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Benign lesions over the auricular region are not uncommon. Most lesions require an excisional biopsy for its histopathological confirmation. If excised, the resultant would be a small to medium sized soft tissue defect, exposing the cartilaginous portion of the ear. Options for reconstruction include a full-thickness skin graft, local flap cover or a wedge composite excision to retain the aesthetic appearance of the auricle. Local flap cover or wedge composite resection are not without demerits. If a full thickness graft is needed, the donor area is usually the post auricular region. We present a modified elliptical incision M-plasty technique to minimize the tissue loss in donor post auricular area when harvesting full thickness skin graft. Although the traditional elliptical incision is used by majority of surgeons to harvest full thickness skin graft from the post-auricular region, the M-plasty technique used in our case is a modification of the traditional elliptical incision which preserves tissue that allows the surgeon to close the wound with less tension and short scar. [ABSTRACT FROM AUTHOR]

Background: The optimal timing of intubation has been debated among healthcare professionals, current studies do not show any differences between early and late intubation. most studies failed to show any significant difference in clinical outcomes between early or late intubation. Methods: The study was conducted as a retrospective review of subjects with confirmed coronavirus disease 2019 admitted to the Dubai Hospital intensive care unit (ICU). Study variables included time to intubation, duration of supplemental oxygen requirement>15L/min, and cumulative duration of tachypnea and tachycardia while on the aforementioned oxygen requirement on this oxygen usage level. Each time duration was assessed for correlation with clinical variables including mortality and length of stay in ICU and hospital. Results: Subjects who require endotracheal intubation within 4 h after the start of oxygen >15 L/min have lower survival (P = 0.03). Subjects who have tachypnea on the aforementioned oxygen requirement for 6–19.5 h (P = 0.01) before they require intubation have better survival. No duration of tachycardia has any significant effect on survival. Only the duration of invasive mechanical ventilation (MV) correlated with the hospital length of stay. Conclusions: Subjects who require endotracheal intubation within 4 h after the start of oxygen >15 L/min have lower survival. The optimal time for intubation is after tachypnea of 6 h but before 19.5 h. No duration of tachycardia has any significant effect on survival. Only the duration of invasive MV correlated with the hospital length of stay. [ABSTRACT FROM AUTHOR]

Introduction: Coagulation dysfunction and thromboembolism emerge as strong comorbidity factors in severe COVID‐19. However, it is unclear when particularly platelet activation markers and coagulation factors dysregulated during the pathogenesis of COVID‐19. Here, we sought to assess the levels of coagulation and platelet activation markers at moderate and severe stages of COVID‐19 to understand the pathogenesis. Methods: To understand this, hospitalized COVID‐19 patients with (severe cases that required intensive care) or without pneumonia (moderate cases) were recruited. Phenotypic and molecular characterizations were performed employing basic coagulation tests including prothrombin time (PT), activated partial thromboplastin time (APTT), D‐Dimer, and tissue factor pathway inhibitor (TFPI). The flow cytometry‐based multiplex assays were performed to assess FXI, anti‐thrombin, prothrombin, fibrinogen, FXIII, P‐selectin, sCD40L, plasminogen, tissue plasminogen activator (tPA), plasminogen activator inhibitor‐1 (PAI‐1), and D‐Dimer. Results: The investigations revealed induction of plasma P‐selectin and CD40 ligand (sCD40L) in moderate COVID‐19 cases, which were significantly abolished with the progression of COVID‐19 severity. Moreover, a profound reduction in plasma tissue factor pathway inhibitor (TFPI) and FXIII were identified particularly in the severe COVID‐19. Further analysis revealed fibrinogen induction in both moderate and severe patients. Interestingly, an elevated PAI‐1 more prominently in moderate, and tPA particularly in severe COVID‐19 cases were observed. Particularly, the levels of fibrinogen and tPA directly correlated with the severity of the disease. Conclusions: In summary, induction of soluble P‐selectin, sCD40L, fibrinogen, and PAI‐1 suggests the activation of platelets and coagulation system at the moderate stage before COVID‐19 patients require intensive care. These findings would help in designing better thromboprophylaxis to limit the COVID‐19 severity. [ABSTRACT FROM AUTHOR]

Background: Sarcoidosis is a granulomatous disease with unknown cause that can vary from an asymptomatic condition. Almost half of the patients with sarcoidosis have no symptoms. Case report: 8 year-old female, referred from Abha Hospital as a case of prolonged fever. The fever was low grade, lasted for months, mostly at night, and was associated with fatigue and no weight gain. Systemic review showed abdominal distension, history of knee pain, mouth ulcers and temporary rash on feet. Conclusion: Sarcoidosis is a disease that mostly affects the lung, but sometimes it is outside the lung, as in our cases. Doctors should pay attention to this so that the wrong diagnosis does not lead to complications or death of the patient. [ABSTRACT FROM AUTHOR]