Engineering a Holistic Response to the Global Crisis of Forced Displacement

The global coronavirus pandemic has demonstrated the necessity of engineering approaches, from research and development to rapid prototyping and production, in saving lives all across the world [1]. From personal protective equipment design to vaccine production and distribution, engineering has been the bedrock of an effective global response. However, despite major gains made in the last several decades, there are still millions all across the world, including the vulnerable displaced, who rarely benefit from new developments at the interface of engineering, biology, and health. Copyright © 2010-2012 IEEE.

Visual Servo Algorithm of Robot Arm Simulation for Dynamic Tracking and Grasping Application

Health pandemics such as Covid-19 have drastically shifted the world economics and boosted the development of automation technologies in the industries for continuous operation without human intervention. This paper elaborates on an approach to dynamically track and grasp moving objects using a robot arm. The robot arm has an eye-in-hand (EIH) configuration, where a camera is installed on the robot arm's end effector. The working principle of the robot arm in this paper is mainly dependent on the recognition of augmented reality markers, i.e., Aruco markers, placed on the dynamically moving target object with continuous tracking. Then, the proposed system updates the predicted location for the markers using the Kalman filter for performing grasping. The proposed approach identifies the Aruco marker on the target object and estimates the object's location using previous states, and performs grasping at the exact predicted location. When extracted information is updated, the vision system also implements a feedback control system for stability and reliability. The proposed approach is tested using simulation of the dynamic moving object with different speeds and directions. The robot arm with the Kalman filter can track and grasp the dynamic object at a speed of 0.2m/s with a 100% success rate while obtaining an 80% success rate at a speed of 0.3m/s. In conclusion, the moving object's speed is directly proportional to the grasping time until it reaches the threshold speed for the camera in identifying the Aruco markers. Future works are required to improve the dynamic visual servo algorithm with motion planning when obstacles are present in the path of robot grasping.

HPLC Method Development and Quantification of Favipiravir in Both Bulk and Solution Form

Favipiravir (FVP) structurally is an analog of pyrazine and showed its antiviral actions against a diverse species of viruses. Due to this fact, it was chosen as a potential candidate to be further investigated to cure COVID-19. A simple, accurate, rapid, precise, high-performance liquid chromatography (HPLC) method has been established for quality control assurance of FVP in pharmaceutical preparations. Column no C8 (150 mm x 4.6 mm;5 mu m) was used for such separation analysis. A combination of acetonitrile and phosphate buffer was used in 10:90 ratios as the mobile phase (90:10, v/v) having a flow rate of 1 mL / min. further, it was detected at 220 nm, and the temperature was maintained at 25 degrees C. The run time was then set at 10 min. A linear relationship of R-2 0.998 was confirmed while drawing a graph between FVP concentration and peak area that has a concentration range of 40-200 ppm. The developed method is sensitive (limits of detection and quantification are 1.83 ppm and 5.75 ppm respectively). Three injections at concentrations of 80,100 and 120 (ppm) were injected the same day to ensure the precision of the method. The prepared solution remains stable for 24 h. The suggested method has been successfully useful for the quantification of FVP in pharmaceutical formulations.

Morphological and metabolic criteria of COVID-19 vaccine associated axillary nodes on 18FDG PET/CT in patients with breast cancer

Aim/Introduction: In the current era vaccine-associated lymphadenopathy (VAL) is not an uncommon presentation on 18F-FDG PET/CT examinations in patients inoculated with Coronavirus disease 2019 (COVID-19) vaccination. In this study, we are presenting data of VAL on 18F-FDG PET/CT regarding its prevalence, temporal response to vaccination and imaging characteristics of VAL. Material(s) and Method(s): Seventy-eight (78) consecutive vaccinated patients with biopsy proven breast cancer who had 18FDG PET/CT for staging or response evaluation were retrospectively analyzed. All patients had COVID-19 vaccine shots in contralateral arms and none in breast cancer site axilla (BSA). In 35 patients 18FDG avid nodes were found in vaccine site axilla (VSA). Morphological criteria on CT images like size, presence of fatty hila and fat stranding of axillary nodes were analyzed. Metabolic criteria on PET images like maximum standardized uptake value (SUVmax) of positive axillary nodes and liver as reference were also measured. Result(s): Out of 78 patients, 35 patients had positive nodes in vaccinated axilla (45% prevalence) and 25/78 had breast cancer axilla (33% prevalence). Mean duration of COVID-19 vaccination in each group was 8 +/-04 week (non-significant p-value). On CT images, 18FDG avid nodes in VSA were significantly smaller (10 +/- 03 mm) and with intact fatty hila without fat stranding than nodes in BSA with loss of fatty hila (25 +/-10 mm;p <0.0001). Mean SUVmax of nodes in VSA was significantly lower (2.4 +/-1.1) than nodes in BSA (10.2 +/-5.5 - p-value <0.0001). Nodes in VSA showed a significant positive linear correlation between size and SUVmax (p-value 0.00001). Similarly, nodes in VSA showed a significant negative linear correlation between duration and SUVmax (p-value 0.00003). In VSA group, 03 patients having SUVmax >2 SD of Hepatic SUVmax were subjected to ultrasound guided fine needle aspiration (FNA) and turned out to be metastatic in nature. Conclusion(s): In COVID-19 vaccinated patients with BC, enhanced 18FDG uptake on PET/CT by axillary nodes in VSA is quite common and may pose diagnostic dilemma. However, morphological (size < 10 mm, intact fatty hila without fat stranding) and metabolic criteria (SUVmax <2.4 with negative correlation with time of inoculation) have higher diagnostic accuracy in resolving the dilemma. Nodes in VSA having SUVmax > 2 SD of hepatic SUVmax should be considered for FNA to rule out possible metastasis.

The Percutaneous Tracheostomy in Head and Neck Oncology Surgery

Introduction/Aims: Enhanced experience in performing percutaneous dilatational tracheostomies (PDT) during the COVID-19 pandemic resulted in changes to airway management for patients undergoing head and neck reconstructive surgery at Queen Elizabeth Hospital Birmingham. All patients now receive a percutaneous tracheostomy over the previously favoured surgical tracheostomy (ST), unless contraindicated. This ambispective case series aimed to review experiences in performing percutaneous tracheostomies, whilst comparing complication rates with surgical tracheostomies performed in similar settings. In addition, we propose a selection criteria for identifying patients suitable for PDT. Material(s) and Method(s): All patients undergoing free flap reconstruction for head and neck cancer treatment between June 2020-November 2021 were included, with 56 patients receiving PDT. This was compared with data of 56 ST performed before the COVID-19 pandemic. Results/Statistics: In the percutaneous group, a marginally lower complication rate was observed over the surgical tracheostomy group;28.57% and 30.35% respectively. Although not statistically significant, time to decannulation was slightly lower in PDT group (5.8 days) compared to ST group (7.3 days). An additional observed advantage included quicker tracheostomy wound healing with PDT. Analysis of the 16 patients who experienced complications with PDT aided development of the selection criteria for identifying patients for percutaneous tracheostomy. This selection criteria considers BMI, ASA, bleeding risk and positioning deformities. Conclusions/Clinical Relevance: This study has demonstrated PDT to be an equally safe and successful technique with a similar complication rate to ST in head and neck cancer reconstruction surgery. Moving forward, further studies with larger sample sizes would be recommended to draw conclusions. Copyright © 2022

Evaluation of Outcome in Patients With Moderate and Severe COVID-19 Via H-Score

Background: Due to uncontrolled lymphocyte reaction, the overproduction of cytokines in COVID-19 patients can cause sepsis-like symptoms, suggesting sepsis, cytokine release syndrome (CRS), and secondary hemophagocytic lymphohistiocytosis (sHLH). Since different therapeutic approaches are used for each diagnosis, differentiation is essential. This study aims to use H-score as a possible prognostic tool in COVID-19 patients. Method(s): A sample of 64 moderate and severe COVID-19 patients was enrolled in this study. Clinical and laboratory findings were assessed. H-score was initially calculated and reevaluated among severe cases 72 hours later and among moderate cases showing severe features of COVID-19. Result(s): Mortality of 31.3% was reported. Laboratory findings, including triglycerides (TG), ferritin, and aspartate aminotransferase (AST) showed significantly higher initial and follow-up laboratory assessment levels in severe cases than in moderate cases. Moreover, fibrinogen was significantly higher among severe cases than moderate cases at the initial assessment, but no significant difference was reported in the second fibrinogen assessment. Conclusion(s): In this study, H-score was useful as a predictive tool for the initial evaluation of severe cases of COVID-19. H-score is much lower in these patients than in non-COVID-19 HLH patients may be due to the different underlying immunologic pathophysiology of COVID-19;thus, each H-score criterion must be evaluated for sensitivity and specificity in COVID-19 patients. The H-score cut-offs, H-score may be useful for diagnosing immune overreaction and determining the need for more exclusive immunomodulatory treatments. Copyright © 2022 Shahid Beheshti University of Medical Sciences. All rights reserved.

Acceptability of zinc biofortified wheat and flour among farmers in Pakistan: experiences from the BiZiFED2 project

In Pakistan, 24.3% of women of reproductive age and 19.5% of children aged under five living in rural areas are zinc deficient(1). Zinc-biofortified wheat flour may be an effective approach to address zinc deficiency in i communities where access to zinc-rich foods is low(2). Key to successful scaling up of biofortified wheat and flour is its acceptability and adoption among its potential consumers and producers(3). A convergent mixed methods study(4) was conducted parallel to the BiZiFED2 cluster- randomised controlled trial(5) in the Peshawar region between November 2020- July 2021. Two semi- structured focus group discussions (FGDs) were conducted with farmers who grew Zincol-2016 wheat for the RCT(5). FGDs were audio-recorded, transcribed, and translated into English. Transcripts were analysed using thematic analysis(6). In addition, a total of 686 farmers located in Pakistan's main wheat growing region, Punjab province, were invited to participate in a survey. These farmers were growing Zincol-2016 as part of a soil-mapping exercise within the broader BIZIFED programme. The survey was designed to capture the farmer's experiences of growing Zincol-2016 in the growing season 2019-2020 and whether they continued to grow it during the subsequent season.418 farmers participated in the survey (61% participation rate), and 12 in the FGDs. Survey data showed that 47% of participants reported growing Zincol-2016 in the subsequent season. Drivers of Zincol-2016 cultivation that were most frequently described as important were: availability of new seed (100%), grain yield (98%), growth and disease resistance (97%), quality of flour from the previous harvest (96.6%), and nutritional benefit (94.5%). Fewer farmers reported cost of the seed (71%) and market demand (57%) as important. A high proportion of farmers reported consuming Zincol-2016 within their own household (79%), and those who consumed Zincol-2016 flour claimed that it had better taste (90%) and texture (79%) than their usual flour. Qualitative analysis of the FGD data revealed that enablers for scaling up include: the value ascribed to the flour's health benefits, perceived improved quality of grain and production, and willingness to produce biofortified wheat if support is provided (i.e., resources and training). Challenges and considerations for scaling up include unfamiliarity with the biofortification process, production costs, external threats to the supply chain and production of wheat (i.e., COVID-19, weather, plant disease), and acceptance and support from the landlord. Results from this mixed-methods study suggest that farmers appeared to value biofortified wheat and flour and may be willing to produce and consume it if resources and training were provided.

HPLC Method Development and Quantification of Favipiravir in Both Bulk and Solution Form

Favipiravir (FVP) structurally is an analog of pyrazine and showed its antiviral actions against a diverse species of viruses. Due to this fact, it was chosen as a potential candidate to be further investigated to cure COVID-19. A simple, accurate, rapid, precise, high-performance liquid chromatography (HPLC) method has been established for quality control assurance of FVP in pharmaceutical preparations. Column no C8 (150 mm x 4.6 mm;5 mum) was used for such separation analysis. A combination of acetonitrile and phosphate buffer was used in 10:90 ratios as the mobile phase (90:10, v/v) having a flow rate of 1 mL / min. further, it was detected at 220 nm, and the temperature was maintained at 25 degreeC. The run time was then set at 10 min. A linear relationship of R2 0.998 was confirmed while drawing a graph between FVP concentration and peak area that has a concentration range of 40-200 ppm. The developed method is sensitive (limits of detection and quantification are 1.83 ppm and 5.75 ppm respectively). Three injections at concentrations of 80,100 and 120 (ppm) were injected the same day to ensure the precision of the method. The prepared solution remains stable for 24 h. The suggested method has been successfully useful for the quantification of FVP in pharmaceutical formulations. Copyright © 2022, Colegio de Farmaceuticos de la Provincia de Buenos Aires. All rights reserved.

Using neural topic models to track context shifts of words: a case study of COVID-related terms before and after the lockdown in April 2020

This paper explores lexical meaning changes in a new dataset, which includes tweets from before and after the COVID-related lockdown in April 2020. We use this dataset to evaluate traditional and more recent unsupervised approaches to lexical semantic change that make use of contextualized word representations based on the BERT neural language model to obtain representations of word usages. We argue that previous models that encode local representations of words cannot capture global context shifts such as the context shift of face masks since the pandemic outbreak. We experiment with neural topic models to track context shifts of words. We show that this approach can reveal textual associations of words that go beyond their lexical meaning representation. We discuss future work and how to proceed capturing the pragmatic aspect of meaning change as opposed to lexical semantic change.

Unsuspecting Adult Case of Rhinovirus Pleuropericarditis

Rhinoviridae are the most common cause of upper respiratory tract infections, especially in children, and often referred to as “the common cold”. Symptoms are usually mild, nasopharyngeal in nature;they have, however, been implicated in cases of infantile viral pericarditis. Its role in the presentation of adult viral pericarditis remains unclear. We present the case of a 45-year-old male with a past medical history of pre-diabetes, hyperlipidemia and hypertension with complaints of severe left-sided chest pain that worsened with movement and coughing but improved when lying supine. Two weeks prior to presentation, he had developed an intermittent cough, treated with antibiotics and steroids. On presentation to the ED, the patient was afebrile but hypotensive to 80/52 mmHg, tachycardic to 116 BPM, hypoxic to 88% on room air, improving to 91% with 3L nasal cannula. Physical examination was notable for wheezing and egophony. Laboratory findings were concerning for WBC 19.97x10-3/uL, Hgb 13.4 g/dL, CRP 176 mg/L, Ferritin 772 ug/L, D-dimer 3.70 ug/mL FEU;procalcitonin 0.2 ng/mL and troponin <0.015 ng/mL. Respiratory viral panel revealed negative COVID-19 test but positive for rhinovirus/enterovirus. Electrocardiogram showed sinus tachycardia. Chest computed tomography demonstrated moderate pericardial effusion, ground glass attenuation of the lungs bilaterally with moderate left pleural effusion and reflux of contrast into the hepatic veins, suggestive of right heart failure. Echocardiogram demonstrated small to moderate pericardial effusion. The patient was admitted with the diagnosis of acute rhino/enteroviral-associated pleuropericarditis. Broad-spectrum antibiotics, prednisone, colchicine and indomethacin were commenced. Upon clinical stabilization of his condition, steroids were discontinued and he was discharged home with close follow-up. While rhinovirus has been associated with infantile viral pericarditis, it is implicated in pneumonia and COPD exacerbations in adults but rarely reported as a cause of adult pericarditis. A case-control study of adults diagnosed with acute idiopathic pericarditis had an independent association with an upper respiratory tract infection or gastroenteritis in the month preceding pericarditis diagnosis but did not delineate causative viruses. Therefore in cases of unknown causes of viral pericarditis, thorough history is vital. Steroids as part of the treatment algorithm for pleuropericarditis management has long been debated. Older literature has not favored the use of steroids due to high recurrence rate. However, Perrone et al refuted this point, noting that low-dose steroids with gradual tapers have equal efficacy and recurrence rates as compared with NSAIDs/colchicine. Therefore, steroids may be a reasonable option for patients with contraindications to NSAIDs/colchicine.

Frequency and Pattern of Myths and Misconception regarding Covid- 19 Vaccine in General Population

Objective: To determine the frequency and pattern of myths and misconceptions regarding COVID-19 vaccine in the general population at Isra University Hospital Hyderabad Material and Methods: This cross-sectional survey base study was conducted at the Isra University Hospital Hyderabad, during a period of six months from August 2021 to January 2022. All the patients who visited the OPD and their attendants of any age or gender, were included. All the subjects were properly counseled that their privacy was fully secured and their name and contact numbers were taken. After obtaining sociodemographic information, the participants were interviewed regarding COVID-19 infection in the past, previous vaccination history for diseases other than COVID-19, conceptions, and myths regarding COVID-19 vaccination, acceptance of COVID-19 vaccination, reasons to vaccinate for COVID-19, and reasons not to vaccinate for COVID-19. All the information was gathered via study proforma including questioner and SPSS version 26 was used for the purpose of data analysis. Results: A total of 145 individuals of either gender were studied regarding myths and misconceptions of COVID-19 vaccine, their average age was 27.71+9.86 years and females were in majority 62.1%. Among the study population, doctors, private employee and housewives were the most common as 44.1%, 11%, 11.7% and 9% respectively. Most of the cases 62.1% were unmarried. According to the myths and misconceptions, 8.3% said it can affect fertility, 23.4% had no trust on its effectiveness and safety, 14.5% said it is an artificial infection procedure, 11% were afraid from its dangerous side effects, 3.4% said the vaccine will change their DNA, 13.8% said it is a controversial substance and 6.9% afraid that they will die within 2 years. 24.1% cases heard myths from family, 24.8% heard from friends and 51% heard by social media. 17.2% had idea that it is an international conspiracy and 4.8% said this may cause sexual dysfunction and 4.8% said it is a procedure of implanting microchip to control them. Conclusion: There were several misconceptions in the general population, most myths like effects of male fertility, distrust on vaccine efficacy, they will be infected artificially, fear of dangerous side effects, controversial substances were observed to be the commonest myths and misconceptions regarding the COVID-19 vaccine in the general population. Above ideas were adopted mostly by the friends and social media.

Evaluation of outcome of Coronavirus disease 2019 patients receiving RAAS inhibitors (OCRAS study): A prospective observational study of Bangladeshi hypertensive patients

Background: The fact that SAARS-Cov2 virus enters cells through ACE2 receptors and the Renin-Angiotensin-Aldosterone System Inhibitors (RAASi) upregulate the ACE2 receptors, there was speculation that use of RAASi may lead increased cellular entry of the virus. There was a pause for a brief period of the use of RAASi in COVID 19 patients. But clinically the speculation has been found to be incorrect. Different professional societies come up with the assertion to continue to use RAASi. As the hesitancy among the clinicians appears to continue and there is no first hand data regarding the safety of the use of RAASi in Bangladeshi population, the study was undertaken to evaluate the safety of RAASi in COVID 19 patients. Aims & Methods This study was a prospective, observational multi-center study to evaluate the outcome of COVID-19 patients receiving RAAS inhibitors. Adult Hypertensive patients (age ≥18 years) with diagnosed COVID-19 confirmed by RT-PCR test who have a history of taking either ACE inhibitor/ARB or any other anti-hypertensive medication. Evaluation of outcome was assessed by rate of hospitalization, requirement of oxygen therapy, requirement of high flow nasal cannula, admission to ICU and mortality between two groups. All statistical analyses were performed using SPSS for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA). Results: We collected data from 147 Covid-19 positive patients confirmed by RT-PCR. Among them, 117 (79.6%) had a history of taking RAAS inhibitor and 30 had history of taking other antihypertensive medications. Of them, two-third patients had more than 50 years of age and more than half of the patients had overweight or obesity. Other than hypertension they had several comorbidities such as Diabetes Mellitus (45.4%), Ischemic Heart Diseases (35.4%), Asthma or COPD (15%) etc. Rate of hospitalization had no statistical difference between RAAS inhibitor group and other hypertensive group (48.7% vs 46.70% respectively;p-value-0.841). There was no statistical difference between two groups in terms of requirement of oxygen therapy (p-value-0.297), High Flow Nasal Cannula (p-value-0.430), intensive care unit (p-value-0.194) and death (p-value-0.383) also. Almost half and one-third of the patients had persistence of symptoms even after 14 days and 28 days respectively. Fatigue, cough, breathlessness, loss of appetite and taste were the most common symptoms among those. Conclusion: In our study we found that RAAS inhibitor treatment had no adverse effect on the outcome of COVID-19 patients compared with other antihypertensive drugs. Patients may continue receiving ACEIs and ARBs for the treatment of any indication for RAASi without an increased risk of worse outcomes.

The role of perceived workplace safety practices and mindfulness in maintaining calm in employees during times of crisis

While prior studies in human resource management have investigated how employee outcomes have been affected in high-risk workplaces, this study stands out by examining this issue through the role played by COVID-19 as a specific stressor. We explained how employees' perceived health risks due to COVID-19 (CV19PHR) and perceived workplace safety practices (PWSPs) affected job performance via burnout and how PWSPs moderated the CV19PHR-burnout and CV19PHR-JP relationships. We also examined how mindfulness moderated the direct effects of CV19PHR and PWSPs on burnout and JP and the indirect effects of CV19PHR and PWSPs on JP via burnout. We performed three studies using an explanatory sequential mixed-method design. In study 1, a three-phase survey with 987 respondents was conducted to test the hypotheses. In study 2, by analyzing verbatim from 22 informants, the findings of study 1 and some main points concerning mindfulness and PWSPs were explained. In study 3, using data from 12 informants, we investigated how COVID-19 affected individuals differently compared with other high-risk workplaces and whether the impact of COVID-19 on individuals was curvilinear. We demonstrated that employees' CV19PHR was positively correlated with burnout, negatively influencing JP. Moreover, PWSPs reduced burnout, which adversely affected JP. Interestingly, PWSPs positively moderated the CV19PHR-burnout relationship but not the CV19PHR-JP relationship. We also found that mindfulness moderated the CV19PHR-burnout and PWSPs-burnout relationships. Furthermore, mindfulness significantly moderated the mediating effects of burnout on the CV19PHR-JP and PWSPs-JP relationships.

A Convolutional Neural Network Model for Screening COVID-19 Patients Based on CT Scan Images

The novel coronavirus (COVID-19) spread all over the world within a few months and turned into a pandemic. Early diagnosis is the only way to combat this pandemic by isolating the affected cases from healthy ones for refraining it from further spreading. At present, RT-PCR is extensively used for screening coronavirus cases, however, WHO stated that it suffers from low sensitivity and low specificity in the early-stage patients. Recent studies advise that the CT scan image embraces key features for detecting this disease. The application of deep learning approaches combined with CT images could be useful for the precise diagnosis of positive coronavirus patients. In this research, we have employed the Convolutional Neural Network (CNN) architecture of deep learning on publicly accessible CT images dataset to build a prediction model for classifying positive COVID-19 from other pulmonary diseases and healthy patients. Moreover, this prediction model has also been utilized for identifying COVID-19 cases from other pulmonary diseases, which is a binary classification. In ternary classification, our proposed CNN model has obtained an accuracy of 98.79%, a precision of 94.98%, a sensitivity of 98.85%. In contrast, for binary classification, it has acquired an accuracy of 98.79%, a precision of 94.98%, a sensitivity of 98.85%. Therefore, this proposed model can be a faster and alternative tool or even a supportive tool along with RT-PCR in rural areas of many countries where there is a scarcity of testing kits and expert physicians. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Acute acalculous cholecystitis: An unusual first manifestation of COVID-19

Introduction: COVID-19 pandemic has become a major global health challenge, with more than 178 million confirmed cases and over 3.86 million deaths to date. While general and respiratory symptoms are common, it may have atypical GI involvement. We chronicle here an extremely rare case of acute acalculous cholecystitis (AAC) in a patient with COVID-19. Case Description/Methods: A previously healthy 35-year-old male presented to the emergency room with abdominal pain and non-biliary vomiting. He was nonsmoker, nonalcoholic, and drugfree. His vitals revealed: temperature 37.1°C, heart rate 82 bpm, blood pressure 114/72 mm Hg, respiratory rate 16/minute, and an oxygen saturation of 99% in room air. Physical examination revealed a positive Murphy's sign. Laboratory parameters revealed leukocytosis and high CRP level. Abdominal ultrasound showed marked gallbladder wall thickening, normal CBD, with no cholelithiasis or sludge formation. EUS also ruled out stones in the gallbladder. Therein, coronavirus rRTPCR came back positive. CT chest revealed bilateral patchy peripheral ground-glass opacities in the lungs, consistent with COVID-19. Based on these findings and exclusion of probable causes of AAC, COVID-19-related AAC was diagnosed. The patient was initiated on standard COVID-19 treatment for the mild disease and conservative treatment for AAC. His hospital course remained unremarkable, except for fever and dyspnea on day 4 of admission. He remained hemodynamically stable. On day 7 of admission, his abdominal pain, vomiting, and fever disappeared with treatment. On day 9 of admission, he was afebrile, dyspnea had resolved, and had no abdominal pain. He was then discharged home in a stable condition. He continues to do well for 2 months now. Discussion: Published medical literature is bereft of reports on the association between AAC and COVID-19. A PubMed search was conducted for all case reports of AAC amidst COVID-19 till June 2021. Search terms included ''acalculus cholecystitis'' and ''COVID-19''. The search resulted in only 4 case reports to date. This case highlights that the GI symptoms may precede the pulmonary manifestations of COVID-19. It further provides the clinical evidence behind a causal relationship between SARS-CoV-2 infection and biliary involvement. The extrapulmonary symptomology of this infection has not been extensively studied, warranting a high index of suspicion for rare manifestations like AAC. Thus, new-onset GI symptoms may indicate COVID-19, requiring prompt testing for SARSCoV- 2.

SPONTANEOUS PNEUMOMEDIASTINUM SECONDARY TO COVID-19 INFECTION

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: SARS-CoV-2 (COVID-19) is a rapidly spreading virus that has resulted in a pandemic. Individuals impacted have varying symptoms and disease courses, ranging from asymptomatic carriers to severe respiratory illness. Pneumomediastinum, a rare complication of COVID-19 (where air is present in the mediastinum with or without pneumothorax) is presented here. CASE PRESENTATION: Our case is that of a 59-year-old man who presented to the emergency department with complaints of fever and chills for five days. His past medical history included hypertension, type 2 diabetes mellitus and hyperlipidemia. He endorsed associated dry cough, decreased appetite and shortness of breath. He denied recent travel or exposure to COVID-19. Initially the patient was hemodynamically stable, but hypoxic with oxygen saturation of 82%, requiring 4L nasal cannula (NC) – with improvement to 93-95%. Chest imaging revealed low lung volumes and patchy bilateral opacities. COVID-19 PCR was positive. He was admitted to the medical floor with acute COVID-19 pneumonia. He was treated with dexamethasone and remdesivir, and was encouraged to self-prone. Due to worsening hypoxia, he required a non-rebreather mask. Daily chest x rays were obtained, and on hospital day seven, imaging revealed air around the neck, suggesting pneumomediastinum without pneumothorax. CT chest and neck showed significant air dissecting up from the superior mediastinum, extending through the neck soft tissues bilaterally, confirming acute pneumomediastinum. With further pulmonary decompensation and respiratory failure, he required intubation and mechanical ventilation. A low PEEP strategy was employed to prevent worsening pneumomediastinum. In the subsequent week, although his pneumomediastinum resolved, the patient unfortunately developed ARDS and passed away. DISCUSSION: This presentation of acute pneumomediastinum in the setting of COVID-19 is an uncommon complication of the viral illness. Diffuse alveolar damage and/or complication of mechanical ventilation have been speculated to be possible causes. Pneumomediastinum is typically a benign diagnosis, but can sometimes progress to malignant mediastinum, where air compresses the trachea or venous return, which can in turn present as cardiac tamponade. In these cases, chest tube, VATS or thoracotomy may be indicated.1 CONCLUSIONS: Cases of pneumomediastinum in patients infected with COVID-19 are limited, hence its impact on worsening illness or outcome cannot be determined. Recommendations continue to focus on close monitoring with daily chest imaging. Should intubation be required, it is recommended to maintain a needle at bedside for needle thoracostomy in the event acute pneumothorax occurs.2 A low tidal volume, low PEEP strategy is also encouraged to mitigate risk of further barotrauma.3 Early paralysis may be beneficial to prevent coughing or ventilator dyssynchrony. REFERENCE #1: Kouritas VK, Papagiannopoulos K, Lazaridis G, et al. Pneumomediastinum. J Thorac Dis. 2015;7(Suppl 1):S44-S49. doi:10.3978/j.issn.2072-1439.2015.01.11 REFERENCE #2: Mousa S, Edriss H. Pneumomediastinum secondary to invasive and non-invasive mechanical ventilation. The Southwest Respiratory and Critical Care Chronicles. 2019;7(27), 36-42. https://doi.org/10.12746/swrccc.v7i27.524 REFERENCE #3: Wali A, Rizzo V, Bille A, Routledge T, Chambers A. Pneumomediastinum following intubation in COVID-19 patients: a case series. Anaesthesia. 2020;75: 1076-1081. https://doi.org/10.1111/anae.15113 DISCLOSURES: No relevant relationships by James McGee, source=Web Response No relevant relationships by Cilian White, source=Web Response No relevant relationships by Momina Zaman, source=Web Response