Periocular necrotising fasciitis after traumatic laceration and concurrent COVID-19 infection: a case report

Background: Necrotising fasciitis (NF) is a rare but severe necrotising infection of the subcutaneous tissues. We report a case of periocular NF associated with a concurrent COVID-19 infection and explore potential mechanisms of pathogenesis of COVID-19 infection and necrotising superinfections. Case Description: A 33-year-old previously healthy female presented with right-sided progressive periocular swelling, erythema, pain and fever, two days after sustaining a laceration to the right superolateral brow from a clenched fist. She had a concurrent COVID-19 infection, detected on nasopharyngeal polymerase chain reaction swab thirteen days prior to presentation and again at presentation. She did not have an oxygen requirement. There was a large bulbous collection of the right upper lid with fluctuance and overlying erythema, and a communicating sinus drained frank pus from the superolateral brow. Pre-operative T2-weighted MRI demonstrated fascial hyperintensity involving the pre-septal tissues and extending to the anterior temporal fossa. She was commenced on intravenous meropenem, clindamycin and vancomycin, and underwent early surgical debridement. Initial debridement demonstrated right upper lid necrosis involving the dermal and pre-septal layers, including the orbicularis, but sparing the tarsus. Streptococcus pyogenes was isolated, and she was continued on a prolonged course of intravenous antibiotic. Periocular defects were repaired with a right-sided brow adipo-fascial flap based on the supratrochlear artery, browpexy and dual full thickness skin grafts on the right upper lid and flap. Conclusions: NF is an acute fulminant infection rarely affecting the periocular tissues. This represents a unique case of periocular NF associated with a concurrent COVID-19 infection. © Annals of Eye Science. All rights reserved.

Asymptomatic post-traumatic bilateral ophthalmic vein and cavernous sinus thrombosis

Purpose: To highlight the considerations in clinical diagnosis and management of ophthalmic vein thrombosis through a challenging case of asymptomatic posttraumatic bilateral superior ophthalmic and cavernous sinus thrombosis. Method(s): A review of electronic medical records. Result(s): A 54-year-old female with no significant past medical history presented to a tertiary trauma and referral hospital two hours after falling from a ladder and sustaining significant head and torso polytrauma. She had a second dose of BNT162b2 COVID-19 mRNA vaccination two weeks earlier. Contrast computed tomography imaging confirmed the presence of bilateral superior and inferior ophthalmic vein thrombi, and suspected cavernous sinus thrombi without carotid-cavernous fistula. The patient's presentation occurred in the absence of any neurological or ophthalmic signs or symptoms, and her visual acuity remained normal throughout follow-up. A serological inflammatory, infectious, and thrombotic screen was negative. Repeat computed tomography imaging demonstrated successful resolution of all thrombi following treatment with systemic anticoagulation. Conclusion(s): This unusual case of bilateral ophthalmic vein thrombi highlights a challenging diagnosis that should not be overlooked despite a normal neurological and ophthalmic examination. Although the cause of SOVT was likely post-traumatic, contribution from recent nVoC-19 vaccination was investigated.

Covid-19 and the Information Crisis of Liberal Democracies: Insights From Action Against Disinformation in Italy and the Eu

Action against disinformation has become more important than ever in the context of the Covid-19 pandemic. This is due to the synchronous global scale of the problem and its potentially deadlier consequences as the public seeks out guidance regarding what they might do to lower the risk of infection. This article investigates the impact of the Covid-19 crisis on the regulation of social media platforms as it is mediated by the legacy of previous responses to disinformation. It shows that the Covid-19 crisis has catalyzed the shift to co-regulatory approaches that imposed reporting obligations on platforms at the European level. It also raises concerns about the implementation of the new European regulatory package that will largely depend on the initiatives of individual Member States such as Italy, where the low level of societal resilience to disinformation increases the incentives for political leaders to ignore the problem of disinformation.

Affective Governance During the COVID-19 Crisis: Building Leadership, Trust, and Good Citizens

Concepts such as emotional governance, affective citizenship and transformational leadership point at the way governments are addressing the COVID-19 crisis from an emotional perspective. The study takes the Italian and Spanish leaders as case studies, analysing TV speeches, press conferences and parliamentary addresses, on the one hand, and Facebook posts, on the other hand. The results show that the two cases adopt different emotional repertoires, depending on the historical and cultural leanings but also on the style of leadership they embrace. This style reverberates in the relationship they seek to build with citizens to stimulate compliance with their decisions and in the use of Facebook to promote positive mes- sages and counter the spreading of misinformation. The article also shows how affective governance and style of leadership contribute to the normative definition of good and deviant citizens in critical historical junctures. In particular, the diffusion of fake news (and not just their manufacturing) is depicted as anti-patriotic and non-civic. We argue that the crisis has catalysed processes and trends that were already at play, while at the same time defining a new trait of leadership in the ability to promote cross-generational solidarity and sense of belonging beyond national boundaries.