Detection of Antibodies for COVID-19 from Reflectance Spectrum Using Supervised Machine Learning

Since the coronavirus disease 2019 occurred, the lateral flow immunoassay (LFIA) test strip has become a global testing tool for convenience and low cost. However, some studies have shown that LFIA strips perform poorly compared to other professional testing methods. This paper proposes a new method to improve the accuracy of LFIA strips using spectral signals. A spectrochip module is applied to disperse the reflected light from the LFIA strips. The obtained spectral signals will be used for supervised machine learning. After training, the trained model has 93.8% accuracy compared to the standard test. This result indicated that the evaluation method based on the spectrum of LFIA strips could enhance the detection performance. © 2022 IEEE.

PATIENT and LEARNER EXPERIENCE in A NEW SET UP of A RHEUM-DERM COMBINED CARE MODEL for PSORIATIC ARTHRITIS

Background: Psoriasis (PsO) and musculoskeletal manifestations are common among patients with psoriatic arthritis (PsA). A shared-care model between rheu-matologists and dermatologists has been advocated to promote early diagnosis and improve management care. Data from Asia is scanty. Patients' and learners' experience of shared-care models are seldom explored. Objectives: We described the set-up of a new shared-cared PsA-PsO clinic incorporating service, education and research between rheumatologist and dermatologist for PsA. We describe the patients' and learners' experience of this shared-care model. Methods: A combined care clinic was newly set up in 2019. Referrals were Internal through either specialty. Each patient was frst seen by a trainee, followed by both a dermatologist and rheumatologist simultaneously in the same consultation room. We collected patients' and learners' experience through self-administered survey. Results: From May 2019 to January 2020, data from 44 visits (55% new referrals, 45% follow-up) from 28 patients were captured in the PsA-PsO clinic. 50% of cases were referred from either specialty. 34% were referred for diagnostic doubts, 66% were for therapeutic issues. 61% of patients continued follow-up in the PsA-PsO clinic, and 39% discharged back to respective care. From patients' experience rated on scale from 0-10, median (interquartile range, IQR) rating of the care was 8 (7, 8). 69.2% and 96% of patients would recommend the care to others. Free text comments included enhanced convenience, time saving, and having both specialties input on management. From 20 learners (3 medial students, 12 residents, 4 senior residents and one scientist), 95% reported extremely or very benefcial to training, 77.8% reported improved confdence in care for PsA and/or PsO patients. The PsA-PsO clinic was temporally suspended during the Covid-19 viral pandemic since February 2020 due to lack of manpower and not fulflling the spacing out requirement for infectious control. The service was resumed gradually from May 2021. Conclusion: Despite challenges, we report the setup of a new care model between dermatologists and rheumatologists for care of patients with psoriatic disease. The care model was well received by patients. Learners from various levels reported beneft from the learning experience.

A Novel Ogremorphin Group of First-in-Class GPR68 Inhibitors Upregulate Endothelial Barrier Function and Rescue Bacterial Pathogens or Acidosis-Induced Inflammation in Lung Endothelium

Rationale: An increase in endothelial permeability resulting from the disruption of endothelial barrier and aggravated inflammatory responses are two major pathological hallmarks of various lung disorders including the current global pandemic COVID-19. Drugs that enable the preservation and restoration of endothelial function represent attractive therapeutic targets to treat endothelial dysfunction-derived cardiopulmonary diseases. A role of G protein-coupled receptors (GPCRs), especially a sub-family of proton-sensing GPCRs including GPR4 and GPR68, has been suggested in modulation of endothelial function. In this study, we analyzed the barrier protective and anti-inflammatory effects of two recently developed novel class of GPR68 inhibitors: ogremorphins OGM8345 and OGM-1.Methods: Transendothelial electrical resistance (TER) was monitored in human pulmonary arterial endothelial cells (HPAECs) to evaluate endothelial barrier function. Quantitative real time PCR and western blot analyses were performed to determine mRNA and protein expression of endothelial inflammation markers, respectively. Acidic pH (6.5) medium was used to induce acidosis, and luciferase-based Tango assay was employed to evaluate GPR68 activation. C57BL/6 mice were exposed to lipopolysaccharide (LPS from Escherichia coli) or heatkilled Staphylococcus aureus (HKSA), and vascular leak/inflammation was assessed by determining the extravasation of intravenously injected Evans blue tracer into lungs and total cells/protein count in bronchoalveolar lavage samples. Results: A robust dose-dependent increase in basal EC barrier function was observed with OGM8345 (1-5 μM) and OGM-1 (0.3-1.5 μM) evident by an 150-200% increase in TER values. Both inhibitors also effectively rescued LPS- and HKSA-induced EC hyperpermeability. RT-PCR analysis demonstrated that LPS or HKSA-induced upregulation of inflammatory cytokines/chemokines genes TNF-α, ICAM-1, VCAM-1, IL-6, IL-8, IL- 1β, and CXCL5 was significantly attenuated by OGMs. Consistently, both OGMs suppressed LPSand HKSA-induced protein expression of VCAM-1 and ICAM-1. In contrast, pharmacologic inhibition of GPR4 by NE 52-QQ57 failed to alleviate LPS or HKSA-induced EC barrier dysfunction and inflammation. Importantly, LPS, HKSA or acidosis stimulation resulted in increased GPR68 mRNA expression and GPR68 activity that was inhibited by OGMs. Intratracheal injection of LPS or HKSA in C57BL/6 mice caused vascular leak and lung inflammation that was attenuated by both OGMs as illustrated by reduced Evans blue accumulation in the lungs and significant inhibition of accumulation of inflammatory cells and protein content in bronchoalveolar lavage samples. Conclusion: These results establish a critical role of GPR68 in endothelial dysfunction and strongly suggest a therapeutic potential of GPR68-selective inhibitors in improving endothelial dysfunction caused by bacterial infections and acidosis associated with acute and chronic lung injury.

Global patterns of daily CO2 emissions reductions in the first year of COVID-19

Observed daily changes in CO2 emissions from across the globe reveal the sectors and countries where pandemic-related emissions declines were most pronounced in 2020. Day-to-day changes in CO2 emissions from human activities, in particular fossil-fuel combustion and cement production, reflect a complex balance of influences from seasonality, working days, weather and, most recently, the COVID-19 pandemic. Here, we provide a daily CO2 emissions dataset for the whole year of 2020, calculated from inventory and near-real-time activity data. We find a global reduction of 6.3% (2,232 MtCO(2)) in CO2 emissions compared with 2019. The drop in daily emissions during the first part of the year resulted from reduced global economic activity due to the pandemic lockdowns, including a large decrease in emissions from the transportation sector. However, daily CO2 emissions gradually recovered towards 2019 levels from late April with the partial reopening of economic activity. Subsequent waves of lockdowns in late 2020 continued to cause smaller CO2 reductions, primarily in western countries. The extraordinary fall in emissions during 2020 is similar in magnitude to the sustained annual emissions reductions necessary to limit global warming at 1.5 degrees C. This underscores the magnitude and speed at which the energy transition needs to advance.

Clinical course and outcomes of COVID-19 patients with hypertension

Background: Coronavirus disease 2019 (COVID-19) is now still an emerging, evolving pandemic, causing more than 64 million people infected. Hypertension, a common cardiovascular condition, has been reported as a risk factor for higher mortality. In order to a better management, it is necessary to know the clinical course and identify the factors associated with clinical outcomes in COVID-19 patients with hypertension.Methods and results: A total of 148 COVID-19 cases who had pre-existing hypertension with clarified outcomes (discharge or deceased) were included in this study. Medical history, clinical manifestation, epidemiological, and laboratory data were analyzed. 45 (30.4%) patients had died during hospitalization, multivariate COX regression analysis revealed some predicted factors at admission for in-hospital death including elevated level of hs-cTn (HR: 3.98, 95% CI:1.95-8.16) and IL-6 (HR: 3.31, 95% CI: 1.42-7.72). Patients with uncontrolled blood pressure (BP) (n = 52) which were defined as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg for more than once (≥ 2 times) during hospitalization, were more likely to have ICU admission (P=0.037), invasive mechanical ventilation(P=0.028), and renal injury(P=0.005). With a stricter criterion which was defined as systolic BP ≥ 130 mmHg or diastolic BP ≥ 80 mmHg for more than once (≥ 2 times) during hospitalization, 105 (70.9%) patients with uncontrolled BP had higher mortality rate (P=0.046). In our study, there were 35 (23.6%) patients taking renin-angiotensin-aldosterone system (RAAS) suppressor including angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB) and spironolactone. Patients with these RAAS suppressors treatment were less likely to be admitted to ICU (P = 0.048). And treatment with RAAS suppressors didn't have an obvious influence in mortality.Conclusion: Among COVID-19 patients with hypertension, elevated hs-cTn and IL-6 at admission were associated with higher mortality, suggesting that they could possibly be used as predictors for fatal outcomes. Blood pressure control with a stricter criterion of less than 130/80mmHg during hospitalization is associated with better prognosis. And treatment with RAAS suppressors didn't not contribute to a higher mortality.

Percutaneous dilational tracheostomy during the COVID-19 pandemic in New York City

INTRODUCTION: The COVID-19 pandemic overwhelmed New York City hospitals. Shortages of ventilators and sedatives prompted tracheostomy earlier than recommended by professional societies. The objective of this study was to determine the impact of percutaneous dilational tracheostomy (PDT) in COVID-19 patients on critical care capacity. METHODS: This is a single-institution prospective case series of SARS-CoV-2 infected patients undergoing PDT from April 1-June 4, 2020 with follow-up through June 25, 2020 at a public tertiary care center. Clinical data were obtained through medical record review. Mechanically ventilated COVID-19 patients were screened for intervention based on the following criteria: ≥ 6 days of intubation with further need for mechanical ventilation, a fractional inspired oxygen concentration of ≤ 60%, positive end expiratory pressure ≤12, no significant organ dysfunction except acute kidney injury, and minimal pressor requirements. The main outcomes measured were change in 48-hour periprocedural sedative/analgesia requirements, liberation from the ventilator, rate of transfer from the ICU, decannulation, PDT-related complications, and in-hospital survival. RESULTS: Fifty-five patients met PDT criteria and underwent PDT a median of 13 days from intubation. Patient characteristics are found in Table 1. Intravenous midazolam equivalents, fentanyl equivalents and cisatracurium equivalents were significantly reduced post- PDT (Table 2). Thirty-five patients were transferred from the ICU and liberated from the ventilator. Median time from PDT to ventilator liberation and ICU discharge was 10 and 12 days respectively. Decannulation occurred in 45.5% and 52.7% were discharged from acute inpatient care. Median follow-up for the study was 62 days. Four patients had bleeding complications postoperatively and 11 died during the study period. Older age was associated with increased odds of complication (OR 1.12, 95% CI 1.04, 1.23) and death (OR=1.15, 95% CI 1.05, 1.30). CONCLUSIONS: Mechanically ventilated COVID-19 patients undergoing PDT using standard criteria improves ventilator and medication utilization in areas strained by the SARS-CoV-2 pandemic. Long term outcomes after PDT in this population deserve further study.

Position statement for a pragmatic approach to immunotherapeutics in patients with inflammatory skin diseases during the coronavirus disease 2019 pandemic and beyond.

Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2, a novel RNA virus that was declared a global pandemic on 11 March 2020. The efficiency of infection with SARS-CoV-2 is reflected by its rapid global spread. The SARS-CoV-2 pandemic has implications for patients with inflammatory skin diseases on systemic immunotherapy who may be at increased risk of infection or more severe infection. This position paper is a focused examination of current evidence considering the mechanisms of action of immunotherapeutic drugs in relation to immune response to SARS-CoV-2. We aim to provide practical guidance for dermatologists managing patients with inflammatory skin conditions on systemic therapies during the current pandemic and beyond. Considering the limited and rapidly evolving evidence, mechanisms of action of therapies, and current knowledge of SARS-CoV-2 infection, we propose that systemic immunotherapy can be continued, with special considerations for at risk patients or those presenting with symptoms.

The Decrease in Hospitalizations For Heart Failure During the Covid-19 Pandemic: A Community and Academic Hospital Comparison Study

Introduction: During the novel coronavirus (COVID-19) pandemic, the incidence of cardiovascular hospitalizations has been observed to decrease. The patient behavior, clinician behavior and pathophysiological contributors are currently unclear. We sought to determine if the pattern of heart failure (HF) hospitalizations was the same between 1 Academic Hospital with Advanced HF and Transplant services and 2 Community Hospitals, within a single health system in Massachusetts (MA). Methods: The 3 hospitals, Academic/Advanced HF Hospital A, Community Hospital B and Community Hospital C, are all located within 30-mile radius and share many clinical protocols, although HF hospitalizations at Academic/Advanced HF Hospital A include advanced HF therapy referrals and patients listed for heart transplantation. We retrospectively reviewed the weekly adult hospitalizations for HF, defined as patients ≥18 years discharged with a principal diagnosis of HF per ICD-10 coding (I110, I130, I132, I50 subsets) across the 3 hospitals, between January 1 and April 26 in 2019 and 2020. The weekly hospitalization volumes for 2019 and 2020 were displayed as a bar graph, alongside the total MA COVID-19 diagnosis and key dates in the pandemic response, for each hospital. Results: The volume of weekly hospitalizations for HF in March and April 2020 were lower at all 3 hospitals, as compared to 2019 (Figure 1). At Academic/Advanced HF Hospital A, the reduction in weekly HF hospitalizations began in mid-February, prior to the MA ‘state of emergency’ declaration effective March 11 and the ‘stay at home’ order effective March 24, 2020. Conversely, at Community Hospitals B and C the reduction in hospitalizations for HF (compared to 2019) occurred closer to the ‘stay at home’ order. The date on which each hospital formally ramped down non-urgent outpatient visits and procedures occurred first for Academic/Advanced HF Hospital A, but HF hospitalization volume reduction still appeared to precede this announcement. Conclusion: The decrease in hospitalizations for HF during the COVID-19 pandemic began in an Academic/Advanced HF Hospital before the MA ‘state of emergency’ and ‘stay at home’ orders, but around the time of the ‘state of emergency’ order in 2 affiliated Community Hospitals. This observation suggests that the factors driving HF volume during a pandemic may differ across patient populations and hospitals, even within the same region.