ABSTRACT
Congenital nasal masses are very rare presentations. Among these masses is a mucous cyst, which might be considered either a congenital or an acquired mass. Our report presents a case of recurrent dorsal nasal swelling that was initially managed with an open rhinoplasty. However, 1 year after the surgery, the swelling started to grow rapidly, and the patient presented with a disfigured nose. We scheduled the patient for the excision of the dorsal nasal swelling and reconstruction using the dorsal nasal flap approach. Several surgical techniques have been performed and published in the literature; however, this is the first time the dorsal nasal flap technique is being reported as a surgical approach to dorsal nasal mucous cysts. While mucous cyst formation might be congenital, the majority occur after rhinoplasty surgery. However, they can be prevented by minimizing unnecessary trauma during the surgery and ensuring the thorough removal of all epithelial tissue and foreign bodies.
ABSTRACT
Nicolau syndrome (NS), also referred as embolia cutis medicamentosa and livedo-like dermatitis, is an uncommon complication followed by drugs administered intramuscularly, intraarticularly or subcutaneously. In this case report we present a case of a 65-year-old lady who had a single dose of diclofenac sodium as an intramuscular injection in her left buttock due to back pain that led to developing what known as NS. She was treated with surgical debridement, drain insertion and skin approximation with antibiotics for 2 weeks with daily sterile dressing. The wound healed completely with scarring. NS is a preventable outcome, thus, proper procedures and precautions should be taken during intramuscular medication administration. Healthcare providers should avoid unnecessary injections, be familiar with the complication and consider it as a potential diagnosis for severe localized pain after any injection.
ABSTRACT
Healthcare researchers have been working on mortality prediction for COVID-19 patients with differing levels of severity. A rapid and reliable clinical evaluation of disease intensity will assist in the allocation and prioritization of mortality mitigation resources. The novelty of the work proposed in this paper is an early prediction model of high mortality risk for both COVID-19 and non-COVID-19 patients, which provides state-of-the-art performance, in an external validation cohort from a different population. Retrospective research was performed on two separate hospital datasets from two different countries for model development and validation. In the first dataset, COVID-19 and non-COVID-19 patients were admitted to the emergency department in Boston (24 March 2020 to 30 April 2020), and in the second dataset, 375 COVID-19 patients were admitted to Tongji Hospital in China (10 January 2020 to 18 February 2020). The key parameters to predict the risk of mortality for COVID-19 and non-COVID-19 patients were identified and a nomogram-based scoring technique was developed using the top-ranked five parameters. Age, Lymphocyte count, D-dimer, CRP, and Creatinine (ALDCC), information acquired at hospital admission, were identified by the logistic regression model as the primary predictors of hospital death. For the development cohort, and internal and external validation cohorts, the area under the curves (AUCs) were 0.987, 0.999, and 0.992, respectively. All the patients are categorized into three groups using ALDCC score and death probability: Low (probability < 5%), Moderate (5% < probability < 50%), and High (probability > 50%) risk groups. The prognostic model, nomogram, and ALDCC score will be able to assist in the early identification of both COVID-19 and non-COVID-19 patients with high mortality risk, helping physicians to improve patient management.
