Mild Drop Research Articles

HISTOLOGICAL COMPARISON OF REPEATED MILD WEIGHT DROP AND LATERAL FLUID PERCUSSION INJURY MODELS OF TRAUMATIC BRAIN INJURY IN FEMALE AND MALE RATS.

In preclinical traumatic brain injury (TBI) research, the animal model should be selected based on the research question and outcome measures of interest. Direct side-by-side comparisons of different injury models are essential for informing such decisions. Here, we used immunohistochemistry to compare the outcomes from two common models of TBI, lateral fluid percussion (LFP) and repeated mild weight drop (rmWD) in adult female and male Wistar rats. Specifically, we measured the effects of LFP and rmWD on markers of cerebrovascular and tight junction disruption, neuroinflammation, mature neurons, and perineuronal nets in the cortical site of injury, cortex adjacent to injury, dentate gyrus, and the CA 2/3 area of the hippocampus. Animals were randomized into the LFP or rmWD group. On day 1, the LFP group received a craniotomy, and on day 4, injury (or sham procedure; randomly assigned). The rmWD animals underwent either injury or isoflurane only (randomly assigned) on each of those 4 days. Seven days after injury, brains were harvested for analysis. Overall, our observations revealed that the most significant disruptions were evident in response to LFP, followed by craniotomy only, whereas rmWD animals showed the least residual changes compared with isoflurane-only controls, supporting consideration of rmWD as a mild injury. LFP led to longer-lasting disruptions, perhaps more representative of moderate TBI. We also report that craniotomy and LFP produced greater disruptions in females relative to males. These findings will assist the field in the selection of animal models based on target severity of postinjury outcomes and support the inclusion of both sexes and appropriate control groups.

Numerical study of the cooling capacity of several alternative liquids in zig-zag cooling system of a power transformer

Mineral oil is the usual coolant of the power Transformers. Nonetheless, the high risk of fire of this liquid due to its low ignition point and its scarce biodegradability has promoted the development of dielectrics alternative fluids with better physical-chemical properties. However, these new liquids have to be as good coolants as mineral oil in order to maintain the power transformer performance. This numerical study analyzes the coolant capacity of some of these new commercial liquids (a natural ester, a synthetic ester, and a silicone oil) by using the zig-zag cooling system of the low voltage winding of a real power transformer. Two types of thermal-fluid studies (parametric and time-dependent studies) have been made by using a 3D model of this system. The comparison of temperatures obtained from the parametric study (different inlet flow rates) allow us to say that the worst coolant is the silicone oil. Also, it can be say that a significant increase in the inlet flow rate produces mild drops of hot-spots temperatures and no modification in the initial temperature distribution. For the time dependent study (25% of overload during 1 hour), the hot-spot temperature exceed the limits, which negatively affects the aging speed of the insulating paper and therefore the transformer lifetime.

Abstract 12764: Reduced EF With Mavacamten Initiation in a Patient With Atrial Fibrillation: A Case Report

Description of Case: A 55-year-old male with a history of paroxysmal atrial fibrillation (AF) and hypertrophic cardiomyopathy (HCM) diagnosed three years prior at an outside institution presented to clinic with exertional dyspnea. Baseline TTE confirmed HCM demonstrating an EF of 69%, mitral systolic anterior motion (SAM), left ventricular outflow tract (LVOT) obstruction, and a peak gradient exceeding 100 mmHg. Initiation of mavacamten 5mg resulted in symptom improvement and a one-month follow-up TTE demonstrating a reduced peak gradient of 74 mmHg and normal EF. However, two months after initiation the patient returned with AF with rapid ventricular response (RVR) and TTE showed a newly reduced EF of 21%. Mavacamten was stopped while home metoprolol XL was increased from 100 to 150 mg daily for rate optimization. Holter monitoring showed a 100% Afib burden with an average heart rate of 108 beats per minute. Stopping mavacamten for four weeks resulted in worsening exertional dyspnea but restoration of EF to 52% on TTE. Mavacamten was reinstated at a lower dose of 2.5 mg, resulting in symptom improvement. Monthly TTE exams over four months consistently demonstrated a normal EF without LVOT obstruction at rest. Discussion: Mavacamten, a promising drug used to treat obstructive HCM, modulates myosin to reduce myosin-actin cross-bridging. Reduction in contractility improves mitral SAM, LVOT obstruction, and symptoms. However, because mavacamten is a negative inotrope it can also precipitate reductions in EF. Generally, patients have a mild drop in EF (~5 points) after initiation. However, our patient had a significant EF drop of over 25 points likely due to both mavacamten initiation and new AF with RVR reducing systolic function. Discontinuation of mavacamten for four weeks and rate optimization likely restored EF. Dose reduced re-initiation of mavacamten resulted in long-term normal EF and improvement in symptoms. This case highlights the need for close monitoring and individualized mavacamten treatment plans. Further research is warranted to understand the interplay and long term outcomes of tachyarrhythmias and mavacamten use.

Flu Induced Acute Chest Syndrome in Sickle Cell Disease Mice

Background: Sickle cell disease (SCD) affects over ~8 million people world-wide. Acute chest syndrome, a type of acute lung injury (ALI) is a major cause of mortality among SCD patients. Flu is an acute respiratory disease primarily caused by the influenza A virus (IAV), which is typically a self-resolving upper airway inflammation. However, epidemiological evidence suggests that flu can result in severe ACS in SCD patients. Although flu associates with a 50-fold higher risk of ICU admission among SCD than non-SCD humans, the etiological mechanism underlying the flu severity in SCD remains unknown. Aim: To determine whether a mild dose of IAV promotes severe lung injury in SCD mice. Methods: We have developed a model of A/PR/8/34 (H1N1) IAV induced respiratory infection in knock-in, humanized SCD mice. Mice were intranasally inoculated with a mild dose of IAV. The body weight was measured every day for three weeks after intranasal IAV administration followed by assessment of lung injury at day 10 and 14 post infection. Severity of lung injury was evaluated using histological scoring and oxygen saturation measurements. Real-time intravital ( in vivo) multi-photon-excitation fluorescence microscopy (MPE) was used to assess thrombo-inflammation and vascular leakage in the lung of mice at 10 and 14 days post IAV-infection. Results: Over the first 8 days post-IAV infection, both SCD and control mice manifested comparable levels of mild lung injury and a mild drop in body weight (15%). Unlike the control mice that started to recover, the lung injury and drop in body weight continued to worsen in SCD mice at 8-10 days post IAV infection. By day 14 post IAV infection, the lung injury was resolved and body weight was recovered in control mice, while SCD mice still manifested severe lung injury and ~20% drop in body weight. Intravital lung microscopy revealed large areas with vascular occlusion, ischemia, neutrophil infiltration and vascular leakage in the lung of SCD mice 10 days post infection, however, such pathophysiology was rarely present in the lung of control mice at 10 days post infection. Conclusions: Our current findings are the first to suggest that the inflammatory milieu in SCD mice promotes a severe non-resolving ALI following an IAV infection, which otherwise leads to a mild self-resolving lung inflammation in control mice.

Lateral Compartment Syndrome From Inversion Injury.

A 17-year-old male presented for the evaluation of right calf pain after an inversion ankle sprain sustained while playing soccer 24hours prior. On exam, he exhibited swelling and tenderness to palpation over his right calf, mild first web space numbness, and compartment pressures <30mmHg. Magnetic resonance imaging was significant for findings of lateral compartment syndrome (CS). Upon admission, his exam worsened, prompting an anterior and lateral compartment fasciotomy. Intraoperative findings were significant for lateral CS, with findings of avulsed, nonviable muscle with associated hematoma. Postoperatively the patient had mild foot drop, which improved with physical therapy. Lateral CS rarely develops from an inversion ankle sprain. This presentation of CS is unique due to its mechanism, delayed clinical presentation, and limited signs of CS. Providers should maintain a high index of suspicion for CS in patients with this injury complex and continued pain beyond 24hours without signs of ligamentous injury.

Dielectric properties of materials for 3D printing at high frequencies

3D printing is widely used method. In the term of developing of components for electronic devices, it is important to provide the good physical properties of the used dielectric. The main parameters are optional and stable value of the relative permittivity and the minimum dielectric losses of the material. The paper is focused on testing of loss factor and relative permittivity of following materials: polylactic acid (PLA, in two dye modifications), polyethylene terephthalateglycol (PET- G) and acrylonitrile butadiene styrene (ABS) in the frequency range of 1-100 MHz. It was proven, that the values of permittivity of the tested materials were 2.9-4.2 and loss factor 0.8-4%. Concerning relative permittivity, the tendency to mild linear drop of relation was observed by increasing frequency, especially expressed in PLA materials. In loss factor, PLA materials displayed increasing values with increasing frequency, whereas the declining curve was observed in PET-G. Absolute value of ABS loss factor varied between 0.9-1.5%. The reasonable influence of added dyes was found out.

Mild haemoglobin drop and clinical outcomes in acute coronary syndrome patients: finding from the BleeMACS registry.

Haemoglobin drop is common in acute coronary syndrome (ACS) patients and correlates with poor prognosis. However, the association between mild haemoglobin drop and adverse clinical outcome remains insufficiently investigated. This study aimed to examine the association between in-hospital haemoglobin drop and risk for adverse clinical outcomes in ACS patients, especially those with mild drop. Included patients from the BleeMACS (Bleeding complications in a Multicenter registry of patients discharged after an Acute Coronary Syndrome) registry were categorized into three groups by the presence and amount of in-hospital haemoglobin drop (non-drop, mild drop and severe drop). The cut-off point between mild drop and severe drop is ≥ 3 g/dL. Multivariate Cox regression was used to assess the association between haemoglobin drop and major adverse cardiac endpoints (MACE). Patients taking potent P2Y12 inhibitors were selected for the additional analysis. Propensity score matching was used to avoid selective bias in the additional analysis. Of 6911 patients, 4949 patients (71.6%) experienced in-hospital haemoglobin drop. Compare with non-drop group, patients with haemoglobin drop had higher risk of MACE [adjusted hazard ratio (HR) = 1.36, 95% CI: 1.03-1.80 for mild drop group; adjusted HR = 1.70, 95% CI: 1.07-2.68 for severe drop group]. Patients in mild drop group were less likely to receive potent P2Y12 inhibitors at discharge (mild drop group vs. severe drop group vs. non-drop group: 10.9% vs. 10.7% vs. 23.8%). After propensity score matching adjustment among patients with potent P2Y12 inhibitors, patients in mild drop group were not associated with an increased risk of MACE than those in non-drop group (adjusted HR = 1.52, 95% CI: 0.49-4.72). In-hospital haemoglobin drop was common in ACS patients and associated with a higher risk for adverse events. Reduced prescription for potent P2Y12 inhibitors may be responsible for poor prognoses among patients with mild haemoglobin drop.

The availability and distribution of vaping retailers across Ontario neighbourhoods, 2016-2019.

To characterize the distribution of vaping retailers and examine the association between neighbourhood income and vaping retailer availability in Ontario prior to and afterregulatory changes to the vaping market in 2018. We quantified vaping access by number of vaping retailers for 19,964 dissemination areas (DAs) in Ontario and percentage of schools near a vaping retailer. We used mixed-effects regression models to examine the associations between vaping access and neighbourhood income in 2018 and 2019. Between 2016 and 2019, the number of vaping retailers in Ontario increased by 22.6% (5999 to 7355), despite a mild drop from 2016 to 2018. In 2019, 59.7% of urban neighbourhoods had one or more vaping retailers within 1000 m of their geographic centre, and 79.4% of elementary, 82.8% of secondary, and 84.2% of post-secondary schools had at least one within 1000 m. Neighbourhood income was associated with access to vaping retailers, with a greater number in low-income regions. In 2019, neighbourhoods in the lowest income quintile had over twice the number of vaping retailers per capita within 1000 m compared to the highest income quintile (adjusted incidence rate ratio 2.40; 95% CI 2.24-2.58). Increases over time in access to vaping retailers did not differ by geographic region, neighbourhood income quintile, or school type. We observed a substantial increase in access to vaping retailers in Ontario including proximity to elementary and secondary schools following the 2018 provincial marketing regulations and federal nicotine regulations. Access to vaping was greatest in low-income neighbourhoods and may contribute to established inequities in vaping-related adverse events.

Drop foot and adult onset tethered cord syndrome caused by filum terminal ependymoma: A case report

Introduction: Filum terminal is a fibrous tissue to stabilize the position of the spinal cord, located in both intradural and extradural sections anchored caudally to the coccyx. Tumors located at the filum terminal are a rare case. Filum terminal does not have any spinal cord component, but tumours in that area can directly cause a significant neurological disorder. Case Presentation: Presenting 43 years old man with chief complaints of drop left foot and tethered cord syndromes. MR Image revealed 9,4x10mm intradural extramedullary mass at L1 with L1-L5 disc desiccation. The patient was untethered by laminectomy and underwent total mass excision. The sample was analyzed pathologically, and the results matched myxopapillary ependymoma. Pain sensation and sensory disturbance immediately improved after surgery. The urinary disorder also gradually improved. The patient was discharged without any urinary problems. After six months of follow-up, painless, mild left lower drop foot and mild gait disturbance was found without residual urinary and other neurological disorder. Conclusion: Filum terminal ependymomas need to be considered for differential diagnoses in patients with drop foot and adult-onset tethered cord syndromes.

Simultaneous reconstruction of septic composite defects in lower extremities: Combination of fasciocutaneous perforator flap and Masquelet technique.

BackgroundManagement of composite defects with deep infection is a challenge to reconstructive surgeons. This study aimed to demonstrate the versatility, safety, and complications of simultaneous reconstruction of infectious composite defects with fasciocutaneous perforator flap combined with the Masquelet technique.MethodsThis study presents 10 patients in whom a fasciocutaneous perforator flap combined with the Masquelet technique was used to restore soft tissue and bone defects of the lower extremity, and were admitted in two level 1 trauma centers in Shanghai. The first stage included debridement of necrotic bone and infected tissues, implantation of a polymethylmethacrylate cement spacer to cover the void; bridging fixation of the osseous defect using external or internal fixators, and soft-tissue reconstruction with a fasciocutaneous perforator flap. The second stage included cement spacer removal with membrane preservation, refreshing bone edges, and grafting the cavity with bone morphogenetic proteins and autologous iliac bone graft.ResultsThe mean follow-up duration after autologous bone graft was 17.5 months. The average bony defects and average flap dimensions were 7.1 cm and 44.9 cm2, respectively. All flaps survived uneventfully. No recurrence of infection was detected in either the second stage of surgery or follow-up period. The mean duration of bone consolidation was 31.9 weeks. One patient had a 2 cm leg length discrepancy, and one patient had mild foot drop. No residual deformity requiring a secondary procedure occurred.ConclusionFasciocutaneous perforator flap combined with Masquelet technique provides a reliable and versatile alternative for patients with composite defects resulting from lower extremity infection.

Effect of antiscalants on organic fouling potential of rough membrane in membrane distillation: Focusing on the evaluation of interfacial interaction

Impacts of antiscalants on fouling potential of rough membranes were explored in membrane distillation (MD) system, and three antiscalants were applied in this study, including 2-phosphonobutane-1,2,4-tricarboxylic acid (PBTCA), diethylene triamine penta methylene phosphonic acid (DTPMPA), and polymaleic acid (HPMA). Deteriorated organic fouling caused by 150 mg/L lysozyme (LYS) solutions was observed with the addition of antiscalants in MD influent, due to variations of surface properties induced by adhesion of antiscalants. In MD operation of LYS solutions, a mild flux drop of 37.7% was obtained for unmodified PTFE membrane, while PBTCA, DTPMPA, and HPMA groups all demonstrated severe flux decline of 58.4%, 46.4%, and 63.5%, respectively. Methods of surface element integration and extended Derjaguin-Landau-Verwey-Overbeek (XDLVO) theory were applied to estimate interfacial interaction among foulants-reconstructed membrane surface. MD membranes initially adhered by PBTCA and HPMA both demonstrated higher surface roughness and correspondingly lower energy barrier, promoting sharper depositions of LYS and faster flux decline. A four-stage pattern was roughly proposed for organic fouling development in MD, which was notably affected by adherence of antiscalants. Comparatively, MD membranes adhered by DTPMPA displayed relatively lower surface roughness and higher interaction energy barrier, suggesting that DTPMPA might be a feasible method for MD fouling mitigation.

How to avoid rapid carbon dioxide changes at the start of veno-venous extracorporeal membrane oxygenation: Role of end-tidal CO2 monitoring.

Background: Venovenous ECMO is a lifesaving technique for patients with severe respiratory failure. Management of carbon dioxide (CO2) levels at ECMO start is crucial, as recent studies found an association between rapid CO2 shifts and increased incidence of neurological complications.Purpose: To describe the role of end tidal CO2 (etCO2) monitoring at the ECMO start to minimize carbon dioxide shifts.Research design: Retrospective cohort study.Methods: We performed a retrospective analysis of patients who started venovenous ECMO support at our institution between 2011 and 2021. We analysed the minute-by-minute variations of etCO2, ventilatory parameters and arterial blood gas before and after the ECMO start.Results: 36 patients with a complete dataset of parameters were included. After the ECMO start, minute ventilation was progressively reduced from 10.8±;3.3 to 2.9±1.2 L/min (p<0.001). etCO2 did not vary significantly (baseline 37±10 vs 35±9 mmHg 20 minutes after ECMO start, p = 0.36). Despite a stable etCO2 level, a mild drop of arterial CO2 tension (9.5 mmHg, corresponding to a 18% change) was recorded at the first ABG sampled after the ECMO start. No patient developed neurological complications after the ECMO commencement.Conclusion: etCO2 monitoring during ECMO start is feasible and allows to adjust gas flow and ventilator settings to limit changes in arterial CO2 levels.

EXPERIMENTAL AND ANALYTICAL STUDY ON THE IMPACT BEHAVIOR OF STEEL–CONCRETE COMPOSITE SLAB

Concrete structures have been widely used for many years to resist impact loads. Steel–concrete composite structures may be considered efficient structures in the emerging modern construction field. Hence, the main objective of this research was to study the impact behavior of steel concrete composite slabs with different shear connectors and compare them with conventional slabs. Seven specimens of dimensions 500 × 500 × 50 mm were cast, which included plain cement concrete slabs, two reinforced cement concrete slabs with steel mesh and steel rebars as reinforcement, and four steel-concrete composite slabs with four different shear connectors: stud, tee, angle, and channel connectors. The composite action was achieved using a steel decking sheet welded with connectors on which the concrete layer was poured at the top. The test setup was fabricated with slots provided for specimens with simply supported end conditions and a mild steel drop weight. The specimens were impacted at the center of the span by dropping a steel mass from a free fall height of 1 m. The number of blows corresponding to the initial cracking and ultimate failure stages was recorded. The parameters that were used to compare the specimens were the impact energy absorbed, crack pattern, crack width, and increase in impact energy from the first blow to the last blow. The experimental results were very close to the analytical results obtained using ANSYS. The experimental and analytical results showed that the composite slabs with channel connectors performed better than the others, and it was proven that the composite slabs performed better under impact loading than conventional slabs.

Numerical study of fixed ended Lean duplex stainless steel (LDSS) flat oval hollow stub column with square perforation under pure axial compression

This paper presents the parametric study of single square perforated fixed ended LDSS (Lean Duplex Stainless Steel) flat oval section stub columns, by varying the square perforation size, location of perforation along transversely as well as longitudinally, using the Finite element software Abaqus (2009). Based on the Finite element study, a near-linear reduction in ultimate load capacity with perforation size has been observed. The reduction is found to be higher for the stockier cross-sections as compared to slender sections. The percentage drop in ultimate load capacity remains relatively unaffected for larger perforation when the section is slender and located at the flat element. It is seen that, in comparison to the slender section, perforated stocky sections showed a mild drop in ultimate load as the perforation is located toward the corner junction of flat and curve portion from the mid-flat region. Further, in general, it is observed that the reduction in load capacity to be highest when the perforation is located near the mid-height. A design approach based on modified ASDM (Automotive Steel Design Manual) has been proposed to estimate the design capacity of single square perforated flat oval LDSS hollow columns

ADAMTS13 activity decreases in the early phase of trauma associated with coagulopathy and systemic inflammation: a prospective observational study

BackgroundWe conducted a prospective observational study for investigating the changes in the 13th member of a disintegrin-like and metalloprotease with thrombospondin type 1 motif (ADAMTS13) and its association with the coagulofibrinolytic response in adult trauma patients.MethodsIn 39 trauma patients hospitalized for longer than 7 days, time-course changes in biomarkers of coagulofibrinolysis and systemic inflammation along with ADAMTS13 activity were examined. The patients were stratified into three groups based on ADAMTS13 activities on admission (day 0): normal group (≥70%), mildly decreased group (≥50 and < 70%) and moderately decreased group (< 50%).ResultsAmong 39 patients with a median Injury Severity Score (ISS) of 20, 11 patients developed disseminated intravascular coagulation (DIC) and 16 patients required transfusion. Six of 39 patients (15.4%) showed moderate decreased ADAMTS13 activity to < 50%, and 20 patients (51.3%) showed mild drops (≥50 and < 70%). These changes in ADAMTS13 activity on day 0 were significantly correlated with changes in IL-6 and other coagulofibrinolytic markers such as platelet counts, prothrombin time and fibrin/fibrinogen degradation product (FDP). Antithrombin activity (AT) and serum albumin (Alb) level showed significantly positive linear correlations with ADAMTS13 activity (AT: r = 0.513, p < 0.001; Alb: r = 0.647, p < 0.001). Simple logistic regression analyses showed that ADAMTS13 activity, if less than 50%, was significantly correlated with the development of DIC (OR 7.499, 95%CI 1.121–49.242, p = 0.038) and the need for transfusion of fresh frozen plasma (OR 9.000, 95%CI 1.327–61.025, p = 0.028).ConclusionsADAMTS13 activity decreased even in the early phase of trauma, which was complicated by coagulopathy and systemic inflammation. Furthermore, the decrease in ADAMTS13 activity was correlated with DIC and plasma transfusion.

The feasibility and value of extraoperative and adjuvant intraoperative stereoelectroencephalography in rolandic and perirolandic epilepsies.

The objective of this study was to illustrate the feasibility and value of extra- and intraoperative stereoelectroencephalography (SEEG) in patients who underwent resection in rolandic and perirolandic regions. The authors retrospectively reviewed all consecutive patients with at least 1 year of postoperative follow-up who underwent extra- and intraoperative SEEG monitoring between January 2015 and January 2017. Four patients with pharmacoresistant rolandic and perirolandic focal epilepsy were identified, who underwent conventional extraoperative invasive SEEG evaluations followed by adjuvant intraoperative SEEG recordings. Conventional extraoperative SEEG evaluations demonstrated ictal and interictal epileptiform activities involving eloquent rolandic and perirolandic cortical areas in all patients. Following extraoperative monitoring, patients underwent preplanned staged resections guided by simultaneous and continuous adjuvant intraoperative SEEG monitoring. Resections, guided by electrode contacts of interest in 3D boundaries, were performed while continuous real-time electrographic data from SEEG recordings were obtained. Staged approaches of resections were performed until there was intraoperative resolution of synchronous rolandic/perirolandic cortex epileptic activities. All patients in the cohort achieved complete seizure freedom (Engel class IA) during the follow-up period ranging from 18 to 50 months. Resection resulted in minimal neurological deficit; 3 patients experienced transient, distal plantar flexion weakness (mild foot drop). The seizure and functional outcome results of this highly preselected group of patients testifies to the feasibility and demonstrates the value of the combined benefits of both intra- and extraoperative SEEG recordings when resecting the rolandic and perirolandic areas. The novel hybrid method allows a more refined and precise identification of the epileptogenic zone. Consequently, tailored resections can be performed to minimize morbidity as well as to achieve adequate seizure control.

HIT THE HEART: A CASE OF ARTERIAL AND VENOUS THROMBOEMBOLI

SESSION TITLE: Medical Student/Resident Pulmonary Vascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Critically ill patients present with a conundrum of different signs and symptoms in need of a unifying diagnosis. This case was interesting given the presence of both arterial and venous thromboemboli in the setting of recent cardiac surgery. CASE PRESENTATION: 62-year-old male with a history of ischemic cardiomyopathy status post coronary artery bypass graft and bio-prosthetic aortic valve replacement (POD 16) presented with complaints of palpitations and lightheadedness for 2 days. His vitals were notable for tachycardia with EKG confirming atrial flutter with a heart rate in the 160s. His exam was notable for a purplish discoloration of his left great toe concerning for limb ischemia. He was admitted to the ICU where his labs showed acute kidney injury and a troponin of 93 ng/l, peaking at 116 ng/l. Due to high clinical suspicion of embolic phenomenon and risk of limb ischemia in the setting of atrial flutter and he was started on empiric anticoagulation with heparin. Arterial Doppler confirmed embolic phenomenon. Vascular surgery was consulted and they recommended medical management. During his first night, his mental status acutely worsened. Code Stroke was called. His CT head and CTA head and neck were negative for evidence for acute bleeding or clot in the cerebral vasculature. His mental status improved back to baseline quickly. On closer review of the CTA neck, a large right sided PE was visualized, and his labs showed a precipitous drop in his platelet count, due to which there was a concern for heparin-induced thrombocytopenia (HIT). His anticoagulation was changed from Heparin to Argatroban. Heparin/PF4 Ab confirmed HIT. DISCUSSION: HIT is a life-threatening complication after exposure to heparin that occurs regardless of the dose or route of administration. Type I is a mild transient drop in platelet counts that occurs within the first 2 days of heparin exposure and is typically not associated with thrombosis. Type II on the other hand is a clinically significant syndrome due to an immune-mediated process resulting in an auto-antibody directed against endogenous platelet factor 4 complex with heparin (HIT antibodies), which in turn can result in rampant thrombosis. It is associated with both arterial and venous thrombosis. Thrombosis occurs in up to 50 percent of individuals with HIT who are not treated with a non-heparin anticoagulant, with venous more common than arterial thrombi. The reported frequencies range from 20 to 50 percent for venous thrombosis and 3 to 10 percent for arterial thrombosis. This case was interesting in the fact that the patient developed both arterial and venous thromboembolic phenomenon that was managed conservatively. CONCLUSIONS: Arterial and venous thromboembolism are a common finding in HIT, although can be easily masked by other possible diagnoses. Diagnostic vigilance is essential for the prompt initiation of treatment. Reference #1: Fathi M. Heparin-induced thrombocytopenia (HIT): Identification and treatment pathways. Glob Cardiol Sci Pract. 2018;2018(2):15. Published 2018 Jun 30. doi:10.21542/gcsp.2018.15 Reference #2: Warkentin TE. Heparin-induced thrombocytopenia-associated thrombosis: from arterial to venous to venous limb gangrene. J Thromb Haemost. 2018;16(11):2128-2132. doi:10.1111/jth.14264 DISCLOSURES: No relevant relationships by Imama Ahmad, source=Web Response no disclosure on file for Thomas Carr; No relevant relationships by Sneha Lakshman, source=Web Response No relevant relationships by Usama Talib, source=Web Response

The possible disappearance of a massive star in the low-metallicity galaxy PHL 293B

ABSTRACT We investigate a suspected very massive star in one of the most metal-poor dwarf galaxies, PHL 293B. Excitingly, we find the sudden disappearance of the stellar signatures from our 2019 spectra, in particular the broad H lines with P Cygni profiles that have been associated with a massive luminous blue variable (LBV) star. Such features are absent from our spectra obtained in 2019 with the Echelle Spectrograph for Rocky Exoplanet- and Stable Spectroscopic Observation and X-shooter instruments of the European Southern Observatory’s Very Large Telescope. We compute radiative transfer models using cmfgen, which fit the observed spectrum of the LBV and are consistent with ground-based and archival Hubble Space Telescope photometry. Our models show that during 2001–2011, the LBV had a luminosity L* = 2.5–3.5 × 106 L⊙, a mass-loss rate $\dot{M} = 0.005{-}0.020 ~{\rm M}_{\odot }$ yr−1, a wind velocity of 1000 km s−1, and effective and stellar temperatures of Teff = 6000–6800 and T* = 9500–15 000 K. These stellar properties indicate an eruptive state. We consider two main hypotheses for the absence of the broad emission components from the spectra obtained since 2011. One possibility is that we are seeing the end of an LBV eruption of a surviving star, with a mild drop in luminosity, a shift to hotter effective temperatures, and some dust obscuration. Alternatively, the LBV could have collapsed to a massive black hole without the production of a bright supernova.

To Evaluate Efficacy And Safety Of Mmc After Excision Of Ocular Surface Squamous Neoplasia With Conjunctival Autograft

Purpose: This study was conducted to determine the treatment of histologically confirmed ocular surface squamous neoplasia by excision with conjunctival auto graft, and Mitomycin C.&#x0D; Methods: A clinical study of 19 eyes of 19 patients in which excision with conjunctival autograft of ocular surface squamous neoplasia was done and treated with Mitomycin C 0.04% eye drop daily for two to three alternate seven day courses according to the protocol. All patients had weekly follow-up visits till the end of the treatment course, then biweekly visits for three months, and finally monthly visits thereafter.&#x0D; Results: The mean ± SD follow-up period was 39.4±15.3 months (range 06-56 months). Four patients (21.05%) experienced recurrence after the initial treatment; three of them responded to re-treatment and were disease-free, thereafter, till the end of follow-up. Survival analysis with Kaplan-Meier was 94.74%, non-recurrence for 36 months (mean 37.83 months with S.D of 14.73) of follow-up. All patients reported mild to moderate redness and irritation which were controlled with lubricants and mild corticosteroid eye drops. No serious ocular or systemic side effects were seen.&#x0D; Conclusion: Mitomycin C (0.04%) drops used daily for two to three alternate seven day courses were found to be safe and effective with lower recurrence rate for ocular surface squamous neoplasia (OSSN).

Ophthalmomyiasis Externa Presenting As Red Eye

Ophthalmomyiasis is the infestation of the eye with fly larva. It is commonly found in unhygienic areas and poor socioeconomic conditions. Internal Ophthalmomyiasis can be vision threatening leading to blindness, therefore early diagnosis and prompt treatment is required. We present a case of a 21year old male patient who presented with pain, redness and foreign body of left eye. Larva was observed on slit lamp examination. On ex-tracting them and examining, it was found to be Oestrus Ovis. The patient was treated with lubricating drops, mild topical steroid, topical antibiotics and topical betadine drops. The patient responded well to the treatment. Keywords : ophthalmomyiasis, oestrus ovis, sheep nasal botfly