthy young adults. Recovery of postural stability achieved quickly with such a simple tool may help increase the degree of participation in sports and other similar activities which can cause muscles to fatigue. However, more studies are required to determine this effect using other clinical measures.

Background: Propranolol is a non-cardio-selective beta-blocker, commonly used in patients with hyperthyroidism to treat the hyperadrenergic symptoms but also for its additional effect of blocking the peripheral conversion of inactive T4 to active T3. However, propranolol has many side effects, one of them being secondary Raynaud phenomenon. Case presentation: S.K., 55 years old was hospitalized in the Endocrinology Department as an untreated hyperfunctioning goiter with typical clinical manifestations such as fatigue, anxiety, palpitations, heat intolerance, difficulties in swallowing and breathing. Unimazole 5 mg (2-2-2 tb) and Propranolol 40 mg (¼ -0- ¼ tb) were prescribed. Thirty minutes after taking Propranolol (the dose 40 mg), she had difficulties breathing, was agitated, sweating and had nausea. Her face was hyperemic and edematous and her extremities were getting blue and cold. Her vitals remained stable and her airways were opened, as evaluated from laryngoscopy and CT-scan of the neck. 8 hours later, her clinical manifestations got worse: her facial edema spread in her lips and submandibular region. On both cases, she clinically improved after prednisolone administration. 12 hours after taking propranolol, she showed no more signs of cyanosis or edema. Propranolol was replaced by Nebivolol, with no side effects. Conclusion: Secondary Raynaud phenomenon is a common side effect of beta-blockers and should be taken in consideration in very patient presenting with cold and cyanotic peripherals. In these cases, propranolol should be stopped and replaced. Further studies on beta-blockers side effects in patients with hyperthyroidism should be made.