Longitudinal quantification of neutralising antibodies after two doses of SARS-CoV-2 mRNA vaccine in MS, NMOSD and other neuroimmunological diseases

Introduction: Several studies have reported attenuated humoral responses following SARS-CoV-2 mRNA vaccination in Multiple Sclerosis (MS) patients on anti-CD20 therapies and fingolimod. However, neutralising antibodies (NAbs) against the receptorbinding domain of the SARS-CoV-2 spike protein were quantified in only a few reports and there is limited data in neuromyelitis optica spectrum disorder (NMOSD) patients. Objectives and Aims: To measure serum NAbs levels prior to, and, at several time points after the first (V1) and second (V2) SARS-CoV-2 mRNA vaccination in patients with neuroimmunological conditions on various immunotherapies, and, to identify the factors associated with poor humoral responses. Method(s): This was a prospective observational study performed at the National Neuroscience Institute, Singapore. Patients with MS (n=77), NMOSD (n=33), myelin oligodendrocyte glycoprotein- antibody associated disease (n=6), autoimmune encephalitis (n=3), other CNS inflammatory diseases (n=5), myasthenia gravis (n=9) and healthy controls (HCs, n=42) were recruited. No subjects had COVID-19 infection prior to V1, V2 and the sampling time points. NAbs were measured using the Genscript cPassTM surrogate virus neutralisation test. Result(s): No patients or HCs had detectable NAbs prior to V1. Two to 4 weeks after V1, patients on anti-CD20 therapies had lower NAbs levels (p=0.010) compared to HCs and untreated patients. Two to 6 weeks post V2, patients on disease-modifying anti-rheumatic drugs (DMARDs) (p=0.010), fingolimod (p<0.0001) and anti-CD20 therapies (p<0.0001) showed decreased NAbs levels compared to HCs and untreated patients. This was also observed 8 to 16 weeks post V2 - DMARDs (p=0.046), fingolimod (p<0.0001) and anti-CD20 therapies (p<0.0001). NAbs levels decreased in both HCs and patients with increasing time interval following V2. There was no correlation between NAbs levels and the time interval from last anti-CD20 treatment to V1 (p=0.508). A multivariable logistic regression model adjusted for age, expanded disability status scale, gender, mRNA vaccine type, ethnicity and body mass index, revealed that fingolimod (p=0.026) and anti-CD20 therapies (p=0.003) were independent predictors of undetectable NAbs following V2. Conclusion(s): Fingolimod and anti-CD20 therapies are associated with attenuated NAbs levels post-vaccination. Future studies are needed to determine whether this translates to an increased risk of COVID-19 infection.

Adaptable eye tracking technology of obscured face

Humans around the world are affected by special infectious pneumonia (COVID-19). There are more and more people wearing masks that are necessary for daily or workplace use. However, the sensitivity of face detection will be affected by feature obscuration, and most of them cannot be performed. Obscured face detection and gaze tracking. This paper proposes a face detection and landmark repair, and then realizes the tracking of the eye trajectory of the obscured face. Model database with obscured face image data can also include unobscured face image data. After calibrated eye area, machine learning [1] algorithm is used for model database training to achieve eye area detection and provide real-time position coordinates. The eye information of the partial simulation model is superimposed and calculated to complete the feature point restoration, feature point detection and definition. Finally, K-means [2] is used to classify the image around the eyes to distinguish the eyeball from the white of the eye and calculate the position of the eyeball center. The face wearing a mask will affect the sensitivity of face detection, and the person wearing a mask cannot be detected. We use a two-stage method to locate the eyeball center of the face wearing a mask. We use the machine learning algorithm to detect the bounding box near the eyes, and we use the obscured image to train our model. Then attach the chin pattern to the place that is expected to be covered. Use a general cross-platform machine learning library [3] to locate area near the eyeball. Then use an unsupervised learning clustering algorithm to classify the image near the eyeball to analyze the eyeball area and find the center of the eyeball, to achieve the purpose of eye tracking. © 2020 ITE and SID.

Masks prevent hospital-acquired COVID-19: A single hospital experience in Taiwan

To estimate the hospital attack rate of coronavirus disease 2019 (COVID-19) and the stratified basic reproduction number (R0) of its causative agent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a hospital setting in Taiwan. A total of 138 healthcare workers (HCWs) in a hospital who were exposed to COVID-19 within a patient household (January 14 to March 7,2020) were divided into two groups, based on their exposure level. All HCWs received throat swab SARS-CoV-2 RT-PCR detection twice. Routine infection control policies included environmental disinfection, use of personal protective equipment (PPE), and hand hygiene per Taiwan Centers for Disease Control guideline. The estimated attack rate and the R0were calculated. Compared with the "low-risk" exposure group, the "high-risk" exposure group was less likely to have used partial PPE, and more likely to have had contact time >1 hour, performed "aerosol-production" tasks, and developed symptoms during quarantine. None of the HCWs in either group acquired COVID-19. All HCWs wore surgical masks and performed routine environmental disinfection. Estimated R0was 1.46 and 0 for household and HCW models, respectively, implying that the index patient did not transmit COVID-19. Using masks may help prevent hospital-acquired COVID-19. © 2021 Society of Internal Medicine of Taiwan. All rights reserved.

[Recommendations for the treatment of severe coronavirus disease 2019 based on critical care ultrasound].

Severe patients with coronaviras disease 2019 (COVID-19) are characterized by persistent lung damage, causing respiratory failure, secondary circulatory changes and multiple organ dysfunction after virus invasion. Because of its dynamic, real-time, non-invasive, repeatable and other advantages, critical ultrasonography can be widely used in the diagnosis, assessment and guidance of treatment for severe patients. Based on the recommendations of critical care experts from all over the country who fight against the epidemic in Wuhan, this article summarizes the guidelines for the treatment of COVID-19 based on critical ultrasonography, hoping to provide help for the treatment of severe patients. The recommendations mainly cover the following aspects: (1) lung ultrasound in patients with COVID-19 is mainly manifested by thickened and irregular pleural lines, different types of B-lines, shred signs, and other consolidation like dynamic air bronchogram; (2) Echocardiography may show right heart dysfunction, diffuse cardiac function enhancement, stress cardiomyopathy, diffuse cardiac depression and other multiple abnormalities; (3) Critical ultrasonography helps with initiating early treatment in the suspect patient, screening confirmed patients after intensive care unit admission, early assessment of sudden critical events, rapid grading assessment and treatment based on it; (4) Critical ultrasonography helps to quickly screen for the etiology of respiratory failure in patients with COVID-19, make oxygen therapeutic strategy, guide the implementation of lung protective ventilation, graded management and precise off-ventilator; (5) Critical ultrasonography is helpful for assessing the circulatory status of patients with COVID-19, finding chronic cardiopulmonary diseases and guiding extracorporeal membrane oxygenation management; (6) Critical ultrasonography contributes to the management of organs besides based on cardiopulmonary oxygen transport; (7) Critical ultrasonography can help to improve the success of operation; (8) Critical ultrasonography can help to improve the safety and quality of nursing; (9) When performing critical ultrasonography for patients with COVID-19, it needs to implement three-level protection standard, pay attention to disinfect the machine and strictly obey the rules from nosocomial infection. (10) Telemedicine and artificial intelligence centered on critical ultrasonography may help to improve the efficiency of treatment for the patients with COVID-19. In the face of the global spread of the epidemic, all we can do is to share experience, build a defense line, We hope this recommendations can help COVID-19 patients therapy.

A three-generation family cluster with COVID-19 infection: should quarantine be prolonged?

OBJECTIVES: Families are a transmission route for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) because of the close contact. Monitoring of the viral load will be a valuable method to reduce the optimal number of quarantine days, especially in presymptomatic and symptomatic carriers of their households. The traditional three-generation families living together are seen frequently in East Asia, including in Taiwan. STUDY DESIGN: We report on a family cluster with six individuals infected with coronavirus disease in Taiwan. METHODS: The current public policy in Taiwan is quarantine for at least 14 days, based on the incubation period, or until the patient has tested negative three days in a row using the SARS-CoV-2 reverse transcription polymerase chain reaction. Details on the onset date of clinical symptoms, throat swab conversion, and course of disease were collected from medical records retrospectively. RESULTS: In the household of this three-generation Taiwanese family, the infection rate was 60%. The ratio of males to females was 4:2, and the age range was 11-85 years. The prevalence of asymptomatic disease was 33.3% (2/6). The longest throat swab conversion time was 37 days, and the estimated course of disease from symptoms to first conversion of throat swab was 59 days. CONCLUSIONS: Large families, including three-generation families in a single dwelling, should be monitored when the index case is found. Presymptomatic and symptomatic family members could be quarantined for an appropriate duration which, in our experience, is 2 months.