Clinical and multimodal imaging features of acute macular neuroretinopathy lesions following recent SARS-CoV-2 infection.

AIM: To describe the clinical characteristics of eyes using multimodal imaging features with acute macular neuroretinopathy (AMN) lesions following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: Retrospective case series study. From December 18, 2022 to February 14, 2023, previously healthy cases within 1-week infection with SARS-CoV-2 and examined at Tianjin Eye Hospital to confirm the diagnosis of AMN were included in the study. Totally 5 males and 9 females [mean age: 29.93±10.32 (16-49)y] were presented for reduced vision, with or without blurred vision. All patients underwent best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscopy, indirect fundoscopy. Simultaneously, multimodal imagings fundus photography (45° or 200° field of view) was performed in 7 cases (14 eyes). Near infrared (NIR) fundus photography was performed in 9 cases (18 eyes), optical coherence tomography (OCT) in 5 cases (10 eyes), optical coherence tomography angiography (OCTA) in 9 cases (18 eyes), and fundus fluorescence angiography (FFA) in 3 cases (6 eyes). Visual field was performed in 1 case (2 eyes). RESULTS: Multimodal imaging findings data from 14 patients with AMN were reviewed. All eyes demonstrated different extent hyperreflective lesions at the level of the inner nuclear layer and/or outer plexus layer on OCT or OCTA. Fundus photography (45° or 200° field of view) showed irregular hypo-reflective lesion around the fovea in 7 cases (14 eyes). OCTA demonstrated that the superficial retinal capillary plexus (SCP) vascular density, deep capillary plexus (DCP) vascular density and choriocapillaris (CC) vascular density was reduced in 9 case (18 eyes). Among the follow-up cases (2 cases), vascular density increased in 1 case with elevated BCVA; another case has vascular density decrease in one eye and basically unchanged in other eye. En face images of the ellipsoidal zone and interdigitation zone injury showed a low wedge-shaped reflection contour appearance. NIR image mainly show the absence of the outer retinal interdigitation zone in AMN. No abnormal fluorescence was observed in FFA. Corresponding partial defect of the visual field were visualized via perimeter in one case. CONCLUSION: The morbidity of SARS-CoV-2 infection with AMN is increased. Ophthalmologists should be aware of the possible, albeit rare, AMN after SARS-CoV-2 infection and focus on multimodal imaging features. OCT, OCTA, and infrared fundus phase are proved to be valuable tools for detection of AMN in patients with SARS-CoV-2.

Characteristics and Outcomes of Covid-19 in an Early-Treated Hiv Cohort in Thailand

Background: Emerging data indicate that people with HIV (PWH) are at risk of more severe outcomes from COVID-19. We described the clinical course and laboratory parameters pre-and post-COVID-19 in an early-treated HIV cohort in Thailand. Method(s): RV254 cohort participants were enrolled during Fiebig I-V acute HIV and initiated antiretroviral therapy (ART) within days. They underwent regular blood tests (CD4+ & CD8+ T-cell counts, HIV RNA), neuropsychiatric (NP) assessment (Color Trails 1 & 2, non-dominant hand Grooved Pegboard, Trails Making A), and mood questionnaires (Patient Health Questionnaire-9, Distress Thermometer) post-enrollment longitudinally. Their assessment outcomes pre-and post-COVID-19 were compared using Generalized Estimating Equations (GEE) with a normal distribution and identity link (CD4+, CD8+ T-cell counts, NP parameters) or binomial distribution with log link (HIV RNA), and autoregressive correlation structure. Result(s): Between 4/2021 and 9/2022, 295 participants on ART (98% male, median age 32 [IQR 28-37] were diagnosed with COVID-19. Of these, 16(5%), 38(13%) and 241(82%) were infected with alpha, delta and o variants, determined by the predominant strain circulating in Thailand at the time of infection;238(81%) received >=2 doses of COVID-19 vaccines prior to diagnosis;121(41%) received favipiravir. While 106 (36%) were managed in hospital or 'hospitel', including one intensive care unit admission, only 4(1.4%) received supplemental oxygen and none required mechanical ventilation (mean length of stay: 12 days). The participants were followed a median of 8 [IQR 5-15] weeks post-COVID. Comparing the outcomes pre-and post-COVID, plasma HIV suppression rate remained stable (98% vs. 96%, p=0.212). CD4+ (782 [IQR 708-856] vs. 823 [IQR 748-899], p=0.018) and CD8+ (622 [IQR 563-681] vs. 667 [IQR 605-728], p=0.023) T-cell counts were higher at follow-up after adjusting for age, sex, and duration between COVID-19 diagnosis and follow-up. The increasing trends of CD4+ and CD8+ T-cell were sustained on subsequent visits. Mood scores and NP performance (n=217) were stable at follow-up. Conclusion(s): In this cohort of young PWH on stable ART, we did not observe major clinical adverse events after COVID-19. Increases of CD4+ and CD8+ T-cell counts were observed while mood and NP parameters remained stable. More extensive NP assessment with incorporation of multimodal imaging outcomes and longer follow-up are needed to determine the long-term sequelae of COVID-19 in PWH.

MaThAI: A MultiModal imaging combining Mammography and Thermalytix for better prioritization of mammography scans to detect early malignancies

Background: Breast cancer screening helps in early intervention and treatment. Post COVID, there is a huge backlog of women who missed their regular screening resulting in increased workload for radiologists, delayed reporting and intervention for malignant women. Thermalytix is an AI-based tool over thermal images that generates a 5 point score called B-Score where 5 is highest suspected risk for breast cancer and 1 is the lowest risk. In this study, we propose and evaluate a multimodal imaging modality called MaThAI that combines mammography and Thermalytix for prioritization of Mammography scans using B-Score. Material(s) and Method(s): Data from two clinical studies were pooled together and a total of 583 women who took both mammography and thermal scans were included in the study. Among them, 72 women were diagnosed to be malignant using mammography, ultrasound, and/or biopsy. Sensitivity and specificity of (i) Mammography alone (as reported by experienced radiologists), (ii) Thermalytix alone (using B-Score >=3 as positive) and (iii) MaThAI (considering a scan as positive if either Mammogram interpretation or Thermalytix interpretation or both were positive) were computed. As a second experiment, we assessed the benefit of MathAI prioritized mammography scans by estimating the reporting times for detecting 95% malignant patients. Result(s): The sensitivity and specificity of mammography were 81.9% and 98.8%, respectively, assuming BIRAD 0 as negative. Assuming BIRAD 0 as positive the sensitivity and specificity were 90.3% and 86.9%, respectively. Six malignancies were found in the 67 women with inconclusive reports (BIRADS 0). When Thermalytix B-Score was considered, the sensitivity and specificity were 94.4% and 81.0%, respectively. MaThAI showed an overall sensitivity and specificity of 98.6% (CI: 95.9%-100%) and 80.6% (CI: 77.2%-84.1%), respectively. The combo modality increased sensitivity over mammography alone by 16.7%, and Thermalytix alone by 4.2%, while decreasing the specificity of mammography by 6.3%. In the second experiment, we evaluated the benefit of MaThAI in prioritizing mammography scans using Thermalytix B-Score. Assuming mammography interpretation time is 20 minutes per exam and considering the order of the interpretation to be scan date + time, a single radiologist would have released the reports of 95% of the women with malignancy in 6720 minutes. Whereas using B-Score to reorder the scans for interpreting, the same radiologist would release the reports of 95% of the women with malignancy in 3080 minutes. Conclusion(s): MaThAI is a promising multimodal tool for breast screening that enables effective and efficient adjunct usage of thermal image along with mammography. It was effective in increasing the sensitivity of mammography by 16.7% and is estimated to reduce the reporting time for malignant patients by 54%. Conflict of interest: Ownership: Yes Board of Directors: Yes Corporate-sponsored Research: YesCopyright © 2022 Elsevier Ltd. All rights reserved

Absence of Long-Term Structural and Functional Cardiac Abnormalities on Multimodality Imaging in a Multi-Ethnic Population of Covid-19 Survivors from the Early Stage of the Pandemic

Background Many patients with COVID-19, particularly from the pandemic's early phase, have been reported to have evidence of cardiac injury such as cardiac symptoms, troponinemia, or imaging or ECG abnormalities during their acute course. Cardiac magnetic resonance (CMR) has been particularly useful to assess myocardial abnormalities given its comprehensive characterization of structure, function, and tissue. Overall, findings have varied, and long term impact of COVID-19 on myocardial structure and function needs further elucidation. Methods We performed TTE and 3T CMR with gadoterate meglumine (Clariscan, GE Healthcare) in survivors of the initial stage of the pandemic without preexisting cardiac disease and matched controls at long-term follow up?>6 months after infection, using an array of techniques to comprehensively evaluate the myocardium. Chi square tests for categorical and t tests for continuous variables were used. P <0.05 was considered significant. Results Our study population consisted of 40 COVID survivors and 12 controls of similar age, sex and race-ethnicity distribution with median age 46, 50% female, 48% Hispanic, 28% Black, mean BMI 27. None had presented with thromboembolism, myocarditis, or ischemia;35% had been hospitalized with 28% intubated. Imaging was performed median 308 days after initial infection. We found no difference in echo characteristics including measures of LV and RV structure and systolic function, valvular abnormalities, or LV diastolic function with median LVEF 60% v 58%, LVEDD 4.0 v 4.4, E/e' ~6, and no RWMA in either group. Using CMR, we confirmed no differences in LV and RV structure and function including median LVEF 57% v 58%, RVEF 53% v 53%, LVEDVi 74 v 72, and RVEDVi 77 v 74. We found no significant differences in T1 (1305 v 1280), T2 (46 v 47), ECV (29 v 30), or LGE mapping. With analysis stratified by patient hospitalization status as an indicator of COVID severity, no differences were uncovered. Conclusion Multimodal imaging of a diverse cohort of COVID-19 survivors who had not presented with acute cardiac pathology reveals no distinct features indicating long-lasting structural or functional damage or inflammation of the myocardium.Copyright © 2023 American College of Cardiology Foundation

Multimodal imaging case series of acute macular neuroretinopathy secondary to COVID-19 infection

Purpose : Understanding of the ocular manifestations of coronavirus disease 2019 (COVID-19) is continuing to develop. While ocular symptoms, chiefly conjunctivitis, have been reported, retinal pathologies have been suggested as a rarer complication and are hypothesized to derive from a combination of the inflammatory and vasculopathic effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Using a retrospective, observational case series design, we describe a series of four eyes in three patients with acute macular neuroretinopathy (AMN) and paracentral acute middle maculopathy (PAMM) associated with COVID-19 illness. Methods : Our practice's electronic medical record (EMR) was retrospectively queried for patients from April 2020 to December 2021 who had been diagnosed with AMN or PAMM and COVID-19 illness. Three patients were identified by this method. Patient demographic information, physical exam, optical coherence tomography (OCT), infrared reflectance (IR), and fluorescein angiography (FA) studies were all used for analysis. Results : Imaging signs of AMN were revealed in four eyes in three female patients, aged 22, 32, and 64 years old, all with confirmed symptomatic COVID-19 corresponding to the start of visual symptoms. The average onset of visual symptoms from COVID-19 illness was 14 days (range 0-56). 4/4 eyes were symptomatic for scotomata. Average logMAR visual acuity was 0.024 (Snellen 20/21, range 0-0.097). 4/4 eyes demonstrated typical findings of AMN: IR imaging with prominent dark petaloid or ovoid parafoveal lesions and corresponding disruption of the ellipsoid zone on OCT (Fig. 1). FA imaging did not show any abnormal fluorescence pattern. Autofluorescence in 1/4 eyes demonstrated hyperautofluorescence corresponding to the abnormal area on IR imaging (Fig. 2). Two month follow-up showed persistent symptoms of scotomata with unchanged findings on follow-up imaging in 100% of cases. Conclusions : This series demonstrates that, although rare, SARS-CoV-2 infection may result in microvasculopathic injuries to the retina, namely AMN and PAMM. (Figure Presented).

Bilateral persistent placoid maculopathy following COVID-19 Vaccines: real or co-incidence?

Purpose : COVID-19 vaccination has been accompanied by reports of inflammatory events. We aim to report the first case of bilateral persistent placoid maculopathy (PPM) following COVID-19 vaccination. Methods : Case report Results : A 58-year-old man presented with bilateral sudden painless decrease in vision approximately two weeks after the second dose of AstraZenaca® COVID-19 vaccine. Visual acuity (VA) at presentation was 1.00 LogMAR in the right eye (RE) and hand movement in the left eye (LE). He had no known medical or ophthalmic history, up until after his first AstraZenaca® COVID-19 vaccine dose, he was diagnosed with palmoplantar pustular psoriasis and was started on 60mg of oral Prednisolone. Fundus examination revealed bilateral well-delineated whitish plaque-like macular lesions involving the fovea, sparing the peripapillary region in the RE (Figure 1a & e). Multimodal imaging including fluorescein angiography, indocyanine-green angiography, fundus autofluorescence and optical coherence tomography were consistent with PPM (Figure 1 & 2). Infective and auto-immune screen were all negative apart from a positive MPO-ANCA, prompting a rheumatology review which subsequently excluded any systemic vasculitis. Patient was monitored closely and his VA improved and stabilised with tapering regime of oral Prednisolone. To prevent relapse of PPM, patient was commenced on Mycophenolate Mofetil as a long-term steroid sparing immunosuppression. Conclusions : Our case demonstrated a likely inflammatory or autoimmune response affecting choriocapillaris driven by the COVID-19 vaccine and there may be a correlation between the two. The patient in our case portrayed features classical of PPM, which is a selective autoimmune vasculitis causing microinfarcts on choriocapillaris, resulting in focal choroidal hypoperfusion after the COVID-19 vaccine. (Figure Presented).

Multimodal Imaging and Phototherapy of Cancer and Bacterial Infection by Graphene and Related Nanocomposites.

The advancements in nanotechnology and nanomedicine are projected to solve many glitches in medicine, especially in the fields of cancer and infectious diseases, which are ranked in the top five most dangerous deadly diseases worldwide by the WHO. There is great concern to eradicate these problems with accurate diagnosis and therapies. Among many developed therapeutic models, near infra-red mediated phototherapy is a non-invasive technique used to invade many persistent tumors and bacterial infections with less inflammation compared with traditional therapeutic models such as radiation therapy, chemotherapy, and surgeries. Herein, we firstly summarize the up-to-date research on graphene phototheranostics for a better understanding of this field of research. We discuss the preparation and functionalization of graphene nanomaterials with various biocompatible components, such as metals, metal oxides, polymers, photosensitizers, and drugs, through covalent and noncovalent approaches. The multifunctional nanographene is used to diagnose the disease with confocal laser scanning microscopy, magnetic resonance imaging computed tomography, positron emission tomography, photoacoustic imaging, Raman, and ToF-SMIS to visualize inside the biological system for imaging-guided therapy are discussed. Further, treatment of disease by photothermal and photodynamic therapies against different cancers and bacterial infections are carefully conferred herein along with challenges and future perspectives.

Bilateral Choroidal Osteoma in a Teenage Girl With Chronic Posterior Scleritis.

A 14-year-old girl with bilateral chronic posterior scleritis was referred to us for poor control of ocular inflammation. There was an incidental finding of choroidal osteoma bilaterally whereby the choroidal mass in her right eye demonstrated a significant tumor growth in a short duration of two months. The right eye choroidal tumor was orangy in color with a well-defined margin, two-disc diameter in size, and located at the macula encroaching the fovea. Multimodal imaging assessments, including serial color fundus photo, enhanced depth imaging optical coherence tomography (EDI-OCT), and B scan ultrasonography monitoring, confirmed a continuous rapid growth of choroidal osteoma with episodes of scleritis flare-ups. Furthermore, intolerance toward second-line immunosuppressants and loss of follow-ups during the coronavirus disease 2019 (COVID-19) pandemic lockdown led to frequent relapses of her posterior scleritis. Therefore, a new treatment plan was designed, and close monitoring of choroidal osteoma growth and control of posterior scleritis were initiated. Subsequently, bilateral posterior scleritis remained quiescent, and her vision remained stable with stagnant growth of choroidal osteoma.

Atypical acute fovealitis in COVID-19 context.

Purpose: To describe the clinical and multimodal imaging findings, including optical coherence tomography (OCT), and OCT angiography (OCTA) in a case presenting with acute fovealitis after COVID-19 infection, and its differential diagnosis. Observations: A 39-year-old man presenting with acute central metamorphopsia in his right eye (OD) right after positive test for COVID-19 underwent comprehensive ophthalmic examination, including best corrected visual acuity (BCVA), color fundus (CF) examination, optical coherence tomography (OCT), OCT angiography (OCTA), fundus autofluorescence (FAF) and fluorescein angiography (FA). Baseline BCVA was 20/40 in his OD and fundus examination showed small inferior juxtafoveal hemorrhages with no other vascular abnormalities or peripheral changes. The OCT B-scans revealed a central focal defect of the ellipsoid and interdigitation zones associated with foveal and perifoveal columnar hyperreflectivities involving the photoreceptor layers, the external limiting membrane and outer nuclear layer up to the outer plexiform layer with preservation of the retinal pigment epithelium-Bruch's membrane complex. Both FAF and FA images were unremarkable. Over three months follow-up, the findings progressively resolved, and BCVA improved to 20/20. Conclusions and importance: The presence of hyperreflective material at the fovea in association with adjacent hemorrhages, the absence of alterations of the retinal pigment epithelium in OCT, OCTA, FAF and FA suggested the diagnosis of acute fovealitis in COVID-19 context. The presence of these findings highlights the importance of detailed ophthalmic evaluation in symptomatic patients with COVID-19 positive test.

Imaging Cardiovascular Inflammation in the COVID-19 Era.

Cardiac complications are among the most frequent extrapulmonary manifestations of COVID-19 and are associated with high mortality rates. Moreover, positive SARS-CoV-2 patients with underlying cardiovascular disease are more likely to require intensive care and are at higher risk of death. The underlying mechanism for myocardial injury is multifaceted, in which the severe inflammatory response causes myocardial inflammation, coronary plaque destabilization, acute thrombotic events, and ischemia. Cardiac magnetic resonance (CMR) imaging is the non-invasive method of choice for identifying myocardial injury, and it is able to differentiate between underlying causes in various and often challenging clinical scenarios. Multimodal imaging protocols that incorporate CMR and computed tomography provide a complex evaluation for both respiratory and cardiovascular complications of SARS-CoV2 infection. This, in relation to biological evaluation of systemic inflammation, can guide appropriate therapeutic management in every stage of the disease. The use of artificial intelligence can further improve the diagnostic accuracy of these imaging techniques, thus enabling risk stratification and evaluation of prognosis. The present manuscript aims to review the current knowledge on the possible modalities for imaging COVID-related myocardial inflammation or post-COVID coronary inflammation and atherosclerosis.

Ophthalmic and Neuro-ophthalmic Manifestations of Coronavirus Disease 2019 (COVID-19).

PURPOSE: To describe a case of inflammatory chorioretinopathy and Adie's syndrome possibly associated with COVID-19. METHODS: Observational case report. RESULTS: A 51-year-old woman developed fever, cough, and headache followed by retro-ocular pain and reading impairment. She tested positive for SARS-COV-2 infection by qualitative real-time reverse-transcriptase-polymerase-chain-reaction. The slit-lamp and funduscopic exam revealed abnormal pupillary response and yellowish creamy deep chorioretinal lesions, which were not present in previous examinations. Instillation of pilocarpine demonstrated denervation supersensitivity, and it was suggestive of bilateral Adie tonic pupil. A comprehensive work-up ruled out other systemic, autoimmune, or infectious diseases. CONCLUSIONS: This case illustrates the possible association between multifocal chorioretinitis and Adie's syndrome, and the SARS-COV-2 infection in humans. Further investigation of virus infectivity specifically within ocular tissues has to be conducted.