ABSTRACT
Case Presentation: Term male infant born to SARS-CoV-2 positive mother with infant testing negative. ECG for perinatal bradycardia revealed ventricular pre-excitation. Echocardiogram showed asymmetric LV hypertrophy with prominent trabeculations, subaortic narrowing with no pressure gradient, and normal biventricular systolic function. Rapid increase in RV pressure estimates and NT-proBNP in first week if life concerning for diastolic dysfunction. Anti-arrhythmic therapy initiated for SVT with subsequent resolution. Later, developed progressive LV dilation and systolic dysfunction. Myocardium showed regions resembling non-compaction and others concerning for infiltrative process. Cardiac MRI showed no obvious tumors, but rhabdomyomas could not be ruled out given similar appearance to myocardium. Due to worsening heart failure, everolimus therapy initiated to target potential rhabdomyomas while awaiting genetic testing for tuberous sclerosis. Subaortic narrowing and LV hypertrophy improved within days, and LV appearance became more consistent with non-compaction. Genetic testing revealed a TSC2 gene variant consistent with tuberous sclerosis. Systolic function improved, and patient discharged on afterload reduction. Echocardiogram 6 months post-discharge shows continued LV dilation and mild systolic dysfunction. Discussion(s): Although outflow obstruction and arrhythmias are common with cardiac rhabdomyomas and can cause dysfunction, our patient developed progressive dysfunction in the absence of outflow tract gradient or prolonged arrhythmia. As rhabdomyomas subsided, it became clearer that he had an underlying cardiomyopathy. We suspect that rhabdomyomas in the setting of abnormal myocardium led to abnormalities in myocardial contractility and compliance causing combined systolic and diastolic dysfunction. After complete resolution of rhabdomyomas, cardiac function has improved. However, he continues to have ventricular dilation and mild dysfunction attributable to cardiomyopathy. It is unlikely that mother's SARS-CoV-2 infection played a role as infant tested negative and clinical picture was not consistent with myocarditis.
ABSTRACT
Multisystem inflammatory syndrome in children (MIS-C) is an inflammatory reaction that occurs weeks after SARS-CoV-2 infection. Solid organ transplant recipients may be protected due to immunosuppression, but this is not yet established in the literature. A 13-month-old male status post heart transplant for ACTC1 gene-positive dilated cardiomyopathy had a post-operative course complicated by rhinovirus/enterovirus, respiratory syncytial virus, and norovirus infections within the first two months. He then presented at 11 weeks post-transplant with high fevers, macular rash, emesis, and diarrhea in the setting of SARS-CoV-2 exposure three weeks prior. Viral panel was negative for active infections, but SARS-CoV-2 antibodies were positive. He developed a mild troponin leak and rising inflammatory markers, ferritin, D-dimer, and NT-proBNP, meeting clinical criteria for MIS-C. No cardiac dysfunction or coronary dilation was present on 2D echocardiography. Tacrolimus levels had large fluctuations in the first three days but later stabilized. Intravenous immunoglobulin, steroids, and anakinra were given with clinical improvement and rapid normalization of laboratory findings, allowing discharge from the hospital in one week. Repeat echocardiogram 10 days after discharge was stable. There is a paucity of MIS-C cases in pediatric solid organ transplant recipients, with only one liver transplant recipient described in the literature. We hypothesize chronic immunosuppression protects against inflammatory reactions, supported by the fact that Kawasaki disease is also not described in transplant recipients. To our knowledge, this is the first reported MIS-C case in a pediatric heart transplant recipient. Recent viral infections may have led to immune system activation that allowed development of MIS-C. The patient has demonstrated good response to anti-inflammatory therapy;however, close follow up for long-term sequelae is warranted. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
Reservoir surveillance and production optimization will remain at the forefront of company strategies in the new post-COVID19 environment. We anticipate that companies will focus more on producing assets and go the route of production enhancement rather than exploration. Accordingly, production logging will remain an important surveillance method in evaluating and strategizing production-optimization schemes pertaining to flow-characterization from reservoir-to-wellbore. This work is culmination of operational and technical excellence that enabled the revival of a loaded-up well through simultaneous lifting-and-logging technique. Conventionally, wireline is the preferred mode of conveyance for production-logging;however, well must be continuously flowing throughout acquisition timeframe. Kicking-off the well using nitrogen-lift and then bringing in wireline-unit for production-logging in Well A-4 was not feasible as previous attempts confirmed well to load-up in few hours post-offloading. Therefore, success of this project was heavily dependent on initial planning stage, which accounted for all available data including production-history, well-events, intervention-details, fluid analysis and well load-up behavior. Next, a multi-domain approach was adopted while bringing-out each domain from its silos and strategize collectively to simultaneously kickoff the well with nitrogen and acquire real-time downhole production-logging data through smart-coiled-tubing (CT). This was first implementation of concurrent lifting and logging operation in Pakistan. By deploying the approach mentioned above through smart CT (using optical-telemetry-link inside the CT-string coupled with downhole-assembly), synchronized lifting-and-logging operation was carried-out successfully. Well was observed to swiftly go back to load-up conditions post-kickoff;however, continuous well dynamics monitoring downhole enabled us to log perforated interval across multiple time domains. Well was activated through CT nitrogen-injection but depicted continuous loading tendency, which was captured downhole in form of flow-transients. Real-time job optimization ensured vigilant monitoring and selection of right-time to acquire meaningful zonal-contribution data for evaluation and diagnostic solutions. Finally, operational excellence was complemented through technical data analysis and interpretation, integrating passes data with transients and stationary measurements. Ultimately, acquired data analyzed using an integrated lens involving fluid velocities, downhole density, temperature, and water hold up data. Consequently, enabling us to decipher gas and water-entries on a zonal-basis across perforated sandstone reservoir. Copyright © 2022, Society of Petroleum Engineers.
ABSTRACT
Introduction: A shift in the practice of medicine to include telemedicine modalities has been gaining momentum, being accelerated even further by the current pandemic. There is a paucity of data regarding patient-perceived barriers to telemedicine in urogynecology patients, a unique and complex population, In a previous study at our institution, we found that conversion to telemedicine in FPMRS during the first 11 weeks of the COVID-19 related shut-down was very low. Objective: The aim of this study is to understand patient-perceived barriers to telemedicine and examine why some patients did not convert to telemedicine. Methods: This was a qualitative study using both a questionnaire and one-onone semi-structured interviews with patients from our institution's urogynecology practice who were scheduled for appointments from March 17th through June 9th, 2020, a time period when our office was closed to meet social distancing guidelines. Informed consent was obtained verbally and interpretation services were used when necessary. All interviews were recorded, transcribed, and coded by two readers. The data was analyzed in a 3-phase coding process and the manifest context analysis method was used to analyze, summarize and refine interview data. Inductive codes were then applied to text fragments. A codebook was developed through serial discussions and triangulated amongst the research team. The codebook was saturated at 30 interviews and the final six interviews were cross-referenced to confirm findings. Results: 36 interviews were conducted. Participants represented a wide age range (39 to 75 years), with 30.6% of participants ranging in age between 45 and 54 years. 66.7% of patients stated English was their preferred language. While some patients (25%) recalled being offered a virtual visit, others reported that this option was not offered (44.4%) or were unsure (19.4%). The majority of participants reported having a smartphone (97.2%). Codes from interviews were organized into four categories (Table 1). Three themes were identified: (1) Patients seemed amenable to telemedicine, yet there was reservation about the use of this modality for FPMRS specific patients. The participants felt concerned with the inability for physicians to examine them, and seemed to equate physical evaluation and diagnostic testing with an optimal experience. (2) The majority of participants felt comfortable using the technology and had minimal concerns regarding costs of cellular data or access to internet connectivity. Although some participants voiced reservations with this technological advancement, most seemed agreeable to using telemedicine in some capacity in the future. (3) There was a willingness to forgo certain comforts of in-person visits, in order to preserve safety, especially given simplicity and ease of accessibility. However, the overarching perception was that telemedicine could lend itself to be more impersonal, and should be used for more straightforward and follow-up visits. Conclusions: While there are certain challenges to incorporating telemedicine into urogynecology practice, many of our patients felt that tele-visits were practical and helpful. However, the concern for loss of human touch and testing obviates that the desire for in-person visits remains. Further patient education and development of systems to streamline telemedicine practices will help those who remain hesitant (Table Presented).
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People with disabilities are often excluded from research, which may be exacerbated during the ongoing Covid-19 pandemic. This article provides an overview of key challenges, opportunities, and strategies for conducting disability-inclusive research during the pandemic, drawing on the experience of research teams working across ten countries on disability-focused studies. It covers adaptations that are relevant across the project lifecycle, including maintaining ethical standards and safeguarding;enabling active participation of people with disabilities;adapting remote research data collection tools and methods to meet accessibility, feasibility, and acceptability requirements;and promoting inclusive and effective analysis and dissemination. While this article is focused on adaptations during the pandemic, it is highly likely that the issues and strategies highlighted here will be relevant going forward, either in similar crises or as the world continues to move towards greater digital communication and connectedness. © 2022 The Authors, IDS Bulletin © Institute of Development Studies and Crown Copyright 2022.
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Background: Hand washing is a simple and inexpensive preventive practice that has been around to thwart infectious diseases for centuries. With corona virus on the rise, its importance cannot be overstated. Aim: To assess the awareness of hand-washing among 3-11 years old Study Design: Cross-sectional comparative study Place and Duration of Study: New Misali Cadet School Students, Dera Ghazi Khan from 1st September 2019 to 31st March 2020. Methodology: Eighty five respondents were included. The responses for demographic, hand washing and level of awareness variables were gathered using a structured pre-tested questionnaire. Results: There were 65 males and 20 were females. Thirty three (38.80%) respondents had age between 3-6 years &52(61.20%) were between 7-11 years of age. Eighty (94.11%) claimed to be aware of hand washing but only 60 (70.60%) were found having satisfactory level of Awareness. Seventy six (89.4%) of them claimed to know the method of hand washing and 52(61.2%) practiced it more than twice a day. Forty seven (55.29%) got awareness from school. Fifty two (61.18%) were aware of benefits of hand washing like prevention of transmission of communicable diseases and 50 (58.80%) were aware of harms of not washing hands like susceptibility to fatal diseases such as diarrhea. Significant association was found between level of awareness and awareness of benefits of hand washing and. harms of not practicing it properly. Conclusion: Irrespective of under developed and remote city status, the school children of Dera Ghazi Khan are as well aware of hand washing as the school children of other developing countries. But the lower satisfactory percentages of hand washing awareness levels asserts the need for more awareness campaigns at the community and institutional level to thwart infectious diseases especially with corona virus on the rise. © 2020 Lahore Medical And Dental College. All rights reserved.
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The Covid-19 pandemic continues to wreak havoc as the world scrambles to find the yet elusive cure. With millions of infected cases and mortalities worldwide, it is mainly a droplet infection though other modalities have been documented. Diseases other than this pandemic infection continue unabated and must be managed alongside the menace of COVID-19 infection. Surgical practices need to adapt to cater for the threat of infection during human interactions in the community, during stay in the hospital and between the surgeon and his patients. Telemedicine is emerging to be an extremely important modality in patient management in the given circumstances. Patients need to be carefully selected for admission and screened for COVID-19 and operating room protocols upgraded. This status quo review of alterations in surgical practice during the pandemic explores the recommendations available on PUBMED, WHO and public funded sites with access to COVID-19 research.
ABSTRACT
COVID-19 (Coronavirus Disease 2019) caused by a novel 'SARS-CoV-2' virus resulted in public health emergencies across the world. An effective vaccine to cure this virus is not yet available, thus requires concerted efforts at various scales. In this study, we employed Computer-Aided Drug Design (CADD) based approach to identify the drug-like compounds - inhibiting the replication of the main protease (Mpro) of SARS-CoV-2. Our database search using an online tool "ZINC pharmer" retrieved ~1500 compounds based on pharmacophore features. Lipinski's rule was applied to further evaluate the drug-like compounds, followed by molecular docking-based screening, and the selection of screening ligand complex with Mprobased on S-score (higher than reference inhibitor) and root-mean-square deviation (RMSD) value (less than reference inhibitor) using AutoDock 4.2. Resultantly, ~200 compounds were identified having strong interaction with Mpro of SARS-CoV-2. After evaluating their binding energy using the AutoDock 4.2 software, three compounds (ZINC20291569, ZINC90403206, ZINC95480156) were identified that showed highest binding energy with Mproof SARS-CoV-2 and strong inhibition effect than the N3 (reference inhibitor). A good binding energy, drug likeness and effective pharmacokinetic parameters suggest that these candidates have greater potential to stop the replication of SARS-CoV-2, hence might lead to the cure of COVID-19.