Noninvasive respiratory support for COVID-19 patients: when, for whom, and how?

The significant mortality rate and prolonged ventilator days associated with invasive mechanical ventilation (IMV) in patients with severe COVID-19 have incited a debate surrounding the use of noninvasive respiratory support (NIRS) (i.e., HFNC, CPAP, NIV) as a potential treatment strategy. Central to this debate is the role of NIRS in preventing intubation in patients with mild respiratory disease and the potential beneficial effects on both patient outcome and resource utilization. However, there remains valid concern that use of NIRS may prolong time to intubation and lung protective ventilation in patients with more advanced disease, thereby worsening respiratory mechanics via self-inflicted lung injury. In addition, the risk of aerosolization with the use of NIRS has the potential to increase healthcare worker (HCW) exposure to the virus. We review the existing literature with a focus on rationale, patient selection and outcomes associated with the use of NIRS in COVID-19 and prior pandemics, as well as in patients with acute respiratory failure due to different etiologies (i.e., COPD, cardiogenic pulmonary edema, etc.) to understand the potential role of NIRS in COVID-19 patients. Based on this analysis we suggest an algorithm for NIRS in COVID-19 patients which includes indications and contraindications for use, monitoring recommendations, systems-based practices to reduce HCW exposure, and predictors of NIRS failure. We also discuss future research priorities for addressing unanswered questions regarding NIRS use in COVID-19 with the goal of improving patient outcomes.

Insecticidal and Antifungal Activities of Chemically-Characterized Essential Oils from the Leaves of Withania frutescens L.

The current study was conducted to investigate antifungal and insecticidal activities of essential oil extracted from the Moroccan Withania frutescens L. (EOW), and their chemical composition was profiled. To achieve this goal, EOW was extracted by the hydro-distillation method and their phytochemical constituents were characterized by gas chromatography-mass spectrometry analyses (GC-MS). Insecticidal activity was evaluated by use of four tests: contact toxicity, inhalation toxicity, and repellent tests. Antifungal activity was evaluated on Fusarium oxysporum f. sp. Ciceris (F. oxysporum) using different concentrations of EOW. GC/MS analysis revealed that EOW was rich in carvacrol (31.87%), thymol (30.08%), and camphor (9.13%). At a 1-µL/L dose, EOW exhibited mortality rates of 23.13 ± 1.07% and 24.41 ± 1.21% against Callosobruchus maculatus (C.maculatus) by inhalation and contact, respectively. Notably, EOW dose of 20 μL/L caused significant mortality rates of 95.1 ± 3.5% and 76.69 ± 1.71% by inhalation and contact, respectively. EOW exhibited an inhibitory effect on mycelial growth against the tested fungi F. oxysporum of 100% and 93.5 ± 1.1% for the 9 and 4.5 mg/mL doses, respectively. The reduced mycelial growth rate for F. oxysporum was recorded to be 0.3 ± 0.1 and 0.6 ± 0.1 mm/h for the EOW doses of 2.25 and 4.5 mg/mL, respectively. The outcome of the present work showed that EOW has a promising antifungal and insecticidal activity, and it can therefore be employed as a natural alternative insecticidal and mycocidal agent to replace the chemically-synthesized ones.

Brain Abscess: A Rare Clinical Case with Oral Etiology

Brain abscess is a very rare condition but has a significant mortality rate. The three main routes of inoculation are trauma, contiguous focus, and the hematogenous route. The odontogenic focus is infrequent and is usually a diagnosis of exclusion. This paper presents a brain abscess case proven to be of dental origin, caused by Actinomyces meyeri and Fusobacterium nucleatum. This case highlights the risk underlying untreated dental disease and why oral infectious foci removal and good oral health are essential in primary care.

A Method for Estimating the Number of Infections From the Reported Number of Deaths

At the outset of an epidemic, available case data typically underestimate the total number of infections due to insufficient testing, potentially hampering public responses. Here, we present a method for statistically estimating the true number of cases with confidence intervals from the reported number of deaths and estimates of the infection fatality ratio; assuming that the time from infection to death follows a known distribution. While the method is applicable to any epidemic with a significant mortality rate, we exemplify the method by applying it to COVID-19. Our findings indicate that the number of unreported COVID-19 infections in March 2020 was likely to be at least one order of magnitude higher than the reported cases, with the degree of underestimation among the countries considered being particularly high in the United Kingdom.

Loeffler endocarditis with intracardiac thrombus: case report and literature review

Background Loeffler endocarditis is a relatively rare and potentially life-threatening heart disease. This study aimed to identify the characteristic features of Loeffler endocarditis with intracardiac thrombus on a background of hypereosinophilic syndrome (HES). Case presentation We described a 57-year-old woman with Loeffler endocarditis and intracardiac thrombus initially presenting with neurological symptoms, who had an embolic stroke in the setting of HES. After cardiac magnetic resonance (CMR), corticosteroids and warfarin were administered to control eosinophilia and thrombi, respectively. During a 10-month follow-up, the patient performed relatively well, with no adverse events. We also systematically searched PubMed and Embase for cases of Loeffler endocarditis with intracardiac thrombus published until July 2021. A total of 32 studies were eligible and included in our analysis. Further, 36.4% of recruited patients developed thromboembolic complications, and the mortality rate was relatively high (27.3%). CMR was a powerful noninvasive modality in providing diagnostic and follow-up information in these patients. Steroids were administered in 81.8% of patients, achieving a rapid decrease in the eosinophil count. Also, 69.7% of patients were treated with anticoagulant therapy, and the thrombus was completely resolved in 42.4% of patients. Heart failure and patients not treated with anticoagulation were associated with poor outcomes. Conclusions Cardiac involvement in HES, especially Loeffler endocarditis with intracardiac thrombus, carries a pessimistic prognosis and significant mortality. Early steroids and anticoagulation therapy may be beneficial once a working diagnosis is established. Further studies are needed to provide evidence-based evidence for managing this uncommon manifestation of HES.

How to Maintain Safety and Maximize the Efficacy of Cardiopulmonary Resuscitation in COVID-19 Patients: Insights from the Recent Guidelines

Since December 2019, the novel coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has remained a challenge for governments and healthcare systems all around the globe. SARS-CoV-2 infection is associated with increased rates of hospital admissions and significant mortality. The pandemic increased the rate of cardiac arrest and the need for cardiopulmonary resuscitation (CPR). COVID-19, with its pathophysiology and detrimental effects on healthcare, influenced the profile of patients suffering from cardiac arrest, as well as the conditions of performing CPR. To ensure both the safety of medical personnel and the CPR efficacy for patients, resuscitation societies have published modified guidelines addressing the specific reality of the COVID-19 pandemic. In this review, we briefly describe the transmission and pathophysiology of COVID-19, present the challenges of CPR in SARS-CoV-2-infected patients, summarize the current recommendations regarding the algorithms of basic life support (BLS), advanced life support (ALS) and pediatric life support, and discuss other aspects of CPR in COVID-19 patients, which potentially affect the risk-to-benefit ratio of medical procedures and therefore should be considered while formulating further recommendations.

Stability, Bifurcation, and a Pair of Conserved Quantities in a Simple Epidemic System with Reinfection for the Spread of Diseases Caused by Coronaviruses

In this paper, we study a modified SIRI model without vital dynamics, based on a system of nonlinear ordinary differential equations, for epidemics that exhibit partial immunity after infection, reinfection, and disease-induced death. This model can be applied to study epidemics caused by SARS-CoV, MERS-CoV, and SARS-CoV-2 coronaviruses, since there is the possibility that, in diseases caused by these pathogens, individuals recovered from the infection have a decrease in their immunity and can be reinfected. On the other hand, it is known that, in populations infected by these coronaviruses, individuals with comorbidities or older people have significant mortality rates or deaths induced by the disease. By means of qualitative methods, we prove that such system has an endemic equilibrium and an infinite line of nonhyperbolic disease-free equilibria, we determine the local and global stability of these equilibria, and we also show that it has no periodic orbits. Furthermore, we calculate the basic reproductive number R 0 and find that the system exhibits a forward bifurcation: disease-free equilibria are stable when R 0 < 1 / σ and unstable when R 0 > 1 / σ , while the endemic equilibrium consist of an asymptotically stable upper branch that appears from R 0 > 1 / σ , σ being the rate that quantifies reinfection. We also show that this system has two conserved quantities. Additionally, we show some of the most representative numerical solutions of this system.

Starting and finishing a cardiac case: Sternotomy, hemostasis, and closure

The cardiac multimedia literature is abundant, but a significant gap exists in educational videos demonstrating routine essential steps such as the sternotomy or the closure. These components are common and carry significant mortality and morbidity should a sternal complication occur, highlighting the importance for the cardiothoracic surgeon to master these steps.

Abdominal surgery in autoimmune and autoimmune-related diseases: A review

Autoimmune diseases can have a widespread effect throughout the system and can cause high mortality and morbidity, depending on their involvement in the abdominal organs and systems. Most of the abdominal organs are damaged as a result of the direct or/ and indirect effects of autoimmune diseases. Therefore, abdominal surgeries should be performed to eliminate any complications related to these effects. There could be a significant relationship between abdominal surgery and autoimmune and autoimmune-related diseases. The aim of this study was to reveal the possible relationship between autoimmune and autoimmune-related diseases that cause significant mortality and morbidity. In this way, we further aimed at increasing the awareness of clinicians on this subject, along with providing them with the related publications on autoimmune and autoimmune-related diseases and abdominal surgery. Taking all these into consideration, autoimmune and autoimmune-related diseases can also influence the abdominal organs. The influence may be directly related to the involvement of the organ and system as a result of the autoimmune disease or indirectly related to the influence of the organs and systems. Such influence leading to complications may require urgent or elective abdominal surgery, which can further cause high mortality and morbidity. Therefore, it is significant for all clinicians, especially surgeons, to be aware of the relationship between autoimmune diseases and abdominal surgery. The early detection and treatment of the complications related to the abdominal involvement of autoimmune and autoimmune-related diseases could decrease mortality and morbidity.

Efficacy of Ethanolic plant extracts of Zingiber officinale, Raphanus sativus, Rosa indica and Aloe vera against Heterotermes indicola

Present study was performed to evaluate the anti-termitic potential of four common plant species of Zingiber officinale, Raphanus sativus, Rosa indica and Aloe vera. During laboratory bioassay, the biological activity of ethanolic extracts of these plants was evaluated. The ethanol extract of Z. officinale caused highest mortality (100%) while least mortality (68%) was observed in R. indica extract. The LT50 for Z. officinale were 24.34, 40.40 and 64.7 h for concentrations of 10%, 5% and 3% respectively. Present findings suggested that these plant extracts can provide environmental friendly management of H. indicola. In A. vera, also resulted in significant mortality against H. indicola i.e. 94%, 64% and 44% on exposure of 10%, 5% and 3% concentraions. While LT50 were 34.66, 65.59, and 100.1 hours against 10%, 5% and 3% concentrations. In R. sativus, mortality of H. indicola was 76%, 50% and 30% while LT50 against were 59.10, 86.20, and 127.3 h, against concentration of 10%, 5% and 3%. Least mortality was observed in R. indica i.e. 68%, 44% and 30% while LT50 were 64.17, 94.58 and 125.5 h at 10%, 5% and 3% respectively. This study revealed that the extracts of Z. officinale, A.vera and R. Sativus have a potential to be used for termite control especially Heterotermes indicola to minimize the damage. Copyright(c) The Author