Post-Lockdown Behaviors and Impacts of Avoiding COVID-19 in Individuals and Caregivers of Individuals at High-Risk of Severe COVID-19: A Qualitative Study

Objectives: Several populations are at greater risk of severe COVID-19 due to inadequate responses to COVID-19 vaccines. Many of these individuals, and their caregivers, continue practicing varying degrees of social isolation to avoid SARS-CoV-2 infection. Following the end of lockdowns, the behaviors and impacts of continued isolation on the quality-of-life of high-risk populations remain poorly understood. This study describes the main avoidance and protective behaviors and ongoing impacts experienced by adults and caregivers of adults at high-risk of severe COVID-19. Method(s): Four virtual focus groups (April-July 2022) were conducted with individuals at high-risk of severe COVID-19, or caregivers, recruited via a convenience sample from patient panels. A discussion guide of open-ended questions was prepared based on COVID-19 guidance documents and a literature review. For qualitative analyses, an inductive approach was used for behaviors, deductive for impacts. A pre-defined codebook was updated throughout as needed. Salient concepts were defined as those mentioned by >=30% of participants or in every focus-group session. Result(s): Fourteen participants were interviewed (12 patients, 2 caregivers). Participants highlighted continued behaviors greatly impacting their quality-of-life. Avoidance behaviors (staying home, avoiding bystanders, avoiding shopping facilities and gatherings, using delivery services, family protection [43%-64%]) and protective behaviors (masking [79%], vaccination [57%]) were reported. Negative impacts included family relationship impacts (71%), collapse of social relationships (57%), difficulties accessing healthcare (43%), anxiety, fear, loneliness and depression (36%-50%), and impacts on employment/finances (36%). Positive impacts included the advent of telehealth (57%) and recognizing family importance (36%). Lack of trust in authority (57%) and hoarding of medications (36%) were negative general impacts of the COVID-19 pandemic highlighted. Concepts reported by patients and caregivers were similar. Conclusion(s): Individuals at high-risk of severe COVID-19 and their caregivers maintained avoidance and protective behaviors similar to those reported during lockdowns. This study highlights the continued burden experienced by high-risk populations.Copyright © 2023

The show must go on(line): Livestreamed concerts and the hyper-ritualisation of genre conventions

This paper examines audience engagement at livestreamed concerts, a form of mediatised cultural consumption that saw an immense growth in popularity during the COVID-19 pandemic. Concerts, as events that draw large groups of people with similar intentions, are the perfect location for the establishment of large-scale interaction rituals – moments of group behaviour characterised by a highly intense collective emotion. Furthermore, as social occasions, concerts are organised around a set of routine interactions that construct and define the collective experience. We argue that in moving online, the definition of the (concert) situation is highly impaired due to a context collapse. In comparing two distinct audiences (classical and Dutch popular music), the first aim of this research is to explore how these differing audiences adapt their cultural behaviour to the virtual sphere. Secondly, by adopting a microsociological perspective, we aim to broaden the theoretical understanding of virtual large-scale interaction rituals, an area becoming increasingly important due to the growth in online communication. This paper uses discourse analysis of the synchronised comments, left on livestreamed concerts on Facebook Live (n = 2,075), to examine the interaction between audience members. We find that both classical and Dutch popular music audiences use a form of hyper-ritualised interaction. In an attempt to combat the plurality of meanings online, they explicitly refer back to the central conventions of the face-to-face concert. This emphasises not only the significance of genre conventions, but also presents a form of virtual interaction distinct form interpersonal interaction.

ECMO in COVID–ARDS

Acute respiratory distress syndrome (ARDS) is a complex pathologic manifesto of acute lung injury that causes noncardiogenic pulmonary edema in different clinical presentations and increases the mortality rate up to 40%. The main physiologic changes are alveolar collapse/de-recruitment, decreased lung compliance, higher pulmonary vascular resistance, and gas-exchange disturbance, which may be combined with the patient's own respiratory response or assisted ventilatory support due to regional heterogeneity of the underlying lung injury. Since the main clinical features of COVID-19 (coronavirus disease 2019) pneumonia are hypoxemia and dyspnea, noninvasive oxygen therapy or mechanical ventilation remains the cornerstone of managing more severe cases. The aim of this chapter is to summarize the current state of knowledge on the worst pulmonary manifestation of the long COVID-19 syndrome, namely, COVID–ARDS, including parenchymal and functional abnormalities, follow-up strategies for early identification, and timely therapeutic interventions including veno-venous extracorporeal membrane oxygenation (vv-ECMO) management. Although only a limited proportion of COVID-19 patients develop severe respiratory failure refractory to advanced conventional treatments, it is of utmost importance to clearly define criteria for the use of vv-ECMO in this steadily growing patient population. The use of vv-ECMO in COVID–ARDS is a rescue treatment, if mechanical ventilation cannot guarantee appropriate gas exchange anymore, resulting in life-threatening or organ-damaging hypoxia and/or hypercapnia, whereas the vv-ECMO treatment modality still has a high all mortality rate in COVID–ARDS (> 50%). © 2023 Elsevier Inc. All rights reserved.

Significantly higher death toll along with COVID-19 mortality than influenza have been reduced by vaccination and restrictions.

The article demonstrates estimated data of influenza and COVID-19 morbidity and infection fatality rate (IFR) mortality in the context of restrictions and vaccination (years 2020-2021 mostly developed countries). A division into two age groups was included: Up to 65 years of age and over 65 years of age. Influenza mortality (IFR) did not change between 2020 and 2021 and was about 0.05% among all, and 0.005 among those under 65 years of age. IFR COVID-19 was on average approx. 0.5% overall, and in groups under 65 years of age a minimum of 0.07%. COVID-19 morbidity varied greatly from about 50/100,000 in Japan to 600/100,000 in Peru during 2020 plus 2021. In the United States and Poland, about 250 per 100 thousand in 2 years. The morbidity rate of COVID-19 in lower risk groups was 70/100 thousand in the United States. The pre-2020 flu morbidity rate in the United States ranged from 1-10 per 100,000 per season. In the 2020/21 season, it decreased to 1/100 thousand. In groups 65 age old and younger, influenza morbidity in the United States was about 0.3 per 100,000 in the 2020/2021 season, and in typical seasons 0.3 to 3/100,000. Examples of absolute numbers. In the United States, in 2021, COVID-19 471,000 victims (a year of available vaccinations). Influenza season 2021 max. 4,500 victims. The average flu season in unrestricted seasons, was about 25,000 victims. Predictions of the consequenc-es of the lack of restrictions and vaccinations are theoretical, because the preliminary ones talk about 2-3 million COVID-19 victims and even more than ten million additional hospitalizations in the United States, which may mean the collapse of the health system, and thus in practice a greater number of victims. The data presented did not result from diagnostic errors. A proper epidemic assessment confirms the effectiveness of vaccination and targeted therapy. COVID-19 vaccination reduced IFR mortality by about 10-fold.Copyright © 2023, Termedia Publishing House Ltd.. All rights reserved.

Diagnosis of Nasal Breathing Using a Rhinomanometer in Patients with Osa Prescribed Conservative Treatment with Intraoral Devices

In recent years, diagnostics in the field of medicine has developed at an extremely rapid pace, thanks to the use and improvement of new medical devices and devices. The problem of timely and adequate diagnosis and treatment of the syndrome of obstructive sleep apnea (OSA) and snoring is particularly relevant world-wide. The disease has been proven to worsen the patients' quality of life, and may even threaten it. Obstructive sleep apnea and snoring syndrome (OSAS) is a widespread disease of social importance in which there is a reduction or cessation of airf low through the nose/mouth during sleep due to upper airway collapse. Obstructive sleep apnea affects the cardiovascular, endocrine, neurocognitive and other systems of the body. There are symptoms of loud snoring, choking, hypoxemia, and micro-awakenings, leading to sleep frag-mentation, daytime fatigue, and sleepiness. The latter greatly worsens the quality of life of patients. There are real risks to the life and health of the patient and others, given the possibility of falling asleep at the wheel in drivers with sleep apnea and participation in traffic accidents. To diagnose the syndrome, a poly-somnographic study is performed, which is still the gold standard. For a better diagnosis, it is recommend-ed to combine it with rhinomanometry. Treatment of OSA includes control of risk factors and removal of obstructive factors that make breathing difficult. Severe OSA syndrome is treated with continuous positive pressure ventilation (CPAP) during sleep, possibly in combination with intraoral devices. Rhinomanome-try can also be used to monitor the effectiveness of CPAP therapy in severe forms of the syndrome by deter-mining tissue resistance. The impact on patients with a milder form of OSA treated with intraoral devices is also monitored. The method can also be used in patients with allergic rhinitis, sinusitis of rhinogenic and other origin, and patients with orthodontic deformities. The correct choice of intraoral appliances for conservative treatment of OSA and timely diagnosis are key to successful treatment.Copyright © 2022, Bulgarian-American Center. All rights reserved.

A rabbit model of tracheal collapse for optimal self-expanding metal stents.

Investigating the characteristics of tracheas can help the understanding of diseases related to the trachea, particularly tracheal collapse (TC) in dogs. This study aimed to compare the mechanical properties of tracheas from New Zealand White (NZW) rabbits and dogs and to introduce a method for inducing a model of TC in the normal trachea. Tracheal samples were obtained from NZW rabbit cadavers (n=5) weighing 3.62-3.92 kg and from dog cadavers (n=5) weighing 2.97-3.28 kg. Three live NZW rabbits weighing 3.5-4.0 kg were used to establish the model. The radial forces of both sample sets were measured using a digital force gauge and statistically compared. Subsequently, TC was surgically induced in three female NZW rabbits by physically weakening their tracheal cartilage under general anesthesia. Their clinical signs were monitored for 3 months, and radiographic examinations were performed monthly for 3 months. The mean radial forces of the two sample sets were comparable (P>0.05). The clinical signs, radiographic examinations, and macroscopic examinations were all comparable to those of dogs with TC. The cadaveric study between the rabbits and dogs demonstrated that the surgically induced rabbit model of TC is an excellent candidate for the experimental study of dogs with TC. This study also provides a reference of tracheal radial force values to enable selection of appropriate mesh types and wire diameters of self-expanding metal stents.

Features of the development and clinical course of pneumothorax in patients with a new coronavirus infection.

New coronavirus infection (COVID-19) is a modern global problem that requires the rapid development of diagnostic and treatment methods, as well as the study of pathological effects on body tissues. Due to severe damage to the respiratory organs, special attention is paid to the study of pneumothorax as a manifestation of gas syndrome, one of the complications of COVID-19. The purpose of the study was to assess the incidence of pneumothorax as a complication of COVID-19, the features of the development of the pathological process, and to determine the criteria for treatment tactics. Materials and methods. In total, for the period from April 2020 to May 2022 at the Clinical Infectious Diseases Hospital named after. S.P. Botkin treated 31532 patients with a confirmed diagnosis of COVID-19. As part of this study, the case histories of 316 patients with clinical manifestations of gas syndrome were retrospectively analyzed. All patients were diagnosed with COVID-19, the diagnostic criterion of which was a positive result of the PCR test - the detection of RNA in a swab taken from the nasopharynx and oropharynx. Results. Analysis of case histories showed that severe COVID-19 occurs in all age groups. Collapse of half of the lung was observed in most cases (59 patients). The main treatment method for pneumothorax was Bulau drainage. At the same time, in 47 patients (32%) this method required active aspiration. In 37 patients (26%), drainage was corrected and the pleural cavity was re-drained. In 37 patients, the result of hospitalization was a fatal outcome, the main causes of which were severe pneumonia and/or severe immunodeficiency, 75 patients (52%) were discharged from the hospital in a stable condition. Conclusions. The occurrence of pneumothorax in patients with COVID-19 is characterized by late onset, protracted course, the formation of purulent complications and a high incidence of fatal outcomes, which do not always correlate with the severity of pneumonia.Copyright © 2022 Authors. All rights reserved.

A Modified Artificial Neural Network (ANN)-Based Time Series Prediction of COVID-19 Cases from Multi-Country Data

The deadly Corona virus that first appeared in a seafood market in the Wuhan city of China in December 2019 has been causing global distress by claiming lives and collapsing economies. Given its serious nature, there is an urgent need to understand the virus's future trajectory. The current study predicts the next day confirmed, death and recovery cases of COVID-19 pandemic for India, Italy, Spain, and the USA by using a modified multilayer neural network (MMLNN) model. The spread of the COVID-19 data is collected from the Kaggle website for the period of 22nd January 2020 to 20th April 2020 (i.e., for 90 days). The predicted figures of the spread of the disease have been estimated and compared with the actual values. Higher precision of the estimates has been observed from the MMLNN model compared to the conventional multilayer neural network (MLANN) model. Specifically, the MMLNN model does faster and more efficient training of the data resulting in less error. The paper forecasts the next day figures (i.e., for 21st April) for all the three cases and does the comparison of the results with the actual values reported. A deviation of 6% is obtained for India, and for the other three countries the deviation is below 3.5%. Given the high accuracy predictive power, the authors recommend that the MMLNN model can be integrated into the health policy of the countries that are struggling with the spread of the virus. Specifically, a decision on health policies such as restrictions on movement can be based on the short-range predictions of the spread of the virus infection.

Covid-19 Vaccine safety and adverse event analysis from Pakistan

Covid immunization commenced on 2nd Feb 2021 in Pakistan and as of 7th Sep 2021, over 84 million vaccine doses were administered in Pakistan, of which 72% procured by the government, 22% received through Covax and 6% were donated. The vaccines rolled out nationally included: Sinopharm, Sinovac and CanSinoBIO (China), AstraZeneca (UK), Moderna and Pfizer (USA), Sputnik (Russia), and PakVac (China/Pakistan). About half of the eligible population in Pakistan (63 m) had received at least one dose of Covid vaccine as of Sep 2021. Pakistan National Pharmacovigilance Centre (PNPC) in coordination with WHO, MHRA and Uppsala Monitoring Centre (UMC) established pharmacovigilance centers across Pakistan. The Covid vaccine AEFIs in Pakistan were mainly reported via NIMS (National Immunization Management System), COVIM (Covid-19 Vaccine Inventory Management System), 1166 freephone helpline and MedSafety. There have been 39,291 ADRs reported as of 30th Sept 2021, where most reported after the first dose (n = 27,108) and within 24-72 h of immunization (n = 27,591). Fever or shivering accounted for most AEFI (35%) followed by injection-site pain or redness (28%), headache (26%), nausea/vomiting (4%), and diarrhoea (3%). 24 serious AEFIs were also reported and investigated in detail by the National AEFI review committee. The rate of AEFIs reports ranged from 0.27 to 0.79 per 1000 for various Covid vaccines in Pakistan that was significantly lower than the rates in UK (~4 per 1000), primarily atrributed to underreporting of cases in Pakistan. Finally, Covid vaccines were well tolerated and no significant cause for concern was flagged up in Pakistan's Covid vaccine surveillance system concluding overall benefits outweighed risks.Copyright © 2022

Scenarios of COVID-19 Epidemic Effects on Socioeconomic and Health Status of Iran.

Background and Objectives: The COVID-19 epidemic and its subsequent effects have become a significant global challenge. In addition to being affected by this crisis, Iran is also facing many other problems, including sanctions and economic problems. So, there is a concern that it will suffer more severe consequences. Method(s): Scenario planning is one of the ways to recognize future changes and environmental uncertainties. This study used the so-called global business network (GBN) method, also known as the scenario matrix method. This method is based on two key uncertainties and six steps have been taken to examine variables related to health and socio-economic factors and use the opinions of relevant experts. Result(s): To be expected, Iran's health system will be able to manage the epidemic in the face of various conditions with severity and weakness, and only in the pessimistic scenario or in Worst-case scenario with the default assumption of the continuation of sanctions and the spread of the epidemic. It leads to global restrictions, loss of foreign exchange reserves, loss of performance or collapse of the health system, increasing the number of deaths and diminishing the quality of life. Conclusion(s): Regarding the COVID-19 epidemic and the existing background factors, scenarios of Iran's health and economic conditions were narrated. Given the ability of the scenarios to understand the complexity and help in decision-making, it is considered a useful tool for policy makers to have a broader, comprehensive and reasonable look to achieve a correct consensus. This situation leads to the preservation and continuation of society health and conventional economic decisions.Copyright © 2022 The Authors. Published by Tehran University of Medical Sciences.

Streptococcus Pneumoniae Purulent Pericarditis

Background Bacterial pericarditis represents < 1 % of all cases of pericarditis in the United States. Most cases of bacterial pericarditis are from contiguous spread from underlying pneumonia or mediastinitis. We present a case of pneumococcal pericarditis in a patient with untreated pneumonia. Case A 54-year-old male with a past medical history of recent COVID-19 pneumonia presented with worsening dyspnea for the past 3 weeks. Vitals were T 99.3, BP 122/93, HR 159 BPM, O2 sat 94% on 3 L NC. ECG demonstrated atrial flutter with 2:1 block. CT scan demonstrated a pericardial effusion and bilateral pleural effusions. Decision-making In the ED, he became hypotensive and bedside echo demonstrated large pericardial effusion with RV collapse. Emergent pericardiocentesis produced 750 cc of purulent fluid. Streptococcus pneumoniae was isolated from the initial fluid aspirate. Right thoracostomy tube was placed with pleural fluid gram stain and culture without bacterial growth. Due to continued purulent drainage from the pericardial drain, repeat CT scan demonstrated persistent pericardial effusion and loculated right sided pleural effusion. He underwent video-assisted thoracoscopic surgery with pericardial wash out and window. He improved and was discharged with 6 weeks of Ceftriaxone. Conclusion Purulent pericarditis is typically a fulminant disease associated with high mortality and rapid progression. Prompt identification and management is critical for patient survival. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Covid-19 Pandemic: Global Scenario, Socialdeterminants and Its Socio-Economic Impact

Background: The COVID-19 pandemic has resulted in about 75.2M cases and 1.67M deaths worldwide, as on 18th December 2020 data live updates of World Health Organizations. In response to this pandemic, this study analyzes the global issue of rising and falling of COVID-19 cases and changing scenario of economies. Method(s): The data has been extracted from January 2020 to December 2020 from some of the reliable sources of the World like WHO Coronavirus disease (COVID-19) dashboard, Worldometer, and Centers for Disease Control and Prevention (CDC). It also represents the global scenario of the COVID-19 pandemic and its social determinants around the world. Result(s): There has been spatial heterogeneity in the number of cases and the number of deaths among regions worldwide. There is a great impact on the countries economy, both on the supply and demand side. It shows that several factors affect the determinants of health at various levels like income, healthcaresystem, education, etc also play a major role in it. Conclusion(s): The increasing cases worldwide have adversely affected the economy and have led to a scarcity of resources which further caused the collapse of the economy and trade.Copyright © 2020 Ubiquity Press. All rights reserved.

Cardiac Angiosarcoma Presenting as Recurrent Pericardial Effusion and Constrictive Pericarditis

Background Malignancy accounts for 15-20% of moderate to large pericardial effusions. Among these, cardiac angiosarcomas are extremely rare. Case A 30-year-old male presented with dyspnea and fatigue, 9 months after COVID-19 infection. He had sinus tachycardia (117 beat/min). Chest X-ray showed cardiomegaly. Echocardiogram demonstrated a large circumferential pericardial effusion with right ventricular collapse. Decision-making Pericardiocentesis yielded 850 ml of bloody fluid, with symptomatic relief. He was discharged on colchicine and indomethacin with a presumptive diagnosis of post-viral pericarditis. A month later, he had recurrent symptoms and re-accumulation of large circumferential effusion. CT chest revealed multiple pulmonary nodules and bilateral pleural effusions. He underwent subxiphoid pericardial window and pleural biopsy. Fluid analysis and biopsy results were inconclusive. Over 3 weeks, he had worsening symptoms, despite a daily pericardial drain output of ~200 ml. Repeat echocardiogram showed loculation of the effusion with signs of constrictive pericarditis. He underwent pericardiectomy. Pathology revealed cardiac angiosarcoma. FDG PET scan showed thoracic metastasis. Anakinra was initiated. Conclusion Idiopathic and post-viral etiologies are the most common causes of pericardial effusion. Although rare, cardiac angiosarcoma should be on the differential diagnosis for recurrent pericardial effusion. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Sensemaking of COVIDian Crisis for Work and Organization.

COVID19 pandemic is pushing business organizations to cope in newer, more resilient ways. In this study, in-depth qualitative research was conducted using Weick's sensemaking framework (1995) to give organizational leaders a snapshot of how individuals grappled with sensemaking during this time. The enactment of sensemaking for individuals occurred based on four major COVIDian realities: life during the lockdown, work from home, moments of reflection, and struggles and emotions. The implications of the findings are two folds. First, the dynamic nature of extracted cues coupled with greater technology use increased enactment frequency amongst individuals leading to a collapse in sensemaking. Secondly, we propose that this collapse has a significant impact on human cognition, which will further affect the nature of work as well as the meaning of work in life.

Corticosteroids Induced Avascular Necrosis of Hip, a "Long Covid-19" Complication: Case Report

Since it first surfaced, the new Coronavirus has multiplied and mutated into different forms, leading to a significant impact on people's lives. COVID-19's long-term impact is not completely known: It can only be hypothesized based on the prior outbreak of severe acute respiratory syndrome (SARS). Avascular necrosis (AVN) is one of these consequences, which if left untreated can lead to catastrophic events and bone collapse. It's important to remember that individuals who have recovered from COVID-19 infection are still at risk of developing AVN. The pathological findings in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are very similar to those seen in severe acute respiratory syndrome coronavirus (SARS-CoV) infection. We present cases of 27- and 69-years old men with no comorbidities admitted with complaints of bilateral hip pain post Covid treatment with corticosteroids and antivirals. The diagnosis was established based on history, physical examination, and magnetic resonance imaging (MRI). The use of corticosteroids in the treatment of SARS-CoV-2 infection has saved many lives, and it is still advised for moderate to severe cases on a short-term basis. The long-term use of corticosteroids is associated with numerous side effects. One of the most prevalent side effects of steroids is avascular necrosis of the femoral head, which is aggravated by the disease process. Early detection of avascular necrosis is very crucial in its management due to its high progression rate. Low therapeutic doses of corticosteroids with minimal effective duration remain the key to halting its occurrence.

Persistent dyspnea in post-COVID patients in the absence of pulmonary embolism: added value of lung perfusion scintigraphy

Aim/Introduction: While there's a wide literature on Computed Tomography (CT) abnormalities in COVID-19 sequelae, the role of lung perfusion scintigraphy has been scarcely investigated. Recent findings reported lung microvascular and endothelial alterations in patients recovered from COVID-19 without pulmonary embolism (PE), presenting persistent dyspnea (post-COVID). We compared perfusion scintigraphy and CT findings of post-COVID patients with dyspneic subjects in whom lung scintigraphy excluded pulmonary embolism (non-COVID). The correlation between lung perfusion scintigraphy findings and 1) CT abnormalities and 2) clinical/biochemical parameters were also assessed. Material(s) and Method(s): 18 post-COVID and 20 non-COVID patients who underwent lung perfusion scintigraphy and chest high-resolution CT for dyspnea from March 2020 to April 2022 were retrospectively enrolled. From lung perfusion scintigraphy images, counting rates for upper, middle, and lower fields were normalized for the total lung counts to calculate the corresponding ratios (UTR, MTR, and LTR, respectively). CT images were analyzed using a semiautomated segmentation algorithm of 3DSlicer (www.slicer. org), obtaining total, emphysematous, infiltrated and collapsed volumes, normalized for the total lung volumes. Similarly, blood vessel's volumes were collected to compute the vascular density. White blood cells (WBC) count, PT, INR, PTT and D-dimer of both groups, and the infection duration of post-COVID patients were collected from clinical records and blood tests performed before the lung perfusion scintigraphy. Result(s): At the per lung analysis, post-COVID patients with persistent dyspnea showed reduced LTR (24.67>5.08) and higher MTR (52.51>5.22) compared to non-COVID patients (29.85>5.05 and 46.66>3.94, respectively;p<0.0001 for both), while UTR resulted bilaterally superimposable between the two groups. At CT imaging, the rates of emphysematous, infiltrated and collapsed volumes and the vascular density were bilaterally similar in both groups. In post-COVID patients, LTR correlated with the percentage of emphysematous (r=0.498;p<0.01), infiltrated (r=-0.464;p=<0.01) and collapsed (r=-0.463;p<0.01) lungs, while no significant correlations were observed between LTR and CTderived volumes in non-COVID subjects. There was no correlation between lung perfusion scintigraphy parameters with infection duration in post-COVID, WBC, and coagulation biomarkers in both groups. Conclusion(s): Lung perfusion scintigraphy can reveal reduced perfusion rates of lower pulmonary fields in post-COVID patients with persistent dyspnea without pulmonary embolism. This phenomenon is correlated with structural lung modifications, including lung parenchymal emphysema, infiltration and collapse, and is independent of infection duration and coagulation biomarkers. Although mechanisms underlying these findings need to be supported by pathological lung tissue examination, pulmonary non-thrombotic microvascular and endothelial dysfunction may be involved.

Application of An Automatic Three-Phase Power Supply Phase Selector in the Medical Ventilator

The Three Phase Power Supply Phase Selector device is critical for the operation of all medical equipment, particularly medical ventilators. Because of COVID 19, the need for ventilators has increased significantly. However, hospitals in rural areas are experiencing single-phase failure and low voltage in distribution lines, which causes interruptions in ventilator operation. This paper proposes an automatic Three Phase Power Supply Phase Chooser with a Programmable Logic Controller (PLC) to keep all medical ventilators running without disruption, especially in the occurrence of single-phase failure. During a phase failure, the proposed system automatically connects the ventilator to the another available phase in a very short period. The PLC detects the restoration of the phase of the single-phase supply and automatically reconnects the ventilator to the restored phase. It also aids in maintaining an uninterrupted power supply to critical single-phase medical appliances. It also protects sensitive single-phase medical equipment from damage and burnout. This system can be used in a variety of locations where critical single-phase medical equipment must operate continuously and without disruption. The key benefit of this controller is that it is reliable, easily programmable, and flexible. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Postpartum Collapse Subsequent to Catatonia in a Female with COVID-19 Infection: a Rare Entity Visited.

Postpartum collapse is a life-threatening condition caused by obstetrical and non-obstetrical events. In this case report, we discuss a case of postpartum collapse in COVID-19-positive woman who required intensive care and mechanical ventilation for two days. After confusing collision of many provisional diagnoses soldiering for three days, she was ultimately diagnosed with malignant catatonia. Targeted therapy with lorazepam challenge resulted in drastic improvement, and she was discharged with her baby in healthy condition.

Rare Presentation of Coxsackie Virus B Myopericarditis as Atypical Pneumonia and Sepsis

INTRODUCTION: While myopericarditis due to Coxsackie virus-B has been widely reported, multi-organ involvement is rare. We report a unique case of Coxsackie B myopericarditis, which presented with rash, atypical pneumonia, hepatitis, and sepsis. DESCRIPTION: A previously healthy 32-year-old man presented to the emergency department in January 2022 endorsing shortness of breath, high-grade fever (39.2degreeC), non-pruritic rash on extremities, vomiting, and diarrhea. He had tachypnea (24/min), hypoxia (SpO2 93% on air), and mild lymphadenopathy in the neck. Initial evaluation was pertinent for leukocytosis (17.8 thousand/muL) with neutrophil predominance (89.4%), elevated inflammatory markers (D-dimer [4390 ng/mL], procalcitonin [1.79 ng/ mL], CRP [180.7 mg/L], lactate [3.19 mmol/L]), and transamnitis (AST: 160 U/L, ALT: 116 U/L);SARS-CoV-2 and blood cultures were negative. Chest imaging showed bibasilar consolidation, perihilar ground-glass nodules, and pericardial effusion;ultrasound showed acute hepatitis. He was empirically started on ceftriaxone and azithromycin. However, absence of clinical improvement, persistence of high-grade fever, and leukocytosis with low absolute CD3, CD4, and CD8 counts (286 cells/UL, 199 cells/UL and 71 cells/UL, respectively) suggested atypical infection;vancomycin and doxycycline were added. Further infection and autoimmune workup was negative. He developed atrial fibrillation and an echocardiogram was remarkable for ejection fraction of 50-55%, moderate pericardial effusion circumferential to the heart, and minimal collapse of the right atrium. On subsequent testing, Coxsackie virus B type 3 IgM was positive (1:320, reference 1:10). All antibiotics were discontinued, and the patient was managed with diltiazem, colchicine, ibuprofen, and supportive care;anticoagulation was not initiated. After a remarkable improvement in symptoms and rash, he was discharged home. Follow-up imaging showed resolution of bibasilar consolidations and pericardial effusion. DISCUSSION: The likely mechanism of Coxsackie virus B-induced damage to myocytes (and possibly multiorgan involvement) is immune-mediated and direct viral cytotoxicity. Our patient's atypical pneumonia responded well to colchicine and ibuprofen. A high index of suspicion is warranted.