From Covid to Bovid to Ovid: A Case of Disseminated Cryptococcus Neoformans

Case Report: Cryptococcosis is an opportunistic infection caused by the encapsulated yeast Cryptococcus, with C. neoformans and C. gattii being the most common species to cause human disease. Immunocompromised individuals are predisposed to infections with C. neoformans, which has known predilection to CNS and pulmonary lymph nodes. We present a unique case of disseminated cryptococcosis in the setting of end-stage renal disease (ESRD), cirrhosis, tumor necrosis factor inhibitor use and steroid use for COVID19. Method(s): A single-patient case report was conducted after IRB approval. Case Presentation: A 55-year-old woman with uncontrolled diabetes, lupus, rheumatoid arthritis on adalimumab, hepatitis C status post boceprevir, cirrhosis, former IV drug use, and ESRD on hemodialysis via bovine arterial-venous fistula graft presented with worsening dyspnea, cough, and altered mental status. Three months prior, patient was admitted to an outside hospital for COVID19, complicated by pulmonary embolism status post anticoagulation therapy. Patient was treated with an unknown steroid regimen, which was continued by a second outside facility when symptoms failed to improve. Patient then presented to our facility 24 hours after discharge due to continued symptoms. On admission, patient was noted to have altered mentation and hypoxia with pulmonary edema on chest x-ray and was urgently hemodialyzed. Further work-up was obtained due to non-resolving symptoms, including blood and sputum cultures, cocci serology and QuantiFERON gold. CT chest revealed bilateral consolidations. Patient was started on antibiotics for presumed hospital-acquired pneumonia. During the hospital stay, preliminarily blood cultures grew yeast and patient was started on Micafungin. However, Micafungin was changed to Liposomal Amphotericin B as ovoid structures seen on gram stain could not confirm nor rule out cryptococcus. Subsequent bronchial wash and bronchoalveolar lavage cultures, as well as final blood cultures resulted Cryptococcus neoformans. Serum cryptococcus antigen returned reactive, titer 1:512. Antibiotics were discontinued and Isavuconazonium was started with Liposomal Amphotericin B. Due to recurrent headaches, lumbar puncture was obtained and revealed lymphocytic pleocytosis without cryptococcal antigenicity. Patient completed 14 days of Liposomal Amphotericin B and Isavuconazole with continuation of Isavuconazole upon discharge. Conclusion(s): Disseminated cryptococcosis in non-HIV patients is rare in the modern HIV era. Clinicians should be aware and include it in their differential of any patient with multiple risk factors for opportunistic infection. In patients with cirrhosis and ESRD, treatment is limited given altered pharmacokinetics. Studies have shown improved survival with the addition of Isavuconazole in patients with disseminated cryptococcosis with CNS involvement in the setting of chronic liver disease and ESRD.

Performance optimization of water cycle algorithm for multilevel lupus nephritis image segmentation

Lupus nephritis (LN) is one of the most common and serious clinical manifestations of systemic lupus erythe-matosus (SLE), which causes serious damage to the kidneys of patients. To effectively assist the pathological diagnosis of LN, many researchers utilize a scheme combining multi-threshold image segmentation (MIS) with metaheuristic algorithms (MAs) to classify LN. However, traditional MAs-based MIS methods tend to fall into local optima in the segmentation process and find it difficult to obtain the optimal threshold set. Aiming at this problem, this paper proposes an improved water cycle algorithm (SCWCA) and applies it to the MIS method to generate an SCWCA-based MIS method. Besides, this MIS method uses a non-local means 2D histogram to represent the image information and utilizes Renyi's entropy as the fitness function. First, SCWCA adds a sine initialization mechanism (SS) in the initial stage of the original WCA to generate the initial solution to improve the population quality. Second, the covariance matrix adaptation evolution strategy (CMA-ES) is applied in the population location update stage of WCA to mine high-quality population information. To validate the excellent performance of the SCWCA-based MIS method, the comparative experiment between some peers and SCWCA was carried out first. The experimental results show that the solution of SCWCA was closer to the global optimal solution and can effectively deal with the local optimal problems. In addition, the segmentation experiments of the SCWCA-based MIS method and other equivalent methods on LN images showed that the former can obtain higher-quality segmented LN images.

Mortality Rate and Years of Life Lost Due to Premature Death From Respiratory Diseases: A Five-year Trend (2014-2018)

Background: Chronic respiratory diseases impose a significant socioeconomic burden on individuals and communities and are severely overlooked compared to other non-communicable diseases, such as cardiovascular disease, cancer, and diabetes. This study aimed to investigate the mortality rate and years of life lost due to respiratory diseases in northern Iran. Methods: The documentary research method was used and data were collected using the census. The population included all deaths registered in the Department of Health, Golestan University of Medical Sciences in Iran during 2014-2018. Results: Between 2014 and 2018, 2462 deaths due to respiratory diseases were recorded in Golestan Province, of which 1416 people (57.5%) were men and 1046 people (42.5%) were women. The Mean±SD age of death was 62.28±26.29 years, with an Mean±SD of 62.56±25.32 years for men and 61.90±27.56 years for women. The highest number of deaths due to respiratory diseases in all the studied years was in men and women aged 80 years and above (28.7% and 31.1%, respectively). Approximately, 6864 years of life were lost due to premature death during this period, with men (3511 years, 7.2 per 1,000) contributing more than women (3353 years, 7.2 per 1,000). Conclusion: Given the rapid increase in population and given that the crucial risk factors for respiratory diseases are smoking, exposure to pollutants, and allergens, more comprehensive research seems necessary throughout Iran. In addition, this study was designed before the onset of the COVID-19 pandemic, and due to changes that this pandemic has caused in the mortality rate, therefore, it is recommended to investigate the trend of mortality by respiratory diseases during this pandemic. © 2023, Gonabad University of Medical Sciences. All rights reserved.

Reduction in SARS-CoV-2 Oral Viral Load with Prophylactic Mouth Rinse

Objectives The medical and health facilities are at high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study tested the preprocedural prophylactic mouthwash rinses to reduce the oral viral load. The findings from this study will help the practitioners to select the best mouthwash for the patients to mitigate the risk of transmission during aerosolizing. This study aimed to evaluate the effectiveness of four commonly used types of mouthwash in reducing intraoral viral load among hospitalized coronavirus disease 2019 patients. Materials and Methods This prospective cohort study was conducted with 116 patients referred to the Masih Daneshvari Hospital in Tehran, Hamadan University of Medical Sciences of Hamadan City, and Mashhad University of Medical Sciences. Patients were randomized into four groups with each group rinsed their mouth with 20 mL of 2% povidone-iodine, 1% hydrogen peroxide, normal saline as a control study group, or 0.12% chlorhexidine, respectively, for 20 seconds. The standard reverse transcription polymerase chain reaction method evaluated the virus load before and at 1 hour, 2 hours, and 4 hours after using the mentioned mouthwash. Results Our results revealed that chlorhexidine and H 2O 2showed the highest efficiency in reducing SARS-Co-2 load in the oral cavity and nasopharyngeal region of patients;they increased the Ct values by 9 to 10 (before: 25.84 vs. after 32. 4, p < 0.455) (17.333 vs. after 26.497, p <0.097). Conclusion Our findings suggest that chlorhexidine and H 2O 2could be used in dental clinics to reduce the risk of transmitting the SARS-CoV-2 virus from infected individuals to dentists before dental procedures. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

An adaptive control framework based on Reinforcement learning to balance energy, comfort and hygiene in heat pump water heating systems

A major challenge in the operation of water heating systems lies in the highly stochastic nature of occupant behavior in hot water use, which varies over different buildings and can change over the time. However, the current operational strategies of water heating systems are detached from occupant behavior, and follow a conservative and energy intensive approach to ensure the availability of hot water any time it is demanded. This paper proposes a Reinforcement learning-based control framework which can learn and adapt to the occupant behavior of each specific building and make a balance between energy use, occupant comfort and water hygiene. The proposed framework is compared to the conventional approach using the real-world measurements of hot water use behavior in a single family residential building. Although the monitoring campaign has been executed during home lockdown due to COVID-19, when the occupants exhibited a very different schedule and water use related behavior, the proposed framework has learned the occupant behavior over a relatively short period of 8 weeks and provided 24.5% energy use reduction over the conventional approach, while preserving occupant comfort and water hygiene. © Content from this work may be used under the terms of the Creative Commons Attribution 3.0 Licence.

Early Recognition and Discrimination of COVID-19 Severity using Slime Mould Support Vector Machine for Medical Decision-making

COVID-19 has spread rapidly across the world, leading to the insufficiency of medical resources in many regions. Early detection and identification of high-risk COVID-19 patients will contribute to early intervention and optimize medical resource allocation. Using the clinical data from the Affiliated Yueqing Hospital of Wenzhou Medical University (Yueqing, China), an evolutionary support vector machine model is designed to recognize and discriminate the severity of the COVID-19 by patients basic information and hematological indexes. The support vector machine is a frequently used pattern classification tool affected by both the kernel parameter setting and feature selection for its classification accuracy. This study recommends an enhanced Slime Mould Algorithm (ESMA), mixing a new movement strategy of white holes, black holes, and wormholes, to perform parameter optimization and feature selection simultaneously for SVM. Therefore, the proposed SVM framework (ESMA-SVM) can also obtain high-quality classification results, and it is less prone to stagnation in the classification process. To verify the capabilities of the proposed methodology, first, the performance of the ESMA is thoroughly verified by using IEEE CEC2017 benchmark functions and the diversity and compared with other similar methods experimentally using these standard benchmark functions. Moreover, the balance between diversification and intensification capability of the enhanced ESMA and the original SMA is also investigated statistically. Finally, the designed model ESMA-SVM and other competitive SVM models based on other optimization algorithms are applied to early recognition and discrimination of COVID-19 severity. Through the analysis of experimental results, the core compensations of ESMA are confirmed, and the ESMA-SVM can obtain strong performance in terms of several performance evaluation indexes on discrimination of COVID-19 severity. Author

Gastrointestinal and kidney manifestations in sarscov and sars-cov-2 infections: Role of angiotensin-converting enzyme 2

The emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in 2020, which has a substantial structural similarity to severe acute respiratory syndrome coronavirus (SARS-CoV) that caused the outbreak in 2003, is currently a threat to global health. Lung involvement is the principal clinical feature in infected patients but extra-pulmonary clinical presentations are also common. The reasons for the extensive involvement of other organs are not yet clear. Angiotensin-converting enzyme 2 (ACE2), the key peptide of renin–angiotensin system (RAS), has recently identified as a major receptor for the both SARS-CoV and SARS-CoV-2 that might be a main target of coronavirus infection. ACE2 is mainly expressed in the pulmonary pneumocytes, the small intestine enterocytes as well as the proximal tubule epithelial cells of the kidneys. In addition to the respiratory tract infection symptoms, the noticeable prevalence of gastrointestinal symptoms as well as kidney impairment in hospitalized infected patients highlights other routes of infection/transmission. In present review, we discussed the role of RAS with emphasis on ACE2 in the pathogenesis of SARS-CoV and SARS-CoV-2, particularly in gastrointestinal and kidney manifestations of the diseases.