In this case report, we present a novel presentation of acute epiglottitis in a patient with severe acute respiratory syndrome—coronavirus 2 (SARS-CoV-2) who presented to the emergency room in extremis and respiratory failure requiring emergent cricothyrotomy. Epiglottitis has become less common since the introduction and widespread use of the Haemophilus influenzae type B (Hib) vaccine. This reduction in cases has shifted demographics of the disease from the pediatric population towards adults with comorbid conditions. Interestingly there is a high degree of overlap between many of the comorbidities between epiglottitis and COVID-19. The novel severe acute respiratory syndrome—coronavirus 2 (SARS-CoV-2), also referred to as coronavirus disease 19 (COVID-19), has been reported to affect the gastrointestinal tract and neural tissue and has been implicated in necrotizing encephalitis. We report the first known case of the novel SARS-CoV-2 virus presenting with acute epiglottitis.

Background: More than half of all road traffic deaths in the world occur among vulnerable road users including pedestrians, motorcyclists and cyclists whereas; motorcyclists contribute almost one fourth of the death toll of road traffic crashes. Implementation of suitable strategies to address the issues of road traffic crashes is much difficult without information, absolute value of the problem, patterns and risks of injuries & death. Objective: To determine the different patterns, severity and distribution of injuries & their frequency in motorized two wheelers accidents. Study Design: Cross-sectional Study. Settings: Study was conducted in the department of Forensic Medicine at Nishtar Medical University, Multan Pakistan. Duration: One year from January 01, 2018 to December 31, 2018. Methodology: Total 167 cases died of road traffic accidents brought for autopsy and of those, 104 cases were reported to be died of motorcycle accidents involving both riders & pillion riders. The data of victim’s age, gender, site and pattern of injuries were obtained through detailed examination of the hospital record, autopsy reports and police inquest. The injuries over head, neck & thoraco abdominal region were given due consideration being dangerous to life. Statistical analysis was done using SPSS version 20. Results: Of the total 104 cases died in motorcycle accidents; 99 (95.20%) were males & 5 (4.80%) female. Riders died in 81 (77.89%) cases & pillion riders 23 (22.11%). The age group between 21-40 years involved 67 (64.42%) cases; maximum injuries were observed on Head/Face affecting 84 (80.8%) cases while on thorax 26 (25%) cases, Neck/Spine 12 (11.5%), pelvis 14 (13.4%) and abdominal area sustained injuries in 8 (7.6%) cases. As regard pattern of injuries; abrasions were found in 48 (31%) cases, lacerations 38 (24%), contusions 14 (9%) while fractures were observed in 56 (36%) cases. Among fatal injuries, 74 (71%) were found on Head, 7 (6.7%) over cervical spines, 3 (2.8%) on limbs whereas fatal injuries on thorax & Abdomino-pelvic areas were found 6 (9.6%) in each category. Of the total 81 riders, fractures of skull were observed in 59 (73%) cases and of 23 pillion riders, 16 (69.5%) got fracture of skull. Conclusion: Male riders of motorcycles belonging to age range 21-40 years were more prone to fatal injuries i.e., fractures of skull, neck, spine & Abdomino-thoracic injuries. Abrasions, contusions and lacerations were the most common type of injuries. Helmet legislation needs to be supported by strong enforcement and social marketing campaigns. Reducing the incidence by strict implementation of traffic rules and safety education via electronic & print media is need of the day.

e23543 Background: Alveolar soft part sarcoma (ASPS) is a rare subtype of soft tissue sarcoma, characterized by a specific unbalanced translocation leading to the fusion of the TFE3 gene on chromosome-X to the ASPSCR1 gene on chromosome-17. Despite its indolent course, ASPS presents a challenge in treatment due to its resistance to conventional anthracycline-based chemotherapy and lack of large scale trial data for this rare sarcoma. This review aimed to assess the efficacy of tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) in metastatic alveolar soft part sarcoma. Methods: A systematic search was performed on Embase and Medline databases for studies that assessed best response of patients with unresectable or metastatic ASPS to TKI and ICI therapy, according to the Response Evaluation Criteria in Solid Tumors (RECIST) edition 1.0 or 1.1. This study followed the Preferred Reporting Items for Systematic Reviews (PRISMA) protocol. Four independent reviewers screened abstracts and extracted the data; any discrepancy was resolved by discussion among reviewers. Pooled objective response rate (ORR) and disease control rate (DCR) were obtained using the Freeman-Tukey double-arcsine transformation using random effects model on STATA software (version. 16.1, StataCorp). Results: 27 articles and abstracts published between 2011 and 2020 were included in the review, resulting in 2 randomized clinical trials (104 participants), 14 single arm prospective trials (214 participants), and 11 retrospective studies (120 patients). Among clinical trials, the pooled ORR and DCR were 18% (95% confidence interval [CI] 8 - 30%; I2 = 72.25%; p < 0.01) and 87% (95% CI 97 - 93%; I2 = 43.2%; p = 0.03) respectively. Conclusions: The response rate to targeted therapy in metastatic ASPS is not only clinically meaningful, but also comparable to that of first-line chemotherapy. The majority of patients receiving targeted therapy achieved disease control. Patients who had refractory or progressive disease to one targeted agent demonstrated response to other agents. More randomized trials are warranted to expand treatment options and compare to standard of care regimens.