ABSTRACT
Fungi are the most frequent skin infections in organ transplant recipients (OTRs) and usually present as superficial mycoses. Deeper infections are much less common, potentially more serious and the incidence is higher in the first few months post-transplant. We report two African OTRs with deep fungal infections caused by dematiaceous (melanized, pigmented or black) fungi, who both presented with suspected skin malignancies. A 60-year-old Nigerian man developed a painful, ulcerated, amelanotic, bleeding nodule on his right fourth toe 2 months after renal transplantation. Clinical differential diagnoses included Kaposi sarcoma (KS), amelanotic acral melanoma and subungual squamous cell carcinoma (SCC). However, histology showed pseudoepitheliomatous hyperplasia, extensive mixed inflammation, multinucleated giant cells and pigmented septate hyphae with rounded 'budding' forms. Periodic acid-Schiff, Grocott and Masson-Fontana stains were positive, and Alcian blue stain was negative, consistent with infection by a dematiaceous fungus. Fungal 18S polymerase chain reaction (PCR) was positive and culture identified Nigrograna mackinnonii. Treatment with oral itraconazole was supervised virtually during the COVID-19 pandemic. After 6 months there was minimal response and he opted for amputation of the digit. A 61-year-old Nigerian man presented 2 months after renal transplantation with a 2-cm diameter nodule on his left thigh at the site of a previous burn. This failed to respond to antibiotics. Magnetic resonance imaging was suggestive of possible malignancy, but surgery was deferred because of the COVID-19 pandemic. Two months later the lesion was 5 cm in diameter and verrucous with an 8-cm sessile, purplish plaque on his right forearm. Atypical KS, lymphoma and chronic burns-associated SCC were all considered. However, histology from both lesions was similar to the first patient. Fungal culture and 18S PCR confirmed infection with the dematiaceous fungus Alternaria alternata. At his request, the right thigh lesion was excised. The lesion on his forearm has partially responded to 8 months of ongoing oral itraconazole. In our African OTR cohort, KS is more common than deep fungal infection. However, despite this suspicion of skin malignancy, both patients had phaeohyphomycoses caused by dematiaceous fungi. Characterized by the presence of melanin in their cell walls, > 130 species of these plant pathogens and soil saprophytes are implicated in human disease, particularly in immunocompromised individuals. Although localized skin diseases (phaeohyphomycoses, chromoblastomycosis and mycetoma) are the most common manifestations, rare disseminated, central nervous system and pulmonary infections may prove fatal. Although uncommon, deep fungal infection should be considered in atypical skin lesions in OTRs;histology, tissue culture and fungal PCR are critical to confirming this diagnosis.
ABSTRACT
COVID-19 Pandemic has affected human being without distinguishing the region and religion around the world. Even though vaccine is available now, we should still be use precautionary steps to avoid being affected by this virus. Use of face mask will help to stop the spread of the virus. COVID - 19 face mask detector will help in detecting whether a person is wearing mask or not by the use of its on face mask net with deep learning techniques. With suggested technique of deep learning get an accuracy of 98 percent. Our suggested technique also works with still pictures and give effective results with live video stream captured using the CCTV cameras and able to identify whether person is using face mask or not. It is very useful at the place of the mass gathering and screening like shopping mall and railway station and shopping streets and colleges. By using this tool for the face mask will help in regulating the use of it and if person found not using it will be easily warned by the regulator. © 2021 IEEE.
ABSTRACT
Background: Maintaining access is essential for haemodialysis dependent end stage renal failure patients. The COVID-19 pandemic has significantly affected surgical and interventional radiology services worldwide. We aimed to review the impact COVID-19 has caused to the management of acute dialysis access thrombosis. Materials and Methods: We conducted a single centre retrospective comparative review of arteriovenous fistula and arteriovenous graft thrombosis cases between March-May 2019 and March-May 2020 (this coincides with the peak of the COVID-19 pandemic in London). Outcomes in both cohorts of patients were compared, including attempts at salvage, salvage success, 1-month patency rates after salvage, and subsequent surgery on the same access. We also analysed the use of tunnelled haemodialysis lines (THL), either due to failed salvage attempts or when salvage was not attempted. Results: During the peak of the pandemic, there was a similar incidence of access thrombosis compared to 2019 (26 vs 38 cases, p=0.21). Access salvage, when attempted (92% of cases in 2019 vs 63% in 2020), had similar success rates (75% vs 83%, p=0.43), and similar 1-month patency (42% vs 38%, p=0.80). The proportion of patients presenting with access thrombosis where access salvage was not attempted and a THL inserted was significantly higher in 2020 compared to 2019 (34.2% vs 3.8%, p=0.007). Significantly more patients had surgical salvage or revision of same access in 2019 than at the height of pandemic (61.5% vs 13.1%, p<0.001). Conclusion: During the peak of the COVID-19 pandemic, there were significantly fewer attempts at access salvage, more line insertions but similar access thrombosis rates. The long-term effects of this shift in practice, which was likely due to added pressures on the service at the time due to COVID-19, remain unknown.