Acute Kidney Injury in Children with Covid-19 Related Multisystem Inflammatory Syndrome (Mis-C)

BACKGROUND: Although children with coronavirus disease 19 (COVID-19) generally experience a mild disease a subset of them develop multisystem inflammatory syndrome (MIS- C) which can lead to multiorgan failure. There is relative rarity of literature regarding acute kidney injury (AKI) in MIS-C. We aim to characterize the clinical features laboratory findings and therapies for AKI in MIS-C in our setup. AIM OF THE STUDY: We aim to characterize the clinical features laboratory findings and therapies for Acute Kidney Injury in Multi-system Inflammatory Syndrome in Children (MIS-C). METHOD(S): This was a 1 year prospective study with patients from GMC Srinagar, its associated hospitals, and Shifa Medical Centre Srinagar. Children <21 years old who had AKI and met the criteria for MIS-C based on CDC guidelines were included in the study. RESULT(S): A total of seven cases were included in the study ranging from 4 to 20 years (mean 11.4 +/- 5) with 4 females and 3 males. Persistent fever was present in all patients. Six children had vomiting/diarrhea along with rashes and/or swelling of hands. Myocardial involvement was seen in four, respiratory in two and musculoskeletal in one patient. Oropharyngeal swab for SARS- Cov2 RNA was negative in all the patients. Anticovid antibodies were positive in five patients, and two had a history of contact with COVID-19 patients. AKI Stage 1 was present in 3, stage 2 and 3 in 2 patients each. Neutrophilia with lymphopenia was seen in all the patients and thrombocytopenia in 4 patients. Laboratory findings for inflammatory markers showed marked elevation of C-reactive protein (mean 87.6 +/- 72.1 mg/l), ferritin (mean 810 +/- 224ng/ml), procalcitonin (mean 4.9 +/- 2.1ng/ml), ESR (mean 64.6 +/- 21.9 mm/hr), fibrinogen (690 +/- 142.1 mg/dl), LDH (mean 578.2 +/- 370.1U/L), and D-Dimer (mean 7.8 +/- 9.4 mugFFU/ml). The patients were treated with a combination of steroids, IVIg and inotropic support wherever needed. All of the patients recovered with a median duration hospital stay of 7 (IQR 5) days. CONCLUSION(S): Children with covid 19 infection should be carefully followed for MIS-C. Although children with MIS-C develop AKI, most of them have full clinical recovery. The longterm prognosis of this syndrome is currently unknown until their follow-up data becomes available in future.

Severe symptomatic bradycardia associated with Remdesivir use in a covid-19 patient: a case report and review of literature

The global pandemic is yet to see any break through in the specific management of Covid-19. Remdesiver was initially given emergency use authorization (EUA) by FDA for severe Covid-19 infection. Recently it use was extended to every hospitalized patient. Little is known about cardiac adverse effects of drug. We report a case of severe symptomatic bradycardia associated with remdesiver use which was managed by close cardiac observation and withdrawal of the drug. © 2022 JK Practitioner. All rights reserved.

TREATMENT SUCCESS IN A RESISTANT CASE OF INSOMNIA WITH AN IRREGULAR CIRCADIAN RHYTHM DISORDER

Introduction: A 19-year-old non-verbal male with history of CHARGE syndrome, severe autism, intellectual disability, coloboma with blindness OD and severely imparied vision OS, deafness, self-injurious and aggressive behavior, Tetralogy of Fallot status post repair, pulmonary valve replacement, hypertension, hypothyroidism, megacolon, gastrostomy tube dependence, eosinophilic esophagitis and chronic kidney disease with an irregular sleep cycle who has failed multiple medications for insomnia has shown treatment success with suvorexant. Report of Cases: This patient's sleep schedule ranges from 1.5 to 5 hour segments at various times of day or night including naps at school with occasional longer periods of sleep up to 10 hours and longer periods of wakefulness up to 22 hours who has been treated with the following medications: trazodone, clonidine, hydroxyzine, diphenhydramine, quetiapine, gabapentin, mirtazapine, eszopiclone, melatonin and ramelteon. His behavioral problems have been treated with olanzapine. He continued to be aggressive and difficult to direct. His parents reported exhaustion. Then, suvorexant 5mg was added at bedtime while the following sleep medications were continued: gabapentin total daily dose of 1500mg (300mg in morning and 3pm;900mg at bedtime, 300mg one hour later if still awake), ramelteon 8mg, mirtazapine 7.5mg and olanzapine 10mg at bedtime and bid prn aggressive behavior. He also takes the following daily medications: bisacodyl, polyethylene glycol, simethicone, hyoscyamine, cholecalciferol, aspirin, levothyroxine, hypoallergenic nutritional formula, starch and albuterol prn. With the addition of suvorexant 5mg, he had been able to get 9.5 hours of consolidated sleep at night with improvement in his behavior until he contracted Covid-19 and regressed. The suvorexant dose was increased to 10mg which again improved his insomnia and behavior. Conclusion: Various medications have either not worked at all or have worked suboptimally for insomnia in this medically complex patient who has an irregular Circadian rhythm disorder. Adding an orexin receptor antagonist as a novel mechanism to his regimen has shown promise. At this time, this patient has been stable for one month with suvorexant 10mg at bedtime after regression on the 5mg dose that coincided with a Covid-19 infection. We are proceeding with cautious optimism.

Euphorbia hirta as a gold mine of high-value phytochemicals: A comprehensive review of its pharmacological activities and possible role against SARS-CoV-2

Euphorbia hirta is a common medicinal plant in folk and traditional medicine systems. This plant has shown promising effects against several human ailments and infectious diseases. Therefore, it is important to summarize the medicinal activities and value of Euphorbia hirta. The main intent of this literature review was to summarize the phytochemical content and pharmacological applications of Euphorbia hirta. The literature review about the pharmacology and phytochemistry of Euphorbia hirta was collected from different global platforms, such as Scopus, ERIC, PubMed, and Web of Science. E. hirta has a rich phytochemistry and exhibits remarkable activity against respiratory diseases, gastrointestinal disorders and venereal diseases. Different extracts of this plant have shown significant preclinical anticancer propensity against an array of different cancer cell lines. It acts as a highly active antiviral agent and has shown pronounced activity against coxsackievirus, human immunodeficiency virus, dengue virus, poliovirus and simian immunodeficiency virus. A clinical study showed its inhibitory responses against flu and fever in dengue patients. Most importantly, the plant possesses remarkable inhibitory action on ACE, which aids SARS-CoV-2 entry into host cells. The multidimensional role of Euphorbia hirta as a potential antiviral agent suggests its possible application to control COVID-19 along with modern and Western medicinal strategies. In conclusion, the literature review regarding Euphorbia hirta showed its strong pharmacological applications, such as antimicrobial, antimalarial, anti-asthmatic, antioxidant, antiviral and anticancer activities. Further in-depth research is necessary to monitor its role in the management of viral diseases, especially COVID-19.

Evaluating Deep Learning Approaches for Covid19 Fake News Detection

Social media platforms like Facebook, Twitter, and Instagram have enabled connection and communication on a large scale. It has revolutionized the rate at which information is shared and enhanced its reach. However, another side of the coin dictates an alarming story. These platforms have led to an increase in the creation and spread of fake news. The fake news has not only influenced people in the wrong direction but also claimed human lives. During these critical times of the Covid19 pandemic, it is easy to mislead people and make them believe in fatal information. Therefore it is important to curb fake news at source and prevent it from spreading to a larger audience. We look at automated techniques for fake news detection from a data mining perspective. We evaluate different supervised text classification algorithms on Contraint@AAAI 2021 Covid-19 Fake news detection dataset. The classification algorithms are based on Convolutional Neural Networks (CNN), Long Short Term Memory (LSTM), and Bidirectional Encoder Representations from Transformers (BERT). We also evaluate the importance of unsupervised learning in the form of language model pre-training and distributed word representations using unlabelled covid tweets corpus. We report the best accuracy of 98.41% on the Covid-19 Fake news detection dataset. © 2021, Springer Nature Switzerland AG.

Medium-term chest computed tomography (CT) follow-up of COVID-19 pneumonia patients after recovery to assess the rate of resolution and determine the potential predictors of persistent lung changes

Background: The data on medium-term follow-up of coronavirus disease-19 (COVID-19) pneumonia survivors is scarce. Medium-term follow-up will generate knowledge and help in devising a structured follow-up plan and to facilitate enrolment in clinical trials assessing the role of antifibrotic drugs in modifying the course of disease in order to avert long-term pulmonary sequelae of disease. The study was aimed to evaluate the lung findings on a medium-term follow-up (3 months or more) chest computed tomography (CT) in COVID-19 pneumonia survivors, assess the rate of resolution or persistence of lung abnormalities and to identify the initial demographic, clinical, and imaging characteristics that could potentially predict the persistence of lung abnormalities on follow-up. Results: Out of the total study cohort of 81 patients, 46 (56.8%) demonstrated complete resolution of lung findings and the remaining 35 (43.2%) had residual lung opacities on follow-up CT. The most common type of residual abnormality was ground glass opacity (GGO) (16/35;45.7%), followed by parenchymal bands (9/35;25.7%), mixed pattern of GGO and parenchymal bands (6/35;17.2%), bronchiectasis (6/35;17.2%), and interlobular septal thickening (4/35;11.4%). Patients with residual abnormalities were older, had higher BMI, more comorbidities, lower SpO2, longer hospital stay, higher rate of intensive care unit (ICU) admission, higher WBC count, a higher CT severity score, and lower rate of steroid administration with all p values < 0.05. Conclusion: Nearly half of post-COVID-19 survivors had residual lung abnormalities after ≥ 3 months of follow-up. Certain clinico-radiological characteristics have the potential to identify the individuals at risk of having residual lung abnormalities on medium-term follow-up. © 2021, The Author(s).