Exudate Research Articles

Морфологическая особенность слизистой оболочки барабанной полости при экссудативном среднем отите и ее изменения на фоне ультразвуковой региональной лимфотропной терапии

The article presents the comparative results of the morphological studies of the mucous membrane of the tympanic cavity in experimental exudative and purulent otitis media (EOM, POM). Thirty male Wister rats with a body weight between 180 g and 250 g were included into the experiment and divided into four groups, including intact individuals with simulated EOM and POM, ultrasonic regional lymphotropic therapy in EOM modeling. The material for morphological examination taken on the 4th and 12th days was processed according to the standard method and studied by light microscopy at different magnifications (×40, ×100, ×200, ×400). It was shown that in the initial stage (4th day) of the process in the second and third groups a similar reaction takes place in the form of the formation of serous exudate and leukocyte infiltration of the mucous membrane of the tympanic cavity. By the 12th day of the experiment, in each otitis forms, a discrepancy in morphological manifestations was detected, such as sluggish serous inflammation, edema, round cell leukocyte infiltration of the mucoperiost, without pronounced destruction of the epithelial tissue in exudative otitis media; and prominent destruction of the epithelium with disintegration of its deep structures in purulent otitis. Ultrasound regional lymphotropic therapy of exudative otitis media led to a decrease in the severity of the infiltrative reaction and restoration of the integrity of the epithelial layer of the mucous membrane of the tympanic cavity. The conducted studies incline the authors to recognize the inflammatory theory of the pathogenesis of exudative otitis media.

Dermatologic Manifestations of Systemic Diseases in Childhood

Dermatologic Manifestations of Systemic Diseases in Childhood

Lobar (croupous) pneumonia: old and new data.

Background and aimPneumonia remains one of the most frequent death causes worldwide. Among the etiological factors S. pneumoniae-causing lobar pneumonia plays a leading role. According to current textbook knowledge at least three sequential stages of lobar pneumonia are distinguished: congestion, red hepatization and gray hepatization. However, there are no detailed data supporting this stage concept. There are also controversial views on its etiology. In this study, the lung changes in lobar pneumonia were related to the cause and duration of the disease. In addition, the complications of the disease were evaluated. PCR studies verified the etiology of pneumonia.Material and methodsLobar pneumonia was analyzed in 252 post mortem cases examined in a large hospital in Irkutsk. The pathology, etiology of pneumonia, course of disease and cause of death were recorded and correlated to its clinical course and duration. In the second part of the study, the results in 95 patients were analyzed in detail and related to PCR findings.ResultsMost patients were adult men of low social status who showed signs of severe alcoholism. Lobar pneumonia was observed in 85% of the patients, while the remaining patients showed sublobar (“lobular”, focal) lung involvement. Histologically, three patterns of inflammation were observed, which in most patients occurred concurrently in different parts of the involved lobe: “congestion”, characterized by serous exudation with multiple cocci (41% of cases), “red hepatization” (41% of cases) and “gray hepatization” (100% of cases). The latter pattern was subdivided into three subgroups according to the ratio of fibrin—neutrophils and the presence of macrophages. The mean number of different histological patterns observed per patient was 3.8. There was no correlation between the inflammatory patterns and the duration of the disease. In 23% of the patients, the cause of death was of pulmonary origin, while the remaining patients died of extrapulmonary complications (i.e. acute heart failure 26%, acute vascular insufficiency 15% purulent meningitis 11–24.3%. In 29/95 patients (20 with lobar and 9 with focal pneumonia) pneumococcal etiology of pneumonia was established by PCR.ConclusionLobar pneumonia is a distinct clinico-pathological entity caused by S. pneumoniae, demonstrated by PCR testing and/or cytological examinations. Bacteriologic studies frequently give falsenegative results. Lobar pneumonia is characterized by three main histopathological patterns (congestion or microbeous edema, and red and gray hepatization) which usually occur side by side and not in chronological order. Early death is often related to heart failure and septic shock, while meningitis is a frequent complication later in the course.

Regional classification-guided wavelet Y-Net network for hard exudate segmentation in fundus images

We propose an hard exudate(EX)segmentation algorithm based on regional classification-guided wavelet Y-Net network to eliminate the influence of optic disc on EX segmentation process. The wavelet Y-Net network was an end-to-end fundus image EX segmentation network, which combined the regional detection of optic disc and hard exudates segmentation by regional classification-guided EX segmentation to effectively reduce the interference of optic disc in EX segmentation.To avoid failure of small EX region segmentation caused by information loss due to down-sampling operation, discrete wavelet transform (DWT) and inverse discrete wavelet transform (IDWT) were introduced to replace the traditional pooling down-sampling and up-sampling operations.Meanwhile, the inception module based on residual connection was used to obtain the multi-scale features.The proposed algorithm was trained and tested on the IDRiD and e-ophtha EX datasets and evaluated at the pixel level. For IDRiD and e-ophtha EX datasets, the proposed algorithm achieved accuracy rates of 0.9858 and 0.9938 with AUC values of 0.9880 and 0.9986, respectively. The proposed method can effectively avoid the influence of the optic disc, retain the image details, and improve the effect of EX segmentation.

Coronavirus disease 2019-associated pulmonary fibrosis: clinical findings, pathogenesis, and potential treatment.

Coronavirus disease 2019-associated pulmonary fibrosis: clinical findings, pathogenesis, and potential treatment.

Public Management Challenges in a Local Government Unit in the Philippines: Implications to the Educational Sector

Public management challenges encompass all the pressing needs and demands of the citizens to be met for a better governance. This study is geared towards the determinants of the challenges of a Local Government Unit (LGU) along public management and the perceived solutions to the perceived challenges. Employing a total of 118 respondents under Descriptive Research design, the following are known: challenges along public management are addressed by a LGU in the Philippines much better than expected by the respondents and the solutions addressing the challenges in public management are exuded in a great extent. Owing to the foregoing findings, it is concluded that the LGU in the current study is exuding efforts to address the challenges along public management. It is further implied that educational institutions as prime entity in changing the landscape of public management are impinged to restructure the content of the curriculum in public management, reinvent and revitalize the teaching approaches, and forge collaboration with the industry and practitioners towards academe-industry complementation.

Cellular composition research of serous pleural effusion fluids. Conceptual issues of preanalytics.

The purpose of this work was to show the effectiveness of the cytological method on a small number of observations, excluding all possible errors of the preanalytical stage. The paper presents several simple and easily reproducible algorithms for the cytological study of serous pleural effusions with small cellular content. On the example of 20 observations of the study of the cellular composition of serous exudates, a direct dependence of the research results on the preanalytical stage is shown. A complete study of effusion fluids in compliance with all stages of preanalytics and the use of modern methods of cytological diagnostics makes it possible to nullify the options for false-negative.

Antimicrobial Photodinamic Therapy Combined with Laser Photobiomodulation in the Treatment of Skin Wounds in a Dog (Canis lupus familiaris)

Background: Laser photobiomodulation has been used in the treatment of various injuries and diseases. This promotes modulation of the inflammatory process, edema reduction and devitalized tissue regeneration. The advantages of Antimicrobial photodynamic therapy are its easy application and the absence of side effects. Other advantages are the cost of the therapy, minimal damage to animal tissue, the broad spectrum of action, and efficiency against strains resistant to antimicrobials. The aim of this study was to report the clinical and their resolution in a female dog with a traumatic, infected wound treated with laser phototherapy as an alternative therapy method.Case: A 3-year-old bitch Border Collie, weighing 18 kg, from the municipality of Ilhéus, Bahia, Brazil, waspresented for examination with a history of traumatic laceration of the left thoracic member. On the anamnesis, it was reported that the patient presented with laceration of the left thoracic member. The wound was cleaned and an antibiotic [30 mg/kg of 12/12 h] and anti-inflammatory [0.1 mg/kg every 24 h were prescribed, both for 5 days]. Twenty-four h after the surgical procedure, there was dehiscence of the sutures, with daily topical therapy based on zinc oxide for secondary intention healing. Upon physical examination, the wound was found to be contaminated with swollen and erythematous edges, an ulcerated area with devitalized tissue, serous exudate, and 8.8 cm2 of wounded area. Given the macroscopic characteristics of the lesion, phototherapy was associated with conventional therapy until complete healing of the wound, with three weekly applications at 48 h intervals. Initially, the wound was cleaned with saline solution at 0.9% and a single treatment with aPDT was scheduled due to the high degree of contamination. The dosimetry parameters of irradiation were calculated according to the wounded area with a diode laser of 0.1W of power, continuous emission, spot area of 0.028 cm2, and energy of 9 J per application point. A gauze imbibed with 1 mL of methylene blue aqueous solution (300 μM), which was the photosensitizer was applied to the lesion, with a pre-irradiation time of 5 min, after which it was irradiated with red laser (RL) (λ = 660nm) for 90 s per point, using the sweeping technique. The edge of the lesion was irradiated with infrared laser (IRL) (λ = 808 nm), total energy of 5 J, using the technique of specific points and 1 J of energy/point. After aPDT, low-intensity laser therapy (LILT) sessions were set up with RL and IRL, with energies of 0.5 J/point and 1 J/point, respectively. The wound was cleaned daily, protected with a bandage, and clinically evaluated until complete regression.Discussion: In the present case, methylene blue was used as a photosensitizer, but it is noteworthy that, apparently, each microorganism responds differently to photosensitizers. Thus, the therapy becomes specific for each application, for example: the type of photosensitizer, its concentration, pre-irradiation time, type of light used in photosensitization, wavelength, energy, power, mode delivery of light. Thus, for the best result, the specific protocol in each application should be used Low-intensity laser therapy is an easily executed technique with effective results. The use of PDT associated with photobiomodulation therapy enabled rapid healing of the cutaneous wound, in addition to an improvement in clinical signs and pain caused by the lesion. The technique proved to be an efficient alternative in the treatment of wounds, whether used in isolation or associated with conventional therapy. Keywords: methylene blue, healing, wound, photobiomodulation, low-level laser.Título: Terapia fotodinâmica antimicrobiana combinada com a fotobiomodulação a laser no tratamento de ferida cutânea em cão (Canis lupus familiaris).

Comparative study on HIV rapid detection of saliva and blood in MSM of Shenzhen

Objective To compare the results of HIV rapid detection reagent in saliva and blood in MSM in Shenzhen, and we clarify the role of saliva rapid detection in HIV screening in this population. Methods The exudate in saliva and blood samples of the same subjects in 393 MSM in Shenzhen were collected, and the HIV immunoblotting kit was used as the reference reagent to confirm the consistency of salivary antibody detection kit (colloidal gold method) and human immunodeficiency virus (HIV) type 1+2 antibody detection kit (colloidal selenium method). Results Totally 393 MSM were recruited. The true positive, false positive, true negative, false negative cases for saliva test reagents were 120, 0, 272, 1, respectively. Those for blood test reagents were 121, 3, 269, 0, respectively. The detection results of the HIV western blot kit were taken as the gold standard to compare and analyze the detection results of saliva and blood detection reagent. The sensitivity, specificity, false-positive rate, false-negative rate and accuracy of exudate in saliva test reagents were 99.2%, 100.0%, 0.0%, 0.8% and 99.8%, respectively. Those of blood test reagents were 100.0%, 98.9%, 1.10%, 0.0% and 99.2%, respectively. Kappa test analysis showed that the results of rapid saliva and blood test were consistent with HIV diagnosis, and the Kappa values were 0.994 and 0.982, respectively. McNemar paired chi-square test was used to analyze the results of saliva and blood rapid test, and the difference was not statistically significant ( P =0.125). Conclusion Saliva and blood screening results have a good consistency, exudate in saliva detection is noninvasive and fast, this method is worth promoting for HIV self-screening in high risk population. 摘要：目的 分析深圳市男男性行为者(MSM)中唾液和血液HIV快速检测试剂结果, 探讨唾液快速检测法在MSM 人群HIV筛査的作用。 方法 同时采集深圳市393名MSM人群的唾液和血液样本 , 使用HIV免疫印迹试剂盒作为参 考试剂, 比较唾液抗体检测试剂盒(胶体金法)和人类免疫缺陷病毒(HIV) 1+2型抗体检测试剂盒(胶体砸法)两种快速 检测试剂结果的符合性。 结果 在393份MSM有效样本中, 唾液检测试剂的真阳性为120例, 假阳性为0例, 真阴性为 272例, 假阴性为1例。血液快速法真阳性为121例, 假阳性为3例, 真阴性为269例, 假阴性为0例。以HIV免疫印迹试 剂盒检测结果为金标准 , 唾液检测试剂的灵敏度为99.2%, 特异度为100.0%, 假阳性率为0.0%, 假阴性率为0.8%, 准确 度为99.8%。血液检测试剂的灵敏度为100.0%,特异度为98.9%, 假阳性率为1.1%, 假阴性率为0.0%, 准确度为 99.2%。Kappa检验分析显示唾液、血液快速检测法与HIV诊断结果存在一致性, Kappa值分别为0.994和0.982; McNemar配对卡方检验分析唾液和血液快速法的检测结果发现二者的差异无统计学意义( P =0.125)。 结论 唾液与血液的 筛査结果具有较好一致性 , 基于唾液检测安全无创、快速, 该方法值得在髙危人群HIV抗体自我筛査中推广使用

Effective Fundus Image Decomposition for the Detection of Red Lesions and Hard Exudates to Aid in the Diagnosis of Diabetic Retinopathy.

Diabetic retinopathy (DR) is characterized by the presence of red lesions (RLs), such as microaneurysms and hemorrhages, and bright lesions, such as exudates (EXs). Early DR diagnosis is paramount to prevent serious sight damage. Computer-assisted diagnostic systems are based on the detection of those lesions through the analysis of fundus images. In this paper, a novel method is proposed for the automatic detection of RLs and EXs. As the main contribution, the fundus image was decomposed into various layers, including the lesion candidates, the reflective features of the retina, and the choroidal vasculature visible in tigroid retinas. We used a proprietary database containing 564 images, randomly divided into a training set and a test set, and the public database DiaretDB1 to verify the robustness of the algorithm. Lesion detection results were computed per pixel and per image. Using the proprietary database, 88.34% per-image accuracy (ACCi), 91.07% per-pixel positive predictive value (PPVp), and 85.25% per-pixel sensitivity (SEp) were reached for the detection of RLs. Using the public database, 90.16% ACCi, 96.26% PPV_p, and 84.79% SEp were obtained. As for the detection of EXs, 95.41% ACCi, 96.01% PPV_p, and 89.42% SE_p were reached with the proprietary database. Using the public database, 91.80% ACCi, 98.59% PPVp, and 91.65% SEp were obtained. The proposed method could be useful to aid in the diagnosis of DR, reducing the workload of specialists and improving the attention to diabetic patients.

Nódulos do ordenhador: um relato de caso

Nódulos do ordenhador é uma dermatovirose causada por vírus da família Poxviridae, que acometem o homem e animais. Em humanos, apresenta-se em forma progressiva com lesões maculopapulares de base eritematosa passando por formato de alvo, nódulo exsudativo, regenerativo, papilomatoso e cicatricial com crosta. O estudo objetivou descrever um Relato de Caso que contribuirá para conhecimento multiprofissional de saúde nas especialidades infecto-dermatológicas que apresentem manifestações cutâneas semelhantes, a fim de ampliar diagnósticos diferenciais. Trata-se de um estudo retrospectivo, descritivo e observacional no formato de Relato de Caso de um paciente que esteve internado no Hospital de Doenças Tropicais da Universidade Federal do Tocantins (HDT-UFT), localizado no município de Araguaína -TO. Os dados foram coletados por meio de prontuário médico eletrônico e relatório dos profissionais de saúde que realizaram o atendimento, após liberação do Comitê de Ética em Pesquisa da instituição hospitalar e assinatura do Termo de Consentimento Livre e Esclarecido, autorizando a divulgação do trabalho e imagens de forma que não cause constrangimentos ao participante. O paciente apresentou manifestações de lesões clássicas na região palmar, mas com presença também no couro cabeludo e joelho, cujos testes histopatológicos não foram realizados pelas limitações do serviço hospitalar; é importante que os médicos compreendam as formas cutâneas desta doença viral, realizar o tratamento ideal e orientar medidas preventivas de infecção secundária. Deve existir um maior aprofundamento quanto à temática com implementação de medidas de controle pelos órgãos responsáveis pela fiscalização da saúde dos animais bovinos e caprinos leiteiros visando combater o contágio em humanos.

Expert recommendations for the diagnosis and treatment of interstitial lung disease caused by novel coronavirus pneumonia

COVID-19 is an acute infectious disease caused by a newly discovered coronavirus (SARS-CoV2). COVID-19 may manifest bilateral interstitial pneumonia on imaging. About 30%-60% of patients present varying degrees of interstitial changes, while most patients have a good prognosis. Since there's little practical instruct on treating interstitial lung disease (ILD) caused by COVID-19, we present this file as references for all the colleagues fighting with this disease. The primary findings on CT are bilateral, peripheral ground-glass opacities (GGO) and consolidation. Inter-/intra-lobular septal thickening are also common. Subpleural lines and traction bronchiectasis can be seen in some cases which indicate the presence of interstitial fibrosis. Images of severe cases are similar with those in advanced stage of nonspecific interstitial pneumonia (NSIP) and organizing pneumonia (OP). COVID-19 could present the typical two phases of diffuse alveolar damage: acute and proliferative phase on pathology. Massive pulmonary interstitial fibrosis may also be present. HRCT is the best radiological approach for the diagnosis and differential diagnosis of COVID-19, and to assess the presence of ILD. Periodical CT following-up is recommended for patients who present interstitial manifestations. Biomarkers such as KL-6, SP-D, RAGE may also helpful on evaluating the severity of interstitial fibrosis and therapeutic response. We do not suggest applying pulmonary function tests and 6-minute walking test on patients in active stage of the disease. The primary treatments in acute phase are antiviral therapy and supportive treatment. We do not suggest routine use of corticosteroids, while on patients with excessive activation of inflammatory response or rapid progression of lung lesions, a low to medium dosage of corticosteroids could be applied for a short course. Pirfenidone and Nintedanib are encouraged to apply on patients in reparative phase with evidence of progressing fibrosis. Low to medium dosage of corticosteroids is also feasible on patients with NSIP or OP manifestation in this phase, with a relatively longer course. Chinese traditional medicine and rehabilitation medicine may also helpful. Lung transplant surgery is an option for severe pulmonary fibrosis patients. Patients should receive CT following-up after be discharged from hospital, especially those whose pulmonary exudation is not well absorbed. We suggest a routine following-up on month 1, 4 and 10 after discharging, and an extended period for those who have developed irreversible interstitial fibrosis.

One-step lateral window approach for removal of benign minor sinus pathologies combined with transcrestal sinus floor elevation without bone grafts: a retrospective study

The aim of this study was to evaluate the clinical and radiographic outcomes of a lateral window approach for removal of benign minor sinus pathologies combined with transcrestal sinus floor elevation. From 2014 to 2018, all patients who received sinus pathology removal via a lateral window approach combined with transcrestal sinus floor elevation were screened. The serous exudate or minor sinus pathology was drained or removed via lateral window approach. Subsequently, transcrestal sinus floor elevation without grafting and simultaneous implant placement were performed. Panoramic radiographs and cone-beam computed tomography were taken preoperatively, immediately after surgery, and after prosthesis delivery. Twelve patients were included in this study. The decrease in Schneiderian membrane thickness was statistically significant (P<0.001). Endo-sinus bone formation was observed on the buccal (1.35±2.31mm) and palatal (1.61±2.65mm) sites of the implant. The implant survival rate was 100%. All implants survived for an average of 21.83±11.11 months. Within the limitations of this study, we suggest that the lateral window approach for minor sinus pathology removal combined with transcrestal sinus floor elevation has several advantages including endo-sinus bone gain without bone graft, minimal patient discomfort, reduced postoperative complications and shorter treatment period.

Comparison of therapeutic effects between monotherapy and combination therapy of Lopinavir/Ritonavir and Arbidol in COVID-19

Objective To compare the therapeutic effects and adverse drug reaction between monotherapy and combination therapy of Lopnavir / Ritonavir and Arbidol in coronavirus disease 2019 (COVID-19). Methods Retrospective analysis were conducted on 75 cases with common COVID-19，in Yongwu Hospital affiliated with the People′ s Hospital of Guangxi Zhuang Autonomous Region between February 16 and 26, 2020. According to medication history, patients were assigned into Lopnavir/Ritonavir combine with Arbidol-based therapy (Group A), Lopnavir/Ritonavir-based therapy (Group B), and Arbidol-based therapy (Group C). The three groups were compared in results of therapeutic effects, ratio of negative conversion in nucleic acid, absorption of pulmonary exudation and adverse drug reactions. Results The average age of the patients in the three groups was (42.68 ± 3.44) years old. The main symptoms of admission were fever (88.00%), cough (84.00%), sore throat (29.33%) and chest tightness (17.33%). There are no significant difference of related results of sex, age, basic disease, blood routine, liver function, kidney function, etc between three groups at the time of admission ( P >0.05); After intervention of treatment, the similarity has been showed in the three groups at the ratio of recovery(group A 94.28%, group B 86.21%, group C 90.91%), absorption of pulmonary exudation(group A 88.57%, group B 82.76%, group C 72.73%) and negative conversion in nucleic acid (group A: 48.57%, group B: 48.28%, group C: 54.55%) ( P >0.05); The diarrhea, nausea, bloating adverse drug reactions rate of group A and B were much more higher than that of group C (group A 88.57%, group B 82.76%, group C 18.18%), (group A 88.57%, group B 82.76%, group C 36.36%), (group A 88.57%, group B 82.76%, group C 36.36%)( P 0.05)，治疗后相比，三组患者发病症状好转率(A 组 94.28%，B 组 86.21%，C 组 90.91%)、肺部病灶吸收率(A 组 88.57%，B 组 82.76%，C 组 72.73%)、鼻咽拭子核酸转阴率(A 组 48.57%，B 组 48.28%，C 组 54.55%)差异无统计学意义( P >0.05)；A 组、B 组患者出现腹泻、恶心、腹胀等药物不良反应症状率显著高于 C 组患者(A 组 88.57%，B 组 82.76%，C 组 18.18%)(A 组 88.57%，B 组 82.76%，C 组 36.36%)(A 组 88.57%，B 组 82.76%，C 组36.36%)( P <0.0167)。 结论 洛匹那韦/利托那韦和阿比多尔及两者联合用药三种治疗方案用于治疗新型冠状病毒肺 炎均取得良好疗效，但临床上洛匹那韦/利托那韦较阿比多尔出现较多药物不良反应

RARE HEPATOPULMONARY FISTULA DUE TO LIVER ABSCESS RUPTURE

SESSION TITLE: Medical Student/Resident Disorders of the Pleura Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Hepatopulmonary fistulas are quite rare, a complication which can be due to primary etiologies such as hydatid or pyogenic cysts (1) These insults cause transdiaphragmatic infiltration leading to rupture at the lower lung leading to the formation of a fistula Secondary causes are congenital abnormalities, surgical or penetrating trauma Our patient developed an extremely rare complication of fistulization with the right lung pleura due to a suppurative hepatic collection leading to a complicated clinical presentation There are known septic embolic or constitutional symptoms associated with the diagnosis which were not present in our case, rather acute hypoxic respiratory failure and septic shock due to rupture of the hepatic abscess CASE PRESENTATION: A 59-year-old female with a recent history of a benign liver tumor presented for shortness of breath and dry cough for two days On physical exam, she was tachypneic and increased work of breathing Vital signs were significant for oxygen desaturation to 86% on room air, required mechanical ventilation She was admitted to the intensive care unit for acute respiratory failure due to possible multifocal pneumonia and rule out COVID-19 Upon admission evaluation, laboratory results significant for transaminitis (Alk Phos 353, AST 197 and ALT 60) Chest X-ray (Figure 1) raised right hemidiaphragm, right lower lobe atelectasis and bilateral alveolar infiltrates CT AP with IV contrast revealed a large right sub diaphragmatic abscess with a right-sided empyema (Figure 2) Upon review of daily CXR, day 6 of the admission, new loculated pneumothoraces in the upper and middle right lung Chest tube was placed for the pnuemothoraces The pleural fluid was exudative and neutrophil predominant Followed by an IR drainage of the liver abscess yielding 60 cc of brown purulent fluid The spontaneous pneumothorax was likely in the setting of a cystopleural fistula resulting from ruptured hepatic abscess given similar microbiology with anaerobic gram positive rod growth from the IR guided liver abscess drainage and the chest tube drainage DISCUSSION: Hepatopulmonary fistulas may have benign courses but there is a significant mortality rate due to septic shock and florid infection A pyogenic abscess causes obstruction of the biliary tree allowing for bacterial overgrowth complicated by rupture leading to peritonitis or sepsis CONCLUSIONS: Our case is a rare presentation showing the severe progression of a pyogenic liver abscess allowing for this communication between the lung and liver This case emphasizes the importance of early recognition of infectious liver abscesses and early intervention Reference #1: Gulamhussein, Patrini, Pararajasingham, Adams, Shukla, Velissaris, Lawrence, Panagiotopoulous “Hepatopulmonary Fistula: a life threatening complication of hydatid cyst” J Cardiothorac Surg 2015 Reference #2: Abbas M, Khan F, Muhsin S, Al-Dehwe “Epidemiology, Clinical features and outcome of Liver Abcsess: A single Reference Center Experience in Qatar” Oman Med J 2014 DISCLOSURES: No relevant relationships by Kinjal Patel, source=Web Response No relevant relationships by Jean Singh, source=Web Response No relevant relationships by Ivan Wong, source=Web Response

Efficacy of intravitreal injection of aflibercept in the treatment of neovascular age-related macular degeneration

Objectives To evaluate the visual and anatomical outcomes following intravitreal injection of aflibercept in patients with neovascular age-related macular degeneration (AMD). Background Neovascular AMD is considered a principal cause of visual impairment worldwide. It is associated with choroidal neovascularization, which causes exudation that affects vision. Early clinical trials showed that intravitreal injection of anti-vascular endothelial growth factor agents is associated with significant improvement of visual outcomes in the majority of eyes. Aflibercept is an anti-vascular endothelial growth factor agent that recently gained approval for treating neovascular AMD. Patients and methods This prospective study conducted at Menoufia University Hospitals, included 60 eyes of 46 patients with treatment–naive neovascular AMD. The patients received 3monthly aflibercept intravitreal injections. The best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure were measured at diagnosis and after each injection. Also, the patients were asked to fill the 25-item National Eye Institute Visual Function Questionnaire at baseline and at the end of the study. Results The mean BCVA improved from 0.061 (decimal fraction) to 0.081 after the third injection (P Conclusion Intravitreal aflibercept in neovascular AMD is associated with increased BCVA and reduced CMT. In addition, intravitreal aflibercept possibly has a benefit of improving the quality of vision-related functions.

Pathological changes in the lungs and lymphatic organs of 12 COVID-19 autopsy cases.

Systematic autopsy and comprehensive pathological analyses of COVID-19 decedents should provide insights into the disease characteristics and facilitate the development of novel therapeutics. In this study, we report the autopsy findings from the lungs and lymphatic organs of 12 COVID-19 decedents—findings that evaluated histopathological changes, immune cell signature and inflammatory factor expression in the lungs, spleen and lymph nodes. Here we show that the major pulmonary alterations included diffuse alveolar damage, interstitial fibrosis and exudative inflammation featured with extensive serous and fibrin exudates, macrophage infiltration and abundant production of inflammatory factors (IL-6, IP-10, TNFα and IL-1β). The spleen and hilar lymph nodes contained lesions with tissue structure disruption and immune cell dysregulation, including lymphopenia and macrophage accumulation. These findings provide pathological evidence that links injuries of the lungs and lymphatic organs with the fatal systematic respiratory and immune malfunction in critically ill COVID-19 patients.

Child of steel

Allergic reactions to metal implants have been on the rise reaching an incidence of 10-17% in the general population. In Asia, nickel ranks among the top five most common source of metal sensitivity. We present a case of nickel allergic contact dermatitis secondary to an orthopaedic implant. 12/M with chronic osteomyelitis of the left tibia presented with non-union of the bones necessitating an Ilizarov fixator implant using conventional SAE 16 stainless steel plate and bone graft. After 9 months, there was paucity of the bone allograft necessitating adjustment of the Ilizarov fixator and repeat bone allograft. 2 weeks after the second revision of the metal implant, the child manifested with pruritic wheals on both his flanks lasting for a week. Months later, the wheals developed along the pin tracts with serous exudate. Orthopaedics entertained a possible hypersensitivity to the metal implant and the fixator was removed. For further work-up, the child was referred to dermatology and allegro-immunology service whereupon further history revealed that he has a prior undocumented allergy to metal accessories when he was 6 years old. A patch test was later performed revealing +1 reaction to nickel. Failure of the union of the left tibia and decreasing function of the left leg necessitated a below-knee amputation and subsequent application of a prosthetic limb. This is a rarely reported case of metal implant allergy in a pediatric patient presenting as failure in wound healing and non-union of tibial fracture. This case further emphasizes the importance of a complete medical history in assessing a patient with possible metal allergy and its proper diagnosis and management. This case also highlights the possible role of metal exposure and the patient’s chronic infection in the pathogenesis of bone non-union.

Guidance for the management of adult patients with coronavirus disease 2019.

In December 2019, a novel coronavirus was identified in Wuhan City, Hubei Province, China and later the disease was named coronavirus disease 2019 (COVID-19). On March 11, 2020, the World Health Organization (WHO) officially announced that COVID-19 had reached global pandemic status. This article summarized the understanding of the etiology, pathogenesis, epidemiology, clinical characteristics, diagnosis, treatment, rehabilitation, and prevention and control measures of COVID-19 based on the available data and anti-epidemic experience in China.

Status of pests and diseases of sorghum and their management practices by Fadama III participating farmers in Abuja, Nigeria

A diagnostic survey was carried out at the end of 2018 and early 2019 to assess the status of sorghum pests, diseases and their management strategies by the “Fadama” III participating farmers in the Federal Capital Territory (FCT), Abuja, Nigeria. Data were collected from the 28 production clusters in 10 Fadama Development Areas in the six Area Councils. Instruments used were semi-structured interview, farm visits and the diagnosis of collected specimens from infested and diseased sorghum. The results indicated that up to 97.95% of the farmers had one form of formal education. On sorghum farms, corn rootworms (Diabrotica virgifera), Striga spp. weed and straying cattle were the major pests encountered. The incidence of Striga weed was 20.97%, while that of anthracnose disease was 76.84% though often left uncontrolled. Indigenous knowledge used for managing sorghum pests included field spraying with goat faeces slurry and placement of neem and Blumea leaves in corn granaries. Sorghum seeds were locally dressed with berry bark exudate, neem extract + pepper pre-planting. Due to the high severity of anthracnose on sorghum in the FCT, Abuja, there is need to embrace integrated disease management practices against this endemic disease. Routine monitoring of sorghum pests and disease prevalence, incidence and severity at different growth stages and implementation of sorghum pests management plan emanating from this study across Fadama Development Areas in Guinea Savannah agro-ecological zone is expected to enable the attainment of sustainable sorghum productivity. Key words: Abuja-Nigeria, Fadama, incidence, insects, Integrated Pest Management (IPM), sorghum, weeds.