Asymmetric Cerebral Perfusion in Comatose Extracorporeal Membrane Oxygenation Patients

Asymmetric cerebral perfusion can occur when extracorporeal membrane oxygenation (ECMO) flow competes with native cardiac circulation. It is unclear whether this phenomenon associates with brain injury. Diffuse correlation spectroscopy (DCS) provides continuous, laser-based, non-invasive, bedside monitoring of relative cerebral blood flow (rCBF). This study measured rCBF in ECMO patients via DCS to determine whether comatose patients experience asymmetric cerebral perfusion. Adults receiving ECMO for any indication were prospectively recruited from 12/2019-3/2021. Patients with prior neurologic injury, scalp/facial lacerations, and SARS-CoV-2 infection were excluded. DCS monitoring was performed daily during ECMO support with sensors placed on bilateral foreheads. Mean arterial pressure (MAP) was continuously recorded from the bedside monitor. The Glasgow Coma Scale (GCS) was assessed by clinical staff multiple times daily with sedation pauses, if possible, per standard of care. rCBF was calculated by comparing continuous cerebral blood flow (CBF) measurements to the daily median CBF, then averaged at each MAP value. Daily rCBF asymmetry was calculated by summing the absolute difference of rCBF between the two hemispheres at each MAP value, normalized for the total MAP range experienced by the patient that day. Twelve subjects were enrolled in this study (ages 21-78, 6 with cardiac arrest, 4 with acute heart failure, 2 with ARDS) and grouped by maximum GCS motor (GCS-M) score during ECMO, with 3 "comatose" subjects (GCS-M <= 4), and 9 "awake" subjects (GCS-M > 4). DCS was performed over 66 sessions with a mean duration of 131.83 +/- 1.13 minutes. Comatose subjects exhibited more rCBF asymmetry than awake subjects (0.28 +/- 0.06 mmHg-1 vs. 0.10 +/- 0.001 mmHg-1, p=0.045). No difference in asymmetry was noted between patients with or without cardiac arrest. We found that comatose ECMO subjects exhibited higher inter-hemispheric rCBF asymmetry over a range of blood pressures than awake subjects. Though our comatose sample is small, further validation of this finding and its causes, such as cerebrovascular dysregulation, is warranted.

Skin lesions in health personnel secondary to the use of personal protective equipment against Covid-19.

Objective: To measure the prevalence of skin lesions in health personnel related to the use of personal protective equipment (PPE) during the SARS-CoV-2 pandemic. Method(s): A cross-sectional, descriptive and quantitative study was carried out;A questionnaire was applied to medical and nursing staff who treated patients with COVID-19, the most frequent adverse reactions caused by: masks, gloves, glasses, protective clothing and alcohol gel were quantified. Result(s): 90 people participated, of which 81 (90%) presented skin lesions associated with PPE. The accessory that caused the most injuries was the mask (87.7%), followed by glasses (85.5%) and alcohol gel (82.2%). The most frequent reaction to masks was nasal bridge ulcer (68.9%);in glasses it was pressure injury to the forehead (76.7%);and due to the use of alcohol gel it was dryness (75.5%). Conclusion(s): Prolonged use (>5 hours) of PPE can cause adverse skin effects in healthcare personnel. The mask was the accessory that generated the most skin lesions, with pressure ulcers on the nasal bridge being the most frequent.Copyright © 2022, Fundacion Index. All rights reserved.

Dental Implants And Orthodontics In Patients With Ectodermal Dysplasia: A Systemic Review

Ectodermal dysplasia is a hereditary disease that is associated with the involvement of organs with embryonic ectodermal structure such as teeth, nails, hair and sweat glands, lacrimal and salivary glands. The prevalence rate of this disease is 1 in every 100,000 people. The most common and severe form of ectodermal dysplasia is the X-linked hypo hidrotic type. The second common type of hidrotic ectodermal dysplasia is autosomal dominant, unlike the first type, sweat glands are not involved. Small and fragile nails, hyperkeratosis of the palms and feet, dry mouth, decreased tear production are some of the clinical symptoms of ectodermal dysplasia, which are the result of intolerance to heat. The facial features of the patient include a prominent forehead, sunken nose bridge, protruding ears, prominent lips, hypoplasia of the middle part of the face, and skin pigment around the eyes and mouth. Dental involvement is one of the most prominent features of ectodermal dysplasia, which can be seen in both primary and permanent tooth systems. Reduction in the number of teeth, delay in tooth growth, abnormal shape of anterior teeth in peg-shaped or conical form, smaller size of posterior teeth and enamel defects are observed. Alveolar ridge hypoplasia is also common due to the lack of teeth, followed by a decrease in the vertical height of the occlusion. A child with ectodermal dysplasia faces many problems in feeding, chewing, and speaking. Early treatment with dental prostheses can significantly reduce these problems.Copyright © 2023 Authors. All rights reserved.

Multisystem inflammatory syndrome associated with COVID-19 in children: Risk factors of severe life-threatening course of the disease

Background/Purpose: Multisystem inflammatory syndrome in children (MIS-C), associated with COVID-19 infection is a life-threatening condition, required intensive care. The aim of this study was to determine risk factors for severe/life-threatening course of MIS-C. Method(s): The retrospective study included 166 children (99 male, 67 female), aged from 4 months to 17 years (median 8.2 years), who met the WHO criteria for MIS-C. The criterion of severity was the fact of the ICU admission. The analysis of the obtained data was performed using the STATISTICA software package, version 10.0 (StatSoft Inc., USA). Result(s): To assess the factors associated with the severe course of MIS-C, patients were divided into two groups: those who were hospitalized in the ICU (n = 84;50.6%), and those who did not (n = 82;49.4%). Patients with a more severe course of MIS-C were significantly older. They had a high frequency of signs such as rash, edema, hepatomegaly, splenomegaly, neurological and respiratory symptoms. Hypotension/shock and myocardial damage were much more common in patients hospitalized in the ICU. Among the laboratory changes there were significant differences in the levels of hemoglobin, leukocytes and platelets, CRP, creatinine, troponin and D-dimer. The presence of macrophage activation syndrome was higher in patients, admitted in the ICU. Children, required intensive care required high dose corticosteroids and IVIG more often (table 1). FIGURE: 1) The first symptoms of progeria in infancy: scleroderma-like changes in the skin of the lower extremities and stiffness of knee joints at the age of 2 months. 2) Girl at the age of 3 years 5 months. Almost total alopecia with the absence of eyebrows and eyelashes. Pronounced venous pattern in the forehead, nasal bridge and nasolabial triangle. Conclusion(s): MIS-C is potentially a severe life-threatening condition, in which more than half (50.6%) of patients needed the ICU admission. The main factors determining the severity of MIS-C were: cardiovascular, resiratory and central nervous system disorders. It has been found that factors such as hepatomegaly, splenomegaly, D-dimer >2568 ng/ml, troponin >10 pg/ml, make it possible to identify a group of patients with high risk of severe MIS-C who may potentially need hospitalization in the ICU.

Evaluation of a Negative Pressure Aerosol Protection Box to Prevent Airborne Transmission of Sars-Cov-2 to Healthcare Providers in Pediatric Intensive Care

BACKGROUND AND AIM: High contagiousness of SARS-COV-2 is caused by bioaerosols' emission. Clinical situations involving tissue manipulation with high viral load called "aerosol-generating procedures" (AGP) may increase this risk of healthcare providers (HCPs) developing infectious diseases. Our aim was to investigate the impact of an aerosol protection box, the Splash-Guard Caregivers (SGGC), on the presence of viral particles after an AGP. METHOD(S): Prospective observational study conducted between April and June 2020, including the HCPs in charge of children admitted to a Pediatric Intensive Care Unit who tested positive for COVID-19. SGCG (https://rsr-qc.ca/ Splashguard-cg/) was not used systematically and room patients analyzed were divided in: SGCG+ and SGCP-. Virus detection was performed: on the air one meter from the patient's head, also on the air near each HCPs (wearable pumps) and at each HCPs forehead (swab) after an AGP. Samples were analyzed for SARS-COV-2 RNA by qPCR. RESULT(S): Eight batches of samples were performed in the single room of SARS-COV-2+ child: SGCG+ (n=3) and SGCG- (n=5), with five qPCR positive (10.2%) for SARSCOV- 2. Three (11.5%) among 26 analyses from the group SGCG-: in the air before the AGP (n=1), in the air near HCP's head (n=1), and in the HCP forehead swab (n=1). And, two (8.7%) in 23 analysis of SGCG+ group: in the HCP forehead swab (n=1) and in the air near HCP's head (n=1). None of the HCPs were infected by SARS-COV2. CONCLUSION(S): Our results document the presence of SARS-COV2 in infected children environment. The protection effect of SGCG needs additional research.

A novel infrared forehead thermometer with ambient temperature compensation for body temperature measurement in low-temperature environment

Body temperature screening and measurement using infrared forehead thermometer (IFT), a non-contact thermometer, is an important method to prevent the spread of COVID-19 at present. However, low accuracy and unreliability of current IFT due to ambient temperature effect prevent it application in most of low-temperature environment. The aim of this study was to measure the body temperature accurately using IFT in low-temperature environment. A novel IFT with broad working temperature range and ambient temperature compensation was designed and fabricated, and the performance was evaluated. Also an ambient temperature compensation method based on Bluetooth module was introduced to improve the accuracy of body temperature measurement for the first time. The experiment results demonstrated that the laboratory indication error and repeatability in test mode of this developed IFT were all below 0.2℃ in ambient temperature range of (3~35) ℃. While the extended uncertainty for laboratory indication error was less than 0.1℃ (k=2). Compared with the contact electronic clinical thermometer, the difference of body temperature was improved within the scope of (-0.3~+0.3)℃ in low-temperature measurement environment. All the results showed that the IFT fabricated in this paper is sufficient and competent for body temperature screening and clinical body temperature measurement in most of low-temperature environment. © 2022 SPIE.

Comparison of Wrist and Forehead Temperature Measurements as Screening Methods during the Covid-19 Pandemic

Background: Temperature screening checkpoints have become prevalent in all public places during the COVID-19 pandemic. Contactless screening methods have been adopted for the early detection and isolation of febrile patients. The tympanic method closely resembles the body core temperature, however, they are not in use due to the disposal charges. This study aims to compare the efficacy of wrist and forehead temperature methods with the standard tympanic temperature. In light of the fact that a large population require rapid screening and that forehead temperature measurement being influenced by the environment, we investigated the accuracy and benefits of wrist temperature measurement in various environments. Material(s) and Method(s): This study was conducted in a tertiary care hospital in Perundurai, Tamilnadu. All the visitors who presented to the OPD between 6th April-13th May 2020 were included in the study. The exclusion criteria were those with ear discharge and tympanic membrane perforation. All the participants were made to wait for 10 minutes in the waiting hall to ensure temperature-controlled settings. We consecutively collected wrist, forehead, and tympanic temperature readings of all participants using infrared thermometers. Fever was defined as a temperature above 37.5degreeC. The data was analyzed using the Bland-Altmann plot in MS Excel 2016. Result(s): A total of 514 participants were enrolled in the study. The mean difference ranged from 2.10 to -2.00 for the forehead measurements and 2.00 to -2.00 for wrist measurements. The agreements for each method with tympanic temperature were calculated. (Forehead temperature: 1.23 to -1.17;Wrist temperature: 1.23 to -1.13). Conclusion(s): The study concluded that the wrist temperature was more stable than the forehead temperature. However, these methods did not provide any diagnostic cut-off value. Furthermore, the asymptomatic nature of some COVID-19 cases reduced the sensitivity of these tests. Further studies are advised to explore the validity of wrist temperature. Copyright © 2022 International Journal of Academic Medicine and Pharmacy. All rights reserved.

An Interesting Case of Bell’s Palsy in Pregnancy Associated with COVID-19 Infection

Recent studies have reported that Coronavirus Disease 2019 (COVID-19) can be the cause of peripheral facial paralysis and neurological symptoms may be the only manifestation of the disease. Hereby, the authors report an interesting case of a pregnant COVID-19 positive female with Bell's palsy, in third trimester of pregnancy. A 33-year-old female, G3P0L0A2, presented with left-side deviation of angle of mouth, excessive lacrimation and redness of right eye for the past three days. She had involuntary drooling on right and left side labial commissural deviation, absence of forehead frowning, inability to close her right eye (positive Bell’s phenomena), and ipsilateral lagophthalmos. No lesions were seen on the external ear and otoscopy was normal. She was confirmed to have right-sided facial nerve palsy. She had an uneventful course of pregnancy till term and underwent caesarean section at 40 weeks, in view of foetal distress. Pregnancy and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, both are immunocompromised state, and hence could be a risk factor for Bell’s palsy. But larger studies with more cases are required to prove the causal association.

Examination The Incidence of Dental, Neurological, Cardiovascular and Radiological Problems in Patients Affected by Covid-19 And Methosd of Drug Therapy in Patients

This study has done a systematic review of drug therapy and assessment of the occurrence of dental and neurological problems in patients affected by covid-19. There are various reasons that can cause an infection in the tooth. One of the most common causes of tooth infection is root canal treatments you have had in the past. Unfortunately, bacteria grow in this area and can lead to infection. Having an infection in the tooth can be very dangerous. Because it may spread to other parts of the body and cause serious problems. For this reason, it is very important to recognize the symptoms of infection. When a crack or cavity is formed on the tooth, if not treated in time, an infection may occur in the tooth. Because these are the gates that can pave the way for bacteria to enter your teeth. The most common type of disease is accompanied by episodes of severe pain that may be felt in the eyes, ears, lips, nose, forehead, cheeks, teeth or jaws, or anywhere on the face. The similarity of the symptoms of this complication with the symptoms of common dental diseases is a factor in misdiagnosis. This can lead to a series of unnecessary dental treatments that not only won't solve the problem, but may actually make it worse. Some patients undergo dental treatment at least once before the diagnosis of the disease. 1.

Efficient Cloaked Face Recognition Methodology throughout The Covid-19 Pandemic

The COVID-19 is a partner in Nursing unequaled disaster resulting in a huge range of casualties and protection issues. to cut back the unfold of coronavirus, individuals typically wear masks to guard themselves. This makes face popularity a truly tough project because bound components of the face rectangular measure hidden. A primary awareness of researchers for the duration of the continuing coronavirus pandemic is to come back up with hints to handle this downside thru fast and reasonably-priced solutions. during this paper, we tend to endorse a dependable technique supported by discard cloaked region and deep learning-based options to deal with the matter of the cloaked face recognition technique. the number one step is to discard the cloaked face vicinity. next, we tend to apply pre-trained deep Convolutional neural networks (CNN) to extract the only options from the received areas (in general eyes and forehead regions). in the end, the Bag-of-features paradigm is carried out on the function maps of the last convolutional layer to quantize them and to induce small illustration scrutiny to the simply related layer of classical CNN. in the end, Multilayer Perceptron (MLP) is implemented for the class approach. Experimental effects on real-global-Masked-Face-Dataset display high popularity overall performance.

Optimizing two-stage surgery by expanding single-stage nasal reconstruction in the COVID-19 era.

The COVID-19 pandemic led to a decrease in the number of operating rooms available. Single-stage islanded forehead flaps have emerged as a good alternative to the classic frontal flap helping to diminish the surgical waiting list. We present our case series of 6 patients reconstructed with islanded forehead flaps between February and July 2020.The purpose of this report is to assess the advantages and disadvantages of this technique in order to inform which subgroup of patients may benefit from the one-stage flap, now the pandemic is better controlled.

Toward an Accurate IR Remote Sensing of Body Temperature Radiometer Based on a Novel IR Sensing System Dubbed Digital TMOS.

A novel uncooled thermal sensor based on a suspended transistor, fabricated in standard CMOS-SOI process, and released by dry etching, dubbed Digital TMOS, has been developed. Using the transistor as the sensing element has advantages in terms of internal gain, low power, low-cost technology, and high temperature sensitivity. A two channel radiometer, based on the new nano-metric CMOS-SOI-NEMS Technology, enables remote temperature sensing as well as emissivity sensing of the forehead and body temperatures of people, with high accuracy and high resolution. Body temperature is an indicator of human physiological activity and health, especially in pediatrics, surgery, and general emergency departments. This was already recognized in past pandemics such as SARS, EBOLA, and Chicken Flu. Nowadays, with the spread of COVID-19, forehead temperature measurements are used widely to screen people for the illness. Measuring the temperature of the forehead using remote sensing is safe and convenient and there are a large number of available commercial instruments, but studies show that the measurements are not accurate. The surface emissivity of an object has the most significant effect on the measured temperature by IR remote sensing. This work describes the achievements towards high-performance, low-cost, low power, mobile radiometry, to rapidly screen for fever to identify victims of the coronavirus (COVID-19). The main two aspects of the innovation of this study are the use of the new thermal sensor for measurements and the extensive modeling of this sensor.

Technologically Advanced Reusable 3D Face Shield for Health Workers Confronting COVID19

The probability of medical staff to get affected from COVID19 is much higher due to their working environment which is more exposed to infectious diseases. So, as a preventive measure the body temperature monitoring of medical staff at regular intervals is highly recommended. Infrared temperature sensing guns have proved its effectiveness and therefore such devices are used to monitor the body temperature. These devices are either used on hands or forehead. As a result, there are many issues in monitoring the temperature of frontline healthcare professionals. Firstly, these healthcare professionals keep wearing PPE (Personal Protective Equipment) kits during working hours and as a result it would be very difficult to monitor their body temperature. Secondly, these healthcare professionals also wear face shields and in such cases monitoring temperature by exposing forehead needs removal of face shield. Doing so after regular intervals is surely uncomfortable for healthcare professionals. To avoid such issues, this paper is disclosing a technologically advanced face shield equipped with sensors capable of monitoring body temperature instantly without the hassle of removing the face shield. This face shield is integrated with a built-in infrared temperature sensor. A total of 10 such face shields were printed and assembled within the university lab and then handed over to a group of ten members including faculty and students of nursing and health science department. This sequence was repeated four times and as a result 40 healthcare workers participated in the study. Thereafter, feedback analysis was conducted on questionnaire data and found a significant overall mean score of 4.59 out of 5 which indicates that the product is effective and worthy in every facet. Stress analysis is also performed in the simulated environment and found that the device can easily withstand the typically applied forces. The limitations of this product are difficulty in cleaning the product and comparatively high cost due to the deployment of electronic equipment.

eP455: Fetal ultrasound presentation and neonatal diagnosis of Freeman-Sheldon syndrome in son of previously undiagnosed adult male

Background: Freeman-Sheldon syndrome [distal arthrogryposis type 2A (OMIM #193700), DA2A, Freeman-Burian syndrome] is a rare autosomal dominant multiple pterygium syndrome caused by alterations in MYH3. The phenotypic features, particularly of the face, are distinct and easily recognizable, and the diagnosis can be confirmed with molecular gene analysis. Fetal ultrasound imaging may provide important diagnostic clues to facilitate the diagnostic process. Informed consent and parental permission were provided by the parents. Case presentation: The infant’s mother presented for a Maternal Fetal Medicine genetic counseling telehealth appointment (due to COVID-19 pandemic restrictions) as a G7P2132, 32-year old female who had insulin-dependent diabetes and thrombocytosis. Her partner was a 24-year old male with a history of hearing loss, a V-shaped palate, and a lower lip cleft. Gestational age was 14 4/7 weeks and the indications were: increased nuchal translucency, paternal complex medical history, maternal G6PD heterozygote, and recurrent pregnancy loss. During the genetic counseling session, the following were addressed: 1) Maternal heterozygote status for G6PD indicated that if the fetus was male, there was a 50% chance he would be affected with G6PD-deficiency;2) Increased nuchal translucency on fetal ultrasound (US) with measurement at 98th percentile is associated with an increased risk of chromosomal abnormalities, microdeletion/duplications, and Noonan syndrome. The patient reportedly had low risk cell-free DNA but results were not available to the counselor at the time of consult. The option for additional genetic screening and diagnostic testing was declined;3) Three first trimester pregnancy losses with the father of this baby (FOB) were addressed, and parents deferred chromosome analyses at the time;4) Mother shared FOB’s complex history of bilateral sensorineural hearing loss, V-shaped cleft palate, lower lip cleft, and micrognathia. However, father was not present during the telehealth encounter. Mother was counseled regarding the possibility of an autosomal dominant condition with the potential risk to the pregnancy of up to 50%. It was recommended that the FOB have a clinical genetics evaluation, which could potentially provide a specific diagnosis and inform recurrence risk and management guidance. Follow-up MFM genetic counseling telephone visit occurred with the mother at 31 6/7 weeks gestation due to multiple congenital anomalies evident on fetal ultrasound. A 25 week fetal ultrasound revealed hypotelorism and a thickened nuchal translucency. A repeat study at 29 weeks revealed a V-shaped palate with a possible cleft, micrognathia, and midline mandibular cleft. FOB’s history was revisited. It was determined that he had 3 previous “no shows” to Genetics clinic appointments and did not pursue evaluation after the last counseling appointment. Again, it was emphasized that in order to best make a diagnosis for the family, an affected person would need to undergo a thorough evaluation, including medical and family history review, physical examination, and any indicated genetic testing. The parents were comfortable with the likelihood that the baby had the same condition as the father, but variable expressivity and broad range pf phenotypic presentation were explained. Recommendations for postnatal evaluation of the infant and pertinent genetic testing were provided. Consultative Genetics evaluation of the infant at 2 days of age revealed a short, broad forehead with supraorbital fullness leading to a horizontal brow indentation;mask-like facial appearance;hypotelorism;very deep set eyes with blepharophimosis;deep, creased nasal bridge;small, upturned nose with hypoplastic alae and narrow nares;microstomia with pursed lips;glossoptosis;micrognathia;2 deep vertical chin creases;short neck with excess nuchal skin;inverted and wide spaced nipples;clenched hands with 5th digits overlying 4th and 2nd overlying 3rd, bilaterally;bilateral vertical talus;2nd toes longer and overlying rd toes;clinodactyly of 4th and 5th toes bilaterally;and deep gluteal crease with no visible sinus. There were no evident contractures. The father has a complex history with no medical assessments prior to age 18. He reported that he did “not look like anyone else” in his family. He has a diagnosis of autistic spectrum disorder, a submucous cleft, vision issues, hearing loss necessitating a hearing aid on the left, and a history of cholesteatomas and of mastoidectomy. On brief examination, he had a mask-like face, blepharophimosis, left microphthalmia, left esotropia, narrowing of his midface, deep vertical crease on the mandibular region, microstomia, broad great toes, single flexor creases on the thumbs, and contracture of right thumb. Maxillofacial CT of the infant revealed hypoplastic mandibular body, ramus, and condyles bilaterally with micrognathia and retrognathia;hypoplastic maxilla bilaterally;and enophthalmos with retracted appearance of globes in the bony orbits bilaterally. Multiple facial bone abnormalities were seen, including microsomia, micrognathia, retrognathia, orbital hypotelorism and enophthalmos Genetic testing was performed via a custom Whole Exome Slice at GeneDx laboratories and included the MYH3 and TNNI2 genes. Results revealed a heterozygous pathogenic change in MYH3 (c.2015 G>A;p. R6724) consistent with the diagnosis of Freeman-Sheldon syndrome. Conclusion: The presentation of “midline mandibular cleft” on fetal ultrasound was the most specific prenatal finding. This is a very rare fetal finding. Thus, it should prompt further evaluation to assess for true clefting versus ridging or creasing. Additionally, targeted assessment for other findings or clinical clues for Freeman-Sheldon syndrome, such as contractures, “windmill vane” hand, and mouth size, could aid in the differential diagnosis considerations and the diagnostic process. Admittedly, these are position and quality dependent, and are challenging to assess even in ideal situations. The phenotype of the father was immediately recognizable. However, due to COVID-19 pandemic restrictions, prior to the infant’s birth, only telehealth visits were conducted and the father’s participation was by telephone. This limited the ability to narrow the differential diagnosis without visualization of his distinct phenotypic features. Finally, missed opportunities to diagnose the father prior to this pregnancy occurred. Many clinics send “no show” letters to referring providers and patients, as we do. Emphasizing the importance of diagnosis prior to pregnancy for individuals concerned about having a genetic disorder should be considered as part of the information shared in these letters.

Smart Teaching Using Human Facial Emotion Recognition (Fer) Model

Emotion recognition has attracted most of numerous technical/ non-technical fields due to its variety of applications such as entertainment, surveillance, psychology, marketing and few tech domains are some of examples. Emotion recognition is done based on some changes in human face, which we call them as regions of interest such as eyes, eyebrows, forehead, cheeks, mouth etc. On the other side, Online mode of education has also been blooming from nowhere especially after the Covid-19 pandemic, all institution including universities and training centers have been adapted to online mode of education, but on a contrary we have to agree to the fact that this mode of education is not as effective as traditional mode of education such as face-to-face [Classroom] teaching. So in this paper we try to provide a software solution to improve the online mode of education. We use Facial Emotion Recognition (FER) model to deploy into one of testing web application which streams live video from the students camera and can able to detect the emotions of students/attendees. We use FER2013 datasets to train our model and have used the google colab platform for testing of the model. we have obtained the good accuracy compared to our previous works. Presently we have developed our application for single device and h a v e b e e n using only LAN protocol, in future this mode of technology can be implemented at multiple device level using WAN protocol . With the help of already available app named "IP webcam" and a web application developed by us using FLASK we were successfully able to recognize the emotion of students in the application.

Transverse myelitis in a pediatric patient with COVID-19

Case Report Transverse myelitis is the segmental inflammation of the spinal cord with motor and sensory abnormalities at and below the level of the lesion. Often, the etiology is unknown but may be attributed to autoimmune conditions or viruses. Here we describe a rare case of transverse myelitis secondary to severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]/coronavirus disease (COVID-19). Case A 5-year-old male with a history of asthma presented for vomiting and altered mental status. The patient was noted to be altered, lethargic, and in respiratory distress. Intubation was performed. After family collateral was obtained, it was revealed that patient possibly ingested Sertraline and/or Risperidone at an unknown time prior to arrival. History also revealed that he had slurred speech, ataxia, and a fall with trauma to forehead 1 day prior to arrival. He tested positive for COVID-19 via PCR and chest x-ray revealed RLL consolidation. Dexamethasone was started. When sedation was weaned in hopes of extubation, patient was noted to be alert, but not moving extremities and had minimal gag and cough reflex. MRI of Brain and Spine were conducted and revealed findings suggestive of long segment transverse myelitis involving C2 to C3. LP was performed with unremarkable CSF studies and IV Solumedrol was started. In light of active COVID-19 infection, and worsening respiratory status, patient started on 5 days Remdesivir. Further, patient underwent ten sessions of plasmapheresis. Repeat MRI was consistent with previous. Physical and occupational therapy initiated at the onset of illness in hopes of achieving musculoskeletal improvement. Patient had some minimal musculoskeletal improvement, however, given his condition, decision was made for patient to undergo placement of gastrostomy and tracheostomy tubes. Patient was weaned off of sedatives and withdrawal was treated with a clonidine taper. Once stabilized, patient was transferred to neurological inpatient rehabilitation center. Discussion Neurological manifestations in children affected by SARS-CoV-2 are relatively common but are often non-specific. Worldwide data reports only 1% of children with COVID-19 present with severe symptoms of encephalopathy, seizures, and meningeal signs. Pathophysiology is multifactorial, including direct invasion of the CNS, vascular insufficiency, immune dysregulation and autoimmunity. Imaging is paramount in the diagnosis of transverse myelitis. Treatments are emerging and may include steroids, immunoglobulin, plasmapheresis, and monoclonal antibodies. Conclusion Much is unknown about COVID-19. Information is emerging and evolving daily. Cases of transverse myelitis in COVID-19 have been reported in few adult patients and minimal pediatric patients. Practitioners should keep transverse myelitis on their list of differentials for neurological complications of SARS-CoV-2 infections and initiate aggressive treatment with a multidisciplinary approach.

Discrepancy between finger probe SPO2 readings when placed on finger vs forehead

Case Report A 25 year old woman, G3P2 at 23w6d presented to the Emergency Department for one week of progressive cough and shortness of breath. Patient was febrile, tachypnic, with oxygen desaturation to 88% with minimal exertion. Chest radiograph showed bilateral airspace disease consistent with viral pneumonia. The Patient was diagnosed with covid- 19 and admitted for acute hypoxic respiratory failure secondary and started on dexamethasone and remdesivir. The patient subsequently had escalating oxygen requirements and was stepped up to the ICU on BIPAP on hospital day two. Her oxygen requirements gradually improved, and she was stepped down to the floor on day 8 of admission on highflow nasal cannula. The following day, the patient was noted to have oxygen saturation of 97% on room air with a disposable finger probe applied to the forehead. Placement of the finger probe on the forehead is an uncommon practice reserved for use when unable to obtain adequate wave-form on the finger. A separate evaluation that day using a disposable finger probe on the finger revealed markedly different oxygen saturation in the low 90's. Confirmatory ABG showed pH 7.46, pCO2 31, O2 48, and HCO3 22. After determining hypoxemia, we placed disposable finger probes on both the finger and forehead at the same time using two separate machines. The probe on the forehead showed an spO2 consistently 10% higher than the reading on the finger. The probe connectors were switched and continued to show a 10% higher reading on the probe attached to the forehead. Discussion Given the hypoxemia confirmed on ABG, we concluded that the disposable finger probe used on the forehead provided a falsely elevated spO2 reading. One small study comparing disposable finger probes on the finger vs the forehead showed a discrepancy of >5% in over half of the patients. Critical management decisions are made based on the spO2, and inaccurate readings pose significant risk to the patient. Use of disposable finger probes on the forehead should be avoided.

Electrical stimulation of the trigeminal nerve as a novel intervention to improve smell function

COVID-19 presented a renewed awareness of the importance of smell, including the striking impact of smell loss on daily functioning, as well as the lack of available evidencebased interventions to improve smell. While medical and surgical treatments exist for inflammatory-related smell loss, interventions to treat loss due to other etiologies are limited. Given the role of the intranasal trigeminal system in smell function, we conducted a proof-of-concept study to determine the effects of electrical stimulation of the trigeminal nerve (TNS) on sensitivity to phenyl ethyl alcohol (PEA) and guaiacol (GUA), 2 odorants with low and high trigeminal properties, respectively. TNS is an emerging form of “bottom-up” brain stimulation in which low-level electrical current is delivered to superficial trigeminal nerve branches innervating the face and forehead. Twenty healthy adults (8M/12F, 27±8.1 years old) were recruited from MUSC and the surrounding community to participate in this double-blind, placebo-controlled, pilot. PEA and GUA thresholds were determined at baseline, immediately postintervention, and again 30-min post-intervention. In a randomized cross-over design, participants received active and sham TNS on separate visits. Results indicated a significant stimulation x odor x time interaction (F[2,76]=3.56, p=.024, η 2=.093). Detection of GUA, but not PEA, was significantly enhanced by active, but not sham, TNS (16% and 9% increase from baseline at the 1st and 2nd follow-up time points respectively). TNS is safe, noninvasive, inexpensive, and easy to administer, rendering it highly scalable. Future study should determine the full effects and durability of TNS on smell function across different stimulation parameters, odorants, and patient populations.

Recognition of Human Face Regions under Adverse Conditions—Face Masks and Glasses—In Thermographic Sanitary Barriers through Learning Transfer from an Object Detector

The COVID-19 pandemic has detrimentally affected people’s lives and the economies of many countries, causing disruption in the health, education, transport, and other sectors. Several countries have implemented sanitary barriers at airports, bus and train stations, company gates, and other shared spaces to detect patients with viral symptoms in an effort to contain the spread of the disease. As fever is one of the most recurrent disease symptoms, the demand for devices that measure skin (body surface) temperature has increased. The thermal imaging camera, also known as a thermal imager, is one such device used to measure temperature. It employs a technology known as infrared thermography and is a noninvasive, fast, and objective tool. This study employed machine learning transfer using You Only Look Once (YOLO) to detect the hottest temperatures in the regions of interest (ROIs) of the human face in thermographic images, allowing the identification of a febrile state in humans. The algorithms detect areas of interest in the thermographic images, such as the eyes, forehead, and ears, before analyzing the temperatures in these regions. The developed software achieved excellent performance in detecting the established areas of interest, adequately indicating the maximum temperature within each region of interest, and correctly choosing the maximum temperature among them.