Palmoplantar inflammation with a broad differential diagnosis made clear upon patch testing

A 51-year-old woman presented to our service with a 2-year history of severely painful, thickened skin of her bilateral hands and feet. She advised of considerable skin pain on mobilizing. She intermittently applied acrylate nails. This was on a background of chronic urticaria, asthma and allergic rhinitis. She described a positive family history of psoriasis. On examination, there was marked hyperkeratosis with welldemarcated erythema on the central palms and entire fingers with deep fissuring and scale. Similar finding were noted on the soles of the feet particularly affecting the heels, arch and also the tips of the toes. The morphology of the lesions favoured psoriasis, but the differential diagnosis included chronic hand dermatitis. She was referred for topical psoralen + ultraviolet A (PUVA) and patch testing to standard battery and acrylates. Treatment with topical PUVA was discontinued and patch testing lists were cancelled as a result of the emergence of COVID-19 in Ireland. Topical therapy of clobetasol propionate was initiated. On follow-up review, the appearances of her feet and hands had deteriorated significantly. She was commenced on acitretin 10 mg once daily, which was escalated to 20 mg 2 months later. Clinical improvement was noted, but appearances deteriorated once again following the application of acrylic nails. Further history revealed the patient had assisted with the application of acrylic nails to clients years prior to her initial review. Patch testing took place 18 months after initial review due to outpatient list cancellations secondary to the COVID-19 pandemic. Upon review 48 h after the application of the (METH) Acrylate Series, the patient was found to have a +2 reaction to 2- hydroxyethyl methacrylate and a further +2 reaction to 2- Hydroxypropyl methacrylate. At her 96-h review, both reaction sites were marked at +1. Following complete avoidance of acrylates, the palmoplantar inflammation entirely resolved. This case highlights the importance of a detailed clinical history where contact dermatitis is considered. In our patient's case, the clinical history and examination of the palmoplantar eruption combined with the first-degree family history of psoriasis were highly suggestive of a diagnosis of psoriasis. The episodic severe flares and its refractory nature to treatment raised suspicion for allergic contact dermatitis. Dermatologists should remain alert for potential contact allergens in cases of severe palmoplantar psoriasis. A further area for consideration is the deleterious effect the COVID-19 pandemic had on the successful diagnosis and treatment of dermatological patients through the cancellation of outpatient services.

Dual-mode visual detection strategies of viable pathogens for point-of-care testing

Here, we introduce a power-free foldable poly(methyl methacrylate) (PMMA) microdevice fully integrating DNA extraction, amplification, and visual detection, realized in novel dual modes – colorimetric and aggregate formation – using 4-Aminoantipyrine (4-AP) for monitoring pathogens. The microdevice contains two parts: reaction and detection zones. A sealing film was utilized to connect the two zones and make the device foldable. The FTA card was deposited in the reaction zone for DNA extraction, followed by loop-mediated isothermal amplification (LAMP) at 65 °C for 45 min. When the detection zone is folded toward the reaction zone, paper discs modified with 4-AP placed in the detection zone are delivered to the reaction zone. Specifically, in the presence of LAMP amplicons, 4-AP is oxidized into antipyrine red or generates aggregates by interacting with copper sulfate, forming copper hybrid nanostructure (Cu-hNs). In the absence of LAMP amplicons, 4-AP is not oxidized and maintains yellow color or fails to form aggregates. Furthermore, we introduced the ethidium homodimer-1 (EthD-1) to identify viable bacteria. EthD-1 penetrated the compromised membranes of nonviable cells and prevented further DNA amplification by intercalating with the DNA. In this way, only samples containing viable cells displayed color change or formed aggregates upon reaction with 4-AP. Using this method, SARS-CoV-2 RNA and Enterococcus faecium were identified by naked eye, with the limit of detection of 103 copies/μL and 102 CFU/mL, respectively, within 60 min. The introduced microdevice can be used for rapidly monitoring viable pathogens and controlling outbreaks of infectious disease in resource-limited settings. © 2022 Elsevier B.V.

Impact of Quaternary Ammonium Disinfectants on Transfer of viruses from Fomites to the Finger

Background. Hard and soft surfaces (fomites) can play a role in the transmission of both enteric and respiratory viruses. Transmission can occur by touching of contaminated surfaces and bringing the hand to the either the mouth or nose or by reaerosolization of the virus from the surface. In adults face touching occurs every 3 to 4 minutes. The amount of virus transfer which occurs depends on the nature of the surface, the virus and the degree and type of activity within a facility. Methods. We conducted studies on the finger transfers of both a non-enveloped (MS-2 coliphages) and an enveloped virus (coronavirus 229E). Results. The greatest degree of the non-enveloped virus occurred with acrylic plastic and stainless steel, while the greatest transfer of the enveloped virus occurred from porcelain. Transfer to the finger from surfaces of the coronavirus was reduced by treatment of surfaces with various commercially available quaternary ammonium disinfectants after 24 hours of application to the fomites by 37% to 99.9%. Using MS-2 coliphage as a tracer virus placed on a high touch fomite, we found that the use of quaternary ammonium containing disinfecting wipes in a long term care facility reduced the contamination of fomites by 80%. Conclusion. The results indicate that spread of viruses in a facility and exposure via hand contact can be significantly reduced by disinfection of fomites.

Hemofiltration for a Positive Il6 Balance in Severe COVID-19 Pneumonia: A Single Centre Experience

Aim and background: A high interleukin-6 (IL-6) level in COVID- 19 plays a major role in the pathophysiology and is considered a relevant parameter in predicting the most severe course of the disease. In COVID-19 extracorporeal blood, purification is proposed as adjuvant therapy and aims at controlling the dysregulation in the autoimmune system. It essentially reduces high levels of several mediators and by this controls the cytokine storm, rather than actively targeting individual pathways of inflammation. Positive IL-6 balance post polymethyl methacrylate (PMMA) filter used for cytokine storm in COVID-19 patients with dialysis has shown to be an independent predictor of mortality. We present outcomes of severe COVID pneumonia patients with cytokine storm, acute kidney injury, chronic kidney disease, sepsis, and septic shock at our centre over a year. Objective: A retrospective analysis of data to understand the effect of hemofiltration for severe COVID-19 pneumonia. Materials and methods: All patients admitted to our unit, with severe COVID pneumonia with chronic kidney disease, sepsis, septic shock, and cytokine storm were included from August to December 2020. Demographic variable, clinical, and laboratory data were compared pre and post filtration with PMMA filters. Dialysis vintage, duration of mechanical ventilation, length of stay, and hospital were analysed. Results: We analysed 17 severe COVID patients (P/F ratio < 100) requiring ventilator support in whom hemofiltration was used for cytokine storm with dialysis, sepsis, and septic shock. The average age of these patients was 70.2 ± 18.2 years with no difference in the distribution of age and comorbidities. They all were divided as responders or non-responders groups based on the decrease or no change and increase, respectively, in their pre and post filtration levels of IL-6. Non-responders (N = 11) had 3.6-fold increase in IL-6 levels post hemofiltration with the majority of them on vasopressors;pre (8/11-72.7%) and post (9/11-81.8%) hemofiltration. None of the non-responders survived and we noted 54.5% of this group received hemofiltration post intubation. The non-responders also had a positive IL-6 balance post-hemofiltration which guided us to use this therapy early in the disease. Therefore, subsequent 6 patients were offered hemofiltration early, where we found a decrease in IL-6 levels by 21.4%. Out of the 6 responders, 4 survived and demonstrated a reduction in the IL-6 of 66.7%. None of these survivors required vasopressor support and we were able to avoid or reduce the need for ventilator support in them. Survivors had an average length of stay in ICU of 24 days and were discharged by the 30th day. One of the two non-survivors had succumbed secondary to a cardiac event, while the other was intubated before filtration in view of heart failure. Conclusion: The most prominent finding was the distinct increase in the IL-6 levels in non-survivors which was directed towards the early use of hemofiltration treatment. The present data though limited to a small subgroup of severe COVID patients suggest the need to prevent the positive IL-6 balance. Hemofiltration may be an alternative to be considered early in to prevent the cytokine storm and its ill effects.

Biopolymeric sustainable materials and their emerging applications

Advancements in polymer science and engineering have helped the scientific community to shift its attention towards the use of environmentally benign materials for reducing the environmental impact of conventional synthetic plastics. Biopolymers are environmentally benign, chemically versatile, sustainable, biocompatible, biodegradable, inherently functional, and ecofriendly materials that exhibit tremendous potential for a wide range of applications including food, electronics, agriculture, textile, biomedical, and cosmetics. This review also inspires the researchers toward more consumption of biopolymer-based composite materials as an alternative to synthetic composite materials. Herein, an overview of the latest knowledge of different natural- and synthetic-based biodegradable polymers and their fiber-reinforced composites is presented. The review discusses different degradation mechanisms of biopolymer-based composites as well as their sustainability aspects. This review also elucidates current challenges, future opportunities, and emerging applications of biopolymeric sustainable composites in numerous engineering fields. Finally, this review proposes biopolymeric sustainable materials as a propitious solution to the contemporary environmental crisis. © 2022 Elsevier Ltd.

ANTI-INFLAMMATORY APPROACH IN CHRONIC DIALYSIS PATIENTS WITH SARS-COV-2: ATA OR PMMA DIALYZERS?

BACKGROUND AND AIMS: High flux haemodialysis membranes may modulate the cytokine storm of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but their impact in chronic haemodialysis (CHD) patients is not assessed [1, 2]. The aim of the study was the evaluation of asymmetric cellulose triacetate (ATA) and polymethylmethacrylate (PMMA) dialyzers on inflammatory markers in CHD patients with SARS-CoV-2. METHOD: A prospective, observational study on CHD patients (age ≥18 years) affected by SARS-CoV-2 was carried out. Patients were enrolled from March 2020 to May 2021 and dialysis was performed at S. Orsola University Hospital (Bologna, Italy) Dialysis Unit. Mechanical ventilation at diagnosis was exclusion criteria. Pre-and post-dialysis C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6) were determined at each session and corrected for haemoconcentration during the complete SARS-CoV-2 period. Patients who underwent online haemodiafiltration (OLHDF) with PMMA dialyzer (Filtryzer BG-UTM, Toray, surface area 2.1 m2, cut-off 20 kDa, KUF 43 mL/h/mmHg) were compared with those who underwent OLHDF with ATA dialyzer (SolaceaTM, Nipro, surface area 2.1 m2, cut-off 45 kDa, KUF 72 mL/h/mmHg). The primary endpoint was to assess the differences in the reduction ratio/session (RR) of CRP, PCT and IL-6. RESULTS: A total of 74 patients were enrolled, 48 were treated with ATA and 26 were with PMMA (420 versus 191 dialysis sessions). The main results are shown in Table 1. Median IL-6RR% was higher for ATA [17.08%, interquartile range (IQR) -9.0 to 40.0 versus 2.95%, IQR -34.63 to 27.32]. CRP and PCT showed higher RR with ATA in comparison to PMMA. When IL-6RR > 25% was the dependent variable in the multiple logistic regression analysis only ATA showed a significant correlation [odds ratio (OR) 1.891, 95% confidence interval (95% CI) 1.273-2.840, P = .0018) while higher CRP favoured the risk of lower IL6RR (OR 0.9101, 95% CI 0.868-0.949, P < 0.0001) (Table 2). CONCLUSION: In SARS-CoV-2 CHD patients treated with OLHDF, ATA showed a better anti-inflammatory profile than PMMA, in particular regarding IL-6 RR.

THE COMPARISON OF AEROSOL EXPOSURES TO ENDOSCOPY PERSONNEL PERFORMING UPPER GASTROINTESTINAL ENDOSCOPY IN THE PATIENTS WITH AND WITHOUT HEAD BOX MEASURED FROM DIFFERENT DISTANCES TO THE PATIENT'S MOUTH: A RANDOMIZED CONTROL TRIAL

DDW 2022 Author Disclosures: Jukkaphop Chaikajornwat: NO financial relationship with a commercial interest ;Rapat Pittayanon: NO financial relationship with a commercial interest ;Prooksa Anancheunsook: NO financial relationship with a commercial interest ;Rungsun Rerknimitr: NO financial relationship with a commercial interest Introduction: Esophagogastroduodenoscopy (EGD) has been considered as an aerosol-generating procedures (AGP) with high risk of transmission of respiratory aerosols similar to an endotracheal intubation during COVID-19 pandemic. However, the risk of AGP at different distances to the patient’s mouth and the benefit of the protective measure such as the head box have never been fully studied. We performed a randomized control trial to evaluate the efficacy of acrylic head box for preventing the aerosol spreading to personnel standing at different distances to the patient’s mouth during EGD. Method: This trial is a randomized, open-label, single center, in adult patients scheduled for EGD between September and November 2021. Patients were randomly assigned with 1:1 allocation to either head box group or without head box group (control group). The 0.3- and 0.5-micron aerosol particles were measured with particle counters (PCE-PCO 1;PCE Deutschland GmbH, Meschede, Germany) at nurse anesthetist’s and endoscopist’s position for 2 minutes before EGD, and every 30 seconds automatically entire the procedure. The primary composite outcomes were the mean difference of aerosol particle level between during and before EGD at the nurse anesthetist’s face position (40 cm from the patient’s mouth) and at the endoscopist’s face position. (Figure) Result: The analysis included 50 patients undergoing EGD in each arm. The baseline characteristics were not difference between the 2 groups. The mean distance between the endoscopist’s face and the patient’s mouth was 66.1 ± 4.9 cm. (Figure) The mean differences of both 0.3- and 0.5-micron particle levels between during the procedure and baseline before the procedure measuring at the nurse anesthetist's position decreased in the head box group whereas those particle level increased in the control group (-491.9 versus 1095.8 particle/L (P=0.008) and -366.7 versus 249.8 particle/L (P=0.004), respectively). There was no significant difference of the mean differences of either 0.3- or 0.5-micron particle levels between during the procedure and baseline before the procedure measuring at the endoscopist’s position whether with or without headbox. (Table) Conclusion: EGD with the head box can reduce significant aerosolization to the endoscopy personnel including nurse anesthetist who standing near the patient’s mouth. However, those who stand further away such as the endoscopist who stands about 2 feet away from the patient’s mouth is already safe from aerosolization and does not get benefit from the head box because AGP from EGD affects only to the short-distant area. [Formula presented] [Formula presented]

Reassessing Undergraduate Polymer Chemistry LaboratoryExperiments for Virtual Learning Environments br

Chemistry laboratory experiments are invaluable tostudents'acquisition of necessary synthetic, analytical, andinstrumental skills during their undergraduate studies. However,the COVID-19 pandemic rendered face-to-face (f2f), in-personteaching laboratory experiences impossible from late 2019-2020and forced educators to rapidly develop new solutions to deliverchemistry laboratory education remotely. Unfortunately, achievinglearning and teaching objectives to the same caliber of in-personexperiments is very difficult through distance learning. Toovercome these hurdles, educators have generated many virtual and remote learning options for not only foundational chemistrycourses but also laboratory experiments. Although the pandemic challenged high-level chemistry education, it has also created anopportunity for both students and educators to be more cognizant of virtual learning opportunities and their potential benefits withinchemistry curriculum. Irrespective of COVID-19, virtual learning techniques, especially virtual lab experiments, can complement f2flaboratories and offer a cost-efficient, safe, and environmentally sustainable alternative to their in-person counterparts.Implementation of virtual and distance learning techniques???including kitchen chemistry and at-home laboratories, prerecordedvideos, live-stream video conferencing, digital lab environment, virtual and augmented reality, and others???can provide a wide-ranging venue to teach chemistry laboratories effectively and encourage diversity and inclusivity in thefield. Despite their relevanceto real-world applications and potential to expand upon fundamental chemical principles, polymer lab experiments areunderrepresented in the virtual platform. Polymer chemistry education can help prepare students for industrial and academicpositions. The impacts of polymers in our daily life can also promote students'interests in science and scientific research. Hence, thetranslation of polymer lab experiments into virtual settings improves the accessibility of polymer chemistry education. Herein, weassess polymer experiments in the emergence of virtual learning environments and provide suggestions for further incorporation ofeffective polymer teaching and learning techniques into virtual settings

Epoxy Resin as Mounting Medium- A Novel Method for Teaching and Learning

Introduction: Anatomy Museum is an indispensable part of a medical college since it gives complete knowledge of the human body in its four walls. It not just displays meticulously and painstakingly prepared prosections of different body parts and organs but also includes many other teaching aids. Aim: The aim of the study is to use epoxy resin to mount specimens for anatomy museum and also to overcome the difficulty in traditional mounting methods. Materials and Methods: Epoxy resin mixture with hardener, fresh goat kidney, and liver plastic mould and Perspex/glass jar was used. Introduction: In 2019, COVID-19 originated from China and rapid spread throughout globe. Transmission of SARS-CoV-2 is high as a result;WHO and countries worldwide have imposed rigorous public health concern, such as lockdown and social distancing. This results the closure of educational institutes globally. Since the outbreak of COVID-19, paramedical institutes have sought ways to shift from traditional teaching to virtual teaching. Aim: The aim of this study was to determine the perception of 1st year paramedical students and to analyze the merits and demerits of virtual learning during the COVID-19 pandemic. Materials and Methods: A descriptive cross-sectional study was conducted at Sri Ramachandra Medical College and Research Institute, Chennai for Paramedical courses Microbiology, BSc sports science and BSc Speech therapy courses. Phase -I students participated in this study with a sample size of 400. A self-designed The fresh specimens were mounted using epoxy resin and allowed for curing. Result: The result obtained was a crystal-clear epoxy resin mounted specimen. The demonstrator as well as the students may feel comfortable and easy to handle as well as to teach and learn. Conclusion: The greatest advantage of this technique was it can be stored and maintained for a long time in the museum without forming any discolouration and dusting of the mounted specimens.

Online art therapy for multiple sclerosis

Introduction: Multiple Sclerosis (MS) is a demyelinating disease that can trigger disabling signs and symptoms. Art Therapy uses various artistic resources as a means to recover and improve wellbeing and mental, emotional and social health. During the period of social distance caused by the COVID-19 pandemic, online art therapy presents itself as a viable technique for people with MS. Objectives: Analyze the possibilities of online art therapy for people with MS. Methods: Nine women with relapsing-remitting MS (n=5/56%) and secondary-progressive MS (n=4/44%), aged from 28 to 63 years (Mean=45;SD=13.65) and EDSS between 0 and 7. All were invited to participate in online art therapy workshops and randomly constituted three groups with three people each. They carried out individual anamnesis and were supplied with materials such as sheets of A4 bond paper, scissors, white glue, gouache or acrylic paint, brushes, felt-tip pens/crayons or colored brushes, notebooks and magazines to cut out. The workshops lasted one hour each and were held by WhatsApp once a week. Results: Reports of anxiety, sadness and need were identified and correlated to the lack of communication and interaction resulting from the social isolation experienced by COVID-19. Thus, Art Therapy promoted therapeutic interaction between participants and art therapists through free artistic expression. Conclusions: Online Art Therapy was effective for this group of women with MS, as it provided improved well-being and quality of life in a period of social distancing triggered by the COVID-19 pandemic. The small number of participants was important for the directed attention and maintenance of focus during the activities.