Assessment of building energy performance integrated with solar PV: Towards a net zero energy residential campus in India

Building Applied Photovoltaics (BAPV) such as Roof-top Solar PV has gained significant attention in recent years for harnessing the untapped potential of renewable energy sources. However, rooftop PV poses hurdles of space restriction and shadowing in densely packed urban residential neighborhoods. This study aims to design and assess the feasibility of an integrated grid-connected Rooftop and Façade Building Integrated Photovoltaic (BIPV) for meeting the energy demand of residential buildings on an academic campus. Three distinctive groups of residential typologies have been investigated in this study, categorized based on built area and occupants' past energy usage. Additionally, the variation in the measured Energy Performance index of the three different residential groups is illustrated to pave the path for the development of a typology-based residential energy benchmarking and labelling system. The Solar PV system has been designed for the maximum household energy demand recorded in CoVID-affected years due to high residential electricity usage in this period. The study showcases that integration of façade BIPV for low-rise residential buildings increases the system energy production to up to 62.5 % based on the utilized surface area for active PV. Furthermore, the Net Zero Energy Building (ZEB) potential for each typology has been achieved by integration of the proposed Solar PV, evaluated as a function of the Energy Performance Index (EPI) and Energy Generation Index (EGI). The designed nominal PV power of the proposed grid-connected plant is 5.6 MW, producing 7182 MWh annually, meeting the maximum residential energy demand in the studied academic campus in CoVID affected year. © 2022 Elsevier B.V.

Embedding Social, Community Projects Within Contemporary Curricular

Social media continues to influence the online behaviours of humans in some of the most profound ways. Furthermore, COVID-19 pandemic has highlighted immense opportunities that socialmedia provides to keep people connected and engaged through difficult circumstances. Unfortunately, it also attracts various dubious users, eager to take advantage to the anonymity of these platforms to conduct unethical and illegal practices. Typical computing studies courses do not focus on developing the skills and attitudes to enable students to work in a globalised environment, and certainly do not focus on exposing many of the social challenges in our societies. Authentic learning experience are not common. An activity was created between the UOW College Australia and UOW College Hong Kong where students from these respective institutions collaborated with each other to identify, explore and suggest a social media-based solution to challenges faced by a NGO located in a third country, that is, not located in Australia or Hong Kong. This gave students to experience working with each other, and through that navigate the various linguistic, cultural and other norms and differences. They also had to identify and communicate with a NGO from a third country, in many cases who had their own linguistic, cultural and other norms about work and communications. This paper will discuss some of the knowledge, skills and attitudes that can be gained from engaging in cross border collaborative social projects. It will also outline some of the challenges and opportunities that exist in establishing these types of learning activities.

Typology-wise Residential Energy Benchmarking and Net ZEB Potential: A Case Study of Residential Complexes inside IIT Kharagpur, India

Rapid urbanization in developing countries has come at great costs in terms of the increasing energy demand. As India is a developing nation, the rising per capita income, and increasing purchasing power of domestic alliances by households, are pushing the household energy demand to rise sharply. Thus, there is a need to move towards the implementation of Net-Zero buildings in the residential sector in India to curb the escalating trend of energy demand. Although Rooftop Solar Photovoltaic has gained attention as a sustainable energy alternative to conventional sources, the potential of façade solar PV for harnessing alternative energy sources remains unexplored. This study aims to design and assess the feasibility of a grid-connected façade solar PV to meet the energy demand of residential complexes in a residential academic campus in India. Three groups of residential complexes based on energy-related user behaviour and built area have been identified in the study. Further, the maximum energy demand recorded in CoVID-affected years has been considered for designing the PV system. The study demonstrates that Façade Solar PV can solely meet 77-82% of the maximum energy demand of each group, and meets the Net-Zero potential for the studied residential typologies. Furthermore, it has been found, that the current residential benchmarking and labeling by the Bureau of Energy Efficiency (BEE), are largely climate-based and do not correspond with housing typology and built area. Thus, this study proposes a novel energy benchmarking and labelling system, based on the studied housing typology and corresponding energy usage, expressed in terms of the Energy Performance Index (EPI). It is found that the proposed energy efficiency labels for different typologies vary from the existing BEE residential benchmarking labels in terms of the calculated EPI and corresponding star rating when considered for Warm and Humid climatic zone. © 2022 ACM.

Impact of the COVID-19 Pandemic on Molecular Surveillance in the KOAR Registry

Background: The SARS-CoV2 pandemic increased the complexity of delivering clinical care and laboratory services for immunosuppressed kidney transplant (KTx) recipients. We evaluated how the pandemic impacted adherence with laboratory draws among patients in the Kidney allograft Outcomes AlloSure Registry (KOAR,NCT03326076). Method(s): 1663 KTx recipients undergoing post-transplant surveillance using donorderived cell-free DNA (dd-cfDNA) were enrolled in KOAR between 2017 and 2021. Participating centers were free to individualize their surveillance strategies. We estimated adherence by using the pre-pandemic distribution of surveillance dd-cfDNA draws across participating sites to establish a baseline regimen, and then compared adherence before the pandemic (P1;through 1/2020) with two subsequent periods in 2020: P2 (2/2020 - 6/2020), coinciding with the first wave of infections, and P3(7/2020 - 12/2020), which captures the bulk of the second and third waves in the US. Result(s): The distribution of surveillance dd-cfDNA draws at participating sites before COVID (P1) identified 7 peaks corresponding to draw points at months 1, 2, 3, 4, 6, 9, and 12 [Figure 1a]. Estimated adherence during P1 based on this regimen was 60.5%. Over the subsequent 5 months (P2), reflecting the early months of the pandemic, adherence declined to 50.5% (p < 0.01). After the expanded availability of mobile phlebotomy services in 7/2020 and despite rising SARS-CoV2 case counts and hospitalizations, adherence during P3 improved to 57.6% (p < 0.01 compared to P2, p = 0.1 compared to P1) [Figure 1b]. Conclusion(s): Our findings demonstrate that adherence to laboratory surveillance among transplant recipients enrolled in the KOAR registry declined in theearly period of the SARS-CoV2 pandemic, however, a variety of adaptations in the latter half of 2020, including the widespread availability of remote phlebotomy for these patients, appears to have led to substantial improvements, with adherence approaching pre-pandemic levels. (Figure Presented).

Association of Remdesivir Treatment With Mortality Among Hospitalized Adults With COVID-19 in the United States.

Importance: SARS-CoV-2, which causes COVID-19, poses considerable morbidity and mortality risks. Studies using data collected during routine clinical practice can supplement randomized clinical trials to provide needed evidence, especially during a global pandemic, and can yield markedly larger sample sizes to assess outcomes for important patient subgroups. Objective: To evaluate the association of remdesivir treatment with inpatient mortality among patients with COVID-19 outside of the clinical trial setting. Design, Setting, and Participants: A retrospective cohort study in US hospitals using health insurance claims data linked to hospital chargemaster data from December 1, 2018, to May 3, 2021, was conducted among 24 856 adults hospitalized between May 1, 2020, and May 3, 2021, with newly diagnosed COVID-19 who received remdesivir and 24 856 propensity score-matched control patients. Exposure: Remdesivir treatment. Main Outcomes and Measures: All-cause inpatient mortality within 28 days of the start of remdesivir treatment for the remdesivir-exposed group or the matched index date for the control group. Results: A total of 24 856 remdesivir-exposed patients (12 596 men [50.7%]; mean [SD] age, 66.8 [15.4] years) and 24 856 propensity score-matched control patients (12 621 men [50.8%]; mean [SD] age, 66.8 [15.4] years) were included in the study. Median follow-up was 6 days (IQR, 4-11 days) in the remdesivir group and 5 days (IQR, 2-10 days) in the control group. There were 3557 mortality events (14.3%) in the remdesivir group and 3775 mortality events (15.2%) in the control group. The 28-day mortality rate was 0.5 per person-month in the remdesivir group and 0.6 per person-month in the control group. Remdesivir treatment was associated with a statistically significant 17% reduction in inpatient mortality among patients hospitalized with COVID-19 compared with propensity score-matched control patients (hazard ratio, 0.83 [95% CI, 0.79-0.87]). Conclusions and Relevance: In this retrospective cohort study using health insurance claims and hospital chargemaster data, remdesivir treatment was associated with a significantly reduced inpatient mortality overall among patients hospitalized with COVID-19. Results of this analysis using data collected during routine clinical practice and state-of-the-art methods complement results from randomized clinical trials. Future areas of research include assessing the association of remdesivir treatment with inpatient mortality during the circulation of different variants and relative to time from symptom onset.

Modeling and Analyzing the Inventory Level for Demand Uncertainty in the VUCA World: Evidence From Biomedical Manufacturer

As the world is witnessing unprecedented events such as the COVID-19 pandemic, we live in a volatile, uncertain, complex, ambiguity (VUCA) world. Where volatility in supplies, Uncertainty in demand, Complexity in getting the products, and Ambiguity in understanding the issues. Such a scenario constitutes a VUCA world, and inventory positioning is no exception. Inventory positioning manages the safety stock across echelons to maintain customer service levels undersupply or demand uncertainties. Therefore, this article focuses on optimizing the inventory levels in demand uncertainty and supply complexity through inventory positioning and making reliable forecasts using machine learning for biomedical equipment, especially knee implants. The product flow is mapped through a discrete event simulation model by considering a biechelon supply chain. The parameters like reorder point, order quantity, supply lead time, and inventory costs are considered, and Arena modelled and simulated inventory replenishment. They are optimized with in-built OptQuest to minimize back orders and total costs. The model determines the safety stock inventories positioned at both echelons to achieve service level constraints. The uncertainty in demand is the root cause of the abovementioned issues and may be reduced through more reliable forecasts.

Impact of the Covid-19 Pandemic on Longitudinal Molecular Surveillance in the KOAR Registry

Purpose: The SARS-CoV2 pandemic increased the complexity of delivering routine clinical care and laboratory services for immunosuppressed kidney transplant (KTx) recipients. We evaluated how the pandemic impacted adherence with scheduled laboratory draws among patients enrolled in the Kidney allograft Outcomes AlloSure Registry (KOAR, NCT03326076). Method(s): 1663 kidney transplant (KTx) recipients undergoing post-transplant surveillance using donor-derived cell-free DNA (dd-cfDNA, AlloSure, CareDx Inc.) were enrolled in KOAR between 2017 and 2021. Participating centers were free to individualize their surveillance strategies. We estimated adherence by using the pre-pandemic distribution of surveillance dd-cfDNA draws across participating sites to establish a baseline regimen, and then compared adherence before the pandemic (P1;through 1/2020) with two subsequent periods in 2020: P2 (2/2020 - 6/2020), coinciding with the first wave of infections, and P3 (7/2020 - 12/2020), which captures the bulk of the second and third waves in the US. Result(s): The distribution of surveillance dd-cfDNA draws at participating sites before COVID (P1) identified 7 peaks corresponding to draw points at or around months 1, 2, 3, 4, 6, 9, and 12 [Figure 1a]. Estimated adherence during P1 based on this regimen was 60.5%. Over the subsequent 5 months (P2), reflecting the early months of the pandemic, adherence declined to 50.5% (p < 0.01). After the expanded availability of mobile phlebotomy services in 7/2020 and despite rising SARS-CoV2 case counts and hospitalizations, adherence during P3 improved to 57.6% (p < 0.01 compared to P2, p = 0.1 compared to P1) [Figure 1b]. Conclusion(s): Our findings demonstrate that adherence to laboratory surveillance among transplant recipients enrolled in the KOAR registry declined in the early period of the SARS-CoV2 pandemic, however, a variety of adaptations in the latter half of 2020, including the widespread availability of remote phlebotomy for these patients, appears to have led to substantial improvements, with adherence approaching pre-pandemic levels.

Indoor air pollution, occupant health, and building system controls—a COVID-19 perspective

The recent COVID-19 pandemic has taken a serious toll on humanity and mankind, affecting every section of society. Scientists are still trying to find out the possible transmission routes of this deadly virus, with airborne routes cited by many as a possible route of infection spread. Because airborne aerosols, dust particles, and other indoor pollutants aid in virus transmission, it becomes important to assess their roles in affecting human health. The study therefore tries to review indoor air pollution and its sources, how it impacts human health, and the role of built components and technological systems in combating indoor air pollution and in the process control infection spread also. Most of the studies have found out that there exists a need to accurately determine the airflow distribution pattern rather than relying on generic ventilation standards like ventilation rates, air change rates, and CO2 levels. Although increasing outdoor airflow rates and avoiding air recirculation are some of the suggestions given to control indoor pollution levels and infection spread, it can become challenging in areas with high ambient pollution levels. This signifies the need to incorporate additional engineering controls, sensing technologies, artificial intelligence tools, and predictive modeling methods to combat the health hazards of indoor air pollution and potential novel viruses that can emerge in the future. © 2022 Elsevier Inc. All rights reserved.

Impact of tele rehabilitation on clinical outcomes in patients recovering from COVID-19: a preliminary investigation

Pulmonary rehabilitation has proven to be an effective therapeutic intervention for people with chronic respiratory disease. Considering the highly contagious nature of coronavirus disease (COVID-19), it becomes imperative to develop a method which can effectively improve clinical disease outcomes of these patients without any physical contact. The purpose of the study was to investigate the impact of tele rehabilitation on dyspnoea, endurance and quality-of-life in patients recovering from COVID 19. Thirty-two participants (age: 42.5 +/- 13.94, height: 165.8 +/- 10.06, weight: 68.5 +/- 9.63, body mass index: 25.0 +/- 3.61) who are recovering from COVID-19 were recruited as per the eligibility criteria. They were randomly allocated into two groups, Tele rehabilitation (n=16) and Control (n=16) by lottery method. All the selected participants were assessed at baseline for perceived dyspnoea, endurance and quality-of-life. Patients in the Tele rehabilitation group received 14 sessions of rehabilitation on alternate days online via google meet over a period of 28 days. Control group received usual care during the study period. Standard statistical tests were employed to test the study hypothesis. Results suggested a significant improvement in both dyspnoea (P=0.001) and endurance (P<0.001) in response to tele rehabilitation. Domains of quality-of-life such as physical role (P=0.02), vitality (P=0.04), emotional role (P=0.03), mental health (P=0.02) and physical components score (P=0.007) also showed significant improvement with tele rehabilitation in patients recovering from COVID-19. Findings of this preliminary study concludes that tele rehabilitation may be considered a treatment of choice in patients recovering from COVID-19 for improving outcomes of dyspnoea, endurance and quality-of-life.

Bilateral facial nerve palsy associated with COVID-19 infections

Objective: To report 3 cases of bilateral facial nerve palsy as the only neurological deficit after a recent COVID-19 infection. Background: Neurologic complications of SARS-CoV-2 infection including hyposmia, cerebrovascular disease and seizures have significantly added to the morbidity and mortality during the COVID-19 pandemic. Bilateral facial nerve palsy while rare, can be attributed to a range of etiologies including infectious, metabolic, oncologic and autoimmune processes, but has rarely been reported with COVID-19 infections. Design/Methods: N/A Case 1: A 54-year old woman presented to the neurology clinic reporting an inability to move her lips and difficulty keeping food in her mouth 14 days after testing positive for COVID-19, her MRI was unrevealing. Case 2: A 36-year-old man presented to the emergency department reporting face numbness and a bifacial droop 5 days after testing positive for COVID-19, his MRI showed inflammation of the right 7 nerve. Case 3: A 42-year-old woman presented to the emergency department for a stroke evaluation with worsening bilateral facial weakness 5 days after testing positive for COVID-19, her MRI showed bilateral enhancement of the 7 cranial nerves. All three patients had bilateral facial weakness on exam. Tests for Herpes, Lyme, HIV, tuberculosis, syphilis, sarcoidosis and diabetes were negative for the first two cases and Stroke workup was unrevealing for the third. None were vaccinated, had other neurologic deficits or cardiorespiratory symptoms. Two of the three patients had a viral prodrome preceding their bifacial palsy. All three were treated with acyclovir and prednisone and showed improvement of symptoms on follow-up. Conclusions: Bilateral facial palsy can impede enteral nutrition and can be distressful from a cosmetic standpoint. COVID-19 infections should now be a part of the differential for bilateral facial nerve palsy. Whether this manifestation is akin to autoimmune phenomena such as a limited Guillain-Barré syndrome or an infectious reactivation needs further research.

Neurologic Manifestations of Patients Hospitalized with COVID-19 in the SCCM VIRUS Registry

Objective: To describe the prevalence, associated risk factors, and outcomes of serious neurologic manifestations (encephalopathy, stroke, seizure, and meningo-encephalitis) among patients hospitalized with coronavirus disease 2019 (COVID-19). Background: Though case series abound, limited prospective multi-center data exists describing neurologic manifestations of COVID-19 Design/Methods: Prospective observational study of hospitalized adults in 179 hospitals in 24 countries with laboratory-confirmed SARS-CoV-2 infection within the SCCM Discovery Viral Infection and Respiratory Illness University Study (VIRUS) COVID-19 Registry Results: Of 16,225 patients enrolled in the registry with discharge status available, 2,092 (12.9%) developed serious neurologic manifestations including 1,656 (10.2%) with encephalopathy at admission, 331 (2.0%) with stroke, 243 (1.5%) with seizure, and 73 (0.5%) with meningitis/encephalitis at admission or during hospitalization. Patients with serious neurologic manifestations were older with median (IQR) age 72 (61.0-81.0) vs. 61 (48.0-72.0) years and had higher prevalence of chronic medical conditions, including vascular risk factors. Systemic viral symptoms (fever, dyspnea, and cough) were less commonly reported in patients with severe neurologic manifestations as were milder neurologic symptoms including anosmia, dysgeusia, and headache. Adjusting for sex and time since the onset of the pandemic, serious neurologic manifestations were associated with more severe disease (OR 1.82, p<0.001) as defined by the WHO ordinal disease severity scale. Patients with neurologic manifestations were more likely to be admitted to the ICU (OR 1.45, p<0.001) and ICU interventions (ECMO: OR 1.78, p=0.009 and RRT: OR 1.99, p<0.001). Hospital and 28-day mortality for patients with neurologic manifestations was higher (OR 1.51 and 1.58, p<0.001), and patients had fewer ICU-free, hospital-free, and ventilator-free days (OR -0.84, -1.34, and -0.84, p<0.001). Conclusions: Encephalopathy at admission is common in COVID-19 infection and is associated with worse outcomes. While serious neurologic manifestations including stroke, seizure, and meningitis/encephalitis were less common, all were associated with increased ICU support utilization, more severe disease, and worse outcomes.

Embedding Social, Community Projects Within Contemporary Curricular

Social media continues to influence the online behaviours of humans in some of the most profound ways. Furthermore, COVID-19 pandemic has highlighted immense opportunities that social media provides to keep people connected and engaged through difficult circumstances. Unfortunately, it also attracts various dubious users, eager to take advantage to the anonymity of these platforms to conduct unethical and illegal practices. Typical computing studies courses do not focus on developing the skills and attitudes to enable students to work in a globalised environment, and certainly do not focus on exposing many of the social challenges in our societies. Authentic learning experience are not common. An activity was created between the UOW College Australia and UOW College Hong Kong where students from these respective institutions collaborated with each other to identify, explore and suggest a social media-based solution to challenges faced by a NGO located in a third country, that is, not located in Australia or Hong Kong. This gave students to experience working with each other, and through that navigate the various linguistic, cultural and other norms and differences. They also had to identify and communicate with a NGO from a third country, in many cases who had their own linguistic, cultural and other norms about work and communications. This paper will discuss some of the knowledge, skills and attitudes that can be gained from engaging in cross border collaborative social projects. It will also outline some of the challenges and opportunities that exist in establishing these types of learning activities. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

3D Printed Medical Accessories Using FDM Process for COVID-19 Virus

The sudden spike in the Covid-19 pandemic cases around the world caused an urgent demand for Personal Protective Equipment (PPE) such as N95 face mask, face shield, ventilator valve, and non-contact door hook. The current situation requires a huge cost involvement and hard to solve the huge demand in a short period by using the traditional fabrication process. Therefore, the three-dimensional (3D) printing technology emerged as a suitable alternative to produce cost-effective production methods for these components. The present research work focuses on the design, types of filament material, and 3D printing process to print the required PPE kits which facilitates to reduce the economic cost, environmentally hazardous, and failure of the product (reusable). Overall the initial investment needed for the 3D printing technology to print the polymer medical accessories is reduced and the material can be reused after appropriate treatment. © The Electrochemical Society

Awareness, Views, and Expectations about COVID-19 Vaccinations: A Cross-Sectional Study of Dental Clinic Patients in India

Introduction: Several vaccines against coronavirus disease 2019 (COVID-19) have been licensed and are being administered worldwide in various countries. However, the awareness, behaviors, and expectations of COVID-19 vaccines among dental clinic patients are poorly understood. Methods: An e-survey was carried out among 1800 patients who visited dental clinics in India. The survey was carried out using a questionnaire of four parts and informed consent (i.e. sociodemographics, knowledge, attitudes, and perceptions). The investigators used Internet methods for data collection during the pandemic. Results: The mean awareness score was significantly higher among participants who reported having a university/higher level of schooling, being in the upper socioeconomic status community, living in cities, and having previously received all required vaccines. The mean attitude score was slightly higher for participants who reported being female and had a history of getting all required vaccinations. Just over half (52%) of participants felt everyone should be vaccinated. This interpretation was slightly higher among females than males (56.9% vs. 47.9%, P = 0.004). Conclusions: The results indicate that patients attending dental clinics in India have insufficient awareness but more optimistic attitudes about the COVID-19 vaccine. Immediate health promotion campaigns must be implemented before vaccine schedules in order to increase awareness.

Compassionate Use of Remdesivir in Pregnant Women With Severe Coronavirus Disease 2019.

BACKGROUND: Remdesivir is efficacious for severe coronavirus disease 2019 (COVID-19) in adults, but data in pregnant women are limited. We describe outcomes in the first 86 pregnant women with severe COVID-19 who were treated with remdesivir. METHODS: The reported data span 21 March to 16 June 2020 for hospitalized pregnant women with polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 infection and room air oxygen saturation ≤94% whose clinicians requested remdesivir through the compassionate use program. The intended remdesivir treatment course was 10 days (200 mg on day 1, followed by 100 mg for days 2-10, given intravenously). RESULTS: Nineteen of 86 women delivered before their first dose and were reclassified as immediate "postpartum" (median postpartum day 1 [range, 0-3]). At baseline, 40% of pregnant women (median gestational age, 28 weeks) required invasive ventilation, in contrast to 95% of postpartum women (median gestational age at delivery 30 weeks). By day 28 of follow-up, the level of oxygen requirement decreased in 96% and 89% of pregnant and postpartum women, respectively. Among pregnant women, 93% of those on mechanical ventilation were extubated, 93% recovered, and 90% were discharged. Among postpartum women, 89% were extubated, 89% recovered, and 84% were discharged. Remdesivir was well tolerated, with a low incidence of serious adverse events (AEs) (16%). Most AEs were related to pregnancy and underlying disease; most laboratory abnormalities were grade 1 or 2. There was 1 maternal death attributed to underlying disease and no neonatal deaths. CONCLUSIONS: Among 86 pregnant and postpartum women with severe COVID-19 who received compassionate-use remdesivir, recovery rates were high, with a low rate of serious AEs.

Remdesivir for Severe Coronavirus Disease 2019 (COVID-19) Versus a Cohort Receiving Standard of Care.

BACKGROUND: We compared the efficacy of the antiviral agent, remdesivir, versus standard-of-care treatment in adults with severe coronavirus disease 2019 (COVID-19) using data from a phase 3 remdesivir trial and a retrospective cohort of patients with severe COVID-19 treated with standard of care. METHODS: GS-US-540-5773 is an ongoing phase 3, randomized, open-label trial comparing two courses of remdesivir (remdesivir-cohort). GS-US-540-5807 is an ongoing real-world, retrospective cohort study of clinical outcomes in patients receiving standard-of-care treatment (non-remdesivir-cohort). Inclusion criteria were similar between studies: patients had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, were hospitalized, had oxygen saturation ≤94% on room air or required supplemental oxygen, and had pulmonary infiltrates. Stabilized inverse probability of treatment weighted multivariable logistic regression was used to estimate the treatment effect of remdesivir versus standard of care. The primary endpoint was the proportion of patients with recovery on day 14, dichotomized from a 7-point clinical status ordinal scale. A key secondary endpoint was mortality. RESULTS: After the inverse probability of treatment weighting procedure, 312 and 818 patients were counted in the remdesivir- and non-remdesivir-cohorts, respectively. At day 14, 74.4% of patients in the remdesivir-cohort had recovered versus 59.0% in the non-remdesivir-cohort (adjusted odds ratio [aOR] 2.03: 95% confidence interval [CI]: 1.34-3.08, P < .001). At day 14, 7.6% of patients in the remdesivir-cohort had died versus 12.5% in the non-remdesivir-cohort (aOR 0.38, 95% CI: .22-.68, P = .001). CONCLUSIONS: In this comparative analysis, by day 14, remdesivir was associated with significantly greater recovery and 62% reduced odds of death versus standard-of-care treatment in patients with severe COVID-19. CLINICAL TRIALS REGISTRATION: NCT04292899 and EUPAS34303.

Secondary amyloidosis presenting as a rare complication of IBD

Introduction: 35% of patients with Inflammatory Bowel Disease (IBD) experience extraintestinal manifestations. However, amyloidosis is a rare complication of IBD;the incidence in the US is <1% for both Crohn's disease (CD) and Ulcerative Colitis (UC). We hope to shed some light in this underdiagnosed consequence with a clinical vignette. Case description/methods: A 75 year old man with recently diagnosed UC 6 weeks prior and history of thoracic laminectomy presented with bilateral lower extremity weakness that resulted in a fall in the shower and complaints of bloody diarrhea. Prior to his admission he was ambulating with a walker, he then developed loss of motor function of his lower extremities. He had been having several episodes of bloody diarrhea a day along with tenesmus and fecal incontinence for almost a year. He delayed getting medical aid until recently due to the COVID-19 pandemic. He had a colonoscopy which revealed pancolitis and he was started on aggressive steroids and mesalamine. CT and MRI imaging of the spine were inconclusive, but revealed swelling of the iliopsoas muscle with concern for polymyositis. However EMG, muscle enzymes and Immunological studies were all unremarkable. Muscle biopsy of the gastrocnemius revealed interstitial amyloid deposition. Mass spectrometry was indeterminate and could not isolate the type of amyloid protein. The patient's UC flare slowly improved after several weeks and he was transferred to acute rehab and later to a tertiary care center for further evaluation. Discussion: Primary amyloidosis is AL amyloid deposition associated with plasma cell dyscrasias such as multiple myeloma (MM). AA Amyloid can also build up as an acute phase reactant from chronic inflammatory conditions such as IBD and be deposited in extracellular tissue. Amyloidosis is more associated with CD than UC, more found in men and is often associated with renal involvement. One study found that only 15 out of 1709 (0.9%) patients with CD and 1 in 1341 (0.7%) patients with UC had amyloidosis. Our patient's long standing uncontrolled UC likely resulted in amyloid protein production and deposition. Although it is important to rule out MM in cases of amyloidosis, the timing of our patient's lower extremity weakness and diagnosis of amyloidosis in the setting of uncontrolled UC flare strongly suggests secondary amyloidosis. We hope this diagnostic walk through can guide clinicians to approach similar situations in the future.

The spectrum of cerebrovascular events in COVID-19 patients in a racially and socioeconomically diverse patient population

Objective: To examine the breadth of cerebrovascular presentations in patients hospitalized with coronavirus disease 2019 (COVID-19) in a racially and socioeconomically diverse population. Background: COVID-19 has been associated with a significant risk for thrombotic events. Although reports suggest an increased number of cerebrovascular events in COVID-19 patients, most still had conventional vascular risk factors. Design/Methods: We conducted a retrospective, observational study of the incidence of cerebrovascular events and their mechanisms in all patients hospitalized with COVID-19 from April 15 to July 11 2020 at the largest academic safety net hospital in Boston, Massachusetts. Results: We identified 921 patients diagnosed with COVID-19;2.1% were found to have a cerebrovascular complication. 14 patients (1.5%) had confirmed ischemic stroke, 3 (0.3%) had hemorrhagic stroke, 2 (0.2%) had cerebral venous sinus thrombosis, and 2 (0.2%) had posterior reversible encephalopathy syndrome. Of all patients with cerebrovascular complications, the mean age was 64 years, 47% female, 53% male, with 16% identifying as White, 58% as African American and 26% as other. In regards to socioeconomic factors, 5% of patients were homeless, and 37% had Medicaid or low cost state funded insurance. Conventional stroke risk factors including hypertension were present in 53%, diabetes in 37%, tobacco use in 26%, hyperlipidemia in 16%, atrial fibrillation in 11% and 16% with history of a prior stroke. No identifiable risk factors were found in 21%. Of the ischemic stroke patients, the stroke mechanism was cardioembolic in 43%, small vessel disease in 7%, cryptogenic in 21.5%, stroke of other determined etiology in 21.5% and transient ischemic attack in 7%. Conclusions: We found that amongst the racially and socioeconomically diverse population at one large safety-net hospital, the rates of acute cerebrovascular events were low however varied in their presentations. Our patient population had fewer associated conventional vascular risk factors than typically observed in stroke patients.

Intravenous tPA for acute ischemic stroke in patients with COVID-19

Objective: To evaluate the safety and efficacy of IV tPA in patients with stroke and COVID-19. Background: Coronavirus disease 2019 (COVID-19) is associated with increased risk of acute ischemic stroke (AIS), however, there is a paucity of data regarding outcomes after administration of intravenous tissue plasminogen activator (IV tPA) for stroke in patients with COVID-19. Design/Methods: We present a multi-center case series from 9 centers in the United States of patients with acute neurological deficits consistent with AIS and COVID-19 who were treated with IV tPA. Results: We identified 13 patients (mean age 62 (±9.8) years, 9 (69.2%) male). All received IV tPA and 3 cases also underwent mechanical thrombectomy. All patients had systemic symptoms consistent with COVID-19 at the time of admission: fever (5 patients), cough (7 patients), and dyspnea (8 patients). The median admission NIH stroke scale (NIHSS) score was 14.5 (range 3- 26) and most patients (61.5%) improved at follow up (median NIHSS score 7.5, range 0-25). No systemic or symptomatic intracranial hemorrhages were seen. Stroke mechanisms included cardioembolic (3 patients), large artery atherosclerosis (2 patients), small vessel disease (1 patient), embolic stroke of undetermined source (3 patients), and cryptogenic with incomplete investigation (1 patient). Three patients were determined to have transient ischemic attacks or aborted strokes. Two out of 12 (16.6%) patients had elevated fibrinogen levels on admission (mean 262.2 ± 87.5 mg/dl), and 7 out of 11 (63.6%) patients had an elevated D-dimer level (mean 4284.6 ±3368.9 ng/ml). Conclusions: IV tPA may be safe and efficacious in COVID-19, but larger studies are needed to validate these results.