Retraction Note: Evolving deep convolutional neutral network by hybrid sine–cosine and extreme learning machine for real-time COVID19 diagnosis from X-ray images (Soft Computing, (2023), 27, 6, (3307-3326), 10.1007/s00500-021-05839-6)

The Editor-in-Chief and the publisher have retracted this article. The article was submitted to be part of a guest-edited issue. An investigation by the publisher found a number of articles, including this one, with a number of concerns, including but not limited to compromised editorial handling and peer review process, inappropriate or irrelevant references or not being in scope of the journal or guest-edited issue. Based on the investigation's findings the Editor-in-Chief therefore no longer has confidence in the results and conclusions of this article. Author Mohammad Khishe disagrees with the retraction. The other authors have not responded to correspondence regarding this retraction. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

The Global Evolution of Clinical Practice During a Pandemic

Following the novel coronavirus disease 2019 (COVID-19) pandemic declaration by the World Health Organization (WHO), unexpected and immediate changes in clinical practice emerged out of clinical necessity on both institutional and regional scales. Due to changes in clinical safety guidelines, the mass disruption in routine surgical care carried extensive implications for resulting long-term sequelae of potential advanced stage pathology. In the absence of a cohesive global response, institutional changes regarding clinical protocols, personal protective equipment, and bed allocation were implemented in collaboration with locoregional and international partners. In light of the void in clinical information and the need to disseminate early data, journal submission guidelines changed, and research collaboratives seeking to study and understand COVID-19 were born. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

An Immunocompetent Adult With Adenovirus Hepatitis

Introduction: In the US there has been a recent outbreak of adenovirus hepatitis in the pediatric population. However, to our knowledge, there has been only one reported case of adenovirus hepatitis in an immunocompetent adult. We have identified another such case. Case Description/Methods: A 25 year old female with no medical history presented with abdominal pain, nausea, vomiting, diarrhea, and subjective fevers for two weeks and was found to have transaminitis 25-30x the upper limit of normal, which were: AST 791, ALT 542, ALP 92, and total bilirubin of 2.9. The patient reported no prior history of liver disease. She denied alcohol, tobacco, illicit drugs, or herbal medications, but did report taking acetaminophen 1500 mg daily for two weeks. Serum acetaminophen levels were normal and serum and urine toxicology were negative. US with doppler was unremarkable, CT showed cholelithiasis, MRCP showed a normal common bile duct without obstructive calculus. Autoimmune causes of hepatitis, ceruloplasmin and alpha-1 antitrypsin were all unremarkable. HAV, HBV, HCV, HDV, HEV, CMV, HSV, VZV, EBV, HIV, and COVID19 were all negative. Ultimately, the serology for adenovirus was positive. After a week of supportive treatment, the patient's labs trended down and symptoms resolved. Discussion(s): Adenovirus is confirmed by a rise in antibody titer or by virus detection. Coagulative necrosis in histopathology is a finding in liver biopsies if they are pursued in unexplained cases of liver injury. Ultimately, adenovirus hepatitis can be diagnosed once all common causes of hepatitis have been excluded. In the current outbreak, only children have been getting adenovirus hepatitis. In adults, a high prevalence of neutralizing antibodies contributes to immunity, and therefore only in immunocompromised states, do adults get such an infection. Supportive care with IV fluids, electrolyte correction, and antiemetics usually is enough with eventual symptomatic and laboratory improvement as it was for our patient. Studies have shown that extensive disease can be treated with antiviral drugs, cidofovir, and ribavirin. Our patient's history of acetaminophen use is a confounder, however, her normal serum level and her symptoms suggestive of an infectious cause made acetaminophen less of a culprit. We hypothesize that our patient's use of acetaminophen when she was initially exposed to the virus is what made her susceptible to developing adenovirus hepatitis and we hope this case adds insight for clinicians dealing with future adult cases.

IgM Multiple Myeloma Presenting With Diarrhea

Introduction: IgM Multiple Myeloma (MM) is a rare subtype of MM consisting of <1% cases of MM. It is distinguished from Waldenstrom Macroglobinemia, which also produces IgM, by the absence of somatic mutation MYD88. We present a patient with a chief complaint of diarrhea which unknowingly led to his hematological diagnosis Case Description/Methods: A 64 year old male with RA-SLE overlap syndrome on steroids, and recent COVID19 pneumonia, had presented with 5 episodes of watery diarrhea every day and 40 Ib weight loss within 2 months. CT revealed small bowel enteritis and stool studies, including C. diff, cultures, ova and parasites were negative. Diarrhea persisted despite antibiotics, therefore an EGD and Colonoscopy were performed which showed duodenal lymphangiectasia and a normal colon. Duodenal biopsy revealed eosinophilic deposits in the villous lamina propria which stained for IgM and stained negative under congo red ruling out amyloidosis. SPEP and a bone marrow biopsy revealed monoclonal IgMspikes and plasma cells in the bone marrow suggesting MMalong with a co-existing population of CLL. Next-generation sequencing was negative forMYD88, supporting IgM MM instead of Waldenstrom. He developed a protein-losing enteropathy with dramatic hypoalbuminemia (albumin 0.9) and lower extremity edema and DVTs. He was started on chemotherapy and frequent albumin infusions. His diarrhea completely resolved, however not in time, as his other medical comorbidities lagged behind and he developed anasarca and continued to deteriorate. Discussion(s): Plasma cell dyscrasias such as IgM MM or more commonly Waldenstrom have rarely been reported to cause GI symptoms. GI involvement can include direct GI infiltration of plasma cells, IgM deposition, or the finding of a plasmacytoma. It has been speculated that IgM deposits can lead to interstitial viscosity and obstructive lymphangiectasia leading to diarrhea and a protein-losing enteropathy as in our patient. Protein loss has led him to have hypoalbuminemia and possibly loss of antithrombotic proteins that have caused DVTs. Few case reports have suggested that treating the underlying cause with chemotherapy stops diarrhea entirely. Although our patient's diarrhea ceased, we believe that it was not in time for him to entirely recover from the later complications of the disease. We hope that this case can help clinicians to attempt prompt treatment of patients when they find GI specimens showing IgM deposits and they suspect a plasma cell dyscrasia.

COVID-19 Challenges and the Role of Islamic Fintech

COVID-19 has created massive havoc to the global operations and business processes and the uncertain economic conditions have made the world think about the abrupt solutions to tackle the problem efficiently. Islamic fintech has provided the world with innovative solutions to overcome the devastating impact of this pandemic. Against this backdrop, this study aims to investigate the effective solutions provided by Islamic fintech in the post-COVID period. The study mainly opted for the qualitative framework to carry out its research and provide workable solutions to the world offered by Islamic fintech in the post-COVID era. Various technological innovations compatible with Islamic finance have initiated a great deal of competition with its long-lasting and sustainable impact on the growth of the economies. The COVID period, which is still going on, is marked by substantial growth and development followed by the fintech innovations to address the demands of the customers. This study is expected to play a key role in promoting the Islamic fintech solutions to overcome the economic hazards created by the coronavirus pandemic. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Impact of COVID-19 on electroconvulsive therapy practice across Canadian provinces during the first wave of the pandemic.

BACKGROUND: Electroconvulsive therapy (ECT) is a procedural treatment that is potentially life-saving for some patients with severe psychiatric illness. At the start of the global coronavirus disease 2019 (COVID-19) pandemic, ECT practice was remarkably disrupted, putting vulnerable individuals at increased risk of symptom exacerbation and death by suicide. This study aimed to capture the self-reported experiences of psychiatrists based at healthcare facilities across Canadian provinces who were delivering ECT treatments during the first phase of the COVID-19 pandemic (i.e., from mid-March 2020 to mid-May 2020). METHODS: A multidisciplinary team of experts developed a survey focusing on five domains: ECT unit operations, decision-making, hospital resources, ECT procedure, and mitigating patient impact. Responses were collected from psychiatrists providing ECT at 67 ECT centres in Canada, grouped by four geographical regions (Ontario, Quebec, Atlantic Canada, and Western Canada). RESULTS: Clinical operations of ECT programs were disrupted across all four regions - however, centres in Atlantic Canada were able to best preserve outpatient and maintenance care, while centres in Western Canada were able to best preserve inpatient and acute care. Similarly, Atlantic and Western Canada demonstrated the best decision-making practices of involving the ECT team and clinical ethicists in the development of pandemic-related guidelines. Across all four regions, ECT practice was affected by the redeployment of professionals, the shortage of personal protective equipment, and the need to enforce social distancing. Attempts to introduce modifications to the ECT delivery room and minimize bag-valve-mask ventilation were consistently reported. All four regions developed a new patient prioritization framework, and Western Canada, notably, aimed to provide ECT to only the most severe cases. CONCLUSIONS: The results suggest that ECT provision was disproportionately affected across different parts of Canada. Possible factors that could explain these interregional differences include population, distribution of urban vs. rural areas, pre-pandemic barriers in access to ECT, number of cases, ability to control the spread of infection, and the general reduction in physicians' activities across different areas of health care. Studying these factors in the future will inform how medical centres should respond to public health emergencies and pandemic-related circumstances in the context of procedural treatments.

Are Exchange Rate Contagions Asymmetric? Evidence from Emerging Market Economies

In view of increasing importance of emerging market currencies in the global foreign exchange markets and the growing concerns regarding the vulnerability of these currencies to global crises, we assess the connectedness of 16 emerging currencies by employing asymmetric domains of time and frequency spanning March 2011 to January 2022. We first notice bidirectional interconnectedness (both positive and negative) among three clusters of sampled exchange rates. The currency contagions follow divergent directions during crisis periods. During US debt selling crisis, there is a short-run negative contagion pointing to the appreciation of currencies. Following the Chinese financial market crisis, emerging market currencies demonstrated devaluation. There is long-run positive contagion (devaluation) in response to European Debt Crisis, Russian Ruble Crisis, Brazilian economic crisis, and Argentinian monetary crisis. The sampled exchange rates demonstrate negative long-run connectedness (appreciation) after COVID-19. The major transmitters to total connectedness are South Africa, Poland, and Mexico and major receivers include Thailand, the Philippines, Malaysia, India, Indonesia, and Egypt. In the long run, China is emerging as a significant transmitter. Our study draws significant policy and practical implications for regulators, investors, and financial market participants. © 2023 Taylor & Francis Group, LLC.

Profil épidémiologique et clinique des patients atteints de COVID-19 - Expérience marocaine du Centre hospitalier universitaire de Fès

Introduction La maladie à coronavirus 2019 (COVID-19) est une maladie infectieuse causée par le virus Sars-Cov-2. Les premiers cas ont été identifiés à Wuhan en Chine. Elle s'est rapidement propagée, provoquant ainsi une pandémie mondiale. Cette infection cause un spectre de gravité de la maladie, allant de l'insuffisance respiratoire asymptomatique au décès. Au Maroc, les travaux de recherche sur le profil épidémiologique et clinique des patients COVID-19 positifs sont rares. L'objectif de cette étude est de déterminer les caractéristiques cliniques et épidémiologiques des patients atteints de COVID-19 hospitalisés au CHU Hassan II de Fès. Méthodes Il s'agit d'une étude prospective descriptive de 226 patients confirmés COVID-19 par RT-PCR, hospitalisés et traités au Centre hospitalier universitaire Hassan II de Fès, entre 19 mai et 10 décembre 2020. Après un consentement écrit, ces patients ont bénéficiés d'un questionnaire comprenant les données socio-démographiques, les symptômes, les données d'imagerie, les traitements et l'évolution clinique. Résultats L'âge médian des patients était de 43 ans, et 57,4 % d'entre eux étaient des femmes avec un sexe ratio de 1,3 ;32,8 % des cas ont un niveau d'étude secondaire. La fièvre (36,7 %) ;l'anosmie (33,2 %) ;le mal de tête (32,1 %) ;l'agueusie (29,4 %) et l'inconfort gastro-intestinal (19,1 % ;avec une prédominance des symptômes de nausées et vomissements (12,6% pour chacun)) figuraient parmi les signes et symptômes les plus fréquemment rapportés par les patients. Cependant, 35,8 % de patients sont restés asymptomatiques. Le diabète (8,41 %), l'hypertension (6,13 %) et les maladies cardiovasculaires (2,81 %) étaient les comorbidités les plus fréquentes. Radiologiquement, 25 cas montrent une atteinte pulmonaire modérée à sévère sur le scanner thoracique. Ces cas ont été besoin des soins intensifs et 4 d'entre eux sont morts (1,89 %). Conclusion Cette étude décrit le profil du COVID-19 chez des patients admis dans un hôpital marocain et montre qu'un triage approprié des patients suivi de bons services de soins intensifs peut aider à contrôler cette épidémie.

Interdependence of clean energy and green markets with cryptocurrencies

The adverse effects of the high-power energy consumption by cryptocurrencies on the environment and sustainability have raised the interest of a large body of policymakers and market participants. We apply a network approach to investigate the dependency across clean energy, green markets, and cryptocurrencies from 1 January 2018 to 30 November 2021. Our results indicate that sustainable investments, particularly DJSI and ESGL, play a pivotal role in the network system during the COVID-19 crisis. We find that green bonds are the least integrated with the other financial markets, suggesting their significant role in providing diversification benefits to investors. Rolling windows estimation shows that the dependency across the examined marked increased sharply during the COVID-19 crisis, especially between March 2020 and March 2021, after which it faded and became weak and stable until the end of the sample period. Results of the centrality network are consistent with the dependency network analysis. © 2023

Computer-aided COVID-19 diagnosis: a possibility?

Coronavirus Disease 2019 (COVID-19) is extremely contagious with a very high mortality rate. Effective and early diagnosis of COVID-19 is therefore crucial when treating patients and limiting its spread. The currently available methods for reliably identifying COVID are time-consuming. Infected people display various symptoms, some of which can be manifested by radiographic imaging such as chest X-rays and CT scans. Recently, many advanced machine learning and deep learning models have been proposed for predicting COVID using chest X-rays and CT scans that have paved the way for computer-aided COVID-19 diagnosis (CACD) systems. Unfortunately, most of these studies employ specific model(s) using a specific dataset making comparison difficult and inconclusive. We still lack a clear picture on which technique is best for a reliable CACD system. In this study, we provide a comprehensive analysis to determine if a CACD system can be developed that can reliably and automatically predict COVID-19 with zero human intervention using currently available tools and techniques? For this purpose, we explore and implement five machine learning models (SVM, LR, RF, KNN and ANN) and three pre-trained deep learning classifiers (VGG-16, Xception and ResNet-50) to compare their performance using 17 benchmark chest X-rays and CT-scans datasets to predict normal and infected samples. Using different classifiers and different datasets, we show that VGG16 with a superior average accuracy (99.10%) is the most suited classifier for CACD when chest X-rays are used. For CT scans, RF can also be used in addition to VGG16 as both records an average accuracy of 93% overall CT scan datasets. Based on the number of experiments, and an average accuracy of 99.10% for the chest X-rays datasets, we conclude that a reliable CACD system is possible. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Sustainable corporate governance and gender diversity on corporate boards: evidence from COVID-19

The unprecedented challenges caused by the COVID-19 pandemic have led to a need to re-examine sustainable corporate governance practices. Within this context, the current study investigates the moderated effect of gender-diverse corporate boards on sustainable corporate governance practices in Malaysian financial and non-financial firms during the period 2011-2020, employing the dynamic estimator (S-GMM). During the COVID-19 pandemic, a negative relationship between ownership constructs and Global Reporting Initiative (GRI) indicators is observed in non-financial firms, whereas the opposite is reported for financial firms. Moreover, the moderated effect of gender-diverse boards is only substantiated in financial firms. The findings reveal that sustainable corporate governance is practised in financial firms but not in non-financial firms. Particularly, we draw significant implications for policymakers and regulatory bodies of Malaysia to carefully monitor the implementation of sustainable corporate governance given uncertain circumstances of COVID-19 pandemic. Further, our study is beneficial for academics, practitioners, and research scholars for their future research endeavours.

Good versus bad information transmission in the cryptocurrency market: Evidence from high-frequency data

Using 5-minute high-frequency data, we study realized volatility spillovers in major crypto-currencies, employing generalized forecast error variance decomposition. We also include COVID19 period observations and report time-varying and asymmetric connectedness across various cryptocurrencies using realized volatilities and semi-variances. Our study provides diverse connections after distinctly considering good-and bad volatilities, which is unique in the related literature. Bitcoin and Ethereum are central to the system and dominant transmitters of positive shocks, while Litecoin propagates negative shocks abundantly. Ripple and Stellar are the least connected currencies with others, whereas Cardano and EOS are isolated in the network. This feature makes these currencies suitable diversifiers in a portfolio with other cryptocurren-cies. Further, the majority of these connections are asymmetric in the long-and short-run. The time-varying and asymmetric nature of connections offers potentially unique opportunities for diversification and portfolios strategies. Total volatility connectedness is not only significantly enhanced but also changed in its nature during the COVID19 period. We observe no significant changes in results after the robustness check through varying lengths of the rolling-window. The findings are important to crypto investors and regulatory authorities for better diversification strategies and effective market oversight, respectively.

Is FinTech providing effective solutions to Small and Medium in ASEAN countries?

With the continuous boom of FinTech, the similar features of different platforms provide effective solutions for small and medium enterprises. This study examines whether FinTech offers useful business mechanisms for SMEs in selected ASEAN countries. The ASEAN countries included in the study are Indonesia, Malaysia, Philippine, Singapore, and Thailand. The study employed factor analysis and segregated the FinTech-SME nexus into five factors. The responses of 300 SME owners were collected through interview questionnaires and surveys. We find that new FinTech and SMEs 'collisions' (our term for new utilization) during COVID-19 are the most important factors in the growth of FinTech and the strength of SMEs. Further, we utilized the Kruskal-Wallis test to validate our results and for ranking the factors alongside the ASEAN countries. We present useful implications for policymakers, regulatory bodies, ASEAN countries, and SMEs for welcoming FinTech solutions to facilitate digital transactions. (c) 2022 Economic Society of Australia, Queensland. Published by Elsevier B.V. All rights reserved.

Functional Improvement Trajectories After Surgery (FIT After Surgery) study: protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults.

INTRODUCTION: Older adults prioritise surviving surgery, but also preservation of their functional status and quality of life. Current approaches to measure postoperative recovery, which focus on death, complications and length of hospitalisation, may miss key relevant domains. We propose that postoperative disability is an important patient-centred outcome to measure intermediate-to-long recovery after major surgery in older adults. METHODS AND ANALYSIS: The Functional Improvement Trajectories After Surgery (FIT After Surgery) study is a multicentre cohort study of 2000 older adults (≥65 years) having major non-cardiac surgery. Its objectives are to characterise the incidence, trajectories, risk factors and impact of new significant disability after non-cardiac surgery. Disability is assessed using WHO Disability Assessment Schedule (WHODAS) 2.0 instrument and participants' level-of-care needs. Disability assessments occur before surgery, and at 1, 3, 6, 9 and 12 months after surgery. The primary outcome is significantly worse WHODAS score or death at 6 months after surgery. Secondary outcomes are (1) significantly worse WHODAS score or death at 1 year after surgery, (2) increased care needs or death at 6 months after surgery and (3) increased care needs or death at 1 year after surgery. We will use multivariable logistic regression models to determine the association of preoperative characteristics and surgery type with outcomes, joint modelling to characterise longitudinal time trends in WHODAS scores over 12 months after surgery, and longitudinal latent class mixture models to identify clusters following similar trajectories of disability. ETHICS AND DISSEMINATION: The FIT After Surgery study has received research ethics board approval at all sites. Recruitment began in December 2019 but was placed on hold in March 2020 because of the COVID-19 pandemic. Recruitment was gradually restarted in October 2020, with 1-year follow-up expected to finish in 2023. Publication of the primary results is anticipated to occur in 2024.

A review on COVID-19 vaccinations

The year 2019 witnessed a pandemic named COVID-19 caused by infection severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It emerged in Wuhan, China, in December 2019 and has affected millions since then. It led to a global cry for vaccine development. Scientists arrayed the SARS-CoV-2 genome within a month of the outbreak. They used the parallels between SARS-CoV-1 and SARS-CoV-2 to speed up the vaccine preparation. As of now, different types of COVID-19 vaccines are prevailing. © 2022 Biomedical and Biotechnology Research Journal (BBRJ).

Religion vs ethics: hedge and safe haven properties of Sukuk and green bonds for stock markets pre- and during COVID-19

Purpose - This study aims to examine the hedge and safe-haven properties of the Sukuk and green bond for the stock markets pre- and during the COVID-19 pandemic period. Design/methodology/approach - To test the hedge and safe-haven characteristics of Sukuk and green bonds for stock markets, the study first uses the methodology proposed by Ratner and Chiu (2013). Next, the authors estimate the hedge ratios and hedge effectiveness of using Sukuk and green bonds in a portfolio with stock markets. Findings - Strong safe-haven features of ethical (green) bonds reveal that adding green bonds into the investment portfolios brings considerable diversification avenues for the investors who tend to take fewer risks in periods of economic stress and turbulence. The hedge ratio and hedge effectiveness estimates reveal that green bonds provide sufficient evidence of the hedge effectiveness for various international stocks. Practical implications - The study has significant implications for faith-based investors, ethical investors, policymakers and regulatory bodies. Religious investors can invest in Sukuk to relish low-risk and interest-free investments, whereas green investors can satisfy their socially responsible motives by investing in these investment streams. Policymakers can direct the businesses to include these diversifiers for portfolio and risk management. Originality/value - The study provides novel insights in the testing hedge and safe-haven attributes of green bonds and Sukuk while using unique methodologies to identify multiple low-risk investors for investors following the uncertain COVID-19 pandemic.

Is the SARS-cov2 evolved in human being: a prospective genetic analysis

COVID-19 is the deadly respiratory disease of the century caused by new type unknown origin Coronavirus. The recent effort of the word researchers is toward finding the origin of the virus. The current study investigated the extent of molecular similarity and divergence between SARS-CoV2 and other related Coronavirus. An attempt has been made to investigate the epidemiological study of this new contagious virus using molecular biology techniques. The phylogenetic trees for all human coronaviruses with the novel Coronavirus have been built using a several complete amino acid sequences of the four known structural proteins, S (spike), E (envelope), M (membrane), and N (nucleocapsid). The result of the study revealed that the SARS-CoV2 is related to human SARS-CoV isolated from different countries very cloely, especially those strains recovered from China in recent times, 2020. The evolutionary changes observed in the inserted 23 amino acids in the RNA binding domain (RBD) of the coronvirus spike glycoprotein which cannot be detected in any other human coronavirus. Moreover, the 2019-nCoV is not closely related to other alpha, beta and gamma human Coronavirus, including MERS-CoV. The current study concluded that 2019-nCoV is more likely believed to originated from SARS-CoV. The probability is more vital to be originated from the strain isolated in China in 2020, which is coincident with the spraed of COVID-19 in the same country. The phyloepidemiologic analyses suggested that the coronaviruses are circulating in human hosts evolving gradually by times in response to the different environment stimuli facing the virus inside the host in different geographical areas. Furthermore, the analysis showed the flow of transmission, and evolutionary changes of SARS-CoV2 which may be directed from the transmission of SARS-CoV from human to Bat and Pangolin then jumped to human again in the crowded market Wuhan city in China.

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.