What does this study add to the field?Using latent class analysis (LCA), we identified two subgroups among a cohort of 483 patients with COVID-19-related ARDS. Class 2 patients had higher inflammatory markers and lactate and corresponded with the previously identified hyperinflammatory subphenotype, whereas Class 1 corresponded with the hypoinflammatory subphenotype. Class 2 had significantly higher 90-day mortality compared with Class 1 (75% vs 48%; p<0•0001). Differential response to corticosteroid treatment was observed, with decreased mortality in steroid-treated patients in Class 2 but not Class 1. SARS-CoV-2 polymerase chain reaction cycle threshold was a predictor of mortality in Class 1, but not Class 2, suggesting distinct drivers of mortality among classes.

PURPOSE: COVID-19 has altered healthcare delivery. Previous work has focused on patients with cancer and COVID-19, but little has been reported on healthcare system changes among patients without COVID-19. METHODS: We performed a retrospective study of patients with breast cancer (BC) in New York City between February 1, 2020, and April 30, 2020. New patients were included as were patients scheduled to receive intravenous or injectable therapy. Patients with COVID-19 were excluded. Demographic and treatment information were obtained by chart review. Delays and/or changes in systemic therapy, surgery, radiation, and radiology related to the pandemic were tracked, along with the reasons for delay and/or change. Univariate and multivariable analysis were used to identify factors associated with delay and/or change. RESULTS: We identified 350 eligible patients, of whom 149 (42.6%) experienced a delay and/or change, and practice reduction (51.0%) was the most common reason. The patients who identified as Black or African American, Asian, or Other races were more likely to experience a delay and/or change compared with White patients (Black, 44.4%; Asian, 47.1%; Other, 55.6%; White, 31.4%; P = .001). In multivariable analysis, Medicaid compared with commercial insurance (odds ratio [OR], 3.04; 95% CI, 1.32 to 7.27) was associated with increased odds of a delay and/or change, whereas stage II or III BC compared with stage I (OR, 0.38; 95% CI, 0.15 to 0.95; and OR, 0.28; 95% CI, 0.08 to 0.092, respectively) was associated with decreased odds of a delay and/or change. CONCLUSION: Almost half of the patients with BC without COVID-19 had a delay and/or change. We found racial and socioeconomic disparities in the likelihood of a delay and/or change. Further studies are needed to determine the impact these care alterations have on BC outcomes.

Mucosal melanomas constitute a subtype of melanoma with less effective treatments than cutaneous melanomas. We present a case of oral mucosal melanoma that recurred despite multiple resections and adjuvant temozolomide. Treatment with topical imiquimod combined with pembrolizumab achieved remission. A 56-year-old woman presented with a pigmented mass on her left anterior hard palate. Biopsy revealed malignant melanoma. The patient had resection with neck dissection with 3 months of adjuvant temozolomide due to positive margins. Malignant melanoma involving the hard palate recurred 1 year later requiring additional resection. Two years later, two additional pigmented lesions were found; further resections were deferred due to expected morbidity. Following 6 weeks of topical imiquimod treatment, the lesions shrunk significantly. Adjuvant pembrolizumab was added and complete histopathologic remission was observed in 6 months. The patient remained in remission for 4 years before new melanoma in situ was diagnosed, requiring five additional months of imiquimod. As of April 2021, there is no clinical evidence of melanoma. There are limited reports of oral melanoma treated with topical imiquimod. Here, imiquimod administered in combination with pembrolizumab achieved complete pathologic response.

Injuries and deaths due to accidents are inescapable in the modern way of living. The accidental deaths are mostly due to the road traffic, but the deaths due to railway fatalities are also not negligible, especially in the areas where railway traffic is high. Southern railways are major mode of transportation of the passengers and goods; consequently, the incidences of railway fatalities and mishaps are also high in South India. Most of the reported cases of railway deaths led to the conclusion that either the victim was directly hit by the train or died due to some other reason, but the body was recovered in the vicinity of the railway platforms. Here, we are discussing the injuries in a young pregnant woman in a train and pedestrian accident, where the injury to the abdomen resulted into the expulsion of preterm fetus and death of pregnant woman.

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Hematological and Renal alterations are seen mostly in Plasmodium falciparum infection, but P.vivax can occasionally contribute for renal, hematological impairment. Malarial ARF, Anemia, thrombocytopenia is commonly found in nonimmune adults and older children with malaria. Occurrence of ARF, jaundice, anemia in severe malaria is quite common in Southeast Asia and Indian subcontinent. Several hypotheses including mechanical obstruction by infected erythrocytes, immune mediated glomerular and tubular pathology, and alterations in the renal microcirculation, lead to renal failure. METHODOLOGY: 220 patients were included in the study who are positive for malarial antigen and routine laboratory tests were like CBC, liver function tests, renal profile, peripheral smear were done at Basaveshwar Teaching and General Hospital, attached to Mahadevappa Rampure Medical College. RESULTS: 220 patients of malaria were analyzed. 60% had Plasmodium vivax, 34% had Plasmodium Falciparum and 6% had mixed infection. Complications of Plasmodium falciparum-Jaundice 47.5%, Anemia 27.5%, Renal failure 25%, Cerebral malaria 15%, ARDS 2.5%,Thrombocytopenia 5% and Hypoglycemia 5%.Complications of Plasmodium vivax-Jaundice 1.5%, Anemia 5.3%, Renal failure 6%. Cerebral malaria occurred in 2.7% of cases. Predominant presentations were altered behaviour, loss of consciousness, 28.5% of mixed malaria and 2.6% of PF patients had cerebral malaria. INTERPRETATION AND CONCLUSION: Malaria being a common infectious disease encountered in day to day practice, early recognition and prompt intervention of complications due to malaria is necessary. Mainstay of treatment consists of appropriate antimalarial drug therapy, fluid replacement, and renal replacement therapy if needed and correction of anemia, thrombocytopenia.