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Digital twin technology is the union of three systems - the physical, the virtual and the interconnecting link layer. It acts as a replica and provides real-time representation of real-world physical objects in a virtual format. Digital twins are promising when applied in healthcare. This brief review gives a schematic overview of the current state of digital twin, specifically in the healthcare industry with gaps to overcome the challenges in building smart healthcare ecosystem. A concise synthesis of the following aspects of digital twin provides a cohesive whole in this paper: new capabilities and functions of the digital twin in healthcare, technologies that support digital twins, with its applications. This study motivated by the current COVID-19 pandemic, focuses on the application of the Digital Twin technology in healthcare. © 2023 IEEE.
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SESSION TITLE: COVID-19 Co-Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Baricitinib with Remdesivir has been Food and Drug Administration (FDA) approved for hospitalized COVID-19 pneumonia patients requiring supplemental oxygen and is used across the United States. However, limited post-marketing surveillance data is currently available for these drugs. We present a case of an unvaccinated, immunocompetent patient with Herpes-Zoster virus (HZV) infection following baricitinib administration. CASE PRESENTATION: A 66-year-old African-American male with unknown vaccination status for Herpes zoster presented with worsening shortness of breath for 1 week. He had an SpO2 85% on presentation however had to be subsequently intubated due to worsening hypoxia in the ER. Cardiorespiratory exam was remarkable for diminished bibasilar breath sounds. Lab work was significant for positive COVID-19, elevated leukocytes and deranged inflammatory markers. CT chest showed bilateral ground glass opacities. He received a 14 day course of baricitinib, 10 days of dexamethasone and 5 days of remdesivir during his hospital stay. Tracheostomy and percutaneous endoscopic gastrostomy were performed due to prolonged vent dependence. On day 37 of hospitalization, the patient developed vesicular rashes over his left shoulder and anterior chest. Disseminated HZV infection was confirmed based on serologic testing. Patient received 7 days of valacyclovir with complete resolution. He was eventually discharged to a pulmonary rehabilitation center. DISCUSSION: Baricitinib was first developed for patients with rheumatoid arthritis and has been used in the treatment of rheumatoid arthritis and acts by reversible inhibition of JAK1 and JAK2. These proteins have been implicated in COVID-19 pathophysiology;promoting intracellular assembly of SARS-CoV-2 and subsequent cytokine release. Baricitinib in COVID-19 leads to the inhibition of proinflammatory cytokine release, antibody production, monocyte activation and viral proliferation. [1] There have been several studies published in support of Baricitinib induced HZV infection in rheumatoid arthritis patients, however there is little data available in COVID patients. Nonetheless, immunomodulatory action is the same. A study comparing the incidence rate (IR) of Baricitinib emergent HZV infection per 100 patient years (PY) vs placebo found IR/100PY 4.3 (p<_0.01) vs 3.1 (p not significant) [2]. Another study found the HZV IR vs placebo of 4.3 vs 1.0, with all-bari-RA IR was 3.2 (95% CI 2.8-3.7) [3]. In our case, the patient developed HZV infection after baricitinib treatment, demonstrating its immunomodulatory effects. CONCLUSIONS: This case demonstrates the ability of baricitinib to cause immunosuppression and hence causing HZV infection in COVID-19 affected patients. Reference #1: Schwartz DM, Bonelli M, Gadina M, O'shea JJ. Type I/II cytokines, JAKs, and new strategies for treating autoimmune diseases. Nat Rev Rheumatol. 2016;12(1):25. Reference #2: Kevin L, Masayoshi H, Mark C et al. Infections in baricitinib clinical trials for patients with active rheumatoid arthritis. Ann Rheum Dis.2020 Oct;79(10):1290-1297. Reference #3: Joseph S, Mark C, Tsutomu T et al. Safety profile of Baricitinib in patients with active rheumatoid arthritis with over 2 years median time in treatment. The Journal of Rheumatology January 2019, 46 (1) 7-18;DOI: https://doi.org/10.3899/jrheum.171361 DISCLOSURES: No relevant relationships by Mark Aloysius No relevant relationships by Gursharan Kaur No relevant relationships by Mohammed Musa Najmuddin No relevant relationships by mashu shrivastava
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Aim center dot To find changes in hematologic parameters in patients who are COVID-19-positive with respect to high resolution computed tomography (HRCT) chest scan so that the exact picture of the disease course can be identified and an adequate treatment protocol can be planned to combat the COVID-19 pandemic. Methods center dot Patients' health-related data including age, gender, symptomatology, associated co- morbidities, laboratory test results and HRCT results were collected. Results center dot The radiologic findings showed ground glass opacities (GGOs) was the most common manifestation. Analysis of HRCTs of patients with COVID-19 showed that lesions were mainly confined to the right and left lower lobes, suggesting that the COVID-19 virus is mainly harbored in the basal areas of the lungs. Conclusion center dot Radiologic and laboratory investigations can greatly help in early detection of COVID-19, thus allowing for timely interventions.
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This paper examines the Global Climate Action Agenda (GCAA) and discusses options to improve sub- and non-state involvement in post-2020 climate governance. A framework that stimulates sub- and non-state action is a necessary complement to national governmental action, as the latter falls short of achieving low-carbon and climate-resilient development as envisaged in the Paris Agreement. Applying design principles for an ideal-type orchestration framework, we review literature and gather expert judgements to assess whether the GCAA has been collaborative, comprehensive, evaluative and catalytic. Results show that there has been greater coordination among orchestrators, for instance in the organization of events. However, mobilization efforts remain event-driven and too little effort is invested in understanding the progress of sub- and non-state action. Data collection has improved, although more sophisticated indicators are needed to evaluate climate and sustainable development impacts. Finally, the GCAA has recorded more action, but relatively little by actors in developing countries. As the world seeks to recover from the COVID-19 crisis and enters a new decade of climate action, the GCAA could make a vital contribution in challenging times by helping governments keep and enhance climate commitments;strengthening capacity for sub- and non-state action;enabling accountability;and realizing sustainable development. © 2021 The Authors. Global Policy published by Durham University and John Wiley & Sons Ltd.
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AIM: To find changes in hematologic parameters in patients who are COVID-19-positive with respect to high resolution computed tomography (HRCT) chest scan so that the exact picture of the disease course can be identified and an adequate treatment protocol can be planned to combat the COVID-19 pandemic. METHODS: Patients' health-related data including age, gender, symptomatology, associated co-morbidities, laboratory test results and HRCT results were collected. RESULTS: The radiologic findings showed ground glass opacities (GGOs) was the most common manifestation. Analysis of HRCTs of patients with COVID-19 showed that lesions were mainly confined to the right and left lower lobes, suggesting that the COVID-19 virus is mainly harbored in the basal areas of the lungs. CONCLUSION: Radiologic and laboratory investigations can greatly help in early detection of COVID-19, thus allowing for timely interventions.