Many patients are affected by HIV/AIDS, and these conditions are highly prevalent worldwide. Patients with HIV/AIDS can experience debilitating wound infections that often require flap reconstruction and become challenging for surgeons to treat. In the past 5 years, mesenchymal stem cells have been tested and used as regenerative therapy to promote the growth of tissues throughout the body because of their ability to successfully promote cellular mitogenesis. To the authors’ knowledge, the use of mesenchymal stem cell grafting following necrosis of a myocutaneous gracilis flap (as part of perineal wound reconstruction) has never been reported in the literature. In addition, the use of mesenchymal stem cells and regenerative medicine combined in the setting of squamous cell carcinoma of the anus with prior radiation (along with comorbid AIDS) has not been previously documented. In this report, the authors outline the case of a 60-year-old patient who had a recipient bed (perineum) complication from prior radiation therapy. Complicating the clinical picture, the patient also developed a Pseudomonal organ space infection of the pelvis leading to the failure of a vertical rectus abdominis myocutaneous flap and myocutaneous gracilis flaps. As a result, the patient underwent serial operative debridements for source control, with the application of mesenchymal stem cells, fetal bovine dermis, porcine urinary bladder xenograft, and other regenerative medicine products, achieving a highly successful clinical outcome. A procedural description for future use and replication of this method is provided.
The Supreme Court of Nepal is the highest court in Nepal. The Supreme Court of Nepal is an important building, built of brick in mud masonry structure and over 54 years of age which got moderate structural damage due to the recent Gorkha earthquake 2015. The need for safety of the building lying at high seismic zone in Nepal, the Seismic Vulnerability Assessment and Retrofit design was carried out to improve the building response in future earthquakes. The seismic vulnerability of the building was assessed after the following:(a) historical investigation about the building, (b) detailed geometrical investigation, (c) identification of materials by means of surveys and literature indications, (d) Detailed Intrusive Tests, (f) Detail linear static analysis of the building by means of a Finite Element (FE) model. After these steps, the FE model was used to assess the safety level of the building by means of linear static analyses and identifying a proper retrofitting strategy for this building. Both side wall jacketing and splint and bandage in some inner walls using the bar wire mesh was carried out for retrofitting this building.
Background: A rapidly growing number of publications cite “cytokine storm” as a contributing factor in coronavirus disease 2019 (COVID-19) pathology. However, a few recent reports led to questioning of “cytokine storm” theory in COVID-19. This study’s primary goal is to determine if exaggerated cytokine response in the range of a “cytokine storm” develops during the initial weeks of hospitalization in COVID-19 patients. Methods: Five proinflammatory cytokines reported to be involved in “cytokine storm” and elevated in COVID-19 (IL-6, IL-8, TNF-α, MCP-1, and IP-10) were analyzed in COVID-19, influenza (with “cytokine storm”: CS), and burn injury patients. The effect of dexamethasone use on cytokine response in COVID-19 was also analyzed. Results: None of the five cytokines in COVID-19 patients reached the lower threshold (95% CI) of the influenza (CS) group at any point during the study period. Furthermore, mean concentrations of all five cytokines in the influenza (CS) group and IL-6, IL-8, TNF-α in the burn group were significantly greater than in COVID-19 patients (p < 0.01). Dexamethasone treatment did not significantly alter the concentrations of any of the cytokines analyzed. Conclusions: Exaggerated cytokine response similar to “cytokine storm” was not observed in COVID-19 patients during two weeks of hospitalization.
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