We have decided to reduce the complexity of this dedicated issue forum. We will continue to collect your bug reports, but there will be no managed "collected" or "closed" sub-forums anymore.
The process to align these forums, the beta forum reports, our internal development database and documents like the version history needed to be streamlined in order to ensure an efficient support service to our customers.
From now on bug reports will directly be transferred into our internal developer database (when confirmed) and "solved issues" will only be communicated in the dedicated version history document that we are releasing with the maintenance updates.
1) Prospective buyer doing their pre-purchase due diligence - they review the bug list, and are wondering which bugs are real, vs. (for example) unhinged rantings of users who don't know they have system-specific difficulties.
2) Current user with difficulty - they'd like to know if their problem is due to a Steinberg-confirmed bug, or whether it's worth their time and effort to continue to troubleshoot.
These are common scenarios, the old system helped them come to conclusions. How does this new arrangement help them?
In what situation is this new arrangement better for users?
You never release a list of bug fixes from x.5 to x.0 versions, so we have no way of learning what has been fixed, And have to try the new version or wait for user feedback in this forum.
I think is a bad move....or you could start making that list from x.5 to x.0 ....it shouldn't be too hard isn't it?
In the old system we had a long list of bug reports, a short list of collected issues and a very short list of closed issues.
Every entry in the bug reports forum had to be approved by one of our team members in order avoid any kind of issues that are not caused by the software. The problem was that the process to go through all the bug reports in order to reproduce and validate them, check if they have already been reported by other users (beta tester, internal, etc), enter them in the developer tool and move them to the collected issues subforum was just to time consuming. As a result the issues forum was just not representing the reality since a lot of the issues in the reported bugs forum were already in the developer database, collected issues were already fixed or some of the collected bugs could just not be fixed at all. The situation was just insufficient for both the customers and Steinberg.
We could have made the decision to emphasise more on this issues forum and have a dedicated support agent and quality assurance engineer constantly work in here. But in this case both of them would not be able to improve the regular support to our customers nor the quality of our products.
We really appreciate your reports and we definitely scan this forum and use your reports to improve our software. The entries are still approved by our team members, but we won't actively manage this forum anymore since we think that we can use our resources more efficiently if we focus on the direct support via the ticketing system and our quality assurance and testing processes.
Hi Matthias, I still don´t believe that this move is beneficial. The long standing bugs in Cubase lead me to think that there is something deeply flawed about the way Steinberg adresses bug fixing. If you only rely on ticketing system, and the issues forum becomes irrelevant an user may think that is doing something wrong and not report a bug or confirm a reported one.
I can´t use the ticketing system because you refer me to the local distributor in my country, do you think that is streamlined?
Also, I want to point out again, the lack of a list of bugs fixed in the x.0 releases. So, we get a lot of forum members (here and other places online) asking "has the xxxx issue been fixed in x.0 release"? And we wait for other users to test and confirm. Again, do you think that this procedure is streamlined or easy for your customers?
These questions are not an attack (sorry if it looks that way), they are geniune concern about the comunication, or lack of, between Steinberg and its customers. An issue that we have been raising for a long time now.
Now you will be not be managing the best way users have to look if the bugs that hinder they workflow are being looked upon or not. I would dearly welcome a dedicated support agent in the forum, so we can have a conversation about the problems with cubase (for example, disable tracks still keeps forgeting assignments, after a lot of updates).
1) Don't lock the thread, so as to allow others to bring more information to the OP.
2) If the reported possible bug has already been reported in another thread, the Steinberg team member consolidate them, so the discussion isn't spread across multiple threads.
3) Delete the bug report when it is fixed in a future update, or instead possibly append a "Solved in update X.Y".
What exactly is the "ticketing system"?
I was a new user from C8.5 and am very dismayed to see that so many of the bugs have been complained out for years sometimes on this forum. Some of them (I have reported them here) are very significant for a professional piece of software, and I'm getting way more frustrated than I've been with the other DAWs I've used in the past, as far as that is concerned. I can see how people feel like no one is paying attention because there quite a few very major workflow-inhbiting bugs and issues that just don't see the light of day as far as a fix.
I don't mean to sit her and complain, but right now I'm incredibly frustrated. I really want to stay with Cubase as a DAW because it's the best over what I've used in the past, but I haven't experienced this kind of thing before with this amount of years-long bugs and significant issues (I'm not talking about features -- I'm talking about actual bugs/issues) with the other DAWs I've used.
Please, if I may ... this thread was started to describe a new method Steinberg has implemented to list bug reports, confirmed bugs, etc.
If it starts expanding to other things, such as "Cubase has too many bugs ..." and the like, then it's going to be very hard to have a discussion on the actual topic, such as how people feel about the new bug listing system, requests for change etc.
I'd like to say that after a few days of working with this system, where anything to do with bugs is listed in one thread - I find it so difficult and frustrating to locate anything to do with a specific bug that I am ready to give up ever looking for info about bugs again.
It's like everything that is loose in the house is thrown into one closet - after several months it's so cluttered no one ever looks in there any more.
Ann I the only one who feels this way?
They did not implement a new method to list bug reports, confirmed bugs etc in the forum. It's the opposite, that they would no longer do so. Debating the point is an absurd way to pass your time.
If you want to report a bug in the forum, just do it. If you really want your report to count, use your my steinberg account to file a support request with a real repro. There have always been many, many items in the dev's bug list that did not appear on the forum.
One thing that's been unclear about the forum is that it's a user to user forum. But, since Steinberg staff participate, voluntarily, I might add, the expectation that the forum is an official technical support venue has grown.
imo, it's just as well they got rid of the former structure, since it added to the false expectations, and was never up-to-date. Now support staff has more time to devote to support, and clearly, they are in great need of that.
SteveInChicago wrote: They did not implement a new method to list bug reports, confirmed bugs etc in the forum. It's the opposite, that they would no longer do so. Debating the point is an absurd way to pass your time.
I'm pretty close to speechless, though I know I shouldn't be.
What an aggressive-sounding post from moderator to customer!
"Streamlined" (the word used by Steinberg in the title to this post) wouldn't usually make one think of "not listing reports or confirming bugs", please excuse my confusion.
Trying to stay on topic - you're saying that bug reports should be filed as "support requests" via mysteinberg, "if we really want the report to count".
I don't know if you missed any information, but requests made through the support system that reveal a bug are formally documented and tracked. That's why they work.
An issue posted here is good, but better yet would be a support ticket with a link to that issue report.
In_Stereo wrote: What exactly is the "ticketing system"?
I presume he means the ticket that's created when you make a support request through the my steinberg website.
I'm trying to figure out the best way to identify and review the Steinberg-confirmed bugs.
Suggestions for how to do that with the streamlined forum?
You could follow the forum posts, and when you see a bug report, do the repro on your system, then report back. That would take care of part of what you're asking, identifying, and also help the dev team to see that the issue is happening on multiple systems.
The next part doesn't involve the forum, I'm afraid: You would apply for a job with Steinberg Media Technologies GMBH in Hamburg Germany, as a Quality Assurance engineer. Once you are hired, you will have access to the database they use to track development, and all the intimate knowledge available therein about bugs, reports, future features, and development progress.
SteveInChicago wrote: You could follow the forum posts, and when you see a bug report, do the repro on your system, then report back. That would take care of part of what you're asking, identifying, and also help the dev team to see that the issue is happening on multiple systems.
The next part doesn't involve the forum, I'm afraid: You would apply for a job with Steinberg Media Technologies GMBH in Hamburg Germany, as a Quality Assurance engineer. Once you are hired, you will have access to the database they use to track development, and all the intimate knowledge available there about bugs, reports, future features, etc.
What a great and helpful answer, thank you!
Please forgive me, I didn't post quite what I wanted to. I'm asking about the old bugs that were identified by Steinberg in the past. The ones that had things like [BON-] , etc. in front of them.
"Individual support for you is provided by one of our Steinberg distributors. Please find a list of distributors on this page"
What the hell, am I have to contact my local store?!!??
Please explain and provide proper instructions for bug reports.
If you're not in a country where Steinberg or Yamaha provide direct support, you would have to post here or send email to info(at)steinberg.de.
I'm not a Steinberg employee, so please don't shoot the messenger. Steinberg employees' names are in blue or red on the forum. I'm green.
I'm Steinberg loyal customer for more than 14 years who pay for each upgrade I believe I deserve to have right to send support tickets.
You sell your product in my country so you have to accept my requests and bug reports.
Wow this is terrible news..
I keep trying to find things to keep me from moving to studio one..
Currently Steinbergs ignorance on console 1 support and now this rubbish! Seems like 9.x was my final upgrade.
This is, as I have already stated, unacceptable....I have bought all my previous upgrades directly from Steinberg. So you should give (legally) support to your customer, don't you?
Please Matthias, I have raised this issue before, can you give us a proper answer?
Pablo1980 wrote: This is, as I have already stated, unacceptable....I have bought all my previous upgrades directly from Steinberg. So you should give (legally) support to your customer, don't you?
If you are in country where the support is handled by the local distributor, you can always send an email to info@steinberg.de to report bugs or issues. These emails are processed by our support team in Hamburg.
As I have stated in the survey today, I believe that Steinberg is not handling the comunication with its customers very well.
So all in all my bug reports posted here, made with step by step reproductions and animated demos aren't as important as support tickets... Because? And why wasn't this told to me earlier before I made the effort?
In any case, I will then report them again but through tickets, like I apparently should've done in the first place.
djw wrote: So all in all my bug reports posted here, made with step by step reproductions and animated demos aren't as important as support tickets... Because? And why wasn't this told to me earlier before I made the effort?
I understand the motivation to do just that, given what was posted by a Steinberg mod/employee, and the recent "streamlined" state of the Bug List.
That flags a (presumably?) unforeseen consequence of such a "streamlining" - less user-to-user interaction (no more great explanatory vids by djw and the others), including less user-to-user teaching. That is undesirable, I think all would agree, especially in a forum where Steinberg likes to emphasize that it is a (paraphrasing) "user-directed forum ... technical assistance here by Steinberg employees/mods is given at their kind pleasure, and is by no means mandated or to be expected".
That is the impression I have gotten over the past months and years. If I paraphrased that above so as to misrepresent Steinberg's position on their categorization of the forum, I do sincerely apologize.
I do ask that Steinberg review their involvement in the forum, and consider assigning employees to help out. There are many other music vendor sites that do that, and it really is a very nice thing. Who knows, maybe with some more interaction, there may even be some more great ideas presented by users that Steinberg can incorporate into their next great update!


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Reconstruction of the lower lip after broad oncologic resection by Colmenero flap: a reliable option| ACTA Otorhinolaryngologica Italica
Reconstruction of the lower lip after broad oncologic resection by Colmenero flap: a reliable option
José-Miguel Costa-Gonzalez Anna Sumarroca Jordi Aguilera-Saez María Martel-Martin Andreas Leidinger María-Pilar Machin Rosa-Delia Ramirez-Ruiz
Department of Otorhinolaryngology, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
Department of Otorhinolaryngology, Hospital del Mar – Parc de Salut Mar de Barcelona, Universitat Pompeu Fabra, Barcelona, Spain
Department of Plastic Surgery and Burns, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Otorhinolaryngology, Hospital Sant Joan Despí Moisès Broggi, Universitat de Barcelona, Barcelona, Spain
Department of Neurosurgery, Hospital Mútua de Terrassa, Universitat de Barcelona, Barcelona, Spain
Anatomical Pathology Department, Hospital de Sant Joan Despí Moisès Broggi, Universitat de Barcelona, Barcelona, Spain
Colmenero flap lower lip reconstruction lip carcinoma squamous cell carcinoma sentinel node
Objective. Reconstruction of the lower lip is complex. The Colmenero flap is an effective albeit rarely described method for the repair of medium- to large-sized defects of the lower lip. Methods. A retrospective review was carried out using data gathered from patients who had undergone Colmenero flap reconstruction of the lower lip at our centre between 2015 and 2020. We analysed demographic, histologic and anatomic variables as well as surgical results. This review assessed flap functionality based on proper mouth closure, absence of microstomia and oral competence.
Results. Thirteen Colmenero flaps were performed in 9 patients, with the flap being used bilaterally in four cases. All patients had squamous cell carcinoma of the lower lip. The mean length of the reconstructed defect was 4.1 cm (ranging between 3-7.5 cm). None of the flaps exhibited signs of necrosis. Five patients required minor surgical touch up during the second procedure: two for dehiscence, two for oral leakage and one for esthetic improvement. All patients had excellent functional and aesthetic final outcomes.
Conclusions. The Colmenero flap is a good resource for medium- and large-sized lower lip reconstructions due to its reliability, limited complications, and good aesthetic and functional results.
The lower lip performs various functions, such as ensuring proper mouth closure during swallowing, oral competence for saliva containment, speech, facial mimicry and aesthetic harmony 1. Squamous cell carcinoma is the most common malignancy of the lower lip 2. Its prognosis depends on the tumour size, degree of invasion 3 and lymph node involvement 2, and its treatment is mainly surgical 4. There are many reconstructive options after excision of tumours of the lower lip, and their use depends on the size, location and type of defect. Smaller lesions (less than one third of the lip) can be resolved with direct closure after wedge excision 5, while larger defects (affecting the entire lip, including the vermilion) can be reconstructed using a free flap 1. Medium- and large-sized defects, involving between one-third and the entire lower lip, can be repaired with pedicled local flaps, such as the Abbe flap 6, the Karapandzic flap 7, the flap designed by Yu 8, or the gate flap described by Fujimori 9. The Colmenero flap 10, first described in 1981 and named after its creator, is a local transposition flap that is pedicled to the inferior labial artery. Although there has been little documentation of this flap, it has been reported to be a useful method to repair medium- and large-sized lower lip defects due to its ease of use, use of defect-like tissue, reliability and the possibility to create a neo-vermilion.
The objective of this study was to document our series of reconstructions of the lower lip after tumour resection using the Colmenero flap, thereby providing an update of its indications, surgical technique and aesthetic and functional results achieved, as well as its complications and suggested resolutions.
A retrospective review was carried out in patients who had undergone lower lip resection and Colmenero flap reconstruction at our centre between 2015 and 2020. We collected data from the registry of patients with head and neck tumours treated at our hospital during admission and outpatient follow up. Gender, age, smoking history, cTNM and pTNM classification, defect size, treatments performed, complications, reoperations, final result and follow-up time were analysed. The follow-up time was measured from the date of the surgery to the date of the last visit. All surgical procedures were performed by the same surgical team. This study was carried out in accordance with the Declaration of Helsinki.
Oncologic management
The overall oncologic management (surgical indication and lymph nodes management) of patients was individualised and agreed by the Functional Oncology Care Unit. The results of histopathology for all lesions corresponded to infiltrating squamous cell carcinomas of the lower lip was performed, and were classified or reclassified according to the 8th Edition of the TNM 3. The tumour excision was performed with macroscopic margins of 1 cm. The patients with suspected regional lymph node involvement and those with cT3 tumours underwent simultaneous homolateral or bilateral functional cervical lymph node dissection, depending on the location of the primary tumour and the results of imaging tests. Patients with cT1N0 or cT2N0 tumors underwent sentinel node detection in the same surgical procedure. The cases which, after histopathological assessment, were classified as pT3 or in which the sentinel node testing revealed positive results, underwent a second cervical lymph node dissection. In one cT2 patient, the sentinel lymph node was not detected due to very extensive anterior cervical lipomatosis, and the surgical treatment was not decided until the final histopathological results of the tumour (pT2) became available. The second case, which was first classified as cT2N0 and reclassified after resection and assessment of the sentinel node as pT3N3b (due to capsular rupture), refused cervical treatment and was closely monitored by clinical and imaging exams. None of the patients received chemotherapy or adjuvant radiation therapy.
The accepted surgical technique at our Unit is as follows: first, a complete "V" wedge excision of the primary lip lesion is performed, with macroscopic margins of 1 cm (Fig. 1 A-B). Secondly, the diameter of the defect is measured and the flap is designed. The donor area is usually homolateral for defects of less than two-thirds of the lower lip, and bilateral for defects greater than two-thirds of the lower lip or for very central defects, to improve postoperative facial symmetry. The flap design is full thickness, including skin, muscle and mucosa. The first incision begins at the corner of the lip and is proportional to the length of the defect. The second incision starts at the distal point of the first incision, and continues down towards the mandibular bar, without reaching it. At the lower end of the second incision, a Z-plasty is designed to facilitate tension-free closure of the donor area.
Once the skin cuts are made, a blunt dissection is performed until the main arteriovenous pedicles of the flap are located and preserved. The main flap vascular supply depends primarily on the inferior labial artery – a branch of the facial artery – and secondarily on the submental artery (Fig. 2A). The inferior labial artery is located 2.58 cm (SD 0.70) and 1.54 cm (SD 0.45) inferior to the lip commissure. It traverses between the muscular and glandular layers of the lip, about 8 mm parallel to the free edge of the lower lip 11. The concomitant arteries and veins are located and protected with Vaseloops® for added safety (Fig. 2B). Once the pedicles are identified, dissection of the flap edges to the mucosa is completed. Subsequently, the upper incision is transfixed by cutting the mucosa 1 cm higher than the skin incision, in order to be able to reverse it to the outside and, thereby, serve as a neo-vermilion. The inferior Z-plasty can be performed with or without preservation of the mucosa. Third, the flap is rotated and tailored to fit the defect and the closure (Fig. 3 A-B). It is possible to perform an island flap, leaving it attached by the vascular pedicle only, which allows better mobilisation and more precise repositioning of the flap. In one patient, the procedure yielded good results (Fig. 4). To provide greater functionality to the lower lip, a muscle band is removed from the upper lip (Fig. 5 A-B) and inserted into the submucosa of the lower lip. Finally, all wounds were sutured in three layers: interrupted stitches of resorbable material (Vycril® 3-0) were used for the mucosa and submucosa, and single stitches of monofilament thread (Prolene® 4-0) were used for the skin. Cutaneous healing can be optimised with epithelialisation ointment.
The anatomic course of the inferior labial artery is fairly constant, and thus we perform this flap guided by anatomic landmarks. Nevertheless, the use of preoperative vascular study with Doppler ultrasound could provide more reliability and safety. We acknowledge its utility especially during the early cases of a surgeon's learning curve.
Nine patients were operated on, which included seven men and two women, with a mean age of 77 years (ranging between 71-88 years). The mean follow-up time was 30 months (range 6-70 months). Eight of the nine patients had previous history of use of tobacco at the time of diagnosis. One patient was staged pT1, five patients were staged pT2 and three patients were staged pT3. The mean length of the defect created in the lip by the excision of the tumour lesion was 4.1 cm (ranging between 3-7.5 cm). In four patients, the flaps were performed bilaterally as part of the same surgical procedure; thus, a total of 13 Colmenero flaps were used: 7 on the right side and 6 on the left. During follow-up, no cases of local, regional, or distant tumour recurrence were observed. Table I summarises these results.
Flap viability
All Colmenero-type flaps were viable and were performed in a single surgical procedure; no partial or total necrosis was observed in any patient. The inferior labial artery could be identified in all cases, in addition to other secondary pedicles. All flaps fulfilled their reconstructive function. Four patients required bilateral flaps due to the large size and central location of the defect. The facial artery was preserved during cervical lymph node dissection.
Four of the 9 operated patients presented minor complications; however, they were all readily rectified. Two patients presented with surgical wound dehiscence. The first patient had undergone bilateral treatment and presented with dehiscence in the midline suture between both Colmenero flaps. The second patient presented a surgical dehiscence at the area of the flap suture, with the medial end of the lower lip preserved. On both occasions, the defect was resolved by refreshing the margins and suture under local anaesthesia in the outpatient clinic, 20 days after the surgery in the first case and one month after the surgery in the second case. Both patients healed well, with no new dehiscence being observed.
Lip incompetence that translated into fluid leakage while drinking was observed in two patients who consequently required surgical correction under local anaesthesia in the operating room. In one case, the flap was unilateral and the leakage was corrected, with improved lip closure at 20 months after the first surgery. Placement of a muscular upper lip band in the submucosa of the lower lip was repeated. In the second case, operated with bilateral flaps, the mucosa suture area was retouched with a Z-plasty to decrease the tension exerted by retractable flanges. Both patients achieved complete lip competence after healing.
On one patient, surgical procedure was performed two times because he was histopathologically recategorised as pT3N0. During the second time, the patient underwent cervical lymph node dissection and an aesthetic lip touch-up, reducing a redundant fold of neolabial mucosa.
None of the flaps or cervical surgeries required urgent surgical revision, nor did they result in any major complications.
Functionality and aesthetics
The functionality of the flaps was assessed based on three items: correct mouth closure, absence of a microstomia based on the ability to eat with normal eating utensils and oral competence with the absence of fluid leakage while drinking. These aspects were reviewed during follow-up, and the flaps were found to have excellent functionality in all cases. All patients maintained proper lip mobility that allowed them to blow and fully close their mouths. None of the cases exhibited microstomies or mouth opening problems stemming from the lip reconstruction. In addition, none of the patients were found to exhibit fluid leakage or alterations in speech, facial animation, or the oral phase of swallowing.
At the aesthetic level, patients were asked about their satisfaction or desire to improve the surgical result. Only one patient requested a reduction of the redundant labial mucosa.
Reconstruction of facial defects owes its complexity to the wide variety of anatomical subunits 1, and this is especially the case for the lip. The vermilion is a mucosa specifically adapted to external exposure, and the mobility of the entire lower lip assembly enables speech, swallowing, oral competence, facial mimicry and correct aesthetics, all of which are key elements for the patient's psychosocial well-being.
The Colmenero flap is an axial type of flap that uses the skin, muscle and mucosa adjacent to the lower lip defect, thereby providing a tissue similar to that resected; it is also performed as part of the same surgical procedure as tumour resection 10. This similarity of the tissue, the possibility of creating a neo-vermilion and the muscular band of the upper lip results in fewer functional repercussions and a good aesthetic result. All patients achieved complete lip competence and there were no limitations during feeding or the oral phase of swallowing. The need for a bilateral flap for lesions exceeding 60-70% of the lip can be replaced by a unilateral flap for patients with loose skin, especially with older patients.
Its straightforward design and the constant location of a vascular pedicle of sufficient caliber, such as the inferior labial artery, make it a reliable flap. Indeed, no signs of necrosis were noted in any of our patients. Furthermore, the possibility to perform a single unilateral flap in most cases considerably reduces surgical time. Moreover, this flap is recognised for its versatility, as it allows good mobilisation and tailoring to the defect, which can be increased if designed on an island flap.
Venous drainage occurs in the veins adjacent to the feeding artery, and it is highly recommended that the integrity of the facial artery is preserved, especially in patients requiring cervical lymph node dissection.
Other reconstructive options have been extensively described in the literature. Direct closure is the most straightforward approach, although it is reserved for defects of less than one-third of the lower lip 5 due to the risk of oral functionality being limited due to the resulting microstomia. In contrast, free flap microanastomosis is the preferred option for reconstruction of the entire lip, including the vermilion 1, because it provides a greater contribution of tissue. The aesthetic result is inferior, however, due to the use of tissue with characteristics other than the recipient area, it requires a higher level of technical expertise and is less reliable. Medium- and large-sized lower lip defects can be resolved with various pedicled flaps of facial tissue. For instance, the inverted Karapandzic flap is easy to perform, but its design entails a risk of microstomia in defects larger than 50% of the lip. This limitation can be resolved by the addition of an inverted Abbe flap 12, although this increases the technical difficulty and involves a second surgery. Few flaps allow reconstruction of the entire lip without causing a lip microstomia. The Yu flap is one of the most complete pedicle flaps for lower lip defects. Its compliance with the lines of tension of the lower one-third of the face, the creation of a neo-vermilion and its wide design provide a satisfactory and symmetric esthetic result that is also functional, while avoiding the risk of microstomia. Compared to the Colmenero flap, the Yu flap involves a higher level of technical difficulty and a smaller supply of tissue, but better aesthetic acceptance and equal or greater lip closure 13. In our experience, the final functional and aesthetic results of the Colmenero flap were satisfactory in all cases, even if half of patients required surgical retouching at a second stage. Retouching can, however, readily be performed with local anaesthesia in patients with high surgical risk.
The 8th Edition of the TNM 3 includes the depth of infiltration of the lesion as criteria, and hence, the length of the lip lesion is not proportional to the T classification in all cases. In our series of patients, we only treated T1, T2, and T3 tumours, although it should also be possible to use this flap with T4 tumours.
One of the supposed limitations of the Colmenero flap is that it does not match facial tension lines. Despite this, we achieved good aesthetic results in our patients. One of the drawbacks of this technique is that it is not a flap specifically designed for lip commissure defects, which, therefore, reduces its indications. Another limitation is that half of the patients required a touch-up of the surgical suture to increase oral competence or to resolve a dehiscence, although all touch-ups performed were minor and could be completed successfully.
The Colmenero flap is a good method for medium- and large-sized lower lip reconstructions due to its reliability, limited complications and good aesthetic and functional results. The ease of performing the procedure and of tailoring it to the defect, the large contribution of tissue similar to that resected, the simple location of the pedicle and the possibility of creating a neo-vermilion make it a useful and suitable technique for lower lip repairs.
Figure 1.Design of the Colmenero flap. (A) Diagram of the flap design. The discontinuous line reflects the need to cut the jugal mucosa 1 cm higher than the cut of the skin to revert the mucosa and facilitate creation of the neo-vermilion. The design should allow the integrity of the Stensen duct papilla (circle) in the mucosa to be maintained. (B) Photograph of the design of tumour resection and design of the bilateral Colmenero flap.
Figure 2.Creation and tailoring of the flap. (A) Diagram of the tailoring and blood supply of the flap. The flap depends mainly on the inferior labial artery, which is a branch of the facial artery (on the right). It is supplied secondarily by another arterial tributary from the submental artery, which is more medial and inferior. Source: A. Leidinger. (B) Photograph of the tailoring of the bilateral flap to the defect. The pedicles are located and preserved with Vaseloops®.
Figure 3.The final outcome of the lower lip reconstruction. (A) The final design of the reconstructed lip. Source: A. Leidinger. (B) Photograph of the patient's lip at six months after the surgery.
Figure 4.Result of the Colmenero flap made on an island.
Figure 5.Placement of an upper lip muscle band for the lower lip. (A) Photograph of the surgical muscle band technique. (B) Photograph of the patient's lip at six months after the surgery.
pTNM
Unilateral/bilateral
Lower lip percentage sacrificed
Final competence and functionality
Follow-up period (months)
1 T2N0 Bilateral 90% Dehiscence Friedrich Yes 70
2 T2N0 Unilateral 75% Leakage Lip band Yes 52
3 T3N0 Bilateral 60% No Aesthetic Yes 50
4 T2N0 Bilateral 75% Leakage Z-plasty Yes 34
5 T1N0 Unilateral 50% No No Yes 30
6 T2N0 Unilateral 60% Dehiscence Friedrich Yes 13
7 T3N3b Unilateral 60% No No Yes 12
8 T2N0 Unilateral 50% No No Yes 7
9 T3N0 Bilateral 90% No No Yes 6
Table I.Characteristics of patients treated with a Colmenero flap.
Vanison C, Beckmann N, Smith A. Recent advances in lip reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2019; 27:219-226. DOI
Cerezo L, Liu FF, Tsang R. Squamous cell carcinoma of the lip: analysis of the Princess Margaret Hospital experience. Radiother Oncol. 1993; 28:142-147. DOI
Baker SR. Current management of cancer of the lip. Oncology. 1990; 4:107-120.
Calhoun KH. Reconstruction of small- and medium-sized defects of the lower lip. Am J Otolaryngol. 1992; 13:16-22. DOI
Abbe R. A new plastic operation for the relief of deformity due to double harelip. Plast Reconstr Surg. 1968; 42:481-483.
Karapandzic M. Reconstruction of lip defects with local arterial flaps. Br J Plast Surg. 1974; 27:93-97. DOI
Yu J.M. A new method for reconstruction of the lower lip after tumor resection. Eur J Plast Surg. 19899; 2:155-159. DOI
Fujimori R. "Gate flap" for the total reconstruction of the lower lip. Br J Plast Surg. 1980; 33:340-345. DOI
Colmenero B. Reconstrucción del labio inferior en cirugía oncológica. Tiempos Médicos. 1981; 182:101-110.
Whetzel TP, Mathes SJ. Arterial anatomy of the face: an analysis of vascular territories and perforating cutaneous vessels. Plast Reconstr Surg. 1992; 89:591-603.
Uglesic V, Amin K, Dediol E. Combined Karapandzic-Abbé/Estlander/Stein flap for subtotal and total lower lip reconstruction. J Plast Reconstr Aesthet Surg. 2019; 72:484-490. DOI
López AC, Ruiz PC, Campo FJ. Reconstruction of lower lip defects after tumor excision: an aesthetic and functional evaluation. Otolaryngol Head Neck Surg. 2000; 123:317-323. DOI
José-Miguel Costa-Gonzalez
Anna Sumarroca
Jordi Aguilera-Saez
María Martel-Martin
Andreas Leidinger
María-Pilar Machin
Rosa-Delia Ramirez-Ruiz

redpajama_set_name: RedPajamaCommonCrawl


The student career questionnaire is designed so as to find out the interest of the students towards his career path. This questionnaire helps the students to prepare firmly towards their goal and therefore, it is one of the important questionnaires which help the student to explore their preferences and strengths. This questionnaire is mainly designed for the students of 13 years or above that.
1) Which subjects interest you the most?
2) Which stream you want to take up on your senior secondary level?
3) What is your plan for studies at graduation level?
4) What career would you want to choose ultimately in your life?
5) Please mention, why do you want this career?
6) How long do you want to study?
7) What are your plans to reach the goal you are aiming for?
8) Which vocational studies interest you more?
9) Do you prefer doing job or utilizing your education through means?
10) Have you enrolled your self in any of the institute to get yourself trained, so that this training would help you achieve your goals easily?
11) What you have done till date to make your dreams come true?
12) How much rating would you give to your efforts for achieving your goals on a scale of 1 to 10?


with that," said longtime General Manager Bob Belber.
economic sense because of the advertising incentives involved.
"The economics are very positive for us," he said.
team, which Belber estimates moves about 7,000 tickets per game.


MILO SWEAT − t-shirt silhouette meets sweat fabric! The clean cut of the iconic MILO t-shirt with rolled sleeves, open edges look at hem and neck meets a semi-firm sweat fabric which creates a whole new and urban look! With the tigha logo at front you'll add some spice to the whole look.


Gukulari Ensemble - Live in the Chapter Hall of the Mdina Cathedral on Tuesday 5 March 2019.
Treasures Of Malta Christmas 2018 Out now!
On the 30th November Etnika launched the Music in Malta - From Prehistory to Vinyl project, playing to a full house at the Manoel Theatre.


Was the June 10 police helicopter crash that killed former Internal Security Minister George Saitoti, his assistant Joshua Ojode and four others the work of drug cartels?
This was the burning question Parliament asked Thursday as it accused the Government of shoddy investigations, cover-up and even outright frustration of the probe team.
It is also the question that rekindled bad memories of Kenya's unresolved murder cases, such as those of Dr Robert Ouko, Tom Mboya and JM Kariuki, as well as the unexplained air crash that killed former Roads minister Kipkalya Kones and former Sotik MP Lorna Laboso on the same June 10 date in 2008.
As a result, and probably as a sign the House does not take the claim lightly, Deputy Speaker Maalim ordered that Nominated MP Rachel Shebesh who made the claim, saying she could only share what she knows with a Parliamentary Select Committee, be put under tight security.
The MPs expressed fury at the fact that just about three weeks after the crash that killed police pilots Nancy Gituanja and Luke Oyugi, as well as Saitoti's bodyguards Joshua Tonkei and Thomas Murimi, the country was still left grappling with speculation over what may have brought the chopper down.
Moved by the contributions by members, Maalim allowed them to ventilate their concerns and several times had to caution Transport Minister Amos Kimunya to be sensitive to the views made by members.
The minister was responding as Deputy Leader of Government Business in the House, even though his Transport ministry was accused by MPs of not cooperating with the probe team.
So serious was the matter that at one point Maalim directed the office of the Sergeant-at-Arms to liaise with the Parliament Police Station to enhance the security of Shebesh.
Shebesh dropped her bombshell after Makadara MP Gideon Mbuvi Sonko told the House Saitoti and Ojode were killed because of their efforts to fight drug trafficking.
Sonko went on to give details of how former GSU officer Erastus Kitur Chemorei, who was in charge of the storage of the Sh6.4 billion cocaine haul seized by police in a private villa in Malindi, was felled "by 400 bullets" fired by his own colleagues.
He further tabled rulings of a magistrate court in Eldoret that among other things confirmed Chemorei was murdered by fellow cops.
The move caused a stir among members who demanded that in light of the revelations by Shebesh she be accorded more security. Gichugu MP Martha Karua consequently asked Maalim see to it that Shebesh was accorded adequate security owing to the information she had.
Karua further accused the Government of being insincere with the investigations because no preliminary reports had been given since a probe team was launched.
"We do not know anything that has been unraveled in the two weeks the investigations have been going on," she said. Kilome MP Harun Mwau claimed there was a conspiracy to kill the two.
"The two comrades were serious investigators of drug dealings. There was a conspiracy to silence them, which could go further to eliminate MPs who have information," added Mwau who, like Sonko and Juja MP William Kabogo, were on a list of alleged drug dealers Saitoti gave Parliament last year.
Lands minister James Orengo said the Government must listen to all theories before dismissing them.
Orengo explained that having been in some of the previous commissions of inquiry, he had come to realise that several theories were bound to come up, but they should not be dismissed.
He said he still remembers the claims that Ouko and British tourist Julie Ward "had killed themselves then set themselves on fire".
Shebesh had also on a point of order questioned why Police Commissioner Mathew Iteere, who was among the first people to arrive at the chopper crash site, only stayed for a few minutes, failed to secure the scene and walked away, leaving Vice President Kalonzo Musyoka, "with bodies of the two who were his bosses". Government Chief Whip Jakoyo Midiwo raised temperatures when he said the crash had all the indications of foul play.
"When it smells like a skunk it is a skunk, " he said adding that the Saitoti family had been sidelined in the investigations.
But Kimunya shot up on a point of order and denied the accusations, saying he was in touch with both families and that they were part of the investigation team. But the remarks did not go down well with members such as Kilgoris MP Gideon Konchellah who took on Kimunya saying Saitoti's family lawyer had complained of the slow pace of investigations.
Konchellah, who was the master of ceremony at Saitoti's burial, further said the late minister's family had equally been sidelined in the probe, which Kimunya denied.
At this point Midiwo, on a point of order, told the House that a member of the family had just sent him a message confirming that they were not involved in the appointment of members of the probe team.
"Mr Speaker, I have just received a message from a member of the family which I can share with the House confirming that they have been sidelined in the probe," he added.
Both Kimunya and his Permanent Secretary Cyrus Njiru were put on the spot with members accusing them of failing to cooperate with the probe team.


text:
National Bureau of Statistics report on violence and crime against women in Nigeria.
According to the data received from the Nigerian Police force and Ministry of Justice, rape cases in Nigeria have been on the rise. The percentage of rape incidence for girls was 63.04percent in 2015 which increased to 72.13 percent in 2016 but decreased to 69.33percent in 2017.
Over 90percent of suspects arrested for drug related offenses in 2015-2017 92.7, 93.5 and 93.9 respectively were men, while women made up 7.3,6.5,6.2 respectively.
Women aged 45-49 had the highest percentage of Female Genital Mutilation compared to other age group.
Offence of trafficking in person's occured mostly in the 16-25 age group where women constituted about 73.63percent.
National Bureau of Statistics.
What could be done to reduce trafficking in Nigeria?
How can we have a healthier future when our teenagers are trafficked?
Let's discuss. Please send in your comments
#togetherwecouldmakeAfricaHealthier.


text:
Date of Submission 03-Nov-2020
Date of Web Publication 06-Jan-2021
Keywords: Coronavirus disease 2019, hematological parameters, pandemic, pediatric age
Margekar P, Kumar A, Margekar VG, Margekar SL. Hematological profile in COVID-19, whether it matters in children. Indian J Med Spec 2021;12:11-4
Margekar P, Kumar A, Margekar VG, Margekar SL. Hematological profile in COVID-19, whether it matters in children. Indian J Med Spec [serial online] 2021 [cited 2021 Jan 15];12:11-4. Available from: http://www.ijms.in/text.asp?2021/12/1/11/306251
Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus, is a rapidly spreading and devastating infection which has become a global pandemic. The first case of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) disease (COVID-19) emerged in Wuhan City of Hubei Province China, in December 2019.[1] There was a continuous growth in the cases and the virus was spreading globally which forced the World Health Organization to declare a global pandemic on March 11, 2020.[2] It has affected more than 200 countries worldwide. As the pandemic is progressing over time, as of late October 2020, more than 300 million cases are diagnosed across the world, with more than 1 million reported deaths attributed to this disease.[3]
Coronaviruses are RNA viruses with glycoprotein spikes that give them a crown-like appearance. Four species have been in circulation for a long time and cause mild respiratory disease. They have a huge genetic diversity and have jumped the species barrier, leading to severe respiratory disease (SARS virus in 2002–2003 and the MERS virus in 2012–2013). In December 2019, this novel coronavirus emerged in China that was later termed SARS-CoV-2 which causes the disease COVID-19.
Spread of Infection
It is mostly by droplets from infected people during sneezing and coughing. Large droplets that travel for 1–2 m, settle on surfaces on which they remain alive for hours or days. Infected person can also spread the infection even before the onset of symptoms.[4] Infection is acquired by either inhalation of the infected droplets or touching surfaces/fomites contaminated with the infected droplets and then touching the eyes, nose, and mouth,[4] but latter is not thought to be the main way the virus spreads.
The viral load in the nasopharynx of children is likely the same or higher as compared with that of adults.[5] However, it is not very well clear whether children and adults both can equally transmit the virus effectively and whether children are as susceptible to infection by SARS-CoV-2 as compared to adults. Recent studies have suggested that children can spread the virus effectively in households and camp settings.[6],[7]
The number of reported COVID-19 cases in pediatric population is low as compared to that of adults.[8] The school closures and taking proper measures to reduce community transmission may explain the low incidence in children compared to adults. Comparing the period before and after the opening of school and other activities may be helpful in providing information regarding the trends in pediatric infections.
Many infected individuals' symptoms range from mild, moderate, to severe and profound inflammatory response that leads to acute lung injury and hypoxemic respiratory failure. The most common cause of death in individuals (adults) with COVID-19 is acute respiratory distress syndrome. In pediatric population, symptoms are mostly mild and the number of severe and critical cases is less as compared to that of adult patients,[8] which suggests that the clinical manifestations of COVID-19 in children may be less severe as compared to that in adult patients.[8] Similar to adults, risk factors for severe illness for COVID-19 in children might be asthma, chronic lung disease, diabetes, obesity, sickle cell disease, or immunosuppression.
In the ongoing pandemic, optimization of the limited human and technical resources is of crucial importance. Early identification and use of routine laboratory parameters will help to identify the severity of disease and to improve the clinical situational awareness, to target patients at increased risk. Availability of testing (laboratory investigation) allows us to describe the disease more accurately.
The hematological alteration potentiality serves as an indicator to provide guidance for the assessment of severity, treatment, and prognosis for COVID-19 patients. A clear pattern of difference in inflammatory, hematologic, and immune parameter abnormalities could be found between patients with or without severe or critical disease.[9] Very limited studies are available on hematological parameter alteration in pediatric COVID-19 cases worldwide and in India as a whole owing to the relatively lower incidence of the disease in the pediatric population. Moreover, laboratory data may provide hints to the underlying pathophysiology and the body's immunological response.
Hematological parameters in COVID-19
The common haematological parameters that are ascertained in the pediatric age group patients and reported by various studies are being discussed one by one, with whatever literature could be available.
In the cases of COVID-19 infection, lower level of hemoglobin is observed. In a study by Tiwari et al. (from North India) of 11 patients, 54.5% (6/11) of the children had anemia, with 45.5% (5/11) cases having hemoglobin level <10 mg/dL.[10] In another study from China (Wuhan) of 244 confirmed cases, 193 children with symptomatic COVID-19 infection had significantly lower hemoglobin levels.[11] Lower level of hemoglobin indicates the severity of infection. In a meta-analysis, hemoglobin value was significantly lower in COVID-19 adult patients with severe disease, compared to those with milder form.[12]
Neutrophilia in COVID-19 patient indicates cytokine storm and hyperinflammatory state. As minimal data on severe cases of children are available, in a case series by Jiehao et al.,[13] which provided data of ten symptomatic children, only one of the three cases that had alternations in leukocyte or neutrophil counts also had radiologic changes suggestive of pneumonia. A study by Liu et al. in January 2020 showed three out of six cases with decreased neutrophil count.[14] In a study conducted in North India by Tiwari et al.,[10] neutrophilia was observed in 36.3% of cases and children younger than 10 years, showed more predominant neutrophilia as compared to children above 10 years; normal total leukocyte count was found in 36.3% (4/11); leukopenia in 9.1% (1/11), and leukocytosis in another 54.5% (6/11) of cases.
Neutrophil-to-lymphocyte ratio (NLR) is a biomarker for the assessment of the severity of bacterial infections and the prognosis of patients with pneumonia and tumor. NLR may serve as a marker of early risk identification in COVID-19 infection.[15] Among pediatric cases, 27.3% had raised NLR above the cutoff value of 3.13. In a study by Tiwari et al.,[10] the mean NLR of the adult cases was 2.7, which was below the cutoff value of 3.13
Lymphocytes are components of the cellular immune system and include B cells and T cells which are present in the peripheral blood; about 75% of the lymphocytes are T cells and 25% are B cells. Lymphocytopenia may go unnoticed if white blood cell (WBC) count is checked without differential as lymphocytes account for a small percentage (20%–40%) of the total WBC count.
Lymphopenia is a common finding in patients with COVID-19 infection. In adults, studies have reported very high rates of lymphocytopenia. Guan et al. studied 1099 patients and found that the rate was 83.2% in adults.[16] However, in a study by Lu et al., among a total of 171 children, there were only 6 children (3.5%) with lymphocytopenia.[17] Henry et al. in a meta-analysis on infants and children have shown that lymphocytopenia is much less common.[18] The pattern of laboratory abnormalities was not consistent, as in a study by Ya-Nan et al. including seven children, none showed thrombocytopenia,[19] whereas increased lymphocyte count was seen in a study by Du et al.[20]
In another study by Wu et al. abnormal lymphocyte count was found in ten cases (13.5%), among whom six (8.1%) had an increased number of lymphocytes (highest value 9.03 × 109/L) and four (5.4%) had a reduced number of lymphocytes (lowest value 0.80 × 109/L).[21] Despite the normal leukocyte count, lymphocytopenia, neutropenia, and neutrophilia were seen in 30.0%, 23.3%, and 13.3% of children, respectively, according to Yarali et al.[22]
Four mechanisms are responsible for lymphopenia in COVID-19. First, this virus may directly invade lymphocytes that leads to lymphocyte death. Lymphocytes express angiotensin-converting enzyme-2 receptor, which is specific for coronavirus and is a direct target for this agent. Second, SARS-CoV-2 infection could directly destroy lymphatic organs, such as thymus and spleen. Third, the various inflammatory cytokines that are released during the course of COVID-19 infection may result in lymphocyte apoptosis. These cytokines including tumor necrosis factor-α and interleukin-6 may lead to lymphocyte deficiency. Fourth, coexisting lactic acidosis could inhibit lymphocytes. Hyperlactic acidemia, which is a complication of severe type of COVID-19, might suppress lymphocyte proliferation.[23]
Du et al. reported that WBC and lymphocyte counts were found to be highly decreased in symptomatic cases than that in asymptomatic cases, which can be explained by a lower inflammatory response in asymptomatic children.[20] Interestingly, higher value of lymphocyte was reported in symptomatic cases.[11] Due to the relative immaturity of immune system of children and differences in the immune response as compared to that of adults, lymphocytopenia may not be seen.[24],[25] Moreover, there may be limited number of severe cases of COVID-19 in children.
A pattern of neutropenia and lymphocytopenia was observed in SARS (emerged in 2002),[26] showing that the WBC count is typically normal or reduced with decreased neutrophil and/or lymphocyte count.[26],[27],[28],[29] Henry et al. reported similar finding in their study of SARS epidemic 2002 with lymphocytopenia in 46% and neutropenia in 52% of children.[21] Furthermore, abnormal lymphocyte count was found in the studies by Wu et al. and Tiwari et al., with the presence of lymphocytosis in 8.1% and 27.3% as well as lymphocytopenia in 5.4% and 27.3% of cases, respectively.[10],[21]
In two studies by Chen et al. and Sun et al., a total of 9 cases[25],[30] reported lymphocyte subsets, of which 44.4% had an increase in CD4+ cell counts, with only 1 patient (11.1%) having increased CD8+ cell count. However, 66.6% (6/9) of patients had decreased counts of natural killer cells.
Monocyte count was normal in 81.8% of the pediatric cases, while only 18.2% of the cases showed mild monocytosis in an observation made by Tiwari et al.[10] Minimal data is available regarding the documentation of monocytosis in pediatric cases. However, for adults, Henry et al. in a meta-analysis on 3377 patients demonstrated reduction of monocytes in COVID-19.[9] Moreover, Xiong et al. report higher monocyte counts in symptomatic as compared to asymptomatic COVID-19 children.[11]
One cohort study reported vacuolated monocyte (13.3%) and hypergranulation/lobulation abnormalities in neutrophils (36.7%) in peripheral smears of children with COVID-19 which was high compared to that of COVID-19-negative cases.[22]
In the early stages of COVID-19 infection, eosinophil count decreases. The mechanism may be related to glucocorticoid exposure. Due to stress response in these patients, glucocorticoid secretion could result in inhibition of eosinophil release in the bone marrow. Eosinopenia was seen in 36.3% (4/11) of pediatric cases.[10] Most studies have reported eosinopenia in their adult patients. Zhang et al. reported that more than half of the patients admitted with COVID-19 (53%) had eosinopenia.[31] Similarly, Du et al. reviewed 85 fatal cases of COVID-19 and noticed 81% of the patients with absolute eosinophil counts below the normal range.[32] Furthermore, eosinophil levels improved in all patients before discharge, which suggests that resolution of eosinopenia may be an indicator of improving clinical status in case of adult patients.
Tiwari et al. reported that 81.8% of cases had platelets within normal limit, while 18.2% of the cases had some degree of thrombocytopenia.[10] On the other hand, Han et al. reported that 14.3% of children showed thrombocytosis.[19] In a cohort study by Yarali et al., thrombocytopenia was detected in four patients, of which one patient had aplastic anemia and COVID-19 and the rest three had SARS-CoV-2 negativity.[22] In a meta-analysis, low platelet count was associated with increased severity and increased mortality in adults with COVID-19.[9] The minimal reporting of thrombocytopenia in children may be related to the better clinical prognosis of the disease.
Platelet–lymphocyte ratio (PLR) is a parameter for predicting the degree of cytokine storm, which might provide a new indicator in the monitoring of patients with COVID-19.[33],[34] Adult patients with higher PLR during treatment had longer average hospitalization days.[34] In their study, Tiwari et al. reported that PLR was slightly higher in pediatric patients as compared to that of adult patients.[10]
A consistent pattern of laboratory derangements is yet to be observed in children with confirmed COVID-19, unlike adults. Milder form is seen in SARS-CoV-2; the possible explanations include less frequent exposure to the main sources of transmission (closed schools); presence of asymptomatic or mildly symptomatic patients, therefore testing is less often, leading to an underestimate of the true numbers of infected individuals; the immature immune system; and the presence of unidentified factors.
PLR might act as a new indicator in monitoring patients with COVID-19. NLR is a biomarker for the assessment of the severity of infections and a marker for early risk identification in COVID-19.
Leukocyte indices do not appear to be a reliable marker for assessing the severity and diagnosis of disease as they appear to be inconsistent in children as compared to adults with SARS-CoV-2. Hence, further studies can be conducted on the role of lymphocyte and other hematologic markers and their interaction with SARS-CoV-2 for timely assessment of the severity of COVID-19.
Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF. The proximal origin of SARS-CoV-2. Nat Med 2020;26:450-2.
World Health Organization. WHO Timeline—COVID-19, 2020. Available from https://www.who.int/news-room/detail/27-04-2020-who -timeline—covid-19. [Last accessed on 2020 Nov 04].
World Health Organization. WHO Timeline—COVID-19, 2020. Available from https://www.who.int/data/detail/19-10-2020-who -timeline—covid-19. [Last accessed on 2020 Nov 04].
Joseph T, Ashkan M. International Pulmonologist's Consensus on Covid-19. Joseph T, India. 1st edn; 2020. p. 1-38.
Heald-Sargent T, Muller WJ, Zheng X, Rippe J, Patel AB, Kociolek LK. Age-related differences in nasopharyngeal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) levels in patients with mild to moderate coronavirus disease 2019 (COVID-19). JAMA Pediatr 2020;174:902-3.
Park Y, Choe Y, Park O, Park S, Kim Y, Kim J, et al. Contact tracing during coronavirus disease outbreak, South Korea, 2020. Emerg Infect Dis 2020;26:2465-8.
Szablewski CM, Chang KT, Brown MM, Chu VT, Yousaf AR, Anyalechi N, et al. SARS-CoV-2 transmission and infection among attendees of an overnight camp Georgia, June 2020. MMWR Morb Mortal Wkly Rep 2020;69:1023-5.
Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics 2020;doi: 10.1542/peds.2020-0702.
Henry BM, de Oliveira MH, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): A meta-analysis. Clin Chem Lab Med 2020;58:1021-8.
Tiwari N, Nath D, Madan J, Bajpai P, Madan U, Singh S, et al. Novel insights into the hematological parameter abnormalities in pediatric COVID-19 cases: Observation from a preliminary study of 11 pediatric COVID-19 cases in a tertiary care center of North India. Saudi J Pathol Microbiol 2020;5:276-84.
Xiong X, Chua GT, Chi S, Kwan MY, Wong WH, Zhou A, et al. Haematological and immunological data of Chinese children infected with coronavirus disease 2019. Data Brief 2020;31:105953.
Lippi G, Mattiuzzi C. Hemoglobin value may be decreased in patients with severe coronavirus disease 2019. Hematol Transfus Cell Ther 2020;42:116-7.
Jiehao C, Jin X, Daojiong L, Zhi Y, Lei X, Zhenghai Q, et al. A case series of children with 2019 novel coronavirus infection: Clinical and epidemiological features. Clin Infect Dis 2020;71:1547-51.
Liu W, Zhang Q, Chen J, Xiang R, Song H, Shu S, et al. Detection of Covid-19 in children in early January 2020 in Wuhan, China. N Engl J Med 2020;382:1370-1.
Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to-lymphocyte ratio predicts severe illness patients with 2019 novel coronavirus in the early stage. medRxiv 2020;18:206.
Guan WJ, Ni ZY, Hu YU, Liang W-H, Ou C-Q, He J-X, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.
Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARS-CoV-2 infection in children. N Engl J Med 2020;382:1663-5.
Henry BM, Lippi G, Plebani M. Laboratory abnormalities in children with novel coronavirus disease 2019. Clin Chem Lab Med 2020;16:16.
Han Y-N, Feng Z-W, Sun L-N, Ren X-X, Wang H, Xue Y-M, et al. A comparative- descriptive analysis of clinical characteristics in 2019-coronavirus-infected children and adults. J Med Virol 2020;92:1596-602.
Du W, Yu J, Wang H, Zhang X, Zhang S, Li Q, et al. Clinical characteristics of COVID19 in children compared with adults in Shandong Province, China. Infection 2020;16:1-8.
Wu Q, Xing Y, Shi L, Li W, Gao Y, Pan S, et al. Coinfection and other clinical characteristics of COVID-19 in children. Pediatrics 2020;146:e20200961.
Yarali N, Akcabelen YM, Unal Y, Parlakay AN. Hematological parameters and peripheral blood morphologic abnormalities in children with COVID-19. Pediatr Blood Cancer 2020;e28596.
Hashemieh M. Hematologic parameters of COVID – 19: A review on alteration of hematologic laboratory findings. Int J Pediatr 2020;8:11321-929.
Klein SL, Flanagan KL. Sex differences in immune responses. Nat Rev Immunol 2016;16:626-38.
Chen F, Liu ZS, Zhang FR, Xiong RH, Chen Y, Cheng XF, et al. First case of severe childhood novel coronavirus pneumonia in China. Chin J Pediatrics 2020;58:179-82.
Zimmermann P, Curtis N. COVID-19 in children, pregnancy and neonates: A review of epidemiologic and clinical features. Pediatr Infect Dis J 2020;39:469-77.
Hon KLE, Leung CW, Cheng WT, Chan PK, Chu WC, Kwan YW, et al. Clinical presentations and outcome of severe acute respiratory syndrome in children. Lancet 2003;361:1701-3.
Chiu WK, Cheung PC, Ng KL, Ip PLS, Sugunan VK, Luk DCK, et al. Severe acute respiratory syndrome in children: Experience in a regional hospital in Hong Kong. Pediatr Crit Care Med 2003;4:279-83.
Bitnun A, Allen U, Heurter H, King SM, Opavsky MA, Ford-Jones EL, et al. Children hospitalized with severe acute respiratory syndrome-related illness in Toronto. Pediatrics 2003;112:e261.
Sun D, Li H, Lu XX, Xiao H, Ren J, Zhang FR, et al. Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center's observational study. World J Pediatrics 2020;16:251-9.
Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy 2020;75:1730-41.
Du Y, Tu L, Zhu P, Mu M, Wang R, Yang P, et al. Clinical features of 85 fatal cases of COVID-19 from Wuhan: A retrospective observational study. Am J Respir Crit Care Med 2020;201:1372-9.
Li Q, Xiuli Ding M, Geqing Xia M, Zhi Geng M, Wang Z, Wang L. A simple laboratory parameter facilitates early identification of COVID-19 patients. medRxiv 2020 https://doi.org/10.1101/2020.02.13.20022830.
Qu R, Ling Y, Zhang YHZ, Wei LY, Chen X, Li X-M, et al. Platelet-to-lymphocyte ratio is associated with prognosis in patients with coronavirus disease-19. J Med Virol 2020;10.1002/jmv.25767.
1 Conundrum of COVID-19: The road ahead
Anupam Prakash
Indian Journal of Medical Specialities. 2021; 12(1): 1
Hematological pa...


Tamanawas Falls. Olympus OM-D EM-1 Mark II, 12-100 mm, ISO 200, f/9 @ .6 sec., Bryan Hansel ND/CPL filter.
It doesn't seem possible, but I am at the halfway point of my solo journey. Rod flew into Portland, so I drove inland and we spent four days in the Columbia River Gorge. Hauling the teardrop through the Portland Airport worked better than I expected and when we made it to the campground, I was anxious to show Rod how well I setup camp. Of course, this campsite was VERY unlevel so I enlisted his help to use the risers that were unused so far. Rod showed me the trailer had feet stabilizers on the back end too. Hmm… I did fine without them so far, I will probably continue without them.
Cold Creek. Olympus OM-D EM-1 Mark II, 12-100 mm, ISO 200, f11 @ 4 sec., CPL filter.
What should have been waterfall alley, wasn't. Don't get me wrong, we found many waterfalls, but since the Eagle fire last summer, most of the gorge is off limits. Including 2 feet outside our campground. We had to pass security every time we drove to our campsite. I know it was for safety, but this communication was lacking on the website or I would have booked a different campsite.
Our first morning in the Gorge, we drove an hour to Tamanawas Falls near Mt Hood, Oregon to capture images before the sun beat down on the creek and waterfall. The two-mile hike was beautiful and we stopped several times on our way to the falls. At the second stop along the creek, I realized I forgot something.
Luckily, Rod was up for a run and he ran back to the car to get my new filter adding an extra 1.5-2 miles to his hike. In the past few weeks, I discovered the Bryan Hansel Waterfall Polarizer filter by Singh-Ray Filters. It shipped to the house and Rod brought it but I forgot to put it in my camera bag that morning. This filter combines a polarizer and a solid ND filter giving 3 to 5 stops of neutral density with a polarizing benefit too. I love it. We stopped many times on the two-mile trail capturing images along the way. When we arrived at the falls, there were only 3 other people there so capturing images was pleasant. I enjoy having a nimble non-photographer with me (Rod) because he helps me get to places I might not carry my gear by myself. When we headed out, the crowds came. It really pays off to wake up early for the best light and avoid people in your landscape image. We had a lovely dinner in White Salmon at Sharon's house with wood fired pizza and wine. It was great swapping stories with her and Steve and enjoyed their beautiful view.
Crown Point State Scenic Corridor in the Gorge was open to vehicles, so we spent a day checking out those waterfalls and short hikes. I didn't worry about getting images, just enjoyed my time with Rod. After all our hiking, we had lunch at White House Gorge Winery where Rod sampled ciders and I sampled wines. Very relaxing, but hot with temperatures in the mid 90's.
Starvation Creek Falls. Olympus OM-D EM-1 Mark II, 12-100 mm, ISO 200, f/10 @ 1 sec., Bryan Hansel ND/CPL filter.
We spent another day hiking around Umbrella falls and Starvation Creek Falls. We thought we were hiking 2 miles to Umbrella Falls, but somehow, it was only .25 miles which gave us plenty of time to view both. Umbrella falls were very exposed to sunlight, so I concentrated on small trickles of water instead of the big falls. Starvation Creek was a great location: large falls, small falls and most of it in the shade. Of course, I am still waiting to see if the poison oak I brushed against breaks out on my skin! I could spend more time in the gorge capturing images of waterfalls, but I would prefer to go in the spring when it isn't so hot.
Rod brought his ukulele so each evening, we had a ukulele jam session! During the past weeks, I would practice during the day after my camping neighbors checked out and less people were around. But with Rod, it was more fun and I wasn't so worried about what the neighbors thought (probably because he plays much better than me!) We ate Tillamook cheese, local smoked salmon and drank 24oz margarita cans! It doesn't get much better than that. Although I am enjoying my solo trip, it is much more fun sharing it with others. Before he flew out, we spent the day in Portland at the Japanese Gardens and Powell's Bookstore. Now, back to the ocean!
When photographing waterfalls, keep the lens cap handy and a dry lens cloth. In between shots, wipe the lens and put the cover back on to minimize spray.
If you are curious about the difference in what filters can do for a waterfall image, here are four examples. I kept the aperture and ISO the same in each photo, notice the difference in shutter speeds and the reflection on the leaves.
This entry was posted in Inspiration, Technique, Water, Waterfalls and tagged #artofmacrophotography, AmysEpicAdventure, travel, Water, waterfalls on July 26, 2018 by admin.
Olympus OM-D EM-1 Mark II, 12-100 mm, ISO 200, f/22.0 @ 4 sec., with circular polarizing filter.
Olympus OM-D EM-1 Mark II, 12-100 mm, ISO 200, f/13 @ 2.5 sec., with circular polarizing filter.
The whole reason I chose the next campground because it was located near Florence, OR. Last summer, Rod and I hiked Sweet Creek Falls and I wanted to go back. I did have my camera and tripod with me last summer, but we arrived after the sun was hitting the creek, so the images were not what I wanted. So, I planned a trip back. And not just one, but two. I went both mornings while camped outside of Florence. It was a 45-minute drive to the creek and I was the first one there, I had the place to myself for at least an hour. Once the sun hit the trees above, the reflections hit the water below and it was magic. This hike has many different waterfalls, some larger and some smaller. All exquisite!
Jessie M Honeyman State Park campground was much busier than any other I stayed in. Sand dunes are attached to the campground and many families were there with the four-wheeled sand vehicles making it much busier and louder. I was happy to spend more time at Sweek Creek Falls!
Olympus OM-D EM-1 Mark II, 12-100 mm, ISO 400, f/8 @ 1/5 sec.
Olympus OM-D EM-1 Mark II, 12-100 mm, ISO 400, f/18 @ 2.5 sec., with circular polarizing filter.
Olympus OM-D EM-1 Mark II, 12-100 mm, ISO 400, f/16 @ 4 sec., with circular polarizing filter.
Florence is a nice little town along the river and I continued my taste testing of clam chowder soup here as well. This time I went to Mo's – the Oregon favorite. It was good, better than any so far.
This entry was posted in Creative, Reflections, Technique, Water, Waterfalls and tagged AmysEpicAdventure, Oregon Coast, reflections, Water, waterfalls on July 13, 2018 by admin.


text:
Saw and did.
It has become a bit of a ritual for me. At least once a year, I like going to film festivals and gorging on art until it leaves you feeling slightly sick and headachy and I don't want to hear 'cinema' again for the next three months. It Delhi, it was Osian/Cinefan, and sometimes, smaller documentary film festivals in the middle of the year. In Bombay, it was MAMI, which made us wait so long this time around that I was actually considering going off to Delhi instead, just to get my annual fix.
However, this time, MAMI left me disappointed. Perhaps, it was because of the huge number of films, and my own awkward instinct, which seemed to be guiding me into mediocre screenings. Though I cannot fathom why there should be so many mediocre films in just one festival. Perhaps, I just missed the good ones. After the first three days, I began to rely on other people's recommendations, but even so, the overall sense I have was one of being underwhelmed.
It did not help that one had to dig deep into one's purse each time one wanted a sip of something warm. Forty rupees for one thimble-sized cup of horrid, oversweet coffee from one of those push-button machines?! That's just plain chori and seenazori.
People have already complained (on blogs, in newspapers) about the technical stuff - power cuts, format issues, terrible sound control, and so on. So I won't go over that in too much detail. But I do want to replay this: during one of the screenings, things started to go horribly wrong. The screen split up and the right side went completely dark. Then the screen split up again, and the bottom half of the frame stood hovering on top of the top half, with a noisy black line in the middle.
Behind me, there was a bunch of people whispering. From their conversation, I guaged that these were government employees. One of the ladies said, "You know, if this had happened at one of our events (meaning: a government-organised festival), they would have been up in arms. There would be such an uproar about the imcompetance of the state..."
She was right. There would have been all sorts of noises about how you cannot expect anything better from the public sector, and how the state should just let the experts/professionals handle this stuff, and how the private work ethic is better than the public one.
Which got me thinking. Why do we react with so much bitterness and anger when something goes wrong at a state-organised event at say, Siri Fort, or the Nehru Centre? And why do we just mumble about technical glitches, and then shut up, when the same thing goes wrong at a privately-owned multiplex? I am not talking about the difference in facilities alone. I am talking about an attitude. People who work with the government also work very hard to make such festivals happen. They help to fund stuff, they run stuff, they get the experts in to do their stuff. But I never hear anyone lauding them for their commitment to art or cinema. Why is that? And when non-government agencies are brought in to take over or partner such events, why is the criticism so muted?
At any rate, the thing is, I am still feeling hungry. The festival didn't have the overdose strength this time. I don't feel engorged with cinema to bursting point.
That said, this time, the documentaries were quite good. It was such a pity that almost all the documentaries were relegated to morning slots, which meant a slim audience, and I couldn't make it to most of them because of a lengthy commute. But I did catch 'Meet Me at the Mango Tree' and 'Made in Pakistan'. Both are good, engaging documentaries that accomplish what good films should - gently zoom in on a few human beings and their lives, and then allow us to see. Not just look, but see.
'Here', a Japanese film, was my usual odd pick. The sort you see only at film festivals and wonder what it was all about. The sort you cannot dislike, cannot accuse of anything, but cannot entirely like either. Experimental to the point of not being able to wow you, and yet, the sort of film you are not likely to forget for years.
Amongst the feature films, I liked a few including 'In the Loop', 'Fish Tank', 'Happy Go Lucky', 'Eden is West', and a Konkani film that roughly translates to 'Man Across the Bridge', made by a young Goan filmmaker called Lakshmikant Shetgaonkar. If you get a chance, watch.
Labels: film