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Abstract:: Coccidioidomycosis is a fungal infection that is a rare cause of prosthetic joint infection (PJI) in patients. This case report describes an immunocompetent patient who had a right total hip arthroplasty (THA) complicated with Coccidioidomycosis. This patient is the 9th reported case of Coccidioidomycosis, causing a PJI and only the second case to be reported in a THA. Once progressed, it can be difficult to treat, often reoccurring and requiring repeat surgical and prolonged therapy. This study discusses the clinical presentation in this patient and reviews the literature on the currently published cases.

Background Currently, the management of SARS-CoV-2 varies with no definitive clinical guidelines, as scientific evidence across the globe differs in therapeutic options. This study intended to provide some clarity to the insufficient data based on the role of monotherapy with tocilizumab (TCZ) and combination therapy with remdesivir (RDV) and TCZ among patients with SARS-CoV-2 infection in El Paso, Texas. We evaluated the use of each therapy in the presence of steroids as the standard of care. Methods One hundred and fifty-four SARS-CoV-2-infected patients from four different medical centers in El Paso, Texas, were screened, with 113 eligible for this longitudinal comparative observational study (February 1, 2020 to October 31, 2020). Group 1 (80 patients) received TCZ in the first 24 hours following admission, then methylprednisolone for the next 72 hours and group 2 (33 patients) were given TCZ as detailed in the single therapy group, plus RDV within the first 24 hours. Mann Whitney U test assessed median differences in laboratory biomarkers and Bivariate Logistic Regression assessed the odds of risk. An observation is considered statistically significant when P-value is ≤0.05. Results Patients in group 1 had a statistically significant lower odds for ventilation use than group 2 (OR=0.34, 95%CI=0.12-0.95, p=0.034), although no statistically significant difference in mortality outcomes was observed across groups (OR=0.43, 95%CI:0.13-1.39, p=0.269). Conclusions We concluded that the use of TCZ in SARS-CoV-2-infected patients in El Paso, with or without RDV, reported no mortality benefit. However, some minimal/non-use of ventilation benefit was observed in group 1. Nonetheless, a randomized controlled trial study is recommended to ultimately determine the combination role of TCZ and RDV among this highly vulnerable group of patients.

Coughing is a primary symptomatic pathway of respiratory or air-borne disease transmission, including COVID-19. Several parameters such as cougher's age, gender, and posture affect particle dispersion indoors. This study numerically investigates the transient cough evolution, contamination range, particle reach probability, and deposition fraction for different age groups of males and females in standing and sitting postures in a ventilated room. The efficacy of a cloth mask has also been studied with and without the influence of air ventilation. Validated Computational Fluid Dynamics methodology has been implemented to model complex physics such as turbulent buoyant cloud, particle-air interaction, particle collision/breakup, and droplet evaporation. Our results show that overall, the contamination range is slightly lower for females due to lower cough velocities and particle counts. Moreover, a significant fraction of particles crosses the two meters social distancing guideline threshold with an unhindered cough. Besides, wearing a cloth mask reduces the average contamination range by approximately two-third of the distance compared to coughing without the mask. However, aerosolized particles reach longer streamwise distances and drift for extended durations beyond thirty seconds. This study can be used to improve the heating, ventilation, and air conditioning recommendations and distancing guidelines in indoor settings.

Coccidioidomycosis is a fungal infection caused by Coccidioides immitis which thrives in dry desert climates such as the southwestern United States. Disseminated coccidioidomycosis is often seen in patients with an underlying immunodeficiency. Historically there have been few reported cases of opportunistic infections in the setting of low CD4+ count and no evidence of HIV infection. Coccidioidomycosis typically presents asymptomatically or as a minor respiratory illness in immunocompetent individuals. We report a case of disseminated coccidioidomycosis in a patient who is otherwise immunocompetent. Patient is a 24-year-old Hispanic male who presented with severe headache, fever, body pain, vomiting, and diarrhea for approximately 14 days. On admission, patient’s CD4+ count was 91 and CSF culture grew Coccidioides immitis, for which patient was started on fluconazole. Patient’s hospital stay was complicated by multiple bouts of altered mental status, fevers, hyponatremia, hydrocephalus, neurogenic bladder, new-onset Mobitz II heart arrhythmia, urinary tract infection, and sepsis. MRI studies revealed abnormal enhancement of leptomeninges, bilateral basal ganglia, thecal sac and cauda equina fibers, signifying disseminated disease. Patient’s serum Coccidioides complement fixation (IgG) titers remained elevated despite aggressive therapy with IV amphotericin B. After a total of six months of hospitalization, including treatment with intrathecal amphotericin B, patient’s last CD4+ count was 549, CSF IgG titers achieved

RESULTS Final results showed that 86% of patients were satisfied or better on a 6-point scale. At week 12, investigators expressed high satisfaction, with a 93% satisfaction rating or better. At weeks 2 and 12, physicians evaluated 98% of patients as improved or better on the Global Aesthetic Improvement Scale. Mild adverse events generally resolved within 2 weeks. Three cases of delayed edema reported 7 to 14 days after treatment resolved without intervention. CONCLUSION Ease of use, minimal postprocedure events, desirable cosmetic outcome, and duration underscore the benefits of CaHA as a safe, efficient, noninvasive treatment option for the aging hand. BioForm Medical Europe commissioned this study and the attendant postmarketing surveillance. BioForm Medical Europe reimbursed each physician a designated sum for each completed patient treatment, including five sets of questionnaires and photos. In return for their participation and completion of the Media Release Form, patients received a maximum of three syringes of BioForm Medical product for treatment of the hands. The individual treating physician determined total cost of treatment.

Stretch of cardiomyocytes in vivo occurs in response to a number of stimuli, including pressure or volume overload, but it is most clearly seen following relatively large, acute myocardial infarctions. It is in this setting that stretch is most clearly related to the pathogenesis of heart failure. Stretch of the remote, noninfacted myocardium leads to the activation of a large number of cellular signal transduction pathways, which sets into motion a series of what are designed to be compensatory responses to the increased wall stress on the surviving myocardium. Herein, we will discuss the cellular pathways activated by cell stretch, which appear to trigger the initial steps in the pathogenesis of ventricular dilatation following myocardial infarction. We will discuss what is known of the "stretch sensors," which convert the mechanical stimulus into molecular signals. I will then introduce the specific cellular signaling pathways activated by stretch and discuss the evidence for their involvement in remodeling. Since many of these pathways will be covered in more detail in specific sections to follow, this will serve as an introduction to stretch-activated signaling. Finally, we will briefly examine later phases of the response, including advanced heart failure. The goal is to identify molecular modulators that might serve as targets for pharmacologic or molecular intervention.

Background —Left ventricular failure is commonly preceded by a period of hypertrophy. Intriguingly, many of the signaling pathways that have been implicated in the regulation of hypertrophy, including the 3 mitogen-activated protein kinases (MAPKs: extracellular signal-regulated kinase, stress-activated protein kinase, and p38), protein phosphatase, calcineurin, and the protein kinase Akt and its target glycogen synthase kinase-3 (GSK-3), also regulate the apoptotic response. Methods and Results —To understand the mechanisms that might regulate the progression of heart failure, we analyzed the activity of these signaling pathways in the hearts of patients with advanced heart failure, patients with compensated cardiac hypertrophy, and normal subjects. In patients with hypertrophy, neither the MAPK nor the Akt/GSK-3 pathways were activated, and the dominant signaling pathway was calcineurin. In failing hearts, calcineurin activity was increased but less so than in the hypertrophied hearts, and all 3 MAPKs and Akt were activated (and, accordingly, GSK-3β was inhibited), irrespective of whether the underlying diagnosis was ischemic or idiopathic cardiomyopathy. Conclusions —In the failing heart, there is a clear prohypertrophic activity profile, likely occurring in response to increased systolic wall stress and neurohormonal mediators. However, with the activation of these hypertrophic pathways, potent proapoptotic and antiapoptotic signals may also be generated. Therapies directed at altering the balance of activity of these signaling pathways could potentially alter the progression of heart failure.

Praise be to God for perpetually bestowing upon us His gifts and favors, and for His benevolence. After this follow our prayers for our lord Muhammad and his family. Peace be upon them!

By the time Islam emerged on the world scene, the two towering giants of Greek philosophy, Plato and Aristotle, had been blended into Neoplatonism. In fact the marriage of the two sets of ideas had already been consummated when Porphyry (d. 309 A.D.) made it a philosophical orthodoxy that Plato and Aristotle were in agreement.1 Islam found itself heir to an Aristotle soaked in Neoplatonism both of the pagan Athenian as well as of the Christian Alexandrian kind, and inherited both the debates as well as the commentatorial preoccupations of the two schools.2

Demographic and drug abuse characteristics of 3,484 new drug abuse contacts presenting to the General Hospital, Kuala Lumpur, Malaysia are reported. The large majority were heroin inhalers. They were different from the traditional Eastern opium inhalers and similar to Western heroin injectors in that they were young, male, single, and frequently unemployed. These features and the relative underrepresentation of Chinese suggest that the Chinese of this study did not learn narcotic abuse from opium-smoking relatives.