⚠️ ኮቪድ - 19 ⚠️

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@DrSofoniasErmias
@DrSofoniasErmias

Extremely rare case of Necrotizing fasciitis (flesh-eating disease)⚠️

This 59 year-old woman was suffering from a very rare disease which has deprived her of the left half of her face, including the left eye and the left ear. The facial muscles have decayed and the left part of the lips also have been decayed exposing her teeth.
Until that day she had been leading a very normal life and had been a healthy lady who worked in order to meet her day to day expenses.

On that fateful day this dreaded disease commenced, she had fainted, subsequently showing symptoms of paralysis. The neighbours have rushed her to the hospital. They could not control the vomiting of the patient. The next day a swelling has developed in the left side of her face, and the following day the entire left area of her face became red. After two days the swelling started subsiding and simultaneously the muscles of the left side of the face started decaying. The left eye and the left ear had started shrinking appearing similar to dried leaves. After keeping her for two months, doctors operated and removed the accumulated pus content and also the left eye and the left ear. She was discharged after a total of three months.

Necrotizing fasciitis, known as flesh-eating disease, is an infection that results in the death of parts of the body's soft tissue.
It is a severe, rapidly progressive inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues.

Typically the infection enters the body through a break in the skin such as a cut or burn.

Unlike cellulitis, necrotizing fasciitis involves the deeper layers of tissue down to the deep fascia and it is caused by anaerobic bacteria or group A streptococci.

Clinical manifestations include fever with an area of erythema.
Symptoms usually include red or purple skin in the affected area, severe pain, fever, and vomiting.

If not treated, the tissue begins to turn gray/black. It spreads quickly and aggressively from the primary infected area and beyond and can result in amputation, shock, and death if not treated by a combination of surgical exploration and debridement (removing the dead tissue) with IV antibiotics.


@medicaltalks101
@medicaltalks101

This is a huge squamous cell carcinoma (T4) in the head, grown over 5 years until this patient sought help.
He was treated initially with a huge Orticochea Multi-Flap and after sent for chemo and radiation therapy.

Cutaneous squamous cell carcinoma (SCC) represents 20 % of all non-melanoma skin cancer and is a deadly threat owing to its ability to metastasize to any organ in the body.
High-risk features are depth of invasion (>2 mm), poor histological differentiation, high-risk anatomic location (face, ear, pre/post auricular, genitalia, hands, and feet), perineural involvement, recurrence, multiple SCC tumors, and immunosuppression.
Metastatic SCC has a mortality rate of >70 %. Treatment options include surgery, radiation therapy, chemotherapy (cisplatin), and any combination of the above.
Surgery alone can be used for metastatic of high-risk SCC treatment but is not as effective as surgery in conjunction with radiation therapy. NCCN guidelines recommend 4-to 6-mm clinical margins for standard excision of low-risk SCC and 6 to 10mm in high-risk, like in this case.

In this patient, the resection was made with a 10mm margin, the resection was full-thickness (up to the periosteum), and in the central part, the outer table of the skull was resected. To cover this defect, a big Orticochea flap was made. The Orticochea flap is an excellent option for scalp reconstruction as it decreases operative time may provide hair-bearing skin. After the surgery, the patient was sent to receive chemo and radiation.


@medicaltalks101
@medicaltalks101

Purple Urine! A 76-year-old male nursing home resident with dementia and end-stage renal disease who was undergoing hemodialysis was admitted to the hospital after a syncopal episode that occurred during dialysis. Torsades de pointes was noted on telemetry monitoring.

When a urinary catheter was placed, purple urine was drained. The patient had no fever, lower urinary tract symptoms, or leukocytosis.

The urinalysis showed a pH of 9.0 and bacteriuria but no hematuria or pyuria.

The urine culture showed 105 colony-forming units or more per milliliter for both Pseudomonas aeruginosa and enterococcus species.

Over the next 3 days, the urine gradually became yellow and clear, in the absence of antibiotic treatment.

Purple discoloration can occur in alkaline urine as a result of the degradation of indoxyl sulfate (indican), a metabolite of dietary tryptophan, into indigo (which is blue) and indirubin (which is red) by bacteria such as Providencia stuartii, Klebsiella pneumoniae, P. aeruginosa, Escherichia coli, and enterococcus species.

The clinical course is benign, and the urine typically clears with resolution of the bacteriuria and acidification of the urine.
This patient had no further episodes of torsades de pointes.


@medicaltalks101
@medicaltalks101

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@medicaltalks101
@medicaltalks101

Don’t Hug Your Kids Even If You’ve Been Vaccinated, Expert Warns

🇬🇧@COVID19Up: Britons should not hug their children even once they’ve been vaccinated, an expert has stressed, amid warnings that millions are likely to begin ignoring coronavirus lockdown rules once they have had the jab.

Scientists have expressed concern that recipients of a COVID-19 vaccine will feel more relaxed about social distancing, which could “offset” the benefits of the national vaccination program.

Asked whether people who had received the jab could hug their children, Janet Lord, director of Birmingham University’s Institute of Inflammation and Ageing, said: “I would certainly advise not to do that at the moment because as you probably know with the vaccines they take several weeks before they are maximally effective."

“There is a risk that changes in behavior could offset the benefits of vaccination, particularly in the early months of vaccine rollout." SOURCE

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Pfizer's COVID-19 Vaccine Slightly Less Effective Against Key South African Mutations, Study Shows

📝@COVID19Up: Pfizer Inc and BioNTech’s COVID-19 vaccine appeared to lose only a small bit of effectiveness against an engineered virus with three key mutations from the new coronavirus variant found in South Africa, according to a laboratory study conducted by the U.S. drugmaker.

The study by Pfizer and scientists from the University of Texas Medical Branch, which has not yet been peer-reviewed, showed a less than two-fold reduction in antibody titer levels, indicating the vaccine would likely be effective in neutralizing a virus with the so-called E484K and N501Y mutations found in the South African variant.

The study was conducted on blood taken from people who had received the vaccine. Its findings are limited because it does not look at the full set of mutations found in the new South African variant. SOURCE

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Schizophrenia is 2nd Highest Risk Factor for Dying of COVID-19, After Age

📝@COVID19Up: Schizophrenia may be one of the highest risk factors for dying from COVID-19, second only to age, according to a new study.

Previous studies had found that people with mental illnesses, particularly depression and schizophrenia—a condition that causes distortions in thinking and perception—had a higher risk of becoming infected with SARS-CoV-2, the virus that causes COVID-19. But it was not known whether mental disorders were also associated with a risk of dying from COVID-19. SOURCE

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Americans Warned Against Travel as COVID Variants Spread and Testing Rules Go in Effect

🇺🇸@COVID19Up: The State Department warned Americans to strongly reconsider travel as a new COVID-19 testing requirement went into effect and new variants of the virus were detected in Latin America and the Caribbean.

"If you're overseas right now, it could be harder to come home for awhile," said Ian Brownlee, the State Department's acting assistant secretary for consular affairs. "Everyone needs to be prepared to be potentially seriously disrupted in their trip."

"The bottom line message is: This is really not the time for people to be engaging in discretionary travel and that all travel should be postponed until we get a better handle on getting this virus under control, and accelerating our vaccination strategies," he said. SOURCE

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Coronavirus Variant First Found in UK Has Now Been Detected in 26 States

🇺🇸@COVID19Up: The more contagious and possibly deadlier variant of the coronavirus that was first identified in the United Kingdom is confirmed to be present in more than half of the states across the U.S., according to the CDC.

“In the United States, 308 cases of B.1.1.7 variant that originated from the U.K. have been confirmed in 26 states as of January 26th,” CDC Director Rochelle Walensky said Wednesday during a White House COVID-19 briefing.

“The variants that have been identified recently seem to spread more easily, they’re more transmissible, which can lead to an increased number of cases and increase stress on our already taxed health care system,” Walensky said.

The U.K. variant is believed to be 50% more contagious than other strains of the virus and there is some evidence that it could even be deadlier than the current common strain. SOURCE

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Oklahoma Seeking to Return $2,000,000 Worth of Hydroxychloroquine

🇺🇸@COVID19Up: The Oklahoma attorney general’s office is attempting to return $2 million worth of a malaria drug once touted by Donald Trump as an effective treatment for COVID-19.

Republican Gov. Kevin Stitt defended the purchase last year, saying the drug was showing some promise as a treatment in early March and he didn’t want to miss an opportunity to acquire it.

“I was being proactive to try and protect Oklahomans,” Stitt said.

The drug has since been shown to have little or no effect on severe cases of COVID-19, and a former state health official chalked up Oklahoma’s purchase to something that happens in “the fog of war.” SOURCE

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California Health Care Worker Dies Days After Receiving 2nd Dose of Pfizer's COVID-19 Vaccine

💉@COVID19Up: A health care worker has died at UC Irvine Medical Center after receiving his second dose of Pfizer's coronavirus vaccine, the Orange County Register reported Tuesday.

Tim Zook, a 60-year-old X-ray technologist at South Coast Global Medical Center in Santa Ana, suffered an adverse reaction within hours after the second shot was administered, according to the newspaper.

He died days later, on Saturday.

The Orange County coroner's office said it was investigating the man's death, adding that if there is a correlation to the vaccine it will notify the OC Health Care Agency. SOURCE

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Philadelphia Let College Kids Distribute COVID-19 Vaccines and the Result Was a "Disaster"

🇺🇸@COVID19Up: When it came time to set up Philadelphia's first and largest coronavirus mass vaccination site, officials turned to the start-up Philly Fighting COVID, a self-described “group of college kids” with minimal health-care experience.

Chaos ensued.

Seniors were left in tears after finding that appointments they’d made through a bungled sign-up form wouldn’t be honored. The group switched to a for-profit model without publicizing the change and added a privacy policy that would allow it to sell users’ personal data. One volunteer alleged that the 22-year-old CEO had pocketed vaccine doses. Another described a “free-for-all” where unsupervised 18- and 19-year-olds vaccinated one another and posed for photos. SOURCE

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