Retropharyngeal Abscess and Pott’s Disease Due to Tuberculosis: A Case Report

Introduction: Extrapulmonary mycobacterial infection can lead to vertebral spondylitis and osteomyelitis (Pott’s disease). Retropharyngeal abscess with concurrent spinal osteomyelitis is a rare presentation of tuberculosis in the US. Chart review on a patient was completed, and the relevant published literature was reviewed. Case Presentation: A previously healthy 34-year-old male originally from Sudan presented to an outside hospital with a 2-month history of neck pain, sore throat, odynophagia, fevers, and chills. MRI showed a retropharyngeal abscess and suspected cervical spine osteomyelitis. Acid-fast bacillus (AFB) smear was positive from a neck drain specimen, but sputum was negative. Chest imaging did not show findings consistent with pulmonary tuberculosis. He was treated with rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) along with moxifloxacin and linezolid due to concern for possible multidrug resistant tuberculosis and transferred to our center for further care. Culture isolated Mycobacterium tuberculosis. CT neck showed vertebral tuberculous osteomyelitis (Pott’s disease) of C1-C3 with a multiloculated retropharyngeal and prevertebral abscess (Figure 1). The patient was taken to the OR for posterior spinal fusion from occiput to C4 and transoral incision and drainage of the abscess. The post-operative course was uneventful, and moxifloxacin and linezolid were discontinued when Xpert MTB/RIF test revealed rifampin susceptibility. At follow-up the patient’s symptoms had resolved. Patient consent was obtained to utilize this case for educational purposes. Conclusions: This report presents the multidisciplinary treatment of this patient requiring infection control measures and antibiotic therapy by infectious disease, posterior spine fusion by orthopedic surgery, and retropharyngeal abscess drainage by otolaryngology

Assessing the Educational Quality of Training Videos for Collection of a Nasopharyngeal Swab

Introduction: The SARS-CoV-2 pandemic has forced healthcare systems to disseminate their training materials quickly and broadly, including instruction on identifying cases of infection through correct nasopharyngeal swabbing. Incorrect nasopharyngeal swabbing technique leads to substandard sampling, patient discomfort, and increased risk of complications. We set out to evaluate the quality of educational videos on the nasopharyngeal swab procedure. Methods: Using video search engines, videos on nasopharyngeal swabbing were identified and distributed to two reviewers. The quality of videos was assessed using a scoring system that examined indications, contraindications, personal protective equipment use, swab depth, swab angle, and audiovisual quality. Descriptive statistics and Spearman’s correlation coefficients were utilized to analyze video quality and its association with individual video characteristics. Results: Videos received an average composite score of 5.4 (range: 0-10), with about half of all videos properly discussing and demonstrating the nasopharyngeal swab technique. Over 62% of reviews indicated that the reviewer would not recommend the video to a trainee, with the vast majority identifying improper swab technique as the main factor. There were no statistically significant associations between video score and publication date, number of views, and subscribers to the publisher. Conclusion: Our study shows a glaring lack of quality educational videos on the nasopharyngeal swab procedure. Health care providers should be cautious when using educational videos to learn procedures as popularity may not be associated with accuracy

Environmental change, if unaccounted, prevents detection of cryptic evolution in a wild population

Detecting contemporary evolution requires demonstrating that genetic change has occurred. Mixed effects models allow estimation of quantitative genetic parameters and are widely used to study evolution in wild populations. However, predictions of evolution based on these parameters frequently fail to match observations. Here, we applied three commonly used quantitative genetic approaches to predict the evolution of size at maturity in a wild population of Trinidadian guppies. Crucially, we tested our predictions against evolutionary change observed in common-garden experiments performed on samples from the same population. We show that standard quantitative genetic models underestimated or failed to detect the cryptic evolution of this trait as demonstrated by the common-garden experiments. The models failed because (1) size at maturity and fitness both decreased with increases in population density, (2) offspring experienced higher population densities than their parents, and (3) selection on size was strongest at high densities. When we accounted for environmental change, predictions better matched observations in the common-garden experiments, although substantial uncertainty remained. Our results demonstrate that predictions of evolution are unreliable if environmental change is not appropriately captured in models

Observables in 3d spinfoam quantum gravity with fermions

We study expectation values of observables in three-dimensional spinfoam quantum gravity coupled to Dirac fermions. We revisit the model introduced by one of the authors and extend it to the case of massless fermionic fields. We introduce observables, analyse their symmetries and the corresponding proper gauge fixing. The Berezin integral over the fermionic fields is performed and the fermionic observables are expanded in open paths and closed loops associated to pure quantum gravity observables. We obtain the vertex amplitudes for gauge-invariant observables, while the expectation values of gauge-variant observables, such as the fermion propagator, are given by the evaluation of particular spin networks.Comment: 32 pages, many diagrams, uses psfrag

Search for High Energy Gamma Rays from an X-ray Selected Blazar Sample

Our understanding of blazars has been greatly increased in recent years by extensive multi-wavelength observations, particularly in the radio, X-ray and gamma-ray regions. Over the past decade the Whipple 10m telescope has contributed to this with the detection of 5 BL Lacertae objects at very high gamma-ray energies. The combination of multi-wavelength data has shown that blazars follow a well-defined sequence in terms of their broadband spectral properties. Together with providing constraints on emission models, this information has yielded a means by which potential sources of TeV emission may be identified and predictions made as to their possible gamma-ray flux. We have used the Whipple telescope to search for TeV gamma-ray emission from eight objects selected from a list of such candidates. No evidence has been found for VHE emission from the objects in our sample, and upper limits have been derived for the mean gamma-ray flux above 390GeV. These flux upper limits are compared with the model predictions and the implications of our results for future observations are discussed.Comment: 15 pages, 2 figures, Accepted for publication in Ap

Semiclassical Mechanics of the Wigner 6j-Symbol

The semiclassical mechanics of the Wigner 6j-symbol is examined from the standpoint of WKB theory for multidimensional, integrable systems, to explore the geometrical issues surrounding the Ponzano-Regge formula. The relations among the methods of Roberts and others for deriving the Ponzano-Regge formula are discussed, and a new approach, based on the recoupling of four angular momenta, is presented. A generalization of the Yutsis-type of spin network is developed for this purpose. Special attention is devoted to symplectic reduction, the reduced phase space of the 6j-symbol (the 2-sphere of Kapovich and Millson), and the reduction of Poisson bracket expressions for semiclassical amplitudes. General principles for the semiclassical study of arbitrary spin networks are laid down; some of these were used in our recent derivation of the asymptotic formula for the Wigner 9j-symbol.Comment: 64 pages, 50 figure

REPAIRS Delphi: A UK and Ireland Consensus Statement on the Management of Infected Arterial Pseudoaneurysms Secondary to Groin Injecting Drug Use

\ua9 2024 The Author(s)Objective: Consensus guidelines on the optimal management of infected arterial pseudoaneurysms secondary to groin injecting drug use are lacking. This pathology is a problem in the UK and globally, yet operative management options remain contentious. This study was designed to establish consensus to promote better management of these patients, drawing on the expert experience of those in a location with a high prevalence of illicit drug use. Methods: A three round modified Delphi was undertaken, systematically surveying consultant vascular surgeons in the UK and Ireland using an online platform. Seventy five vascular surgery units were invited to participate, with one consultant providing the unit consensus practice. Round one responses were thematically analysed to generate statements for round two. These statements were evaluated by participants using a five point Likert scale. Consensus was achieved at a threshold of 70% or more agreement or disagreement. Those statements not reaching consensus were assessed and modified for round three. The results of the Delphi process constituted the consensus statement. Results: Round one received 64 (86%) responses, round two 59 (79%) responses, and round three 62 (83%) responses; 73 (97%) of 75 units contributed. Round two comprised 150 statements and round three 24 statements. Ninety one statements achieved consensus agreement and 15 consensus disagreement. The Delphi statements covered sequential management of these patients from diagnosis and imaging, antibiotics and microbiology, surgical approach, wound management, follow up, and additional considerations. Pre-operative imaging achieved consensus agreement (97%), with computerised tomography angiography being the modality of choice (97%). Ligation and debridement without arterial reconstruction was the preferred approach at initial surgical intervention (89%). Multidisciplinary management, ensuring holistic care and access to substance use services, also gained consensus agreement. Conclusion: This comprehensive consensus statement provides a strong insight into the standard of care for these patients