ABSTRACT
CASE: A 41-year-old woman with recent COVID-19 pneumonia presented to the hospital with several months of fever, polyarthralgia, and weight loss. She reported waxing and waning shoulder, elbow, wrist, hip, knee, and ankle pain without identifiable triggers. She had no pertinent medical or family history. Vital signs were only notable for fever of 40C which recurred daily. Exam revealed tenderness to palpation of multiple joints;her skin had no rash, purpura, or nodules. Hepatosplenomegaly and axillary lymphadenopathy were noted. Infectious workup was negative for bacterial, viral, fungal, mycobacterial, parasitic, and protozoal infections. Initial studies demonstrated hemoglobin 8.2 mg/dL, lymphopenia, and aspartate transaminase 58 U/L. Flow cytometry, excisional lymph node biopsy, and bone marrow biopsy were negative for lymphoproliferative disease. Rheumatologic workup revealed elevated ferritin, triglycerides, Interleukin-6, soluble Interleukin-2 receptor (sIL-2R), and “C-X-C Motif Chemokine Ligand 9” (CXCL9);extensive rheumatologic serologies were otherwise negative. Her clinical picture was consistent with Macrophage Activation Syndrome (MAS). She also met diagnostic criteria for Adult-Onset Still's Disease (AOSD) given arthralgia, fever, lymphadenopathy, splenomegaly, abnormal liver function test (LFT), and otherwise negative workup. Her presentation suggested COVID-19 triggered AOSD which triggered MAS. We administered intravenous immune globulin (IVIG) and high-dose steroids. She clinically improved and was discharged with oral steroids. She returned to the hospital two months later for fever, arthralgia, and faint, evanescent rash with elevated erythrocyte sedimentation rate, C-reactive protein, ferritin, lactate dehydrogenase, and LFT consistent with an AOSD flare. She received intravenous steroids and Anakinra. Symptoms resolved, and she was discharged with plans to continue Anakinra and oral steroids. At followup, she had resolution of all symptoms. IMPACT/DISCUSSION: COVID-19 has many chronic complications, including triggering of underlying rheumatic disease. This sequence of events suggests that COVID-19 Pneumonia triggered an underlying diagnosis of AOSD. AOSD should be considered in the differential diagnosis of patients with quotidian fever and arthralgia following COVID-19 infection. AOSD is a diagnosis of exclusion and requires ruling out infectious, malignant, and rheumatic etiologies. AOSD may trigger MAS, a dysregulated immune response to underlying inflammation, and should be considered in patients with suspected infection refractory to treatment who have fever, splenomegaly, cytopenias, and elevated ferritin, triglycerides, sIL-2R, and CXCL9. CONCLUSION: COVID-19 has many chronic complications. AOSD may manifest after COVID-19 infection and should be considered in the differential diagnosis of patients with persistent fever and arthralgia. MAS should be suspected in patients with systemic inflammation refractory to treatment. AOSD may cause MAS.
ABSTRACT
The market volatility in the oil and gas (O&G) sector, the dwindling demand for oil due to the impact of COVID-19, and the push for alternative greener energy are driving the need for innovation and digitization in the O&G industry. This has attracted research interest from academia and the industry in the application of industry 4.0 (I4.0) technologies in the O&G sector. The application of some of these I4.0 technologies has been presented in the literature, but the domain still lacks a comprehensive survey of the application of I4.0 in the O&G upstream sector. This paper investigates the state-of-the-art efforts directed toward I4.0 technologies in the O&G upstream sector. To achieve this, first, an overview of the I4.0 is discussed followed by a systematic literature review from an integrative perspective for publications between 2012-2021 with 223 analyzed documents. The benefits and challenges of the adoption of I4.0 have been identified. Moreover, the paper adds value by proposing a framework for the implementation of I4.0 in the O&G upstream sector. Finally, future directions and research opportunities such as framework, edge computing, quantum computing, communication technologies, standardization, and innovative areas related to the implementation of I4.0 in the upstream sector are presented. The findings from this review show that I4.0 technologies are currently being explored and deployed for various aspects of the upstream sector. However, some of the I4.0 technologies like additive manufacturing and virtual reality are least explored. Author