Case report of an antimelanoma differentiationassociated protein 5 antibody-associated amyopathic dermatomyositis

Autoantibodies against melanoma differentiation-associated protein 5 (MDA5) associated with dermatomyositis have recently been described in Asians with rapidly progressive respiratory disease. Here we report the case of a middle-aged white woman with anti-MDA5 antibody-associated amyopathic dermatomyositis with interstitial lung disease (ILD), which is stable with minimal immune suppression. A 55-year-old woman was referred to a virtual dermatology clinic during the COVID-19 pandemic suspected of having widespread eczema involving the chest, face, arm and hands on the background of atopy. On direct questioning, she admitted to having constitutional symptoms, exertional dyspnoea, joint pain and symptoms of proximal muscle weakness. On clinical suspicion of possible connective tissue disorder, she was urgently reviewed in the hospital, where she was found to have a photodistributed rash involving cutaneous ulceration and violaceous plaques. Hand examination showed mechanic's hand mimicking hand eczema, ragged nail cuticles and acute tenosynovitis in the left index finger. Her upper and lower limb muscle power was normal and respiratory examination revealed bi-basal fine end-expiratory crepitation. Her repeated biochemical, haematological and muscle enzymes remained normal. Skin biopsy taken from photosensitive rash over the wrist showed hypergranulosis, Civatte body formation, colloid bodies and dyskeratotic keratinocytes, in keeping with severe lichenoid eruption. Superficial dermis showed patchy red-cell extravasation, perivascular chronic infiltration, dermal oedema and serum on the surface, in keeping with ulceration secondary to severe inflammatory processes. There were no eosinophils and eccrine coils were free of inflammation, raising the suspicion of a drug eruption. Her antinuclear antibody and double-stranded DNA were repeatedly negative. Myositisspecific antibody panel was performed owing to a high clinical suspicion of photosensitive dermatoses, both clinically and histologically. Histology revealed positive anti-MDA5 antibodies;repeated positive testing confirmed this. Although lung function was normal, computed tomography revealed evidence of ILD. We made a diagnosis of anti-MDA5 antibodyassociated amyopathic dermatomyositis with ILD. Her malignancy screening was negative. The patient was started on lowdose prednisolone and hydroxychloroquine 200 mg twice daily, with topical steroid applications, which resulted in remarkable clinical improvement. Anti-MDA5 associated dermatomyositis has characteristic cutaneous lesions consisting of skin ulceration and tender palmar papules, mechanic's hands, inflammatory arthritis and rapidly progressive ILD, which is frequently fatal. Although our patient had ILD, she was relatively stable on minimal immunosuppression. It is important for clinicians to have an increased awareness of this disease as it could have a highly variable clinical presentation in the white population.

COVID-19 vaccination effectiveness: a review in early vaccine adopters in Asian Countries.

COVID-19 vaccines were designed to stimulate an immunological response, producing neutralizing antibodies against the SARS-CoV-2 spike protein. Vaccine variants such as mRNA, viral vector, whole-cell inactivated virus, and protein subunit vaccines, have been reported to be efficacious in phase III trials and have gained emergency use approval in many countries. However, several adverse effects are reported in certain types of vaccines. All vaccines are being expedited by some Asian countries as part of their national immunization programs. This review primarily discussed the selected manufacturers of the COVID-19 vaccines used and their effectiveness in early-adopting Asian countries. The effectiveness in reducing the infection rate and safety of COVID-19 vaccines in Japan, Thailand, Singapore and Malaysia was also analyzed based on the available data. Strategies that can be used to speed up the vaccination rate in reducing the number of COVID-19 cases were also evaluated.

Covid Redux: The Risk to Critically Ill Cancer Patients Remains High

INTRODUCTION: Since the start of the COVID-19 pandemic there has been an evolution of variant strains that have spread throughout the world. As time has passed, clinicians have appreciated that these variants have different symptomology and clinical course. As our understanding of the disease process has progressed, medical management has evolved. Throughout, cancer patients have represented a uniquely at-risk population. We sought to compare the characteristics of critically ill cancer patients with Omicron variant to those infected with the ancestral strain. METHOD(S): Single-center retrospective cohort study analyzed all cancer patients >=18 years of age with current or past (< 2 years) diagnosis of cancer, who were admitted to ICU with COVID-19. The ancestral strain period was defined as March 1 to June 30, 2020, and the Omicron variant period was December 15, 2021 to April 1, 2022. Demographics, clinical and laboratory data of critically ill cancer patients were extracted from electronic health record and an ICU database. RESULT(S): A total of 127 patients were analyzed (38 Omicron and 89 ancestral strain). Median age was similar (67 years Omicron, 65 ancestral) and slightly higher male (47% Omicron, 58% ancestral). There was a higher number of hematologic malignancy (53% Omicron, 43% ancestral). Mechanical ventilation and vasopressors were less commonly used (58% and 53% Omicron, 67% and 71% ancestral), respectively. Prone positioning was utilized less frequently (47% Omicron, 56% ancestral) as was tracheostomy (11% omicron, 34% ancestral). ICU mortality was similar in both groups, (39% vs 37% however, hospital mortality was higher (55% Omicron group, 45% ancestral). CONCLUSION(S): Critically ill cancer patients infected with the Omicron variant may be less likely to undergo tracheostomy however, they are more likely to die during their hospitalization. Even with higher hospital mortality Omicron patients also seemed to be less acutely ill as their requirement for mechanical ventilation, vasopressors and prone positioning was lower. This should be considered as we counsel patients and set expectations about what might happen during a COVID admission to the ICU.

Y COVID-19 vaccination effectiveness: a review in early vaccine adopters in Asian Countries

COVID-19 vaccines were designed to stimulate an immunological response, producing neutralizing antibodies against the SARS-CoV-2 spike protein. Vaccine variants such as mRNA, viral vector, whole-cell inactivated virus, and protein subunit vaccines, have been reported to be efficacious in phase III trials and have gained emergency use approval in many countries. However, several adverse effects are reported in certain types of vaccines. All vaccines are being expedited by some Asian countries as part of their national immunization programs. This review primarily discussed the selected manufacturers of the COVID-19 vaccines used and their effectiveness in early-adopting Asian countries. The effectiveness in reducing the infection rate and safety of COVID-19 vaccines in Japan, Thailand, Singapore and Malaysia was also analyzed based on the available data. Strategies that can be used to speed up the vaccination rate in reducing the number of COVID-19 cases were also evaluated.

Authentic assessment and work-based learning: the case of professional studies in a post-COVID Australia

Purpose To explore the conceptualisation and operationalisation of authentic assessment in work-based learning and research. Design/methodology/approach The relationship between authentic assessment and work-based learning and research is examined using a postgraduate degree program at a regional university in Australia as a case example to identify unique pedagogical features of work-based learning as they are linked to assessment. Findings A dynamic is created between formative and summative authentic assessment practices and the cross-current nature of learning in work and research, leading to a range of lifelong learning outcomes. A framework for such a dynamic is presented. Originality/value The pedagogy informing work-based learning emphasises developing higher-order thinking through reflective practice, developing competencies and capabilities associated with professional practice and developing academic writing and research skills to enhance professional identity at the postgraduate level for mid- to senior-career professionals. However, the relationship of authentic assessment to work-based learning and research has not been explicated in the literature and its application in post-COVID work environments has yet to be fully examined.

National customer orientation: a framework, propositions and agenda for future research

Purpose>This paper aims to propose a new country-level construct, national customer orientation, to provide a benchmark for global headquartered managers’ decisions and scholars investigating cross-national research.Design/methodology/approach>A conceptual framework and unique propositions are developed that focus on how one macro-economic driver, e.g. the wealth of a country, and one macro-marketing driver, e.g. customer price sensitivity, affect national customer orientation during and after global economic downturns such as recessions and a pandemic.Findings>An agenda setting section proposes distinct theoretical, empirical and managerial themes for future research aimed at testing the propositions at the country and organization levels over time.Research limitations/implications>Although the new construct offers substantial benefits for scholars and managers, current measures of national customer orientation are limited to data provided by the World Economic Forum or expensive primary survey-based research that restrict the number of countries, respondents and time periods.Practical implications>The new national-level customer orientation construct and propositions about its drivers over time promise to provide global managers a country-level customer-based benchmark so that they can better understand, set expectations and manage customer orientation across different countries over time.Originality/value>Research on market and customer orientation is consistently designated a priority by academics and practitioners. However, most previous studies exclusively focus at the micro organizational-level, with less known on how customer orientation varies at the macro country-level and over time.

Households' Socioeconomic Vulnerability Assessment Due to COVID- 19 Outbreak: A Web-Based Survey in Bangladesh

Aim: COVID-19, which can be considered a disastrous event, has created not only a public health emergency but also a major socio-economic crisis in Bangladesh. This study, therefore, aimed to assess households' socioeconomic vulnerability due to the COVID-19 outbreak in the country. Methods: A quantitative cross-sectional survey was performed among 404 households from different districts in Bangladesh. The socioeconomic vulnerability index (SeVI) was developed using data collected from participants via an online-based self-reported questionnaire that included demographic, social, economic, and physical characteristics as well as exposure to COVID-19. Results: The socioeconomic vulnerability index (SeVI) was calculated as an index score of 0.405 where social, economic, and COVID-19 exposure were reported to be the more impactful components of adaptive capacity, sensitivity, and exposure, respectively. Furthermore, the economic options for households were greatly limited by the consequences of the COVID-19 pandemic. Practical implications: This study may help to identify the socioeconomic issues that resulted from the COVID-19 outbreak in the country and instruct the policymakers and corresponding authorities on which areas to emphasize for policy implementation so that households become socially and economically less susceptible to the COVID-19 outbreak as well as related infectious diseases and disastrous events in the upcoming years. Conclusion: This study found socioeconomic vulnerability among Bangladeshi households. The corresponding authorities should adopt policy initiatives to minimize the socioeconomic vulnerability due to the COVID-19 outbreak in the country.

Parasomnias

The fourth article is a unique literature review on COVID-19–related sleep disturbances among various populations, including patients at high risk for complications, health care workers, students, and patients who have been infected with COVID-19. Understanding and treating the more dramatic and violent parasomnias is vital for improving quality of life, reducing unintentional injuries, and decreasing distressing situations that arise for patients and family members. Safia S. Khan, MD, is an Assistant Professor, Sleep Specialist, and Family Physician, Department of Family and Community Medicine, Department of Neurology, UT Southwestern Medical Center, Dallas, Texas;an Attending Physician, Parkland Medical Hospital, Dallas, Texas;and an Attending Physician, Texas Health Resources Presbyterian Hospital, Dallas, Texas.

COVID-somnia: Sleep Disruptions Associated with the COVID-19 Pandemic

The risk of exposure to coronavirus disease 2019 (COVID-19) and the extent of illness an individual will experience are difficult to predict and leads to much apprehension for patients, family members, coworkers, and health care workers. What distinguishes this pandemic from previous ones is the ability of a major portion of the world's population to live and work without significant in-person interaction with other people, made possible with the help of the internet and remote work. Although this ability to interact without physically being in the same space is helpful in many ways, it has also caused anxiety and led to isolation for many people. Acute situational and chronic insomnia, delayed sleep phase, and sleep fragmentation have been the main pandemic-related sleep disturbances. The risk of prolonged hospitalizations and intubation for respiratory failure has been high among patients with obstructive sleep apnea and obesity hypoventilation syndrome. In this article, we discuss the impact of COVID-19–related isolation, confinement, and sleep health consequences on vulnerable populations and health care workers. [Psychiatr Ann. 2021;51(12):566–571.]

Role of hematological parameters in stratification of COVID-19 disease severity

Background : Covid-19 disease involves respiratory as well as other body systems including cardiovascular, gastrointestinal, neurological, immunological and hematopoietic system. Patient of covid-19 pneumonia presents with wide range of hemostatic abnormalities. These hemostatic abnormalities in COVID-19 are related with disease progression, severity and mortality. Aims : The aim of our study is to evaluate the role of hematological parameters in determination of COVID-19 disease severity. Methods : This was a retrospective study, conducted in Department of Pathology and Department of medicine, FMH college of Medicine and Dentistry from May 2020 to July 2020. Total of 101, confirmed cases of covid-19 disease, both genders between 17 and 75-year age were included. Hematological parameters were compared in mild, moderate, severe and critical disease group. Continuous variables were analyzed by using non parametric, Kruskal Wallis test while categorical variables were analyzed by chi-square test. Results : Out of 101 patients, 20.8%, 51.8%,19.8% and 7.9% were in mild, moderate, severe and critical group respectively. Median (IQR) values of WBCs ( P -value 0.004), ANC ( P -value 0.002), NLR ( P -value 0.001), D-dimer level ( P -value 0.001), ferritin (0.0001), LDH (0.0001) were significantly increased in patients with critical disease. Median (IQR) values of APTT ( P -value 0.003) and CRP ( P -value 0.0001) were suggestively higher in patients with severe disease. Other parameters like Hemoglobin, MCV, HCT, ALC, Platelet count, prothrombin time did not show statistically significant association with severity of disease. Conclusions : The study concluded that Leukocytosis, neutrophilia, elevated Neutrophil to lymphocyte ratio, APTT, D-dimer, LDH, serum ferritin and CRP are associated with severity of covid-19 disease.

COVID-19 mRNA Vaccine Degradation Prediction using Regularized LSTM Model

Due to the advantages of mRNA vaccines such as potency, safety, and production feasibility, recent researches in vaccinology has seen strong focus in mRNA vaccines. As leading researches involving COVID-19 mRNA vaccine candidates are being carried out, the challenge of overcoming the stability tradeoff of mRNA vaccines stand between the production and effective mass distribution stages. With the help of the OpenVaccine RNA database with degradation rate measurements provided by Stanford researchers, we developed an artificial recurrent neural network model to help bioinformatics researchers identify whether and where mRNAs might be unstable and prone to degrade under certain incubation measures. For this purpose, we've prepared a regularized LSTM model which minimizes mean columnwise root mean squared error for several degradation rates. We've found that recurrent algorithms perform better than tree-based algorithms.

Mental health impacts of COVID-19 outbreak and associated drivers among university students in Bangladesh

BACKGROUND: Mental health impacts due to COVID-19 outbreak are observable among university students. The aim of this research was to determine the mental health impacts of COVID-19 outbreak and associated drivers among university students in Bangladesh. METHODS: Across-sectional study was performed among 368 participants from Khulna University (Khulna-9208) in Bangladesh. Data were collected through an online self-reported questionnaire including demographic and selected characteristics of the participants, 7-item generalized anxiety disorder (GAD-7) scale to measure the prevalence of anxiety and 9-item patient health questionnaire (PHQ-9) scale to measure the prevalence of depression. The ordered logit model was used to determine the associated drivers of anxiety and depression. RESULTS: The estimated prevalence rates of anxiety were 87%, among them 29.3%, 33.7%, and 23.9% had mild, moderate and severe, respectively. Accordingly, the estimated prevalence rates of depression were 81.5%, among them 25%, 23.9%, 20.1%, and 12.5% had mild, moderate, moderately severe and severe, respectively. The likelihood of anxiety and depression among participants has been mostly derived by residing urban area, not having stable family income, living with parents, having relatives or acquaintances infected with COVID-19, being worried about academic delays, and with the disruption of daily-life. CONCLUSIONS: University students are experienced a higher level of anxiety and depressive symptoms in Bangladesh. As the majority of students spend their time in social media during the quarantine, the implications of COVID-19 on mental health in this population can be reduced by means of online consultancy, campaigns and other awareness initiatives.

Addressing the challenges of COVID-19 pandemic outbreak: Pakistan's preparations and response

This study examines the challenges faced by Pakistan during COVID-19 pandemic and the policies taken by the Government of Pakistan to contain and control the spread of the pandemic. Pakistan is considered among those countries that have been severely affected by COVID-19 due to insufficient health infrastructure. Moreover, the pandemic has affected the country socially and economically, which has slashed down GDP and overall wellbeing. However, the government has taken effective policy measures that enhanced the recovery rate of infected patients, for instance, out of 276,288 confirmed cases, 244,883 cases have been recovered. Currently, only 26,421 cases are active;it shows 88.6% recovery. Since the implementation of consistent plans, policies, and effective actions, the recovery rate has been ramping up, and infected cases have been getting down.

Functional immune mapping with deep-learning enabled phenomics applied to immunomodulatory and COVID-19 drug discovery (preprint)

Development of accurate disease models and discovery of immune-modulating drugs is challenged by the immune systems highly interconnected and context-dependent nature. Here we apply deep-learning-driven analysis of cellular morphology to develop a scalable "phenomics" platform and demonstrate its ability to identify dose-dependent, high-dimensional relationships among and between immunomodulators, toxins, pathogens, genetic perturbations, and small and large molecules at scale. High-throughput screening on this platform demonstrates rapid identification and triage of hits for TGF-{beta}- and TNF--driven phenotypes. We deploy the platform to develop phenotypic models of active SARS-CoV-2 infection and of COVID-19-associated cytokine storm, surfacing compounds with demonstrated clinical benefit and identifying several new candidates for drug repurposing. The presented library of images, deep learning features, and compound screening data from immune profiling and COVID-19 screens serves as a deep resource for immune biology and cellular-model drug discovery with immediate impact on the COVID-19 pandemic.

Identification of potential treatments for COVID-19 through artificial intelligence-enabled phenomic analysis of human cells infected with SARS-CoV-2 (preprint)

To identify potential therapeutic stop-gaps for SARS-CoV-2, we evaluated a library of 1,670 approved and reference compounds in an unbiased, cellular image-based screen for their ability to suppress the broad impacts of the SARS-CoV-2 virus on phenomic profiles of human renal cortical epithelial cells using deep learning. In our assay, remdesivir is the only antiviral tested with strong efficacy, neither chloroquine nor hydroxychloroquine have any beneficial effect in this human cell model, and a small number of compounds not currently being pursued clinically for SARS-CoV-2 have efficacy. We observed weak but beneficial class effects of {beta}-blockers, mTOR/PI3K inhibitors and Vitamin D analogues and a mild amplification of the viral phenotype with {beta}-agonists.