Successful treatment of a large profunda femoris artery aneurysm and associated pseudoaneurysm using endovascular stenting.

Profunda femoris artery aneurysms are a rare form of peripheral arterial aneurysm. In this report, we present the case of an 83-year-old lady who was found to have a 65 mm aneurysm arising from the proximal left profunda femoris artery and associated pseudoaneurysm. Successful treatment was achieved using an endovascular approach in which two stents were deployed.

Systematic review of groin wound surgical site infection incidence after arterial intervention.

The objectives were to determine the surgical site infection incidence (including superficial/deep) fter arterial intervention through non-infected groin incisions and identify variables associated with incidence. MEDLINE, EMBASE and CENTRAL databases were searched for randomised controlled trials and observational studies of adults undergoing arterial intervention through a groin incision and reported surgical site infection. Infection incidence was examined in subgroups, variables were subjected to meta-regression. One hundred seventeen studies reporting 65 138 groin incisions in 42 347 patients were included. Overall surgical site infection incidence per incision was 8.1% (1730/21 431): 6.3% (804/12 786) were superficial and 1.9% (241/12 863) were deep. Superficial infection incidence was higher in randomised controlled trials (15.8% [278/1762]) compared with observational studies (4.8% [526/11 024]); deep infection incidence was similar (1.7% (30/1762) and 1.9% (211/11 101) respectively). Aneurysmal pathology (ß = -10.229, P < .001) and retrospective observational design (ß = -1.118, P = .002) were associated with lower infection incidence. Surgical site infection being a primary outcome was associated with a higher incidence of surgical site infections (ß = 3.429, P = .017). The three-fold higher incidence of superficial surgical site infection reported in randomised controlled trials may be because of a more robust clinical review of patients. These results should be considered when benchmarking practice and could inform future trial design.

A Vaccination Simulator for COVID-19: Effective and Sterilizing Immunization Cases.

Accurate modeling provides a means by which a complex problem can be examined for informed decision-making. We present a particle-based SEIR epidemic simulator as a tool to assess the impact of vaccination strategies on viral propagation and to model both sterilizing and effective immunization outcomes. The simulator includes modules to support contact tracing of the interactions amongst individuals as well as epidemiological testing of the general population. The simulator particles are distinguished by age, thus enabling a more accurate representation of the rates of infection and mortality in accordance with differential demographic susceptibilities and medical outcomes. Moreover, thanks to the age differentiation of particles, the vaccination can be simulated based on the age group descending order or randomly across all age groups. The simulator can be calibrated by region of interest and variable vaccination strategies (i.e. random or prioritized by age) so as to enable locality-sensitive virus mitigation policy measures and resource allocation. The results described, based on the experience of the province of Lecco, Italy, indicate that the tool can be used to evaluate vaccination strategies in a way that incorporates local circumstances of viral propagation and demographic susceptibilities. Further, the simulator accounts for modeling the distinction between sterilizing immunization, in which immunized people are no longer contagious, and that of effective immunization, in which symptoms and mortality outcomes are diminished but individuals can still transmit the virus. The sterilizing-age-based vaccination scenario results in the least number of deaths compared to other scenarios. Furthermore, the results show that the vaccination of the most vulnerable portion of the population should be prioritized for the effective immunization case. As the vaccination rate increases, the mortality gap between the scenarios shrinks.

Endotracheal application of ultraviolet A light in critically ill severe acute respiratory syndrome coronavirus-2 patients: A first-in-human study

BackgroundPromising preclinical experiments show that, under specific and monitored conditions, ultraviolet-A (UVA) exposure reduces certain bacteria, fungi, and viruses including coronavirus-229E without harming mammalian columnar epithelial cells. We aimed to evaluate the safety and effects of UVA therapy administered by a novel device via endotracheal tube in critically ill subjects with SARS-CoV-2 infection. MethodsFive newly intubated mechanically ventilated adults with SARS-CoV-2 infection, with an endotracheal tube size 7.5mm or greater, were treated with UVA for 20 minutes daily for 5 days, and followed for 30 days. ResultsFive subjects were enrolled (mean age 56.6yrs, 3 male). At baseline, all subjects scored 9/10 on the WHO clinical severity scale (10=death) with predicted mortality ranging from 21 to 95%. Average log changes in endotracheal viral load from baseline to day 5 and day 6 were -2.41 (range -1.16 to -4.54; Friedman P=0.002) and -3.20 (range -1.20 to -6.77; Friedman P<0.001), respectively. There were no treatment-emergent adverse events. One subject died 17 days after enrollment due to intracranial hemorrhagic complications of anticoagulation while receiving extracorporeal membrane oxygenation. The remaining subjects clinically improved and scored 2, 4, 5, and 7 on the WHO scale at day 30. In these subjects, the slope of viral load reduction during UVA treatment correlated with the slope of improvement in clinical WHO severity score over time (Spearman rho=1, P<0.001). ConclusionIn this first-in-human study, endotracheal UVA therapy under specific and monitored settings, was safe with a significant reduction in respiratory SARS-CoV-2 viral burden over the treatment period. Trial RegistrationClinicalTrials.gov #NCT04572399. Key MessagesO_LIWhat is the key question? Can endotracheal narrow-band UVA therapy be a safe and effective treatment for severe SARS-CoV-2 infection? C_LIO_LIWhat is the bottom line? Under specific and monitored settings, endotracheal UVA light therapy may be an effective treatment for SARS-CoV-2 infection. Endotracheal UVA light therapy appears to be well tolerated in critically ill patients with SARS-CoV-2 infection. C_LIO_LIWhy read on? This is the fist-in-human trial of internal UVA therapy using a alternative novel approach to combat COVID-19. C_LI

A Network-Based Stochastic Epidemic Simulator: Controlling COVID-19 with Region-Specific Policies

In this work, we present an open-source stochastic epidemic simulator, calibrated with extant epidemic experience of COVID-19. Our simulator incorporates information ranging from population demographics and mobility data to health care resource capacity, by region, with interactive controls of system variables to allow dynamic and interactive modeling of events. The simulator can be generalized to model the propagation of any disease, in any territory, but for this experiment was customized to model the spread of COVID-19 in the Republic of Kazakhstan, and estimate outcomes of policy options to inform deliberations on governmental interdiction policies.

Brachial plexus lipomata presenting with neurogenic and venous thoracic outlet syndrome: case reports and review of the literature.

BACKGROUND: Compression of the brachial plexus causing neurogenic symptoms is involved in most cases referred to vascular surgeons for consideration of treatment of thoracic outlet syndrome (TOS). The causative factor of the compression can be difficult to diagnose with multiple pathologies implicated. METHODS: We present 2 rare cases of supraclavicular lipomata causing compression of the neurovascular structures in the thoracic outlet. The only 6 other cases of brachial plexus lipomata were described to our knowledge in the literature worldwide. RESULTS: We highlight that there are a small number of neurogenic TOS cases where the causative pathology can be successfully managed by surgery with expectation of a good recovery. CONCLUSIONS: Surgeons operating on these lesions can expect good symptom resolution for their patients.