Kaposi sarcoma (KS) is an angioproliferative disorder. While KS of the head and neck is common in HIV-positives, it’s rare in HIV-negatives. Our case and the past 24 reported cases of ear KS reviewed here, highlight the importance of considering KS in the differential diagnosis of ear lesions in HIV-negatives.
The sternum is an exceptional localization for Diffuse Large B Cells Lymphoma. A Case of a man with a sternal mass that mimics a sarcoma on the CT scan. Needle biopsy was not contributive. Surgical resection was indicated because of a local progression. Histopathological examination concluded to a primary DLBCL
There are few reports on pregnancy and childbirth of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients. We present a woman who diagnosed with HAM/TSP and used a wheelchair in daily life. She had no neurological impairments and no obstetrical complications during her three courses of pregnancy and childbirth.
A female presented with segmental vitiligo on right Ophthalmic(V1) nerve distribution followed by hemifacial atrophy on right mandibular(V3) nerve distribution which stabilized after treatment with chloroquine and betamethasone pulse. Both dermatoses have younger onset, rapid progression followed by stabilization and dermatomal distribution suggests a possible common aetiological link.
Background: Internationally, the COVID-19 pandemic severely curtailed access to hospital facilities for those awaiting elective/semi elective procedures. For allergic children in Ireland, already waiting up to 4yr for an elective oral food challenge (OFC), the restrictions signified indefinite delay. At the time of the initiative there were approx 900 children on the Chidren’s Health Ireland(CHI) waiting list. In July 2020, a project was facilitated by short term(6wk) access to an empty COVID stepdown facility built, in a hotel conference centre, commandeered by the Health Service Executive Ireland(HSE). The aim was to the achieve rapid rollout of an off-site OFC service, delivering high throughput of long waiting patients, while aligning with hospital existing policies and quality standards, international allergy guidelines and national social distancing standards. Methods: The working group engaged key stakeholders to rapidly develop an offsite OFC facility. Consultant Paediatric Allergists, Consultant Paediatricians, trainees and Allergy Clinical Nurse Specialists were seconded from other duties. The facility was already equipped with hospital beds, bedside monitors(BP, Pulse, Oxygen saturation) bedside oxygen. All medication and supplies had to be brought from the base hospital. Daily onsite consultant anaesthetic cover was resourced and a resuscitation room equipped. Standardised food challenge protocols were created. Access to onsite hotel chef facilitated food preparation. A risk register was established. Results: After 6wks planning, the remote centre became operational on 7/9/20, with the capacity of 27 OFC/day. 474 challenges were commenced, 465 (98%) were completed, 9(2%) were inconclusive. 135(29.03%) OFC were positive, 25(5%) causing anaphylaxis. No child required advanced airway intervention. 8 children were transferred to the base hospital. The CHI allergy waiting list was reduced by almost 60% in only 24 days. Conclusions: OFCs remain a vital tool in the care of allergic children, with their cost saving and quality of life benefits negatively affected by delay in their delivery. This project has shown it is possible to have huge impacts on a waiting list efficiently, effectively and safely with good planning and staff buy in – even in a pandemic. Adoption of new, flexible and efficient models of service delivery will be important for healthcare delivery in the post-COVID-19 era.
A kyphotic gentleman with chronic obstructive pulmonary disease and Marfan syndrome whose history was significant for thoracoabdominal aortic replacement secondary contained rupture, presented with chest pain and an acute DeBakey type I aortic dissection. In this anatomically challenging total arch replacement, Cor-Knot fastener was employed without short-term or long-term complications.
Background: Limb ischemia is a major complication of femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO). Use of ankle-brachial index (ABI) to monitor limb perfusion in VA-ECMO has not been described. We report our experience monitoring femoral VA-ECMO patients with serial ABI and the relationships between ABI and near infrared spectroscopy (NIRS). Methods: This is a retrospective single-center review of consecutive adult patients placed on femoral VA-ECMO between January 2019 and October 2019. Data were collected on patients with paired ABI and NIRS values. Relationships between NIRS and ABI of the cannulated (E-NIRS and E-ABI) and non-cannulated legs (N-NIRS and N-ABI) along with the difference between legs (D-NIRS and D-ABI) were determined using Pearson correlation. Results: Overall, 22 patients (mean age 56.5±14.0 years, 72.7% male) were assessed with 295 E-ABI and E-NIRS measurements, and 273 N-ABI and N-NIRS measurements. Mean duration of ECMO support was 129.8±78.3 hours. ECMO-mortality was 13.6% and in-hospital mortality was 45.5%. N-ABI and N-NIRS were significantly higher than their ECMO counterparts (ABI mean difference 0.16, 95%CI 0.13-0.19, p<0.0001; NIRS mean difference 2.51, 95%CI 1.48-3.54, p<0.0001). There was no correlation between E-ABI vs. E-NIRS (r=0.032, p=0.59), N-ABI vs. N-NIRS (r=0.097, p=0.11), or D-NIRS vs. D-ABI (r=0.11, p=0.069). Conclusions: ABI is a quantitative metric that may be used to monitor limb perfusion and supplement clinical exams to identify limb ischemia in femorally cannulated VA-ECMO patients. More studies are needed to characterize the significance of ABI in femoral VA-ECMO and its value in identifying limb ischemia in this patient population.
Background: Several new variants of SARS-CoV-2 have emerged since fall 2020 which have multiple mutations in the receptor binding domain (RBD) of the spike protein. It is unclear which mutations affect receptor affinity versus immune recognition. Methods: We produced RBD with single mutations (E484K, K417N or N501Y) or with all three mutations combined and tested their binding to ACE2 by biolayer interferometry (BLI). The ability of convalescent sera to recognize RBDs and block their interaction with ACE2 was tested as well. Results: We demonstrated that single mutation N501Y increased binding affinity to ACE2 but did not significantly affect its recognition by convalescent sera. In contrast, single mutation E484K had almost no impact on the binding kinetics, but essentially abolished recognition of RBD by convalescent sera. Interestingly, combining mutations E484K, K417N and N501Y resulted in a RBD with both features: enhanced receptor binding and abolished immune recognition. Conclusion: Our data demonstrate that single mutations either affect receptor affinity or immune recognition while triple mutant RBDs combine both features.
Significant changes or cancellation of MCIT could result in limiting access to breakthrough medical technologies that could improve the health and well-being of Medicare beneficiaries. For these reasons, we encourage federal agencies to work together and CMS to implement the MCIT rule without delay to ensure timely access to breakthrough technologies
OBJECTIVES: The frozen elephant trunk (FET) technique has become an important tool in the treatment of acute type A aortic dissection. The aim of this study was to evaluate the effect of long FET on spinal cord injury (SCI) and distal aortic remodeling after acute type A aortic dissection based on clinical and radiological outcomes. METHODS: From January 2018 to November 2019, 158 patients [mean age 51.8 years (range 32 - 78 years), 88.6% male] with acute type A aortic dissection were treated by FET with 100 mm (n=113) or 150 mm (n=45) open hybrid stent graft prosthesis. Patients were divided into two groups according to the length of FET. The clinical and radiological outcomes of the patients were reviewed retrospectively. RESULTS: Postoperative outcomes did not differ significantly: in-hospital mortality (9.7% vs 6.7%, P=0.758) and SCI (5.3% vs 2.2%, P=0.674). Aortic remodeling, which was evaluated by aortic diameter, true lumen diameter, false lumen diameter and the rate of false lumen complete thrombosis, was more positive in long FET group in the descending thoracic aorta during the follow-up period. At the abdominal level, there was no statistically significant difference between the two groups. CONCLUSIONS: The long version of FET does not increase the risk of SCI in patients with acute type A aortic dissection. The application of long FET can achieve better results in terms of remodeling of the thoracic aorta in the short- and medium-term follow-up.
Infectious endocarditis (IE) is a rare condition with an estimated yearly incidence of 3 to 10 cases per 100,000 people. Its in-hospital mortality rate hovers around 18%, with one-year mortality reaching up to 40%. Although nearly 50% of IE cases now undergo surgical intervention, it does not appear to elevate the in-hospital mortality risk. Wei et al conducted a study on the relationship between red blood cell distribution width (RDW) value and postoperative death of IE patients. Their most remarkable finding was the in-hospital mortality rate was significantly higher in the High RDW group(55.6%vs.2.7%). Their results suggestted that RDW may become a valuable biomarker for estimating poor postoperative outcome in patients with IE. RDW reflects the variable size of circulating red blood cells and is routinely used to narrow the differential diagnosis of anemia. However, many studies had revealed that RDW maybe a new prognostic marker to predict the cardiovascular event. The increased value have been always linked with inflammatory and oxidative states. Further studies are required to explore the mechanism for the relationship between the RDW and adverse clinical outcomes.
Current guidelines do not adequately acknowledge the potential acute consequences in patients receiving both rituximab and COVID-19 vaccination. We report a case of rituximab-induced lympholysis and pancytopenia in a patient who received Moderna COVID-19 vaccine ten days before rituximab infusion. These observations highlight the urgent need to update current guideline.
We report a case of a 35-years-old Lebanese pregnant lady with a background of beta-thalassemia major who was diagnosed with COVID-19 infection (Cycle threshold value 18) during her 23rd gestational week. Unfortunately, the pregnancy outcome was unfavorable. To our knowledge, this is the first report of such a case