Radiological findings of mucormycosis rhinosinusitis among Indian COVID-19 patients during the pandemic second wave

Background: Sinonasal mucormycosis is a quickly progressing and lethal fungal disease which showed an increased incidence in COVID-19 patients in the Indian population during the second wave of the pandemic. The objective of this study was to study the various sinus areas affected and the imaging findings of the disease. Method(s): The imaging records of patients with sinonasal mucormycosis during the second wave of the COVID-19 pandemic were reviewed and analysed for whom computed tomography (CT) and/or magnetic resonance imaging (MRI) images had been performed. Result(s): Of the 65 patients, 6.1% had single sinus involvement, and 93.9% had multiple sinus involvement, and out of latter, 91.8% had bilateral sinuses affected by the disease process. A total of 49.2% patients with sinus involvement had erosions of the sinus walls. A total of 35.4% patients had only sinonasal mucormycosis, 38.5% patients had rhino-orbital mucormycosis, 4.6% patients had rhino-cerebral mucormycosis and 16.9% patients had rhino-orbitocerebral mucormycosis. The pterygopalatine fossa was affected in 26.2% patients. A total of 9.2% patients had cavernous sinus thrombosis. A total of 12% of the cases had infarction in the cerebral hemispheres. Conclusion(s): In a setting of sinonasal mucormycosis, especially in the immuno-compromised and with those infected with COVID-19, cross-sectional imaging can assess the presence and extent of the disease and helps plan its medical and surgical management.Copyright © 2023, The Author(s).

New definition of RIME: Mucocutaneous eruptions, bullous lesions and multi-mucosal involvement

Objectives: A 14-year-old female patient presents with marked haemorrhagic, adherent crusting of the upper and lower lip and enoral vesicles and erosions. Two weeks before, she had suffered from a respiratory tract infection. She did not take antibiotics but ibuprofen. One week later, she described a swelling and crusting of the upper and lower lips. Urogenital mucosa was also erosive. There was no ocular involvement. Another week later, cocard-like single lesions with partly central blister formation developed. A flaccid blister of 15 mm in diameter was detected in the left ear helix. In total, there was a limited cutaneous involvement of <10% BSA. The girl was admitted to the paediatric clinic. Method(s): Due to mucocutaneous eruptions, bullous lesions and multimucosal involvement, we assumed a Steven-Johnson syndrome or reactive infectious mucocutaneous eruption (RIME). Intravenous rehydration and prophylactic administration of cefotaxime and aciclovir were given. She was balanced and given analgesia with novalgin. The recent increased intake of ibuprofen was discontinued. Local therapy included mometasone cream and serasept dressings. During the inpatient stay, the general condition stabilised and the skin efflorescence's showed a clear regression. Result(s): The microbiological smears for COVID-19, HSV, VZV, mycoplasma, and chlamydia were negative. Discussion(s): As adult classifications for blistering severe cutaneous adverse reactions are limited applicable in children, Ramien et al. proposed revised paediatric-focused clinical criteria 2021. They leave traditional definitions of EEM, SJS and TEN. But they distinguish erythema multiforme (EM) for classic targets with/without mucosal involvement, RIME for cases with mucosal predominance and a respiratory infection trigger, and drug-induced epidermal necrolysis (DEN) for cases caused by medications. (Ramien BJD 2021) There are no current guidelines for RIME therapy. A reasonable management approach includes symptomatic therapy, treatment of identifiable infectious triggers (if possible), consulting urologists, ophthalmologists and gynaecologists (if necessary), immunosuppression, and psychological support. (Ramien ClinExpDermatol 2021).

Influence of climate change, overfishing and COVID19 on irregular migration in West Africa

Throughout 2020, according to the Spanish Ministry of Home Office, 23,023 irregular migrants reached the coasts of the Canary Islands in Spain, 757% more than the previous year. The migrants left from the coasts of West Africa, mainly from Senegal, trying to reach the nearest European Union (EU) territory. Apart from the migrants who arrived in the Canary Islands, nearly 1,500 stayed on the way, and 594 of them died drowned or of dehydration. Behind this migratory tragedy, there is a combination of factors, with three essential ones operating synergistically: climate change, which is affecting agriculture, fishing and exacerbating coastal erosion;overfishing, which is depleting regional fisheries;and the COVID-19 pandemic, which, in addition to the victims caused, has left the region without tourism, and with an economy in recession. This paper reviews these causal factors, highlighting his influence on migration and the responsibility of migrants receiving countries – especially those in the EU – for the causes of migration.

Disaster Risk Reduction for Resilience: Disaster Risk Management Strategies

This book is part of a six-volume series on Disaster Risk Reduction and Resilience. The series aims to fill in gaps in theory and practice in the Sendai Framework, and provides additional resources, methodologies and communication strategies to enhance the plan for action and targets proposed by the Sendai Framework. The series will appeal to a broad range of researchers, academics, students, policy makers and practitioners in engineering, environmental science and geography, geoscience, emergency management, finance, community adaptation, atmospheric science and information technology.This volume offers the international guidelines and global standards for resilient disaster risk reduction and lessons learned from disasters, particularly the COVID-19 and Cholera pandemics. A resilient health system and an effective disaster risk management Index are then suggested. The book further emphasizes urban resilience strategies with local authorities, adaptation strategies for urban heat at regional, city and local scales, and lessons from community-level interventions. Also addressed are coastal erosion, displacement and resettlement strategies. Land use planning and green infrastructure are suggested as tools for natural hazards reduction. Human security in times of climate change and urban heat at regional, city and local scales is discussed for an integrated action, with case studies based in Manila, Burkina Faso, Chad, Mauritania, Niger, Senegal, Nigeria, India, Spain, and Ghana. Structure design for cascading disasters resulting from mining and flooding is presented and sustainable smart city planning using spatial data is recommended. © Springer Nature Switzerland AG 2022.

Parietex Mini Male Sling for Stress Urinary Incontinence at the Time of Three Piece Penile Prosthesis: Technique and Outcomes

INTRODUCTION AND OBJECTIVE: Male stress urinary incontinence (SUI) and climacturia are often comorbid with erectile dysfunction (ED) post prostatectomy. While the inflatable penile prosthesis (IPP) is the gold standard surgical option for ED, there are many surgical options for male SUI as well as climacturia including bulking agents, Virtue male sling, AdVance>= male sling, mini Jupette with IPP, and artificial urinary sphincter (AUS). We present our technique and outcomes for mini male sling (MMS) with IPP insertion for mild SUI and climacturia using a hydrophilic monofilament polyester mesh. METHOD(S): After obtaining IRB approval, a retrospective review of all IPPs performed by a single high volume surgeon was performed. Those men who underwent IPP insertion with concomitant MMS were analyzed. The technique of MMS placement involves measurement of an approximately 5x3cm Parietex>= mesh (Covidien, MN) and overlying this ventrally over the bulbar urethra. The Parietex>= mesh includes a hydrophilic absorbable collagen film to minimize tissue reaction and risk of erosion. The lateral edges of the mesh are sutured to the 3- and 9 o'clock positions on the left and right corporal bodies, respectively, using a nonabsorbable, braided suture in an interrupted fashion. Mesh is sutured just proximal to the corporotomy sites. Tightness of mesh was measured using the proximal end of a Debakey forceps, with ease of passage when IPP deflated and inability to pass forceps when IPP inflated indicative of proper sizing. RESULT(S): A total of 63 men underwent IPP with MMS between January 2018 and October 2022. All patients had ED after radical prostatectomy. Average patient age was 67 years old, and average IPP size was 21cm with 1cm rear tip extender (RTE). A total of 59 men had SUI, with average pad per day (PPD) of 1.5. Twenty-five men with SUI had comorbid climacturia, and 4 men had preoperative climacturia without SUI. Average PPD post IPP with MMS was 0.1. Of the 29 men with preoperative climacturia, only one did not have resolution of his symptoms post MMS. There was only one reported complication of acute urinary retention requiring temporary foley catheter placement. Two patients required subsequent AUS insertion for persistent SUI. There were no reported cases of infection or mesh erosion. CONCLUSION(S): The hydrophilic Parietex>= mesh is a safe, easy to use, nonreactive, and effective material for mini male sling insertion at the time of IPP placement for men with ED and mild/moderate SUI or climacturia.

Clinical Study of Surge of Mucormycosis in COVID-19 Pandemic: A Tertiary Care Center Study.

The aim of this study is to evaluate the prevalence, pathogenesis and management of mucormycosis in post covid 19 patients in our tertiary care covid dedicated hospital. A prospective cross sectional study was done in 70 patients who were admitted in the covid department of BJ Medical College, Civil hospital Ahmedabad and presented with mucormycosis during admission or after discharge over a period of 10 months from March 2020 to December 2020. Middle aged to elderly population were found to be most commonly affected with mucormycosis. It was found that majority of the affected population was uncontrolled diabeteic and had a delayed presentation to hospital due to ongoing covid pandemic crisis. Covid infection had major effect on the hormonal balance of the body as evident from the uncontrolled blood glucose levels of affected patients. In patients with mucormycosis, early detection, surgical debridement, suitable antifungal therapy, and control of risk factors like diabetes mellitus are the main parameters of successful management of this lethal infection. Early diagnosis and treatment of mucormycosis can be life saving as it is a rapidly progressing disease and have been proven fatal.

Impact of Covid-19 on Endoscopic Demography: A Cross Sectional Study

Background: Pandemics are never easy to deal with, especially this new covid pandemic which has exposed the vulnerability and multiple lacunae in our existing health care. In this midst of chaos and uncertainty delivering endoscopic services had become a nightmare, as endoscopy is a procedure done in the aero digestive tract and also an aerosol generating procedure. This led to a lot of enigma and skepticism in selection of patients and precautions to be taken while performing procedures. Objective(s): To Know the Feasibility and Utility of endoscopy as diagnostic and therapeutic services in Covid pandemic in the midst of chaos and uncertainties. Material(s) and Method(s): It is a retrospective study conducted from May 2020 to December 2020 in a Tertiary care Gastro hospital. Patients were screened clinically by Questionnaire highlighting the travel history, contact history, and residing history (hot spots for covid). X-Ray, HRCT and RT-PCR was done to exclude high risk cases. Clinical screening for symptoms, Vitals, Spo2 was done on all the patients. The procedures were performed using standard endoscopy equipment with appropriate COVID 19 protocols. Result(s): One thousand two hundred and eighty (1280) patients aged between 20 years to > 70 years were referred and undertake upper and lower GI endoscopy in a Tertiary Care gastro hospital. Majority of the cases who underwent endoscopy were in the age group 31-40 years 317 (24.8%). They comprised of 59.9% males and 40.1% females. Common endoscopic diagnoses were Gastric erosions 31.4% followed by Normal Upper gastrointestinal endoscopy (UGIE) / Lax Gastroesophageal (GE) Junction 17.4%. The most common symptom was dyspepsia seen in 725 (56.6%) of the patients, followed by dysphagia in 92 (7.2%), abdominal discomfort 64 (5%). Conclusion(s): This study highlights, with proper history and clinical screening and appropriate precautions it was possible to provide endoscopy service to the needy without a strict protocol and expensive pre-endoscopy work up like HRCT and RT-PCR for all patients, without compromising patient or staff safety. Patients with alarm symptoms like Dysphagia and GI Bleed benefited the most, many patients with functional GI Disorders also were reassured with negative endoscopy and counseling. As during these times, people were in panic mode with all negative things happening around;many of these functional patients with overlap anxiety disorders were scared to death. A positive diagnosis is very important while managing most of these GI disorders.Copyright © 2022 Dr. Yashwant Research Labs Pvt. Ltd.. All rights reserved.

Global prospects to deliver safe drinking water services for 100 million rural people by 2030

The climate crisis and global pandemic have accelerated the urgency of providing safe drinking water services around the world. Global progress to safe drinking water is off-track with uncertain and limited data on the extent and performance of rural water service providers to inform policy and investment decisions. This report documents a global diagnostic survey to evaluate the status and prospects of rural water service providers from 68 countries. The service providers describe providing drinking water services to a population of around 15 million people through over 3 million waterpoints. The data provides information on the scale and sustainability of rural water services to examine: . The extent and type of professional water service provision in rural areas globally;. Self-reported metrics of operational and financial performance;and, . The size and scope of current rural service providers that could transition to resultsbased funding. Five major findings emerge. First, most service providers aim to repair broken infrastructure in three days or less. Second, almost all service providers reported at least one type of water safety activity. Third, most service providers collect payments for water services. Fourth, about one third of service providers reported major negative shocks to their operations from the COVID-19 pandemic. Fifth, non-governmental service providers in low income countries less often report receiving subsidies for operations, and more often report paying part of user fees to government, including through taxes. Most rural water service providers are working towards provision of affordable, safe and reliable drinking water services. Key barriers to progress include sustainable funding and delivery of services at scale. We propose four conditions to promote scale and sustainability based on policy alignment, public finance, professional service delivery, and verifiable data. To illustrate these conditions, we consider the differing context and service delivery approaches in the Central African Republic and Bangladesh. We conclude by identifying a group of 77 service providers delivering water services for about 5 million people in 28 countries. These 77 service providers report operational metrics consistent with a results-based contracting approach. Technical assistance might support many more to progress. We argue that government support and investment is needed to rapidly progress to the scale of 100 million people to provide evidence of pathways to universal drinking water services for billions more.

A historical review of pandemics with a dermatological perspective

We present a literature review of dermatology features in historical pandemics. A pandemic is an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and affecting a large number of people. Smallpox was the first documented pandemic, around 10 000 BC, spread by the inhalation of airborne droplets. A few days after an initial high fever, headache and fatigue, a mucocutaneous maculopapular eruption appeared, which then developed pustules and erosions. The last outbreak occurred in the USA in 1949. Smallpox was eradicated in 1980, following a vaccination programme. Mycobacterium tuberculosis is the causative agent of tuberculosis (TB), an ongoing global pandemic. The earliest documentations were 3300 years ago. In 2020, the World Health Organization (WHO) provisionally estimated 1.5 million deaths globally. Most commonly affecting the lungs, cutaneous TB may present with inflammatory papules, plaques, suppurative nodules and chronic ulcers. Requiring long, complex antibiotic regimens, multidrug resistant TB is an increasing problem. Now extremely rare, yet still with recent outbreaks in 2021 in Madagascar, bubonic plague arrived in Europe in 1346 causing 75-200 million deaths. It is caused by the bacterium Yersinia pestis, transmitted through fleas that have fed on infected rodents. Clinical features include papules, pustules, ulcers and eschars, tender lymphadenopathy and systemic symptoms, and it responds to antibiotics. Syphilis, caused by the bacterium Treponema pallidum, is sexually transmitted. The first known outbreak was during warfare in 1494-5 in Naples, Italy. In 2020, the WHO estimated that, globally, seven million people had new infections. Primary syphilis typically produces a painless, genital ulcer (or chancre). Secondary syphilis presents with a nonitchy, maculopapular erythema over the trunk, palms and soles. Early recognition and antibiotic treatment usually lead to good outcomes. Estimated by the WHO to affect 37.7 million people in 2020, HIV is thought to have mutated from simian immunodeficiency virus by the 1960s in sub-Saharan Africa, spreading to the Caribbean and USA by the late 1960s. Initial symptoms include a fever, headache and lymphadenopathy. Dermatological features are common, including opportunistic cutaneous infections, nonspecific exanthemas, seborrhoeic dermatitis and Kaposi sarcoma. Advances in antiretroviral therapies mean people with HIV can have an excellent prognosis, although the WHO estimated in 2020 that more than 200 000 people with HIV died from concomitant TB. Since 2019, COVID-19 has had a considerable global impact on healthcare. With more than 300 million cases and 5.5 million deaths to date, some services have been overwhelmed owing to large case numbers, variable vaccine uptake, workplace changes to reduce transmission and staff shortages. Cutaneous features include perniosis, urticarial, purpuric, vesicular or maculopapular eruptions. Pandemics throughout history have been repeatedly shown to present with an element of skin involvement. We can utilize this to promote education and early recognition of these features, to facilitate diagnosis and raise awareness of the potential complications of serious diseases.

Dermatomyositis: severe acute respiratory syndrome coronavirus 2, an initiator or a trigger?

Dermatomyositis is an immune-mediated inflammatory myopathy. In adults, the common triggering factors for its onset include viral infections, malignancy, and drugs. The clinical manifestation of these group of disorders may be cutaneous, neurological, pulmonary, or a combination of all. The cutaneous manifestations are helpful in the early clinical diagnosis. The detection of myositis-specific autoantibodies serves as specific biomarkers for the diagnosis and helps in predicting the prognosis. We are presenting two cases of dermatomyositis, temporally related to the severe acute respiratory syndrome coronavirus 2 infection and vaccination. Copyright © 2022 Journal of the Egyptian Women's Dermatologic Society.

Telemedicine for follow-up of lupus nephritis in the Covid-19 outbreak: A randomised controlled trial

Background: Blockade of JAK, preferably JAK1, by upadacitinib is a feasible approach to achieve erosion repair as it (1) is approved for the treatment of rheumatoid arthritis (RA), (2) effectively controls the inflammation and (3) targets pathogenic pathways that influence local bone homeostasis in the joint. To address the question whether inhibition of JAK1 could lead to erosion repair in patients with active RA, we performed a pilot non-randomized study comparing the changes in bone erosions on high-resolution peripheral quantitative computer tomography (HR-pQCT) before and after upadacitinib. Method(s): This is a 24-week, single-centered, prospective, non-randomized pilot study. We enrolled 20 adult patients with active RA (Disease activity score 28-C- reactive protein [DAS28-CRP] > 3.2) and >=1 bone erosion on HR-pQCT. They were given upadacitinib 15mg once daily for 6 months. HR-pQCT of the 2-4 metacarpophalangeal (MCP) head was done at baseline and 6 months. The primary outcome was the change of erosion volume on HR-pQCT. Secondary outcomes included change in RA disease activity and predictors of response to treatment. Erosion regression was defined as decrease in volume exceeding the smallest detectable change. Result(s): The baseline clinical characteristics of the recruited patients were shown in Table 1. Of the 20 patients, 11 (55%) patients failed to respond to 3 or more csDMARDs. At 24-week, there was significant improvement in mean DAS28 (-1.75, P < 0.001). Erosion regression was seen in 8 (40%) patients on HR-pQCT (Figure 1). Although no significant change in overall median erosion volume before and after upadacintinib (0.07 [-0.90 to 0.76 mm3] mm3, P = 0.904) was noted, the deterioration was less obvious compared to a historic cohort of 20 patients with similar age and disease activity on csDMARDs (median erosion volume change in 6 months: 0.67 mm3). When patients were stratified according to whether or not they had failed multiple csDMARDs, significantly high proportion of patients in the non-multiple- DMARDs failure group had volume regression in at least one erosion compared to those in the failure group (75% vs 25%, P = 0.04). There was improvement in mean total erosion volume in the non-failure group (-0.33 +/- 1.33 mm3), whereas mean erosion volume in the failure group worsened (2.09 +/- 7.62 mm3). One patient developed chest infection requiring hospitalization and withdrew from the study. No other serious adverse event was noted. Conclusion(s): The results of the study suggest upadacitinib is clinically efficacious in refractory RA disease and can retard erosion progression. Regression of erosion is possible, particularly in those with limited csDMARDs exposure. Whether early JAK1 inhibition could lead to better structural outcome warrants further investigations. (Figure Presented).

Epidemiology of Occupational Contact Dermatitis (OCD) on health workers in Covid-19

Background Generally, the diagnosis of OCD can be considered after a history of exposure to the suspected material and a thorough physical examination. Meanwhile, vital information about it is often overlooked during the initial consultation. Objective Evaluating the epidemiological profile of OCD cases in health workers due to the COVID-19 pandemic and evaluating complaints, manifestations and causative materials of OCD cases in health workers at the isolation ward of Dr. Soetomo Surabaya Hospital during the Covid-19 pandemic. Methods Purposive sampling was used to design research samples from accessible populations that matched the inclusion requirements while those who met exclusion criteria were included as research samples. Results Majority OCD patients are women and the most common age range is between 22-35 years old. The occupation most affected by OCD while working at isolation ward during the pandemic is nurses. The most common complaint is itching followed by redness of the skin which appears most frequently on the hands. The most prominent clinical manifestations are desquamation followed by erythema-like skin lesions. Medical gloves are the sort of personal protection equipment that causes OCD the most, followed by hand hygiene activities. High risk factors for OCD include a family history of atopic illnesses, history of asthma and an early history of atopic dermatitis. Conclusion The use of PPE can cause several effects on the skin such as physical trauma to the skin, acne, contact dermatitis, urticaria, and aggravate previous skin diseases. The most common skin disorders are erythema, papules, scales, fissures, erosions, ulcers, vesicles and wheals. Complaints of contact dermatitis can be reduced and prevented by taking preventive measures in the form of using moisturizers on areas that are often exposed. Copyright © 2023 Pakistan Association of Dermatologists. All rights reserved.

Duodenal Stricture as a Rare, Possible Complication of Eosinophilic Gastrointestinal Disease (Egid)

EGID is a recently described condition with an unknown etiology and pathogenesis. There are three case reports of duodenal stricture associated with EGID: one in an adult requiring pancreaticoduodenectomy due to the suspicion of malignancy and 2 cases in a child and a young adult, who responded to oral steroids. We report the case of a 10-year-old who presented to A&E with a 9-month history of epigastric abdominal pain and 1 episode of haematemesis, on a background of asthma. He was treated for Helicobacter pylori, based on a positive stool antigen. Abdominal pain and vomiting persisted, therefore an oesophago-gastro-duodenoscopy (OGD) was performed. This identified widespread white plaques throughout the oesophagus, erythema and nodularity of the gastric antrum and white nodules in the first part of the duodenum. Histology revealed changes of EGID and eosinophilic oesophagitis (EOE) and patient was commenced on Montelukast, oral viscous Budesonide (OVB), Cetirizine and continued proton pump inhibitor (PPI). After the allergy workup identified house dust mites, cat sensitisation and fish allergy, a 6-food elimination diet was initiated. During the next 2 years, symptoms subsided, and endoscopy changes improved, with only mild signs of active EOE while on OVB, PPI and diary/egg/fish free diet. However, the patient relapsed due to poor compliance to treatment. He became more unwell during the Covid pandemic with recurrent vomiting and static weight. A trial of dupilumab was considered, however his reassessment OGD had to be delayed due to restricted access to theatre. He was treated empirically with a reducing course of oral prednisolone, with temporary response. The endoscopic assessment performed subsequently showed erythema, erosions and white plaques in the distal oesophagus and gastric antrum with narrowing between the first and the second part of the duodenum (D2), that could not be entered. Histology identified mild upper oesophagitis (4 eosinophils (eos)/HPF), active middle and lower oesophagitis (20 eos/HPF and 12 eos/HPF, respectively), chronic gastritis (80 eos/HPF) and nonspecific reactive changes of the proximal duodenum. A barium meal confirmed a duodenal stricture. At this stage, we recommended a sloppy diet and a second weaning course of oral prednisolone, along with Montelukast. He was subsequently commenced on azathioprine for maintenance of remission. A repeat barium study and small bowel MRI performed post course of steroids and on azathioprine revealed stable appearances of the proximal duodenal stricture, excluding the presence of further strictures. While the patient has responded to the course of oral steroids and azathioprine, a repeat upper GI endoscopy is currently planned to dilate the duodenal stricture. The challenges posed by this case were the rarity of the condition, limited treatment options and access to endoscopy during the Covid pandemic and the fact that unlike previous case reports a sustained remission could not be obtained on steroids, and a maintenance immunosuppressive medication was required. We can conclude that this subgroup of patients should be monitored closely for signs of bowel obstruction and will require more intense treatment, including immunomodulators, endoscopic dilatation and or surgery.

Not all shortness of breath and throat pain is COVID

Case Report: A previously, healthy 18-year-old female presents to a Pediatric Emergency Medicine Department with shortness of breath, fever, and worsening throat and abdominal pain for 3 days. She had a sick contact, a teacher that tested positive for COVID-19 2 weeks prior to presentation. She denies runny/stuffy nose, cough, loss of taste/smell, or rashes/lesions. She denies any significant past medical history including allergies, as well as any history of smoking or any illicit drug use. Upon arrival to the ED, the patient was noted to be tachycardic, hypotensive and febrile. There were no desaturations. Initial physical examination revealed a generally uncomfortable female that was alert and oriented, with noted tenderness over the right anterior neck region, diffuse cervical lymphadenopathy, and painful neck range of motion. Her pharynx was noted to be erythematous without exudates or any unilateral tonsillar swelling. In the ED patient received IV fluid resuscitation and was started on norepinephrine drip, broad spectrum antibiotics. Initial lab workup revealed an anion gap metabolic acidosis, likely secondary to uremia or lactic acidosis from poor perfusion in setting of sepsis and hypovolemia. BUN and creatinine were elevated, likely due to an acute kidney injury (AKI) secondary to hypovolemia. The patient was also found to have an elevated LDH, fibrinogen, and mild elevation of AST. D-Dimer was elevated at 29 000. Covid PCR, Rapid Strep, and respiratory PCR panel were negative. Her chest X-ray (CXR) was negative and ECG showed sinus tachycardia. Given the patient's history of throat and neck pain with shortness of breath, in the setting of a septic picture, a CT scan of neck, chest, abdomen was ordered prior to transferring the patient to the PICU. CT scan of the chest revealed small patches of consolidation with ground glass opacities in the right lung apex, as well as an nearly occlusive, acute thrombosis of the anterior right facial vein. The patient's initial blood cultures grew gram negative bacilli which later were revealed to be Fusobacterium necrophorum. These findings are consistent with Lemierre's syndrome. The patient was treated in the PICU on vasopressors, heparin anticoagulation, and antibiotics for 6 days and discharged with a course of Augmentin. Lemierre's syndrome is an infectious thrombophlebitis of the internal jugular vein. First described by Andre Lemierre in 1936, it begins as a bacterial pharyngitis, generally developing into a peritonsillar abscess or other deep space neck infection with progressive erosion into the internal jugular vein. Diagnostic criteria for Lemierre's syndrome includes radiographically evidence of thrombophlebitis of the internal vein and positive blood cultures. CT and MRI can help make the diagnosis, but are not always required. Treatment is prompt intravenous antibiotics with beta-lactamase penicillins, metronidazole, clindamycin, and third generation cephalosporins. [Figure presented] Copyright © 2023 Southern Society for Clinical Investigation.

Deep Content Information Retrieval for COVID-19 Detection from Chromatic CT Scans.

In this paper, we investigate the role of the chromatic information in CT scans in COVID-19 detection and we aim to confirm the inclusion of the artificial intelligence findings in assisting COVID-19 diagnosis. This paper proposes a freezing-based convolutional neural network learning using a morphological transformation of CT images to classify COVID-19 cohorts to help in prognostication pneumonia disease monitoring. The experiments made on the collected CT images from previous works have proven to be a powerful aid to recognize the lesions in CT images which works at comprehensively greater accuracy and speed. The proposed CNN architecture has reflected the viral proliferation in infected patients and archives an accuracy of 87.56% with an improvement by 3% compared to the baseline method on the available database of CT images.

Mathematical Morphology View of Topological Rough Sets and Its Applications

This article focuses on the relationship between mathematical morphology operations and rough sets, mainly based on the context of image retrieval and the basic image correspondence problem. Mathematical morphological procedures and set approximations in rough set theory have some clear parallels. Numerous initiatives have been made to connect rough sets with mathematical morphology. Numerous significant publications have been written in this field. Others attempt to show a direct connection between mathematical morphology and rough sets through relations, a pair of dual operations, and neighborhood systems. Rough sets are used to suggest a strategy to approximatemathematicalmorphology within the general paradigm of soft computing. A single framework is defined using a different technique that incorporates the key ideas of both rough sets and mathematical morphology. This paper examines rough set theory from the viewpoint of mathematical morphology to derive rough forms of themorphological structures of dilation, erosion, opening, and closing. These newly defined structures are applied to develop algorithm for the differential analysis of chest X-ray images from a COVID-19 patient with acute pneumonia and a health subject. The algorithm and rough morphological operations show promise for the delineation of lung occlusion in COVID-19 patients from chest X-rays. The foundations of mathematical morphology are covered in this article. After that, rough set theory ideas are taken into account, and their connections are examined. Finally, a suggested image retrieval application of the concepts from these two fields is provided. © 2023 Tech Science Press. All rights reserved.

The evolution of digital MNEs: an empirical note

UNCTAD first published a list of the top 100 digital multinationals in the World Investment Report 2017. This research note builds on the analysis and conceptual framework on digitalization and foreign direct investment set out in that report. It provides an updated list, allowing for an analysis of trends over the five-year period including the COVID-19 pandemic and adds new features to the data set that will be exploited in forthcoming UNCTAD work. The note describes the methodology to create the new and extended data set and points at possible avenues for further work. The purpose of the research note is to provide academic scholars with the basic elements needed to pursue further research in this field. © 2022 UNCTAD United Nations Conference on Trade and Development. All rights reserved.

Design spherical particles of potassium peroxymonosulfate compound salt with high stability and good powder properties via an agglomeration-dissolution mechanism

With the outbreak of COVID-19, disinfection protection has become a necessary measure to prevent infection. As a new type of disinfectant, potassium peroxymonosulfate compound salt (PMS) has the advantages of good bactericidal effect, non-toxicity, high safety and stability. However, the current PMS products with irregular particle shapes lead to poor flowability, high hygroscopicity, poor stability of reactive oxygen species (ROS) and serious caking problems. In this work, an agglomeration-dissolution mechanism was designed to prepare spherical PMS particles with large size (>300 μm) and high sphericity (up to 90%), effectively addressing the above problems. Shaping (dissolution and abrasion) is the key to improving sphericity, which is mainly controlled by the design of the heating mode, residence time and stirring rate. Compared with the irregular PMS particles, the large spherical particles present better flowability (angle of repose decreased by 35.80%, Carr's index decreased by 64.29%, Hausner's ratio decreased by 19.14%), lower hygroscopicity (decreased by 38.0%), lower caking ratio (decreased by 84.50%), and higher stability (the monthly loss of ROS was reduced by 61.68%). The agglomeration-dissolution mechanism demonstrates the crystallization, agglomeration, dissolution and abrasion process of inorganic salt crystals, providing an opportunity to prepare high-end inorganic crystal materials with high-quality morphologies. © 2022 Chinese Society of Particuology and Institute of Process Engineering, Chinese Academy of Sciences