ABSTRACT
Improving the diagnosis and provision of dental care for patients with chronic periodontitis in combination with herpetic diseases is an urgent goal of many studies. At the same time, the COVID-19 pandemic, including the course of its post-covid period, has somewhat changed the view of specialists on the diagnosis and treatment of these comorbid diseases. The aim of the study was a metagenomic analysis of the microbiota of patients with periodontitis in combination with herpetic lesions in the postcovid period. Materials and methods. 28 people aged 18—19 years were examined: 8 patients with chronic periodontitis and herpes of the lips in the postcovid period (group I), 9 patients with chronic periodontitis and herpetiform stomatitis in the postcovid period (group II), 11 conditionally healthy young people (group III, comparisons). The biomaterial was selected after professional oral hygiene from periodontal spaces;metagenomic analysis was carried out using a Nanodrop ND-2000 spectrophotometer, "Quant-iT dsDNA HS” analysis kits and "MiSeq” sequencer (Illumina). Results. The structures of microbial communities of 28 samples of the microbiome of periodontal spaces were analyzed, the average length of the resulting sequences was 460 base pairs, an average of 13 974 sequences accounted for the sample, 183 phylotypes belonging to 17 types were identified, of which 46 of the most numerous phylotypes were identified. Relative to the comparison group, the experimental groups showed a tendency to decrease the normal microbiota (Streptococcus, Rothia), an increase in the biodiversity of Shannon and individual representatives of the conditionally pathogenic spectrum (group I — Prevotella, Fusobacterium, Campylobacter, Haemophilus, Selenomonas, Treponema, Tannerella and Filifactor;group II — unclassified TM7-3, Actinomyces, Veillonella, unclassified Gemellaceae, Porphyromonas). Conclusion. The features of the microbiome of the periodontal pocket in comorbid patients with periodontitis and herpes in the postcovid period were revealed, individual representatives of the microbiome were identified, their features were described, which gives grounds for the use of various treatment methods, including using minimally invasive therapy against the background of antiviral agents. © 2023 Clinical Dentistry LLC. All rights reserved.
ABSTRACT
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).
ABSTRACT
Objectives: Chilblain lupus erythematosus (LE) is a rare chronic cutaneous lupus erythematosus (CCLE) characterized by the appearance of violaceous plaques in acral regions most exposed to cold. The isolated form affects middle-aged women, while the familial form manifests in early childhood and is associated with mutations in the TREX1 gene. Result(s): A 13-year-old adolescent, with no relevant family history, was referred in March 2021 for suspected chilblain-like lesions associated with COVID-19 infection. The patient presented with multiple violaceous papules on hands and feet. The lesions were slightly painful. Small hyperkeratotic papules were also observed on finger pads. Physical examination also revealed some aphthae affecting the lips. No other systemic symptoms were reported. A skin biopsy and blood tests were performed due to presumed chilblain LE with probable systemic involvement. Histology revealed basal vacuolar damage and intense perivascular and periadnexal lymphocytic inflammatory dermal infiltrate. Remarkably, mucin was noted among the collagen bundles. Leukopenia and positive ANA antibodies (titre 1:320) were detected. Complement levels were normal. SARS-CoV2 infection was ruled out. Skin lesions disappeared within 1 month under topical corticosteroids. Hydroxychloroquine was afterwards started by Rheumatology without recurrence of skin symptoms until last follow-up. Discussion(s): We present an uncommon case of an adolescent with systemic LE presenting as chilblain LE. Chilblain LE can be accompanied by other discoid CCLE. It can progress to systemic LE in up to 20% of patients, especially when concomitant CCLE is present. This rare presentation of CCLE should be differentiated from typical chilblain and other resembling lesions, such as SARS-CoV2-associated chilblain and acral purpuric lesions (COVID toes). The Mayo Clinic diagnostic criteria can be helpful, particularly in this last SARS-CoV2 outbreak scenario, when the reporting of similar skin lesions has been significant.
ABSTRACT
Introduction: Several studies have evaluated the occurrence of oral lesions and changes in sensory functions in patients positive for COVID-19. Objective(s): To evaluate the manifestations of COVID-19, emphasizing olfactory and gustatory changes, xerostomia, and oral lesions. Material(s) and Method(s): A cross-sectional and observational study was conducted. Approved by the Institutional Ethics Committee (#46151121.6.0000.5141). All patients were diagnosed by reverse transcription-polymerase chain reaction assay (RT-PCR) and considered to have mild symptoms, according to the latest WHO joint report. The patients were evaluated at a reference Service for COVID-19 in Minas Gerais, Brazil. The oral cavity was evaluated for each patient on the second and seventh days. Result(s): A total of 414 patients older than 18 years were evaluated. One hundred thirty-nine presented at least one of the studied conditions, oral lesions (19.08%) were the most frequently observed, followed by gustatory disorders (18.11%), xerostomia (14.25%), and olfactory dysfunction (14%). Among the oral lesions, there were various anatomical locations and clinical presentations. The occurrence involving lips and tongue represented 49 oral lesions, the most prevalent being, respectively, ulcerations (n=51), candidiasis (n=8), and erythema or red plaques (n=7). Fifty patients died. Conclusion(s): This study represents, to date, the largest case series of oral lesions in Brazilian patients with COVID-19, and oral alterations were observed in an expressive percentage of patients with COVID-19. However, it cannot be concluded that SARS-CoV-2 directly causes them.
ABSTRACT
Lip carcinoma is one of the most frequent conditions affecting the general population. It is among the ten most common neoplasms, but despite advances in research and therapy, its prognosis has not improved in a significant way in the past few years, making it a challenge in the medical research field and in surgical treatment. This study was conducted with the aim of evaluating the available reconstructive surgical options for the treatment of lip carcinomas in order to define which could be the most appropriate technique to achieve satisfying aesthetic and functional outcomes considering hospital resources in the COVID-19 era. Seventeen patients were included in this retrospective study, which took place between January 2019 and April 2021. There were two groups: seven patients who underwent a radial forearm free flap and ten who underwent locoregional flaps. The statistical analysis was performed to evaluate four different endpoints. Surgical length, ICU stay, and hospitalization time were minor for locoregional flaps. There was no statistically significant difference between the two groups when considering post-operative complications. Locoregional flaps have a more aesthetically pleasing result, but from a functional point of view, the results can be superimposable. Both techniques are associated with adequate speech, mouth opening, sealing, and symmetry. Given the impact of the COVID-19 pandemic on the healthcare system, locoregional flaps have been proven to be a good surgical option in the reconstruction of lip defects both in terms of aesthetics and functional outcome. © 2023 by the authors.
ABSTRACT
INTRODUCTION: Clefts of the lip are of the most common congenital craniofacial anomalies. The development and implementation of an enhanced recovery after surgery (ERAS) protocol among patients undergoing cleft lip repair may decrease postoperative complications, accelerate recovery, and result in earlier postoperative discharge. METHODS: A modified ERAS program was developed and applied through Global Smile Foundation outreach craniofacial programs. The main components of this protocol include: (1) preoperative patient education, (2) nutrition screening, (3) smoking cessation when applicable, (4) use of topical anesthetic adjuncts, (5) facial nerve blocks, (6) postoperative analgesia, (7) preferential use of short-acting narcotics, (8) antibiotic administration, (9) use of elbow restraints, (10) early postoperative oral feeding and hydration, and (11) discharge planning. RESULTS: Between April 2019 and March 2020, GSF operated on 126 patients with cleft lip from different age groups and 58.8% of them were less than 1 year of age. Three patients (2.4%) had delayed wound healing and one (0.8%) had postoperative bleeding. There were no cases of mortality, length of hospital stay did not exceed 1 postoperative day, and patients were able to tolerate fluids intake at discharge. CONCLUSION: The implementation of an ERAS protocol among patients undergoing cleft lip repair has shown to be highly effective in minimizing postoperative discomfort while reducing opioids use, decreasing the length of stay in hospital, and leading to early oral feeding resumption. The ERAS principles described carry increased relevance in the context of the ongoing COVID-19 pandemic and opioid crisis and can be safely applied in resource-constrained settings.
ABSTRACT
Case report Background: Delayed hypersensitivity reactions to hyaluronic acid fillers are usually self-limiting and uncommon, and spontaneous resolution is frequent. These are presumably T-lymphocyte- mediated reactions that can be caused by flu-like infections and vaccinations. A delayed hypersensitivity reaction after hyaluronic acid filler following the mRNA vaccine against coronavirus has already been described in the literature. We wish to present a case that followed the ChAdOx1-s recombinant COVID-19 vaccine produced by Oxford/ AstraZeneca. Case report: Female patient, 61 years old, submitted to filling of the nasojugal sulcus and nasolabial fold with 1 ml of cross-linked hyaluronic acid -15 mg/ml and after 5 days filling in the lips with 1 ml of cross-linked hyaluronic acid -12 mg/ml, dermatological office, under aseptic technique and using cannulas. It evolved with ecchymosis on the lips and nasolabial folds, with spontaneous resolution after about a week. Sixteen weeks after the procedure, she received the first dose of the ChAdOx1-s recombinant COVID-19 vaccine, and 11 weeks later, the second dose. After 30 days of the 2nd vaccine dose, asymptomatic nodules appeared distributed in the upper and lower portions of nasolabial folds, in melomentonian grooves, in the supralabial region, in the upper and lower lip in the right and left lateral portions and in the infralabial region in the left lateral portion, coinciding with the topographies of the populated areas. Ultrasonographic evaluation with Doppler confirmed these findings. At the time, she denied fever or previous infectious signs or symptoms. Previously, the patient had already been submitted to the filling of the nasojugal and nasolabial folds with a hyaluronic acid-based filler (1 ml), 29 months before the current procedure, without intercurrences. After the appearance of the nodules, she underwent treatment with prednisone 40mg for 15 days, with total weaning after another 15 days, in addition to the use of levoceritizine 5 mg daily for 20 days, with partial reduction in the size of the nodules. Due to aesthetic complaints on the part of the patient, an intralesional injection of hyaluronidase was scheduled, but it was not performed at the request of the patient herself, who opted for expectant management and clinical treatment. In October 2021, the patient reported that the nodules had involuted and in December 2021 she remained asymptomatic, referring to resorption of the entire filler.
ABSTRACT
OBJECTIVES/GOALS: Evaluate the impact of COVID-19 on oral clefts services including surgical and dental treatments in Puerto Rico. METHODS/STUDY POPULATION: This Observational retrospective cohort study will consider patients 0-21 y/o with CL/P that visited the UPR school of Dental Medicine, Pediatric University Hospital Dr. Antonio Ortiz and ongoing case-control research project Face-Genes. Records to be used are classified as follow: Pandemic (March 15, 2020 to March 15 2022) Pre-pandemic (March 15, 2015 to March 15, 2017) Power analysis (power=0.80 alpha=0.05) will be calculated. Unavailable and incomplete medical records and those that did not attended study clinic during study period will be excluded. Data extraction instrument will be based on previous published study. Descriptive statistics, Chi-square, Odds Ratios at 95% confidence intervals and multiple logistic regression will be estimated. RESULTS/ANTICIPATED RESULTS: We hypothesize that surgical and dental services in Puerto Rico will be adversely impacted because of COVID-19 pandemic. DISCUSSION/SIGNIFICANCE: CL/P are common congenital diseases that require early interdisciplinary attention. Lack of timely care as well as surgery and treatment delays, could be associated with poorer prognosis, increased morbidity and mortality. If there is high risk of dh services during emergency situations, our findings will help to allocate the available resources
ABSTRACT
OBJECTIVES: Professionals in the United Kingdom providing care to new families affected by cleft lip and/or palate (CL/P) had to adapt to ensure families' needs were met during a time of uncertainty due to Covid-19. The aims of this study were to explore the impacts of the pandemic on CL/P care provision for new families from the perspectives of professionals working in medical and community settings along with any personal impact on professionals and their reflections on the future of CL/P care. DESIGN: Semistructured interviews (n = 27) were completed about experiences from March 2020 to October 2020 with consultant cleft surgeons (n = 15), lead clinical nurse specialists (n = 8), and staff working at the Cleft Lip and Palate Association (n = 4). Transcripts were analyzed using inductive thematic analysis. RESULTS: Three themes were identified: (1) the impact of Covid-19 on the provision of cleft care in the United Kingdom, including working conditions, delays to treatment, and Covid-19 policies; (2) the impact of the pandemic on professionals' mental health, including personal distress and concerns about Covid-19 exposure; and (3) reflections on the future of CL/P care, whereby professionals expressed both hope and concern about the Covid-19 recovery effort. CONCLUSIONS: The ongoing Covid-19 pandemic has impacted CL/P service delivery for new families significantly, warranting recommendations for cohesive psychological support for families in addition to a safe and resourced recovery effort. Support for professionals is also suggested, following existing evidence-based models for providers' needs that address the difficulties of working throughout challenging times.
ABSTRACT
Objective. The aim of the study was to intercept early problems and difficulties in onset and stabilization phases of breastfeeding, in a population of healthy full-term newborns - during the COVID-19 pandemic - through a Clinical Governance Project, supported by the Department of Neonatology and Pediatrics, which introduced a speech therapist, as part of the professional team acting synergistically with neonatologists, pediatricians, pediatric nurses, midwives and gynecologists. Materials and Methods. Over a period of two months (2020), n = 72 newborns, 38 males and 34 females, were recruited (mean age:1.3 days) in the Departments of Neonatology and Obstetrics and Gynecology of Castelli Hospital, ASLRM6. Lingual frenulum neonatal screening (Martinelli, 2015) was administered to all the newborns and the frenulum was classified as normal, doubtful or impaired. Breastfeeding difficulties were evaluated and speech therapist counseling was performed, to support early onset and stabilization of breastfeeding. Results. Lingual frenulum screening resulted normal in 36 (50%), doubtful in 20 (28%) and impaired in 16 (22%) of total newborns. An alteration of both lingual and upper labial frenulum was found in 16 (22%) of the newborns studied. n = 23 newborns (32%) showed alterations able to hinder breastfeeding: these cases were successfully managed by helping the mothers to change the breastfeeding position, adopting a rugby hold position. Conclusions. According to our preliminary results, speech therapist counselling, in the critical COVID-19 pandemic, allowed early detection of lingual frenulum alterations, and their impact on the onset of breastfeeding. We found that altered lingual frenulum was associated with breastfeeding difficulties: in these patients, speech therapist intervention resulted useful in managing early breastfeeding problems.
ABSTRACT
Paediatric patients comprise a small proportion of the SARS-CoV-2 infected population. They usually present with mild symptoms, however a small proportion of them may require intensive care due to shock and multi-organ failure related to Paediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS). This review article summarises the oral mucosal lesions in children with COVID-19 and PIMS-TS. The most common sites affected are the tongue and lips. Commonly reported lesions include cheilitis, dry and red lips, and tongue swelling. This article is of importance to all healthcare professionals involved in the multidisciplinary care for this group of patients.Copyright © 2021 The Authors
ABSTRACT
Background/Purpose: Kikuchi-Fujimoto disease (KFD) is a rare, self-limited histiocytic necrotizing lymphadenitis. Although it is of uncertain aetiology, it is associated with viral infections and autoimmune diseases. Hence, it is crucial to identify KFD from other conditions with lymphadenopathy. Here we present a case of KFD after COVID-19 infection. Method(s): Medical records were traced and reviewed Results: A previously healthy 13-year- old girl was admitted in April 2022 with four weeks of fever, dry cough, loss of weight, followed by 1 week history of painful cervical lymphadenopathy and nonspecific maculopapular rash. She received her second dose of Covid 19 vaccine in January 2022. Unfortunately, she was diagnosed with CAT II, COVID 19 infection in March 2022. There was no history of allergy, recent traveling and cat scratch injury. Clinically there was no strawberry tongue, erythema of the lips, conjunctivitis or distal extremities changes to suggest Kawasaki disease. She was initially diagnosed with infection related lymphadenitis, treated with oral azithromycin for three days and intravenous ceftriazone for one week with no improvement. Her laboratory results showed hypochromic microcystic anaemia with leucopenia, raised inflammatory markers and lactate-dehydrogenese levels. Extensive workup for infection was unremarkable. Immunology test showed ANA, ANCA, ENA were negative with normal complements. Ultrasound abdomen was normal. Excisional lymph node biopsy revealed confluent areas of necrosis surrounded by histiocytes (CD68+) with absent of neutrophils. No granuloma or atypical lymphoid cells seen. Based on histopathology report, diagnosis of KFD was established. As she was not able tolerate orally, IV hydrocortisone was started and subsequently switched to oral prednisolone. She responded well to corticosteroids with fever subsided within a day and cervical lymphadenopathy reducing in size and resolved in one month. Prednisolone was able to taper off by two months. She showed complete recovery with no recurrence during follow-up. Conclusion(s): In persistent febrile painful lymphadenopathy, excision lymph node biopsy is essential to establish definite diagnosis. This case highlights the possible association between COVID-19 and KFD.
ABSTRACT
BACKGROUND: Our research results will not only help the cosmetic market, but also help the overall marketing implications of the niche market, which will be greeted by a variety of cosmetic markets in the future. AIM: This study attempted to investigate what are the consumer selection criteria for lip products represented by the lipstick effect that creates continuous demand even in the COVID-19 era, and the main factors driving the continuous demand for lip products. METHODS: We collect research data through a survey targeting 600 male and female consumers who have purchased lip products through online/offline stores during the COVID-19 period (2020-2021) in Korea. RESULTS: As a result of examining the effect of perceived quality on consumer attitude formation on lip products, the factors of usability sensitivity and price had a positive effect on consumer attitude formation. Consumer awareness of lip products naturally acts as a bridge to consumer satisfaction. CONCLUSION: This study focused on consumers' perception and potential for development of lip products whose demand has rather rebounded due to the lipstick effect during the COVID-19 crisis. It is thought that this will act as a positive mechanism for the formation of a favorable attitude toward lip products by consumers.
ABSTRACT
In light of the COVID-19 pandemic, wearing a mask is crucial to avoid contracting infectious diseases. However, wearing a mask is known to impair communication functions. This study aims to address the communication difficulties caused by wearing a mask and provide a strategy for aiding in understanding the speaker's speech through facial animation. Facial animation is generated in real-time, and upper facial information is processed to detect the speaker's emotions, generating a lower facial expression. In addition, the system detects the mask's shape and enables accurate registration in the proper position. This technology can improve communication and alleviate challenges associated with communication between persons wearing face masks. © 2022 Owner/Author.
ABSTRACT
A hemofilia A adquirida (HAa) e uma coagulopatia autoimune rara, associada a deficiencia do fator de coagulacao VIII, diagnosticada em idosos, que apresenta altas taxas de morbidade e mortalidade. Os principais sintomas sao sangramentos recorrentes, espontaneos e prolongados em regioes subcutaneas e mucosas, alem de hematomas musculares. O prolongamento isolado do Tempo de Tromboplastina Parcial Ativada (TTPA) e o Tempo de Protrombina (TP) normal, acompanhados de sangramento anormal, sugerem aprofundar a investigacao diagnostica. Por ser um disturbio autoimune, o paciente desenvolve inibidores contra o fator de coagulacao VIII, tornando o tratamento ainda mais complexo, ja que a reposicao do fator de coagulacao deficiente pode sofrer ataque dos autoanticorpos envolvidos. Medicamentos antifibrinoliticos e imunossupressores sao opcoes terapeuticas complementares. Um homem de 71 anos, branco, com historico profissional na agricultura e construcao civil, foi encaminhado a equipe de Hematologia apresentando dor nas pernas, hemartrose no joelho e hematomas extensos nos membros superiores e inferiores, relatando inicio dos sintomas apos segunda dose vacinal para Sars-Cov-2. Com historico de hipertensao arterial, artrite reumatoide e hiperplasia prostatica benigna, encontrava-se em uso de sinvastatina, enalapril, prednisona, diclofenaco sodico, carisoprodol e doxazosina. Os exames laboratoriais demonstraram hemograma, RNI, TP e plaquetograma dentro dos limites de normalidade. Ja a dosagem de fator de coagulacao VIII foi de 3% e o TTPA de 69,5 segundos, levando ao diagnostico de HAa. Por queixa de dor dentaria, o paciente foi encaminhado a Odontologia. Ao exame fisico, observou-se edentulismo superior e uso de protese total, pseudomembrana removivel a raspagem no palato, compativel clinicamente com candidose pseudomembranosa, presenca de quatro dentes inferiores com mobilidade, acumulo de biofilme bacteriano e caries. Alem disso, apresentava pequena ulceracao em labio inferior, indolor, nao endurecida a palpacao, compativel clinicamente com queilite actinica. Para as manifestacoes estomatologicas, prescreveu-se dexpantenol labial, fator de protecao solar e nistatina suspensao oral (100.000UI) para bochecho durante 7 dias, ocasionando a melhora incompleta da lesao labial e resolucao completa da infeccao fungica. Apesar da conduta indicada ter sido a extracao de todos os dentes, o quadro hematologico instavel nao permitiu tais procedimentos, ja que agentes antifibrinoliticos foram considerados insuficientes para controlar a hemorragia e o uso de alfaeptacogue ativado nao foi liberado pelo Ministerio da Saude para realizacao das exodontias. Assim, optou-se pela prescricao de analgesicos e proservacao do caso, enquanto as condicoes hematologicas aguardavam estabilizacao. Esse fato limitou a acao da equipe multiprofissional, uma vez que os focos infecciosos dentarios podem ocasionar episodios de dor intensa e sangramentos espontaneos, agravando ainda mais a condicao geral. O caso demonstra a complexidade do manejo hematologico de um paciente com HAa, levando a dificuldade do tratamento odontologico, nao sendo possivel atender imediatamente as necessidades do paciente mesmo em condicoes onde a intervencao odontologica nao podia ser considerada eletiva. Copyright © 2022
ABSTRACT
The COVID-19 pandemic has dramatically changed the education sector, which led to a rise in online learning. E-learning has exponentially increased and it has become difficult to conduct exams offline too. Need for online education and conducting online exams has led various institutes and educational sectors to develop a platform where exams can be proctored. The ability to proctor online examinations more effectively has become a crucial factor in the education sector. Presently, human proctoring is the most common approach of evaluation, by monitoring them during exams via a webcam. It has become challenging for supervisors/teachers to examine and conduct online exams. In addition to that, studies say that there has been a significant rise in cheating during online exams. The main objective of the project is to conduct honest, faithful examination by developing an AI based online proctoring system which will help teachers to check the examinee's authenticity, eliminate suspicious behaviour during the exam and keep track of students throughout the exam time. In addition to that, conducting smooth and honest examinations will increase everyone's trust in the online education sector. Proposed project is a website developed using AI algorithms such as CNN/RNN algorithm which monitors students during the exam, allowing students to attend the exam from any location, which will help in detecting any malicious activities via webcam and guarantee fair evaluation of exams. Vision based tracking consists of Eye ball tracking, Lip movement, additional member detection in frame and more. The website will also ensure that the candidate is sharing his/her screen. Conclusion, the proposed project provides an online platform with features like view students screen anytime, send warning messages, terminate someone's exam, eye tracker, lip tracker for conducting effective exams. © 2022 IEEE.
ABSTRACT
SESSION TITLE: Unique Inflammatory and Autoimmune Complications of COVID-19 Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Acute eosinophilic pneumonia is a rare illness characterized by eosinophilic infiltration of the lung parenchyma. Cases often present with fever, severe dyspnea, bilateral infiltrates, and eosinophilia on BAL exams. The cause of eosinophilic pneumonia is unknown, but is thought to be related to inhalational exposure of an irritant or toxin. Most cases are responsive to steroid treatment. This case demonstrates acute eosinophilic pneumonia in a patient who recently recovered from COVID-19 pneumonia. CASE PRESENTATION: A 50 year old female with a history of multiple sclerosis, seizure disorder secondary to MS, Irritable Bowel Syndrome, and a distant history of tobacco smoking and opiate dependence on chronic suboxone therapy, presented with dyspnea secondary to respiratory failure. The patient was urged to present by her husband after findings of hypoxia to 79% on room air with cyanosis of the lips and fingers. She recently recovered from COVID-19 1 month prior, at which time she had symptoms of cough productive of red mucus, fever, and exhaustion;but states she never returned to her baseline. With ongoing hypoxia, the patient was intubated for mechanical ventilation. Subsequent bronchoscopy with BAL resulted in a elevated eosinophil count to 76%, with fungal elements and PCR positive for HSV-1. The patient was initiated on high dose glucocorticoid therapy in addition to Acyclovir and Voriconazole. A CT with IV contrast revealed extensive bilateral pulmonary emboli involving the segmental and subsegmental branches throughout both lungs and extension into the right pulmonary artery;the patient was started on anticoagulation. Shortly after beginning glucocorticoid therapy, the patient had significant improvement and was able to be weaned off ventilation to simple nasal cannula. She was able to be safely discharged home with two liters of supplemental oxygen and steroid taper. DISCUSSION: Acute Eosinophilic pneumonia is a rare condition with an unknown acute disease process. The diagnostic criteria for acute eosinophilic pneumonia includes: a duration of febrile illness less than one month, hypoxia with an SpO2 <90%, diffuse pulmonary opacities, and otherwise absence of inciting causes of pulmonary eosinophilia (including asthma, atopic disease, or infection). Diagnosis of eosinophilic pneumonia is attained after meeting clinical criteria with a BAL sample demonstrating an eosinophilia differential of >25%. The mainstay of treatment for this condition is glucocorticoid therapy with most cases resolving rapidly after treatment. CONCLUSIONS: Fewer than 200 cases of acute eosinophilic pneumonia have been reported in medical literature. It is imperative to keep a wide differential as critical illness may be rapidly improved with appropriate therapy. The cause of acute eosinophilic pneumonia is largely unknown, it is unclear what role COVID-19 may have played in the development of this pneumonia. Reference #1: Allen J. Acute eosinophilic pneumonia. Semin Respir Crit Care Med. 2006 Apr;27(2):142-7. doi: 10.1055/s-2006-939517. PMID: 16612765. Reference #2: Nakagome K, Nagata M. Possible Mechanisms of Eosinophil Accumulation in Eosinophilic Pneumonia. Biomolecules. 2020 Apr 21;10(4):638. doi: 10.3390/biom10040638. PMID: 32326200;PMCID: PMC7226607. Reference #3: Yuzo Suzuki, Takafumi Suda, Eosinophilic pneumonia: A review of the previous literature, causes, diagnosis, and management, Allergology International, Volume 68, Issue 4, 2019, Pages 413-419, ISSN 1323-8930 DISCLOSURES: No relevant relationships by Tayler Acton No relevant relationships by Calli Bertschy No relevant relationships by Stewart Caskey No relevant relationships by Shekhar Ghamande No relevant relationships by Tyler Houston No relevant relationships by Zenia Sattar No relevant relationships by Heather Villarreal
ABSTRACT
SESSION TITLE: Poster Cases in Asthma and Allergy SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Anaphylaxis is an acute, potentially life-threatening, systemic allergic reaction that presents as a multitude of manifestations after exposure to an allergen. It is rare to have an anaphylactic reaction to the SARS-Cov-2 vaccine, however, we present a patient who had a prolonged anaphylactic reaction to the SARS-CoV-2 virus itself. CASE PRESENTATION: A 23-year-old female with past medical history of chronic idiopathic urticaria and dermatographism presented with fatigue, rash, rhinitis, and lip swelling in the setting of being COVID-19 positive. She had received two doses of the Pfizer-BioNTech COVID-19 vaccine nine months prior without any adverse affects. During the SARS-CoV-2 Omicron variant surge, the patient was exposed to a family member who had contracted COVID-19 infection. Two days prior to presentation, she started having a diffuse rash throughout her body. In the Emergency Department, she was given IM epinephrine x2, IV Solu-Medrol and IV Benadryl with temporary improvement in her symptoms. She developed hypotension that required initiation of a continuous epinephrine infusion and was admitted to the Medical Intensive Care Unit. Each time the epinephrine was held, generalized urticaria recurred and she would become hypotensive with her systolic blood pressure decreasing below 80 mmHg. The urticaria completely resolved and her blood pressure improved when the epinephrine infusion was restarted. The patient was treated with remdesivir, Solu-Medrol, loratadine, and famotidine. She was able to be weaned off the epinephrine infusion over the course of four days. Immunological workup was unremarkable apart from elevation of IL-10 on her cytokine panel. DISCUSSION: The symptoms and syndromes associated with COVID-19 infection remain diverse and while urticaria has been a documented manifestation of the virus, it is uncommon (1). There is a single case report of an anaphylactic reaction in response to COVID-19 (2). Given our patient's symptoms were temporally related to the COVID-19 infection, we believe the SARS-COV-2 virus was the trigger. She did not have any other exposure during this time. This case is unique in that the virus not only triggered the urticaria, but that her symptoms persisted for four days. After receiving antiviral therapy plus steroids and antihistamines, her symptoms finally resolved. The SARS-COV-2 virus itself is primarily attacked by immune cells, including mast cells, which release an array of proinflammatory cytokines (3). We postulate that in our patient, her history of chronic urticaria predisposed her to an exaggerated inflammatory response. CONCLUSIONS: SARS-CoV-2 has clinically presented itself in a multitude of ways across many disciplines. In a patient with a history of urticaria, prolonged anaphylactic symptoms can be triggered by the virus itself. Reference #1: Adeliño R., Andrés-Cordón J.F., De la Cruz Martínez C.A. Acute urticaria with angioedema in the setting of coronavirus disease 2019. J Allergy Clin Immunol Pract. 2020;8(7):2386–2387. Reference #2: Alvarez-Perea A, Baeza ML. Anaphylactic shock following the diagnosis of coronavirus disease 2019. Ann Allergy Asthma Immunol. 2020;125(4):477-478. Reference #3: Kritas SK, Ronconi G, Caraffa A, Gallenga CE, Ross R, Conti P. Mast cells contribute to coronavirus-induced inflammation: new anti-inflammatory strategy. J Biol Regul Homeost Agents. 2020 January-February,;34(1):9-14. DISCLOSURES: No relevant relationships by Brianne Navetta-Modrov No relevant relationships by Azzam Paroya Speaker/Speaker's Bureau relationship with Bayer Please note: current Added 03/30/2022 by Paul Strachan, value=Honoraria Speaker/Speaker's Bureau relationship with United Therapeutics Please note: more than 5 years Added 03/30/2022 by Paul Strachan, value=Honoraria Speaker/Speaker's Bureau relationship with Gilead Please note: $1001 - $5000 by Paul Strachan, value=Honoraria Removed 03/30/2022 by Pau Strachan Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 by Paul Strachan, value=Honoraria Removed 03/30/2022 by Paul Strachan Speaker/Speaker's Bureau relationship with Boehringer Ingelhein Please note: More than 5 years Added 03/30/2022 by Paul Strachan, value=Honoraria Stock Ownership relationship with Pfizer Please note: Purchased in 2000-2002 Added 03/30/2022 by Paul Strachan, value=nothing, I purchased stock Speaker/Speaker's Bureau relationship with Portola Please note: $1001 - $5000 by Paul Strachan, value=Honoraria Removed 03/30/2022 by Paul Strachan Stock Ownership relationship with Portola Please note: $5001 - $20000 by Paul Strachan, value=nothing, I purchased stock Removed 03/30/2022 by Paul Strachan Stock Ownership relationship with La Jolla Pharmaceuticals Please note: Purchased a few years back Added 03/30/2022 by Paul Strachan, value=nothing, I purchased stock Stock Ownership relationship with Seatle Genetics Please note: Purchased more than 5 years ago Added 03/30/2022 by Paul Strachan, value=nothing, I purchased stock PI relationship with United Therapeutics Please note: Current Added 03/30/2022 by Paul Strachan, value=Grant/Research Support PI relationship with Actelion/Janssen Please note: Current Added 03/30/2022 by Paul Strachan, value=Grant/Research Support PI for clinicial trial relationship with Roche Please note: Current Added 03/30/2022 by Paul Strachan, value=Grant/Research PI for clinicial trial relationship with Bellerophon Please note: Current Added 03/30/2022 by Paul Strachan, value=Grant/Research Support Speaker/Speaker's Bureau relationship with Actelion/Janssen Please note: Current Added 03/30/2022 by Paul Strachan, value=Honoraria
ABSTRACT
Background: Multisystem Infammatory Syndrome in Children (MISC) is a hyper-infammatory state with similarities to Kawasaki Disease, 4 to 6 weeks after Covid-19 infection1. Literature describes a 11:1 Relative Risk for Asian children versus Caucasians2. Since the start of the pandemic, 17,699 children under 12 years were infected with Covid-193. Objectives: To describe presentation and short term outcomes, for a cohort of children with MIS-C at the sole Children's Hospital in Singapore. Methods: Demographic and clinical/lab data were collected from children diagnosed with MIS-C accrording to the WHO criteria4 at KK Woman's and Children's Hospital, Singapore. Nonparametric descriptive statistics were used to describe and analyse data. Results: Eleven patients were diagnosed with MIS-C between October 2021 and Jan 2022. Seven (64%) were male and 4 (36%) were Chinese, with median age at presentation was 8.08 years (IQR 4.54-9.79). All patients had positive COVID-19 serology at the time of diagnosis. Median duration of fever prior to diagnosis was 5 days (IQR 4-5);Nine (82%) had gastrointestinal symptoms and median number of Kawasaki Disease (KD) features were 2 (IQR 2-3.5);common manifestations were conjunctivitis (90%), red lips (55%) and rash (36%). Of note, 8 (70%) patients had KD type peeling on follow-up. No BCGitis was found during acute phase. Seven (64%) were admitted to higher dependency care. Table 1, all patient received IVIG and IV steroids;6 (55%) as pulse (30mg/kg/day) therapy. Patient 8, additionally received Anakinra. Median duration of admission was 6 days (IQR 5-13). One patient developed complications post therapy and was re-admitted to hospital for hematochezia. Treatment involved stopping Enoxaparin and Prednisone. Aspirin was resumed as soon as bleeding ceased. Laboratory characteristics and outcomes are denoted in Table 1. All patients had a monophasic course during the median of 10 weeks (IQR 8-11.5) of follow-up. Conclusion: 1.Asian prevalence of MIS-C is not as high as that reported from the West. Similarities in presentation as to age and gender were noted. 2.Most of our MIS-c patients developed periungual peeling at follow up, similarly to Kawasaki Disease. 3.Different from our typical KD population, no BCG site infammation was found.