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Mucormycosis of the mandible (MOM) is a rare fungal infection, and only 23 cases had been reported during the last 50 years worldwide, from seven different countries. Most of the cases were reported in India (n=8, 34%), followed by the United States (n=5, 22%). It is usually associated with an immunocompromised state and generally occurs after tooth extraction. Radiographically, it presents with the characteristic sign of osteomyelitis. Most of the previous case reports/series on MOM described successful outcomes with the resection of the involved segment. However, our experience in managing these cases was quite different and it was observed that resection is seldom required. It was seen that MOM rarely causes cortical perforation. One of the probable reasons is the thicker cortical bone and well-confined boundary of the mandible. Another reason could be the fulminating nature of the disease that leads it to rapidly spread in less resistant medullary bone before perforating cortical bone. During surgery, a clear line was seen separating necrotic medullary bone from healthy cortical bone. The thicker cortical bone of the mandible was found to be resistant to fungal invasion; however, the medullary bone was rapidly invaded. Therefore, the healthy cortical bone could be saved. The preservation of the cortical parts thus helps in maintaining the continuity of the bone. Surgical curettage of necrotic medullary bone is usually the optimal method to manage MOM affecting the mandibular body or ramus region.
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Cases of COVID-19 and its variant omicron are raised all across the world. The most lethal form and effect of COVID-19 are the omicron version, which has been reported in tens of thousands of cases daily in numerous nations. Following WHO (World health organization) records on 30 December 2021, the cases of COVID-19 were found to be maximum for which boarding individuals were found 1,524,266, active, recovered, and discharge were found to be 82,402 and 34,258,778, respectively. While there were 160,989 active cases, 33,614,434 cured cases, 456,386 total deaths, and 605,885,769 total samples tested. So far, 1,438,322,742 individuals have been vaccinated. The coronavirus or COVID-19 is inciting panic for several reasons. It is a new virus that has affected the whole world. Scientists have introduced certain ways to prevent the virus. One can lower the danger of infection by reducing the contact rate with other persons. Avoiding crowded places and social events with many people reduces the chance of one being exposed to the virus. The deadly COVID-19 spreads speedily. It is thought that the upcoming waves of this pandemic will be even more dreadful. Mathematicians have presented several mathematical models to study the pandemic and predict future dangers. The need of the hour is to restrict the mobility to control the infection from spreading. Moreover, separating affected individuals from healthy people is essential to control the infection. We consider the COVID-19 model in which the population is divided into five compartments. The present model presents the population's diffusion effects on all susceptible, exposed, infected, isolated, and recovered compartments. The reproductive number, which has a key role in the infectious models, is discussed. The equilibrium points and their stability is presented. For numerical simulations, finite difference (FD) schemes like nonstandard finite difference (NSFD), forward in time central in space (FTCS), and Crank Nicolson (CN) schemes are implemented. Some core characteristics of schemes like stability and consistency are calculated. © 2023 Tech Science Press. All rights reserved.
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Digital Rumors, because of the ease and innovations in social networking technologies, has become an important issue. These rumors become a critical issue in a disaster, epidemic, or pandemic. Considering classification power of conventional and deep learning techniques, we propose a hybrid learning technique that identifies rumors effectively. For this, TF-IDF description has been used to build a stack of multiple conventional learning techniques;logistic regression, Naïve Bayes, and random forest. Whereas, word-embedding features have been used for purpose of deep learning;LSTM and LSTM-RNN. The combination of LSTM and RNN makes this study unique in the field of rumor detection. With LSTM and RNN gated architectures, huge series rumor tweets may be efficiently managed. To aggregate the decisions, the labels of deep learning and the stack of conventional learning have been combined using majority voting based ensemble classification. To evaluate the performance of the proposed technique, we used publically available standard COVID-19 RUMOR dataset. The proposed technique obtains 99.02% accuracy, which shows its effectiveness. The dataset utilized and the ensemble model created for rumor identification distinguish our work from existing methods. © 2021 ACM.
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BACKGROUND: Branch duct (BD)-IPMNs with increased risk for malignant transformation are typically treated with surgical resection, and alternate therapies are needed for patients with prohibitive risks for perioperative complications. Injection of cysts with paclitaxel may prevent or reverse transformation, but current formulations are not retained in cysts to provide durable benefit. A Submicron Particle formulation of Paclitaxel (SPP) has been designed to avoid clearance into the systemic circulation and effectively provides a depot effect releasing the drug at constant saturation levels. In this initial study of EUS-guided fine needle injection (FNI) with SPP we evaluated safety, tolerability, pharmacokinetics, and cyst response in BD-IPMNs. METHODS: A diagnosis of BD-IPMNs was confirmed by EUSguided confocal laser endomicroscopy and cyst fluid next generation sequencing. Subjects received EUS-FNI of SPP (15mg/mL concentration) at volumes equal to the aspirated cyst fluid as part of an ongoing clinical trial [NCT03188991] (Study was interrupted due to COVID-19 pandemic). This report covers 5 of the study subjects enrolled at one site. SPP was administered on two occasions 12 weeks apart in 4/5 subjects and once in 1 subject. CT Scans were performed at 0, 12, and 24 weeks to assess changes in cyst size. RESULTS: The mean6standard deviation duration of follow-up from 1st EUS-FNI was 37.3±19.8 weeks. The mean size on CT-Scan of BD-IPMNs at time 0 weeks (1st EUS-FNI) was 3.360.8 cm, 12 weeks (2nd EUS-FNI) was 3.02±1.2 cm, and 24 weeks was 3.15±1.8 cm (Table 1). The mean dosage of SPP injected by EUS-FNI was 75±39 mg for 1st dose and 40.6±15.1 mg for 2nd dose. No dose limiting toxicities, study-related serious adverse events, or clinically significant changes in blood work were observed. The paclitaxel levels (PK) in plasma and cyst fluid is shown in Figure 1. Systemic paclitaxel concentration did not exceed 1 ng/mL at any point post-administration, falling below lower limit of quantitation (25 pg/mL) within, at most, 4 weeks. Cyst fluid analysis confirmed sustained presence of SPP for at least 12 weeks. At baseline evaluation, 4 of 5 subjects had GNAS mutations in cyst fluid (Table 1). In total, DNA mutations (KRAS or GNAS) were not detectable in two of 4 (50%) subjects after EUS-FNI with SPP (Table 1);both subjects (Figure 1) had a dose-dependent high intracystic concentration (> 1000 ng/mL) of SPP immediately prior to 2nd EUS-FNI (week 12). CONCLUSION: EUS-FNI of intracystic SPP appears to be safe and tolerable in patients with BD-IPMNs. SPP is likely retained in these cysts up to 12 weeks in a dose-dependent manner and higher doses are associated with regression of mutations that are specific for BD-IPMNs. Future studies with additional injections and longer-term follow-up are needed to understand the durability of the benefits observed.(Table presented)(figure presented)
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Objective: To study High resolution computed tomography chest findings in polymerase chain reaction (PCR) positive patients of COVID-19. Study Design: Cross sectional study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from May to Jun 2020. Methodology: Study included high resolution computed tomography chest of 200 patients admitted to COVID ward who were polymerase chain reaction positive. Patients having previously diagnosed Interstitial lung disease were excluded. Informed consent from patients were taken. Different findings on High resolution computed tomography chest were summarized as percent of total cases. British society of thoracic imaging (BSTI) classification was used to classify high resolution computed tomography chest patterns of COVID-19 pneumonia. Results: Out of 200 patients included in study, 7 had previous changes on their chest imaging and were excluded. 193 patients (145 males and 48 females) enrolled had a median age of 52 years. One hundred and two patients (52.9%) showed classical pattern for COVID-19, 81 patients (41.9%) had indeterminate changes, 3 patients (1.6%) had atypical changes while 7 (3.6%) had normal high resolution computed tomography chest. Four had pleural effusions while 5 had mediastinal lymphadeno-pathy. One hundred and eight nine (97.9%) patients had bilateral lung involvement, 145 (75.1%) had central and peripheral while 48 (24.9%) had peripheral invol-vement only. One hundred and forteen (59%) patients had ground glass opacities while 70 (36.3%) had ground glass opacities with consolidation. Nine (4.7%) patients presented with consolidation only. Conclusion: High resolution computed tomography chest and COVID polymerase chain reaction done at the same time gives better diagnostic accuracy and helps in classifying these patients into different categories with early detection and treatment of patients. © 2021, Army Medical College. All rights reserved.
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Objective: To identify common neurological complications in COVID-19 patients. Background: The novel Sars-CoV-2 virus was declared a Pandemic by WHO on March 11, 2020. Majority of the data published at this time brings into light the profound respiratory distress and cardiovascular outcomes however much is left to be discovered as far as neurological outcomes are concerned as suggested by anecdotal evidence and limited data. Design/Methods: We conducted a retrospective observational study from January 1, 2020 to April 30, 2020 on data collected from a multicenter health system based in Kansas City Metro area in United States. Composite neurological outcomes from the data included seizures (new onset), delirium (requiring medications), hemorrhagic and ischemic strokes (new onset, diagnosed > 48-72 hours after hospitalization). Results: Of the 346 people who tested positive for COVID-19, 89 (25.7%) were admitted to the hospital with 27 (30%) of the admitted patients requiring ICU level of care at some point. Delirium was seen in 19 patients (21%) of the total admitted out of which 14 patients (51%) were in the ICU. We observed a total of 2 cases of stroke, one ischemic and one hemorrhagic (2.2% of admitted patients). Seizures were not observed in this cohort of patients. Conclusions: Contrary to anecdotal data, we did not observe significant number of patients experiencing seizures or strokes in this cohort of patients. COVID-19 patients admitted to the hospital were documented to have significant levels of delirium. It is unclear as to why delirium was highly prevalent, could this be due to underlying ARDS or attributable to the critical condition or can it be a primary neurological outcome of COVID-19 is yet to be established. It would however benefit clinicians to closely monitor for worsening mentation or neurologic examination in COVID-19 patients.
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Objective: To determine the association between serum phosphorus, serum calcium, and serum iPTH and the occurrence of cardiovascular events in patients with diagnosed chronic kidney disease. Methodology: A prospective cohort study was conducted at Pir Abdul Qadir Shah Jeelani Institute Of Medical Sciences Gambat, Khairpur Mirs and Jinnah Postgraduate Medical Centre between August 2019 and July 2020. All patients over 18 years of age were eligible to participate in the study. Patients with incomplete data or those who were lost to follow-up were excluded from the study. Mineral metabolism parameters including, serum calcium, Phosphorus, and intact iPTH (iPTH), levels were recorded for all patients. Patients were followed up till the start of August 2020 to record any cardiovascular event. Patients were sub stratified into two groups i.e. with or without a CV event. Results: The study reported that with the exception of serum calcium, both iPTH and serum phosphorus were significantly associated with occurrence of CV events. iPTH levels had a direct association with CV events with a mean iPTH of 157.34±106.95 pg/ml in patients with CV events versus 108.98±85.63 pg/ml in patients without any CV event (P=0.0005). The mean serum phosphorus for the group with CV event was 3.57±0.73 mg/dl which was significantly higher than those without CV events (P=0.03). Conclusion: The current study indicated that serum phosphorus and intact iPTH levels were significantly associated with CV events in patients with CKD.
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COVID-19 pandemic has disrupted the economies around the world and the economic fallout from preventive measures such as lockdown is enormous. It has massive repercussions for the sharing economy as well. This research paper empirically analyses the impact of lockdown restrictions on five major sectors of the sharing economy such as ride-hailing, accommodation, freelance work, entertainment and delivery services. To evaluate this impact, we employed the difference-in-difference estimation technique using the Google trends data for selected countries. Daily search data of 2019 and 2020 is reindexed to examine the change in search patterns that occurred after lockdown. The empirical results show that transportation and accommodation sectors are negatively impacted by COVID-19 related lockdown while the other sectors of the sharing economy such as freelance work, streaming services and online deliveries are seeing a surge in searches. The findings of this study provide vital insights into the economic disruptions caused by COVID-19 related lockdown. We have highlighted the sectors that are booming during pandemic thus the sharing economy platforms and government shave opportunities to invest in these sectors to jump-start the economy. The recently unemployed gig workers can also be employed in these sectors to address the problem of unemployment.
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SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The novel Sars-CoV-2 virus causes a viral pneumonia (COVID-19) and corticosteroids have been shown to prolong viral shedding and may increase mortality in viral pneumonias(1). Patients with asthma typically require inhaled corticosteroids. It is unknown if asthmatics will therefore have worse outcomes as a result. METHODS: This is a retrospective cohort study of asthmatics compared to the general population diagnosed with COVID-19 pneumonia from a multicenter health system in Kansas City. The primary outcome is admission to a hospital. Secondary outcomes include mechanical ventilatory support and in-hospital all-cause mortality. RESULTS: In this cohort, asthmatics had an average BMI of 32.9 +- 3.2, as compared to 31.2+-0.8 in the general population. Mean age is 49.0 +- 6.0 vs 54+-1.79. As of 5/1/2020 there have been 345 patients positive for COVID 19. 24 have asthma. 7/24 with asthma (29.2%) vs 79/321 non-asthmatics (24.6%, OR 1.26, p=0.6) have required admission to a hospital. 2/24 (8.3%) asthmatics have required mechanical ventilation vs 17/321 (5.2%, OR 1.49, p=0.6) non-asthmatics. 0 asthmatics have died and 7/321 (2.8%, OR 0.8, p=0.9) non-asthmatics have died. CONCLUSIONS: In conclusion, based on this limited retrospective data, asthma does not appear to be a significant risk factor for hospital admission, mechanical ventilation, or death. CLINICAL IMPLICATIONS: Larger, prospective studies are needed to ensure asthmatics are not at increased risk of worse outcomes due to COVID-19. DISCLOSURES: No relevant relationships by Ibrahim Alakhras, source=Web Response No relevant relationships by Hashaam Arshad, source=Web Response No relevant relationships by Taylor Brinton, source=Web Response No relevant relationships by Ain Ejaz, source=Web Response no disclosure on file for Gregory Howell
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The new pandemic coronavirus disease (COVID-19) has affected children, including neonates, who mostly comprise of approximately 2% of total confirmed cases. Most children are asymptomatic or have mild disease and much lower mortality compared to adults for yet unknown reasons. Recovery from illness has largely been universal and <2% have severe disease requiring intensive care. Standardised guidelines from initial studies are now available for diagnosis, treatment, and prevention. Treatment is mostly supportive with no recommendations for any specific drugs so far. As the pandemic evolves, it is expected that more children will be diagnosed and treated with evolving newer regimens. Research should now focus on early diagnosis, better drugs for children, intensive care modalities, and a universal vaccine. New developments will help in better prevention asides from the other precautionary measures already being practiced.