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.

Chemical meningitis is a rare, noninfectious complication of intrathecal manipulation. The common complaint of back pain may result in the need for neurosurgical procedures or placement of intrathecal pain pumps, which may give rise to this complication.

We consider the global well-posedness and asymptotic behavior of compressible viscous, heat-conductive, and non-resistive magnetohydrodynamics (MHD) fluid in a field of external forces over three-dimensional periodic thin domain $\Omega=\mathbb{T}^2\times(0,\delta)$. The unique existence of the stationary solution is shown under the adhesion and the adiabatic boundary conditions. Then, it is shown that a solution to the initial boundary value problem with the same boundary and periodic conditions uniquely exists globally in time and converges to the stationary solution as time tends to infinity. Moreover, if the external forces are small or disappeared in an appropriate Sobolev space, then $\delta$ can be a general constant. Our proof relies on the two-tier energy method for the reformulated system in Lagrangian coordinates and the background magnetic field which is perpendicular to the flat layer. Compared to the work of Tan and Wang (SIAM J. Math. Anal. 50:1432–1470, 2018), we not only overcome the difficulties caused by temperature, but also consider the big external forces.

The purpose of this study is to obtain the solution using the Lie group of symmetry method for the problem of propagating magnetogasdynamic strong cylindrical shock wave in a self-gravitating non-ideal gas with the magnetic field which is taken to be axial. Here, isothermal flow is considered. In the undisturbed medium, varying magnetic field and density are taken. Out of four different cases, only three cases yield the similarity solutions. Numerical computations have been performed for the cases of power-law and exponential law shock paths, to find out the behavior of flow variables in the flow-field immediately behind the shock. Similarity solutions are carried out by taking arbitrary constants in the expressions of infinitesimals of the Lie group of transformations. Also, the study of the present work provides a clear picture of whether and how the variations in the non-ideal parameter of the gas, Alfven-Mach number, adiabatic exponent, ambient magnetic field variation index and gravitational parameter affect the propagation of shock and the flow behind it. Software package “MATLAB” is used for all the computations.

Large cell neuroendocrine carcinoma (LCNEC) was first proposed by Travis et al. in 1991 and subsequently classified as high grade neuroendocrine carcinoma (HGNEC) by the world health organization. It is a rare tumor with unclear clinicopathologic features. Herein, we describe a rare case of LCNEC with a unique Cushing’s presentation.

We are concerned with the inverse problem of recovering the unknown wave speed and also the source in a multidimensional wave equation. We show that the wave speed coefficient can be reconstructed from the observations of the solution taken at a single point. For the source, we may need a sequence of observation points due to the presence of multiple spectrum and nodal lines. This new method, based on spectral estimation techniques, leads to a simple procedure that delivers both uniqueness and reconstruction of the coefficients at the same time.

Background: COVID-19 pandemic has caused fear all around the world. With people avoiding hospitals, there has been a significant decrease in outpatient clinics. In this study, we aimed to compare and explore the first-peak of the pandemic period by studying its effects on patient applications, new diagnoses, and treatment approaches in a non-infected hospital. Methods: We collected data from the first peak of the pandemic period in Turkey, from the pandemic’s declaration (March 11, 2020) to social normalization (June 1, 2020), and compared it with data from a pre-pandemic period with a similar length of time. We analyzed the data of breast cancer patients from application to surgery. Results: The data of 34,577 patients were analyzed for this study. The number of patients who applied to outpatient clinics decreased significantly during the pandemic period. After excluding control patients and benign disorders, a figure was reached for the number of patients who had a new diagnosis of breast cancer (146 vs 250), were referred to neoadjuvant treatment (18 vs 34), and were treated with surgery (121 vs 229). All numbers decreased during the pandemic period, except for surgeries after neoadjuvant treatment (29 vs 27). Surgical treatment approaches also changed. However, the rate of newly diagnosed breast cancer patients treated with surgery was similar in both periods. None of these patients were diagnosed with COVID-19 or died during the pandemic. Conclusion: This study shows that non-infected hospitals can be useful in avoiding delays in the surgical treatment of cancer patients.

A document by Anand Manickavasagam. Click on the document to view its contents.

Tissue Coverage MattersArvindh Kanagasundram, Travis D Richardson, and William G StevensonFrom the: Division of Cardiovascular Medicine, Arrhythmia Section,Vanderbilt University Medical Center. Nashville, TN

Main Text FileUsefulness of thymus and activation-regulated chemokine (TARC) for FPIES diagnosis

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.

In this paper, we generalized E.C. Kim’ s estimates by taking in to account the trace of the divergencefree symmetric tensor non−zero. We have also shown that E.C. Kim’s estimates still valid in case of the trace of the divergencefree symmetric tensor vanished identically. In the equality case, we characterized eta−Killing spinor with Killing pair over the Sasakian spin manifolds.

A 13-year-old healthy girl presented with dizziness and palpitations, found to have a left atrial mass. An 8 cm tumor was removed. Pathology confirmed leiomyosarcoma, Grade 3 with positive margins. She was treated with ifosfamide and doxorubicin prior to radiation with concurrent ifosfamide alone. She was treated to 66 Gy in 33 fractions to the operative bed. Prospectively graded toxicities included Gr 2 esophagitis and Gr 1 anorexia, dermatitis and fatigue. She completed a total of 6 cycles of ifosfamide. One year after treatment she had no evidence of disease with normal ECHO and no cardiac, pulmonary or esophageal symptoms.

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 and Objective: The knowledge about the impact of the nonpharmacological measures to control the COVID-19 pandemic can give insight to ways in which they can also be applied for other respiratory diseases. To assess the impact of containment measures of the COVID-19 pandemic on pneumonia hospitalizations in children from 0 to 14 years of age in Brazil. Methods: Data from hospital admissions for pneumonia were obtained from the Department of Informatics of Brazilian Public Health System database in the period of 2015–2020 and analyzed by macro-regions and age groups. To evaluate the effect of containment measures, used in the pandemic, on the incidence of pneumonia, the absolute reduction and relative reduction were calculated by analyzing the subsets 2015-2019 vs 2020. Results: Comparing the subsets of April-August 2015-2019 vs April-August 2020, there was an expressive reduction in the average incidence of hospitalizations, with numbers ranging from -87% [IRR 0.12 (0.10 to 0.14)] for < 4 years, -79% [IRR 0.21 (0.07 to 0.57)] for 5-9 years, -73% [IRR 0.26 (0.05 to 1.21)] for 10-14 and -86% [IRR 0.14 (0.06 to 0.29)] for <14 years. Conclusion: We found a significant decrease in cases of pneumonia during the COVID-19 pandemic. Nonpharmacological public health interventions can contribute to the decline of other respiratory infectious diseases.

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.