Rare Case of Immune-Mediated Necrotizing Myopathy With Isolated Dysphagia as Presenting Symptom

Introduction: Immune mediated necrotizing myopathy (IMNM) is a rare, but progressive disease that accounts for about 19% of all inflammatory myopathies. Dysphagia occurs in 20-30% of IMNM patients. It often follows proximal muscle weakness and ensues in the later stages of the disease. We report a rare case of IMNM, presenting with dysphagia as the initial symptom, followed by proximal muscle weakness. Case Description/Methods: A 74-year-old male with a past medical history of coronary artery disease, hypertension, and hyperlipidemia presented to the ED with 2-3 weeks of intractable nausea, vomiting, and dysphagia for solids and liquids. Vital signs were stable, and initial labs displayed an AST of 188 U/L and ALT of 64 U/L with a normal bilirubin. Computed tomogram of the chest, abdomen, and pelvis were negative. An esophagram showed moderate to severe tertiary contraction, no mass or stricture, and a 13 mm barium tablet passed without difficulty. Esophagogastroduodenoscopy exhibited a spastic lower esophageal sphincter. Botox injections provided no significant relief. He then developed symmetrical proximal motor weakness and repeat labs demonstrated an elevated creatine kinase (CK) level of 6,357 U/L and aldolase of 43.4 U/L. Serology revealed positive PL-7 autoxantibodies, but negative JO-1, PL-12, KU, MI-2, EJ, SRP, anti-smooth muscle, and anti-mitochondrial antibodies. Muscle biopsy did not unveil endomysial inflammation or MHC-1 sarcolemmal upregulation. The diagnosis of IMNM was suspected. A percutaneous endoscopic gastrostomy feeding tube was placed as a mean of an alternative route of nutrition. He was started on steroids and recommended to follow up with outpatient rheumatology. He expired a month later after complications from an unrelated COVID-19 infection. Discussion(s): The typical presentation of IMNM includes painful proximal muscle weakness, elevated CK, presence of myositis-associated autoantibodies, and necrotic muscle fibers without mononuclear cell infiltrates on histology. Dysphagia occurs due to immune-mediated inflammation occurring in the skeletal muscle of the esophagus, resulting in incoordination of swallowing. Immunotherapy and intravenous immunoglobulin are often the mainstay of treatment. Our patient was unique in presentation with dysphagia as an initial presenting symptom of IMNM, as well as elevated enzymes from muscle breakdown. It is critical as clinicians to have a high degree of suspicion for IMNM due to the aggressive nature of the disease and refractoriness to treatment.

Analysis Of The Impact Of Covid-19 Pandemic On Older People's Social Well-Being

The repercussions of the Covid-19 pandemic on people's daily lives are immeasurable. effects on healthcare, business, the economy, and society;medical practitioners face difficulties in identifying and treating possible cases;patients with other health issues are often ignored;the healthcare system as a whole is strained. Having supportive relationships is crucial to a healthy mind. There are numerous threats to societal health during the COVID-19 pandemic. Elderly people have a lot of issues because they haven't had any of the pleasures of life since the COVID-19 pandemic. Many lost their eyesight during the pandemic, making even intimate human contact impossible. This left the elderly feeling entirely alone. The purpose of this research was to investigate the impact of the recent COVID-19 pandemic on the social well-being of the elderly by analyzing factors such as social contacts, neighborhood and neighborhood cohesion, material deprivation, main occupation, social isolation, societal institutions, and participation.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Identification of SARS-CoV-2 variants using viral sequencing for the Centers for Disease Control and Prevention genomic surveillance program.

BACKGROUND: The Centers for Disease Control and Prevention contracted with laboratories to sequence the SARS-CoV-2 genome from positive samples across the United States to enable public health officials to investigate the impact of variants on disease severity as well as the effectiveness of vaccines and treatment. Herein we present the initial results correlating RT-PCR quality control metrics with sample collection and sequencing methods from full SARS-CoV-2 viral genomic sequencing of 24,441 positive patient samples between April and June 2021. METHODS: RT-PCR confirmed (N Gene Ct value < 30) positive patient samples, with nucleic acid extracted from saliva, nasopharyngeal and oropharyngeal swabs were selected for viral whole genome SARS-CoV-2 sequencing. Sequencing was performed using Illumina COVIDSeq™ protocol on either the NextSeq550 or NovaSeq6000 systems. Informatic variant calling, and lineage analysis were performed using DRAGEN COVID Lineage applications on Illumina's Basespace cloud analytical system. All sequence data and variant calls were uploaded to NCBI and GISAID. RESULTS: An association was observed between higher sequencing coverage, quality, and samples with a lower Ct value, with < 27 being optimal, across both sequencing platforms and sample collection methods. Both nasopharyngeal swabs and saliva samples were found to be optimal samples of choice for SARS-CoV-2 surveillance sequencing studies, both in terms of strain identification and sequencing depth of coverage, with NovaSeq 6000 providing higher coverage than the NextSeq 550. The most frequent variants identified were the B.1.617.2 Delta (India) and P.1 Gamma (Brazil) variants in the samples sequenced between April 2021 and June 2021. At the time of submission, the most common variant > 99% of positives sequenced was Omicron. CONCLUSION: These initial analyses highlight the importance of sequencing platform, sample collection methods, and RT-PCR Ct values in guiding surveillance efforts. These surveillance studies evaluating genetic changes of SARS-CoV-2 have been identified as critical by the CDC that can affect many aspects of public health including transmission, disease severity, diagnostics, therapeutics, and vaccines.

YOLOv4-Based Monitoring Model for COVID-19 Social Distancing Control

The coronavirus disease 2019 (COVID-19) has appeared in December 2019 at Wuhan city, China. The virus started spreading over the world. Most of the governments have taken different measures to prevent the outbreak. Social distancing (SD) is one of the effective solutions to prevent the spread of COVID-19, in which people should maintain a specific distance between each other. This paper aims to provide a YOLOv4-based model for monitoring social distancing. The model begins by taking a video/picture as input and generating warnings of SD violation. The YOLOv4 we used in this model detects pedestrian’s people in public places such as streets, malls, train stations, and universities based on deep learning techniques. The model uses a predefined SD threshold (SDTH) and a violation index (VI) to determine when the violation occurs and trigger a warning sub-system to make an awareness action immediately. A comprehensive investigation and discussion on the existing literature of SD, object detection methods, and SD monitoring have also been provided in this paper. The model provided is supposed to operate continuously in the targeted places to monitor people, thus reducing the impact of COVID-19 spread. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.