Herpes Gastritis: A Rare Cause of Gastric Outlet Obstruction

Introduction: Gastrointestinal tract involvement from herpes simplex virus is commonly associated with esophagitis. However, herpes simplex infection of the stomach is very rare with only a handful of cases being reported in immunocompromised patients. We present a case of herpes gastritis causing gastric outlet obstruction in an otherwise healthy, immunocompetent individual. Case Description/Methods: A 37-year-old male with a recent past medical history of COVID-19 infection, presented to the hospital with intractable nausea, vomiting, bloating, and early satiety for two days. Upon evaluation, CBC and CMP were remarkable for a WBC of 12.5 k/mm3 and ALT and AST of 124 U/L and 129 U/L, respectively. Lipase was 373 U/L. A CT abdomen/pelvis w/contrast showed circumferential wall thickening with edematous changes in the antrum consistent with localized inflammatory response. There was suspicion for gastric lymphoma and patient was admitted for further workup. An EGD was performed which showed exudative esophagitis and antral wall edema with luminal narrowing of gastric antrum. Endoscopic ultrasound (EUS) showed a 2.5 x 3 cm antral wall lesion worrisome for linitis plastica. Esophageal biopsies showed focal cytologic changes consistent with herpes esophagitis. The FNA of the gastric antral wall showed multinucleation of the basal cell layer with classic ground glass nuclei, consistent with herpes infection. No dysplasia or malignancy was seen. Both HSV1 and HSV2 IgG were elevated. HSV IgM was normal. A HSV PCR was ordered but never resulted. Patient was started on Valacyclovir 1 g PO BID for 10 days. He underwent a follow-up EGD 3 months later which showed complete resolution of the gastric antral changes (Figure). Discussion(s): Herpes gastritis is extremely rare. Literature review has revealed only 3 case reports of herpes gastritis;and all involved immunocompromised patients. To the best of our knowledge, this is the first case of herpes gastritis in an immunocompetent patient. Our patient presented with symptoms of gastric outlet obstruction which was caused by local inflammation from herpes simplex. It is unclear if having a COVID 19 infection altered patient's immunity and lead to herpes gastritis. This may need further investigation. No established guideline exists for treatment duration. Our patient received 10-day course of Valacyclovir, and his symptoms improved. Furthermore, patient had complete resolution of the herpes infection on follow-up EGD, indicating adequate treatment response.

Check Point SOS! A Case of Cemiplimab-Associated Sinusoidal Obstruction Syndrome

Introduction: Hepatic veno-occlusive disease (VOD) or sinusoidal obstruction syndrome (SOS), is a clinical syndrome characterized by hepatomegaly, right-upper quadrant pain, and ascites that occurs most commonly in the setting of high-dose chemotherapy or hematopoietic stem cell transplantation (HSCT). The diagnosis can be confirmed on biopsy. Cemiplimab is an immune checkpoint inhibitor recently approved for the treatment of cutaneous squamous cell carcinoma. There are currently no known reports of immune checkpoint inhibitor-related VOD/SOS. Case Description/Methods: A 58-year-old female with a history of locally advanced basal cell carcinoma of the left eye treated with six months of Cemipilimab presented with ascites. On admission, labs were notable for a total bilirubin of 1.2, mildly elevated liver function tests, alkaline phosphatase 884, and international normalized ratio 2.1. A diagnostic tap revealed a high SAAG ascites that was negative for infection. A comprehensive serological workup for viral, metabolic and autoimmune causes was unrevealing. A transjugular liver biopsy demonstrated a hepatic venous pressure gradient of 18mmHg, nodular regenerative hyperplasia (NRH), and portal venopathy. The patient was discharged on steroids but returned one month later for recurrent ascites and worsening bilirubin to 12.6 (direct 7.3);COVID PCR was negative. A full rheumatologic and vasculitis workup was unremarkable. Repeat biopsy (Figure 1) demonstrated moderate NRH changes, prominent central vein sclerosis with fibrous obliteration, signs of SOS/ VOD and central venulitis with fibrotic changes with sinusoidal portal hypertension. Discussion(s): VOD occurs most often with hematopoietic stem cell transplantation, and chemotherapeutic agents. Here we present the first case of checkpoint inhibitor-induced VOD/SOS. Despite discontinuation of the offending agent and a trial of steroids, the patient's clinical course continued to deteriorate. She eventually developed refractory ascites and portosystemic encephalopathy. She was deemed not a candidate for liver transplant given her underlying malignancy. She was transitioned to home hospice before further treatment, such as Defibrotide could have been pursued. VOD associated with immune checkpoint inhibition should be considered in the differential of patients who develop new onset liver dysfunction and ascites while receiving these medications (Figure Presented).

Outcomes for Anti-CD19+ Chimeric Antigen Receptor T (CAR-T) Cell Therapy for Non Hodgkin Lymphoma (NHL) across a Large Community Transplant and Cellular Therapy Network

Background: The Sarah Cannon Transplant and Cellular Therapy Network (SCTCTN), which offers community access to transplant and cell therapy, implemented a coordinated approach to deliver CAR-T therapy through 5 programs. We conducted a retrospective review of clinical outcomes after FDA-approved anti-CD19+ CAR-T in B-cell NHL. Method(s): All patients referred for evaluation within SCTCTN were tracked in our prospective registry (Stafa-CT). We identified 110 patients who received FDA-approved anti-CD19+ CAR-T for NHL within the network between 12/10/2018 and 3/7/2022. All patients received care through standardized eligibility criteria, process, care pathways, toxicity management protocols, and a single quality plan. Result(s): The median age at referral was 60 years (range 23-82), 63% were male, the referral indication was diffuse large B-cell lymphoma (70%), mantle cell lymphoma (7%), follicular lymphoma (15%), or other B-NHL (8%). 35% had received a prior autologous transplant. The median time from referral to infusion was 143 days (range 89- 224), and from collection to infusion was 32 days. The infusion year was 2018 (1), 2019 (20), 2020 (31), 2021 (48), 2022 (10). The CAR-T cell products were Axi-cel (70), Tisa-cel (27), Brexu-cel (9), and Liso-cel (4). 16 patients (15%) were infused as outpatient, of which 10 patients were subsequently hospitalized at a median of 8 days (range 1-26) after infusion. Of the 94 patients (85%) infused as inpatient, the median length of stay was 15 days (range 6 to 85). Cytokine release syndrome (CRS) was observed in 78% with a median maximum grade 1. Maximum grade CRS was none, grade 1, grade 2, grade 3, grade 4, grade 5 in 22%, 36%, 32%, 7%, 2 % and <1%, respectively. The median times to onset and resolution of symptoms were day 3 and 8, respectively. Tocilizumab was administered to 39% for a median of 2 doses. Neurotoxicity was observed in 55% with a median maximum grade 1. Maximum grade neurotoxicity was none, grade 1, grade 2, grade 3, grade 4, grade 5 in 45%, 19%, 13%, 18%, 4 % and 0%, respectively. The median times to onset and resolution of symptoms were day 7 and 13, respectively. Neutropenia (<0.5/ muL) and thrombocytopenia (<20K/muL) at day 30 were reported in 11% and 12%, respectively. 18% required ICU stay. 37 deaths (34%) were reported from disease progression (23), infections (7, including 5 from COVID), CRS (2) and other causes (5).(Figure Presented) Conclusion(s): Administration of anti-CD19+ CAR-T is feasible in specialized community hospitals with outcomes similar to registrational clinical trials. Outpatient administration is feasible in selected patients, but subsequent hospitalization needs to be anticipated. CRS, neurotoxicity, cytopenias and infection remain challenges, while disease progression was the commonest cause of deathCopyright © 2023 American Society for Transplantation and Cellular Therapy

Systematic review on digital transformation among teachers in public schools

Radical changes across almost all areas, including education, due to the COVID-19 outbreak. One of the rapid transformations is digital learning, also known as e-learning. Digital learning transformation has been taking place for more than a decade. However, little comprehensive analysis of digital transformation in teaching in public schools. To the best of the authors' knowledge, no comprehensive analysis incorporates external and internal barriers and examines the prominent theories to study successful e-learning integration among teachers. The aim of this study was to provide a thematic and theoretical understanding of digital learning transformation among teachers in public schools. The data for the study was acquired from the Scopus databases. The study employed content and comparative analysis and advocated a grounded theory approach to inductively analyze and criticize the theme construction for answering two research questions. Based on a set of criteria to determine whether each derived study should be included or excluded, 42 articles were reviewed between 2010 and 2022. The analysis uncovered 10 themes of antecedents that were constructed as a framework based on the first-second-order barriers. Results also indicated that CHAT, TPACK, TAM, and UTAUT are the most prominent theories used to conduct digital transformation research. The findings offered significant implications for digital transformation and educational technology communities, especially for policymakers to strategize and reflect on the practice they implemented and improvised if necessary for future sustainable education and efficient teachers' performance in teaching. © Institute of Advanced Engineering and Science.

Nanotheranostics to target antibiotic-resistant bacteria: Strategies and applications

Various health agencies, such as the European Medical Agency (EMA), Centers for Disease Control and Prevention (CDC), and World Health Organization (WHO), timely cited the upsurge of antibiotic resistance as a severe threat to the public health and global economy. Importantly, there is a rise in nosocomial infections among covid-19 patients and in-hospitalized patients with the delineating disorder. Most of nosocomial infections are related to the bacteria residing in biofilm, which are commonly formed on material surfaces. In biofilms, microcolonies of various bacteria live in syntropy;therefore, their infections require a higher antibiotic dosage or cocktail of broad-spectrum antibiotics, aggravating the severity of antibiotic resistance. Notably, the lack of intrinsic antibacterial properties in commercial-grade materials desires to develop newer functionalized materials to prevent biofilm formation on their surfaces. To devise newer strategies, materials prepared at the nanoscale demonstrated reasonable antibacterial properties or enhanced the activity of antimicrobial agents (that are encapsulated/chemically functionalized onto the material surface). In this manuscript, we compiled such nanosized materials, specifying their role in targeting specific strains of bacteria. We also enlisted the examples of nanomaterials, nanodevice, nanomachines, nano-camouflaging, and nano-antibiotics for bactericidal activity and their possible clinical implications.Copyright © 2023 The Author(s)

Diarylheptanoid and SAR-CoV-2

The recent outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has posed a serious challenge to mankind. The need for an urgent cure for SARS-CoV-2 increased, as there was no specific treatment protocol designed for this global pandemic. Previous studies show similarities in the genomic structure of SARS-CoV-2 and SARS-CoV. So, the treatment strategy applied for SARS-CoV can be applied on SARS-CoV-2 as well. This chapter focuses on the effectiveness of diarylheptanoids against SARS-CoV-2. © 2023 Elsevier Inc. All rights reserved.

Covid-19, disrupted vegetable supply chain and direct marketing: experiences from India

Purpose: This paper examines the impact of the Covid-19 induced lockdown on selected vegetables to confirm if the vegetable supply chain was disrupted during that period. It attempts to see if direct marketing via FPOs/FPCs helped Indian farmers to cope with adverse situations aroused in vegetable marketing. Design/methodology/approach: This study opted for mixed methods research. First, a granular data set comprising daily observation on wholesale price and the market arrival of vegetables were analysed. Descriptive statistics and Kalmogorov-Smirnov test were used to understand the severity of disruptions in the vegetable supply chain in India during the lockdown. Then, qualitative information from different stakeholders engaged in the vegetable marketing was collected through a phone survey and assessed using content analysis to comprehend how FPOs have helped farmer's during this crisis. Findings: This paper confirms disruptions in the vegetable supply chain. Quantities of chosen vegetables arriving in the mandis were significantly lower than in the previous year for all phases of lockdown. Consequently, prices were much higher than in 2019–2020 for both the lockdown and subsequent phases unlock. Results further suggest that those farmers who are already in networks of FPOs/FPCs are able to get benefited. It was also observed that direct marketing through institutional supports is being more explored in the regions where FPOs/FPCs already exist. Research limitations/implications: Since it is an exploratory study involving a small sample, the research results may lack generalisability. Originality/value: This study provides scope for direct marketing through FPOs/FPCs in improving the food supply chain. © 2021, Emerald Publishing Limited.

Virtual machine tree task scheduling for load balancing in cloud computing

The increasing number of publications towards cloud computing proves that much research and development has been done, especially for task scheduling. Organizations are eager to get more customized technology to run the most smoothly in the provision of visual cloud services for fruity users. As the circumstances of Covid indicate to technology that everyone should run digitally, the workload on machines increased. For workload solutions, organizations are trying to balance the situation with the successful operation of cloud services to use appropriate services/resources. Nevertheless, the issues are still to be resolved by researchers, so we respect all my friends who are putting a lot of effort into developing new techniques. A proposed paper is showing a new collation with the load balancing factor by implementing quality of service (QoS) and virtual machine tree (VMT). A CloudSim toolkit will then be used to compare them. A tree structure graph is included in the VMT algorithm to schedule tasks with the appropriate distribution on each machine. The QoS algorithm performs the task of scheduling based on the service required by the user with the best quality and satisfies the user. © 2023 Institute of Advanced Engineering and Science. All rights reserved.

Severity and Mortality of Covid-19 in Patients with Diabetes Mellitus

Background: Covid-19 infection appeared as rapidly spreading cases of acute respiratory disease in Wuhan city of China that became pandemic. It was brought to the notice of WHO on December 31, 2019. Diabetes mellitus is one of the biggest health problems and fast growing emergencies of the 21st century. Diabetic patients with who got infected with Covid-19 have more chance of in hospital treatment need, intensive care unit care requirement, intubation and death. Objective(s): The objective of this study was to know the severity and mortality of covid-19 in patients with diabetes mellitus. Study Design: This was a descriptive case series study. Study Setting: It was done in the Covid-19 isolation and ICU unit of Ayub Teaching Hospital Abbottabad from May 2020 to October 2021. Method(s): Using non-probability consecutive sampling, 189 diabetic patients were enrolled. Sample included all covid-19 patients having diabetes that received indoor treatment during this period. All patients from both genders with age > 18 years were included. Patients with malignancy or on immunosuppressants for more than 1 month were excluded. Patients who were maintaining oxygen saturation at room air/facemask/nasal prongs were labelled as having non-severe disease while patient who needed CPAP or assisted ventilation were labelled as having severe covid-19 disease. All patients who died during admission were documented as covid-19 related mortality. Patients were labelled as diabetic who were known diabetic and taking diabetes treatment. Data was collected on a structured pro forma. Statistical program SPSS version 16.0 was used for the analysis of data. Result(s): In this study, mean age was 61.29 +/- 11.73 years. There were 40.2% male and 59.8% female patients. 86.2% patients were not-vaccinated, 3.7% patients were partially vaccinated and 10.1% patients were fully vaccinated. Hypertension was most common comorbidity (42.3%) and only CKD was significantly associated with increased mortality. 43.92%patients had non-severe illness while 56.08% patients had severe illness. The overall mortality of illness was 48.15% while it was 84.9% in patients with severe illness. Practical implication: These published publications provide a variety of various estimations and impact amounts due to the numerous different study designs and demographics. A comprehensive and methodical study is required because of the unpredictability of the situation. So that we conducted this study to assess the severity and mortality of covid-19 in patients with diabetes mellitus Conclusion(s): Our study concluded that severity and mortality of covid-19 was high in diabetic patients with high fasting & random sugar levels, pack smoking years and low oxygen saturation. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

Ipsilateral axillary lymphadenopathy after COVID-19 vaccination in a young female, a case report and literature review

It has been two years since vaccination for COVID-19 was launched worldwide. In Pakistan, the vaccination started in the beginning of 2020. Since then, several side effects were reported after vaccination, including soreness of the arm, fever, chills, malaise and diarrhoea. Axillary lymphadenopathy has been found to be associated with several conditions that include autoimmune disorders, infections, malignancy and some idiopathic causes. We present a rare case of a 30-y old female with recent recovery from COVID-19, who developed ipsilateral axillary lymphadenopathy after 15 days of Sinovac vaccination. Ultrasonography was done to confirm the diagnosis and its spread towards breast and cervical region. This case report discusses some key points and recommendations regarding unilateral axillary lymphadenopathy after COVID-19 vaccination. Copyright © 2022 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.

Understanding the impact of pandemics on society with a special focus on COVID-19

The study aims to ascertain how different levels of society have been influenced by the impact of pandemics over the last many years. The study also determines the societal implications of the COVID-19 pandemic. The integrative literature survey method is adopted to extract the secondary data pertinent to the socio-economic effect of pandemics and COVID-19 on society. Primary data is collected to diagnose the impact of the COVID-19 pandemic and lockdown on employees (N = 210) working in the Indian organized sector. Findings of the study suggest that pandemics have been a cause of economic slowdown measured with a fall in gross domestic product (GDP) at the macro level. The reduced level of economic activity is found to be negatively related to an individual socio-economic status building their psychological distress. The descriptive analysis of the data reveals that although employees have managed their jobs and finances during COVID-19, they have experienced stress in their lives due to the pandemic. The study assimilates the pandemic effect using inductive reasoning to develop a COVID quadrilateral conceptual framework.

Determinant Upgrading Agribusiness MSMEs in the COVID-19 Pandemic

Enterprise upgrading strategy is related to investment decisions by MSMEs as investors, closely related to the sustainable development of business. This research aims to identify determinants upgrading, the risks faced and the performance of Agribusiness MSMEs in Palu, and also the influence of determinants upgrading on the performance of Agribusiness MSMEs in Palu during the COVID-19 pandemic. The response of the research on the characteristics of entrepreneurs earned an average of 4.04. It means that the characteristics of entrepreneurs include the "GOOD” category. Other while the response for company characteristics earned an average of 4.41, which gives the meaning of employer characteristics including the "VERY GOOD” category. The response for business and social networks, gained an average of 4.43, entering the category of "VERY GOOD” and last the response to risk earned an average of 3.04 including the "MEDIUM” category. The constant value (α) has a value of -5,633 which means that if the characteristics of entrepreneurs (X1), company characteristics (X2), business and social networks (X3), and business environment (X4) are equal to zero (0), then agribusiness MSMEs will be decreased. The results of the analysis of business characteristic variables (X1), corporate characteristics (X2), business and social activities (X3), and business environment (X4) partially have a significant effect on the performance of Agribusiness MSMEs.

SARS-CoV-2 Antibody Seroprevalence in Jakarta, Indonesia

The SARS-CoV-2 transmission dynamics in low- and middle-income countries remain poorly understood. This study aimed to estimate the SARS-CoV-2 antibodies seroprevalence in Jakarta, Indonesia, and to increase knowledge of SARS-CoV-2 transmission in urban settings. A population-based serosurvey among individuals aged one year or older was conducted in Jakarta. Employing a multistage sampling design, samples were stratified by district, slum and non-slum residency, sex, and age group. Blood samples were tested for IgG against three different SARS-CoV-2 antigens. Seroprevalence was estimated after applying sample weights and adjusting for cluster characteristics. In March 2021, this study collected 4,919 respondents. The weighted estimate of seroprevalence was 44.5% (95% CI = 42.5-46.5). Seroprevalence was highest among adults aged 30-49 years, with higher seroprevalence in women and the overweight/obese group. Respondents residing in slum areas were 1.3-fold more likely to be seropositive than non-slum residents. It was estimated that 4,717,000 of Jakarta's 10.6 million residents had prior SARS-CoV-2 infection. This suggests that approximately 10 infections were undiagnosed/underreported for every reported case. About one year after the first COVID-19 case was confirmed, close to half of Jakarta's residents have been infected by SARS-CoV-2.

Colchicine anti-inflammatory therapy for non-intensive care unit hospitalized COVID-19 patients: results from a pilot open-label, randomized controlled clinical trial.

Systemic inflammation is a hallmark of severe coronavirus disease-19 (COVID-19). Anti-inflammatory therapy is considered crucial to modulate the hyperinflammatory response (cytokine storm) in hospitalized COVID-19 patients. There is currently no specific, conclusively proven, cost-efficient, and worldwide available anti-inflammatory therapy available to treat COVID-19 patients with cytokine storm. The present study aimed to investigate the treatment benefit of oral colchicine for hospitalized COVID-19 patients with suspected cytokine storm. Colchicine is an approved drug and possesses multiple anti-inflammatory mechanisms. This was a pilot, open-label randomized controlled clinical trial comparing standard of care (SOC) plus oral colchicine (colchicine arm) vs. SOC alone (control arm) in non-ICU hospitalized COVID-19 patients with suspected cytokine storm. Colchicine treatment was initiated within first 48 hours of admission delivered at 1.5 mg loading dose, followed by 0.5 mg b.i.d. for next 6 days and 0.5 mg q.d. for the second week. A total of 96 patients were randomly allocated to the colchicine (n=48) and control groups (n=48). Both colchicine and control group patients experienced similar clinical outcomes by day 14 of hospitalization. Treatment outcome by day 14 in colchicine vs control arm: recovered and discharged alive: 36 (75.0%) vs. 37 (77.1%), remain admitted after 14-days: 4 (8.3%) vs. 5 (10.4%), ICU transferred: 4 (8.3%) vs. 3 (6.3%), and mortality: 4 (8.3%) vs. 3 (6.3%). The speed of improvement of COVID-19 acute symptoms including shortness of breath, fever, cough, the need of supplementary oxygen, and oxygen saturation level, was almost identical in the two groups. Length of hospitalization was on average 1.5 day shorter in the colchicine group. There was no evidence for a difference between the two groups in the follow-up serum levels of inflammatory biomarkers including C-reactive protein (CRP), D-dimer, lactate dehydrogenase (LDH), ferritin, interleukin-6 (IL-6), high-sensitivity troponin T (hs-TnT) and N-terminal pro b-type natriuretic peptide (NT pro-BNP). According to the results of our study, oral colchicine does not appear to show clinical benefits in non-ICU hospitalized COVID-19 patients with suspected cytokine storm. It is possible that the anti-inflammatory pathways of colchicine are not crucially involved in the pathogenesis of COVID-19.

Did We Deliver Quality Education in Online Sessions during Covid 19 Lock Down? Learner’s Perspective from a Developing Country

Objective: COVID-19 pandemic pushed unprepared educational institutes towards online sessions. Though equivalence of online sessions proved already in many studies before pandemic, unplanned sessions and inexperienced teachers with networking issues and novice software for online sessions could not meet the standard of teaching that was expected or experienced during these sessions. We planned this study to know perspective of learners to measure quality of online sessions and to find out factors which could improve these sessions in future. Design: Prospective questionnaire based study Place & duration of study: Hitec IMS Dental College, from 10th Feb 2022 to 10th March 2022 Methodology: Questionnaire was distributed to 150 students of BDS who has attended online session during COVID-19 pandemic. Results: 85% of the responders appreciated online sessions happening during pandemic to avoid wastage of time but as high as 50% students were of the opinion that teachers could not maintain standard of teaching as in on campus session. Factors for this dis-satisfaction of students included issues like connectivity issues, gadgets of students as well as teachers, novelty to softwares to attend online class, and psychological issues like depression. So at the end 83% of students preferred on-campus sessions on on-line sessions. Conclusion: On the basis of findings of this study, it is recommended that we should continue activity of online teaching with improvement in resources and train our staff and students even in the absence of such emergency.

COVID-19 crisis – an opportunity for mainstreaming digital financial transactions

Digital financial transactions, in comparison to in-cash transactions, provide an efficient and time saving option. Considering the significance of digital financial transactions in the present scenario of the COVID-19 crisis, this study has twin objectives: firstly, to examine the use of digital financial transactions in COVID-19 and secondly, to explore the existence of any relationship between financial literacy and the use of digital financial transactions, especially by low-income groups in India. This study uses secondary data from authorised and government sources for the analysis of the research objectives. Logistic regression model was deployed on National Centre for Financial Education (NCFE) (2019) survey data of around 36,600 low-income group to interpret the relationship between financial literacy and digital financial transactions. The analysis of the data suggested that financial literacy was significant in positively affecting digital financial transactions. In this regard, financial literacy could play an instrumental role, which is also being indicated through our estimated results. Copyright © 2022 Inderscience Enterprises Ltd.

Technology Application among Teachers from Rural Schools in Johor

The COVID-19 pandemic has disrupted the world???s education system, including Malaysia. This disruption has affected approximately 1.6 billion students in more than 200 countries. The closure of educational institutions has caused various changes in people???s lives. This research examines the associations between institutional support, perceptions of usefulness, personal innovation, perceived social pressure, and age with the application of technology among teachers from rural schools in Johor. One hundred ten teachers were involved in this study. The results showed that perceived usefulness, personal innovativeness, and perceived social pressure had influenced technology adoption among the teachers from rural schools.

CovXR: Automated Detection of COVID-19 Pneumonia in Chest X-Rays through Machine Learning

Coronavirus disease 2019 (COVID-19) is the highly contagious illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The standard diagnostic testing procedure for COVID-19 is testing a nasopharyngeal swab for SARS-CoV-2 nucleic acid using a real-time polymerase chain reaction (PCR), which can take multiple days to provide a diagnosis. Another widespread form of testing is rapid antigen testing, which has a low sensitivity compared to PCR, but is favored for its quick diagnosis time of usually 15-30 minutes. Patients who test positive for COVID-19 demonstrate diffuse alveolar damage in 87% of cases. Machine learning has proven to have advantages in image classification problems with radiology. In this work, we introduce CovXR as a machine learning model designed to detect COVID-19 pneumonia in chest X-rays (CXR). CovXR is a convolutional neural network (CNN) trained on over 4,300 chest X-rays. The performance of the model is measured through accuracy, F1 score, sensitivity, and specificity. The model achieves an accuracy of 95.5% and an F1 score of 0.954. The sensitivity is 93.5% and specificity is 97.5%. With accuracy above 95% and F1 score above 0.95, CovXR is highly accurate in predicting COVID-19 pneumonia on CXRs. The model achieves better accuracy than prior work and uses a unique approach to identify COVID-19 pneumonia. CovXR is highly accurate in identifying COVID-19 on CXRs of patients with a PCR confirmed positive diagnosis and provides much faster results than PCR tests.

Severe Multifocal Cortical Encephalopathy Following COVID-19 Vaccination: A Case Report

Objective: This clinical case history details a woman who received the COVID-19 vaccine BNT162b2 and developed an acute, severe encephalopathy associated with new onset seizures within days of her first vaccination. Background: BNT162b2, an mRNA-LNP-vaccine, has been strategically purified and modified to suppress immunogenicity. It still possesses powerful intrinsic immune-stimulatory features that induce type-I INF production, which has been associated with both inflammation and potentially autoimmunity in several mRNA-vaccine phase-I/II clinical trials (HIVNCT02413645, influenza-NCT03076385, rabies-NCT02241135 and Zika virus-NCT03014089). Design/Methods: A 69-year-old woman who received her first dose of BNT162b2 five days prior, was found unresponsive. Within twenty-four hours of arrival, she developed focal seizures with secondary generalized, and remained in non-convulsive status epilepticus on longterm EEG monitoring until day 5 of admission despite three anti-seizure medications and a propofol drip. Brain MRI on day 3 of admission showed gyriform-pattern diffusion restriction in the right hemisphere and left frontoparietal region without features suggestive of an acute vascular event. Vascular imaging was normal. Cerebrospinal fluid examination revealed an elevated protein level (135 mg/dl), with negative findings for infections from bacteria, fungi, mycobacteria, HIV, syphilis, and viruses, including COVID-19 PCR, as well as paraneoplastic and autoimmune encephalitis panels. Serum COVID-19 IgG antibody was negative on post-immunization day 8. Results: There was no significant improvement following empiric methylprednisolone and meningitis antibiotic/antiviral treatment. She was discharged in a deeply comatose status on day 30 of hospital admission. Repeat MRI brain on day 14 showed similar findings to her previous scan with the addition of Wallerian degeneration in the right cerebral peduncle. Conclusions: In a patient who develops an acute encephalopathy with new onset of seizure within days of BNT162b2 vaccine, do consider mRNA-vaccine related encephalopathy in the differential diagnosis.

Successful Treatment of Pediatric Holo-Spinal Epidural Abscess With Percutaneous Drainage.

Spinal epidural abscess (SEA) is a rare and potentially devastating neurologic disease that is commonly treated with neurosurgical decompression and evacuation. We describe the case of an 11-month-old immunocompetent infant who presented with a large multiloculated methicillin-resistant Staphylococcus aureus abscess in the left lung apex with likely mediastinal involvement, extending into the epidural space from C7 down to L2 causing cord compression which was successfully treated with percutaneous placement of an epidural drainage catheter and antibiotic therapy. Although there are rare reports of percutaneous drainage of SEAs, to our knowledge, there are no reports of successful use of percutaneous indwelling catheters resulting in the complete resolution of an SEA. Holo-spinal epidural abscess in an infant is an extremely rare disease with limited literature available regarding the best practice for its treatment. Multiple considerations must be taken into account when weighing the different treatment options ranging from surgical decompression to conservative management with antibiotic therapy. We present a unique case of successful treatment with percutaneous epidural drain placement. This provides a reasonable alternative for management in children for whom surgical decompression carries multiple risks for complications both acutely and delayed.