Virtual Communities and Achieving Electronic Institutional Excellence in the Kingdom of Saudi Arabia- University of Hail as a Model

This study aims to examine the reality of virtual communities and institutional excellence in the Kingdom of Saudi Arabia, using the University of Hail as a case study. It aims also to investigate the extent to which mechanisms for virtual communities and institutional excellence are available at Hail University. the achievement of the goals of electronic institutional excellence, and the major obstacles that stand in the way of achieving the goals and electronic institutional excellence. This study employs a random sample and a descriptive analysis. Social survey method is descriptive and analytical studies. 245 students who got help were studied. To gain data, a sample was given a questionnaire. The study's spatial and human limitations were Hail University teachers and students. Finalizing the research will take 12 months. After analyzing the study's underlying assumptions, the first and third hypotheses were approved as the college's electronic information networks, academic communication, and information sources. Due to limited electronic collaboration, the second theory was partially accepted. Due to lack of experience, the report proposed building rehabilitation and training programs for "virtual communities." One researcher' biggest issues was not knowing how to use virtual communities to attain greatness. Main results The most important results were a high institutional level under the coronavirus pandemic (3.82), followed by an average of 3.81 for academic processes. The results highlight the prospects for effective application of the COVID-19 crisis responses by offering a secure electronic educational environment with expanded virtual capabilities. This highlights the University's role in handling the crisis, establishing institutional excellence, and addressing education.

Aki and purpuric rash in a COVID patient

Introduction: AKI in COVID-19 patients are reported in several studies with an incidence of 23%. We report a case of COVID-19 pneumonia with AKI and purpuric rash. Case Description: A 54 y/o female with hypertension, CKD stage 3, with a COVID+ swab, presented with CT chest findings consistent with COVID-19 pneumonia, purpura of the lower limbs concerning for leukocytoclastic vasculitis and non-oliguric AKI. Creatinine on admission was 8.5mg/dl, (baseline of 1.6mg/dL), CBC showed a wbc 26.9, Hb 6.9, platelets 196 and eosinophilia. Serologies were notable for elevated direct coomb, low haptoglobin, low C3/C4, and rheumatoid factor of 26. UA had no hematuria, UPCR 0.75 mg/mg. Home medication, naproxen was stopped one month ago. Renal biopsy showed severe acute tubular injury (ATI), coarse vacuolization of tubular epithelial cells, severe leukocytic infiltration of lymphocytes, neutrophils, eosinophils, severe vascular hyalinosis, global glomerular sclerosis (11 out of 30 glomeruli), severe (60%) interstitial fibrosis & tubular atrophy. Per institutional protocol, Immunofluorescence could not be performed in COVID+ patients. Renal function improved significantly after a 5 day course with IV steroids alone and patient remained stable with a creatinine of 3.4 mg/dL. Discussion: This case features multiple potential mechanisms for AKI in a COVID-19 patient. Viral effects include, acute interstitial nephritis (AIN), severe ATI, and endothelial inflammation leading to vasculitis and purpuric rash. Recently, vasculitis similar to Kawasaki disease has been described in COVID-19 patients. Our case suggests that immune dysregulation from COVID infection may result in autoimmune findings such as elevated RF and hemolytic anemia. AKI improved in our patient after steroids, suggesting that a biopsy with features of AIN should be treated and could change the course of the disease.

Late rejection of failed renal allograft precipitated by COVID-19 in a hemodialysis patient (HD)

Introduction: We present a case report of an HD patient with a failed allograft that had been stable off immunosuppression who presented with acute allograft rejection in the setting of COVID-19 infection. Case Description: 50 y/o male with a history of hypertension, living-related kidney transplant in 2005 E.S.R.D after his allograft failed in 2018. The patient's allograft remained stable off immunosuppression on HD until 3/2020, when the patient presented with severe allograft tenderness with no fever or evidence of urinary tract infection. An abdominal CT was consistent with allograft rejection. Abdominal pain resolved after IV steroids and initiation of low dose tacrolimus. He was discharged but returned 4 days later, with recurrent abdominal pain, fever and shortness of breath. CT chest was consistent with COVID19 pneumonia with a positive swab. His condition was complicated by acute respiratory failure and cytokine storm. Despite receiving Ankinra for COVID-19, our patient died. Discussion: Failed allograft rejection for patients who initiate HD usually occurs within the first 6-12 months. Unless allograft failure occurs within a year of transplantation, many nephrologists complete withdrawal of immunosuppression in failed grafts after 4 months to decrease the risk of infections. In our case, the development of allograft rejection after stable long-term HD, is very unusual. We propose that the cytokine storm from COVID-19 in our patient provided the appropriate 'danger signals' that triggered innate inflammation and augmented effector responses against the allograft. COVID-19 infection triggers a pro-inflammatory immune response, with IL-6 being a key cytokine that potentially drives T-cell effector responses and inhibits T-regulatory responses to donor allograft.