A "new" role of amantadines in COVID-19 in patients with Parkinson's disease: results of own comparative study.

Amantadine has begun to be used as a possible alternative in COVID-19 therapy to mitigate its effects. There is anecdotal evidence that patients with Parkinson's disease (PD) treated with amantadine and who test positive for COVID-19 often do not develop clinical manifestations of COVID-19. Objective(s): to compare the clinical course of COVID-19 in patients with PD who took or did not take amantadine sulfate. Patients and methods. A prospective continuous study included 142 patients with PD who were treated in Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy in Kazan from October 2021 to January 2022. Patients filled out a proprietary internally developed questionnaire. Results and discussion. Out of 142 individuals with PD COVID-19 occurred in 77 (54.2%), of which 52.0% had a mild course, 39.0% had a moderate course, 2.6% had a severe course, and in 6.5% the severity of the disease has not been established. Deterioration after COVID-19 infection was noted by 36% of patients: the appearance or increase in motor fluctuations (41%), increased tremor, stiffness or slowness (31%), the appearance of "exhaustion" of the effect of a single dose of levodopa (13%), the appearance or increased dyskinesia (21%), hallucinations (3.5%). Patients taking amantadine sulfate had PD much longer (11.5+/-5.62 years versus 5.12+/-3.24 years) and had a more pronounced (III-IV) stage of the disease. These patients were more likely to experience mild COVID-19 (in 60.87% of cases), in contrast to patients not receiving amantadine sulfate (only in 48.15% of cases). There was no correlation between the severity of COVID-19 and levodopa intake. Conclusion. The results of the study showed that patients with PD taking amantadine sulfate are more likely to have a mild course of COVID-19.Copyright © 2022 Ima-Press Publishing House. All rights reserved.

A "new" role of amantadines in COVID-19 in patients with Parkinson's disease: results of own comparative study

Amantadine has begun to be used as a possible alternative in COVID-19 therapy to mitigate its effects. There is anecdotal evidence that patients with Parkinson's disease (PD) treated with amantadine and who test positive for COVID-19 often do not develop clinical manifestations of COVID-19. Objective(s): to compare the clinical course of COVID-19 in patients with PD who took or did not take amantadine sulfate. Patients and methods. A prospective continuous study included 142 patients with PD who were treated in Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy in Kazan from October 2021 to January 2022. Patients filled out a proprietary internally developed questionnaire. Results and discussion. Out of 142 individuals with PD COVID-19 occurred in 77 (54.2%), of which 52.0% had a mild course, 39.0% had a moderate course, 2.6% had a severe course, and in 6.5% the severity of the disease has not been established. Deterioration after COVID-19 infection was noted by 36% of patients: the appearance or increase in motor fluctuations (41%), increased tremor, stiffness or slowness (31%), the appearance of "exhaustion" of the effect of a single dose of levodopa (13%), the appearance or increased dyskinesia (21%), hallucinations (3.5%). Patients taking amantadine sulfate had PD much longer (11.5+/-5.62 years versus 5.12+/-3.24 years) and had a more pronounced (III-IV) stage of the disease. These patients were more likely to experience mild COVID-19 (in 60.87% of cases), in contrast to patients not receiving amantadine sulfate (only in 48.15% of cases). There was no correlation between the severity of COVID-19 and levodopa intake. Conclusion. The results of the study showed that patients with PD taking amantadine sulfate are more likely to have a mild course of COVID-19.Copyright © 2022 Ima-Press Publishing House. All rights reserved.

Rigidity in crisis: The impact of OHSAS 18001 certification on production repurposing during COVID-19

It is important for firms to repurpose production responsively during a crisis such as the COVID-19 pandemic, to seize the market opportunity and create social value. However, occupational health and safety (OHS) can also be a concern in a crisis, and adherence to OHS management systems can undermine a firm's responsiveness in repurposing decision making. We adopt the "capability-rigidity" lens to construct a connection between OHS management standards (i.e., OHSAS 18001) and firms' adaptation responsiveness. After sampling 734 listed Chinese manufacturing firms, our match-based analysis reveals that firms certified with OHSAS 18001 were less responsive during COVID-19 in terms of production repurposing than those without the certification. Yet, certain experience, namely, prepandemic manufacturing of related products, experience of the severe acute respiratory syndrome (SARS) epidemic, and being geographically located close to firms that produced medical supplies, could attenuate this effect. We discuss the implications of our findings in the context of and adding to the literature on safety management, certified management standards, and organizational adaptation and learning.

Precise Epitope Organization with Self‐adjuvant Framework Nucleic Acid for Efficient COVID‐19 Peptide Vaccine Construction

Peptide vaccines have advantages in easy fabrication and high safety, but their effectiveness is hampered by the poor immunogenicity of the epitopes themselves. Herein, we constructed a series of framework nucleic acids (FNAs) with regulated rigidity and size to precisely organize epitopes in order to reveal the influence of epitope spacing and carrier rigidity on the efficiency of peptide vaccines. We found that assembling epitopes on rigid tetrahedral FNAs (tFNAs) with the appropriate size could efficiently enhance their immunogenicity. Further, by integrating epitopes from SARS‐CoV‐2 on preferred tFNAs, we constructed a COVID‐19 peptide vaccine which could induce high titers of IgG against the receptor binding domain (RBD) of SARS‐CoV‐2 spike protein and increase the ratio of memory B and T cells in mice. Considering the good biocompatibility of tFNAs, our research provides a new idea for developing efficient peptide vaccines against viruses and possibly other diseases.

A "new" role of amantadines in COVID-19 in patients with Parkinson's disease: results of own comparative study.

Amantadine has begun to be used as a possible alternative in COVID-19 therapy to mitigate its effects. There is anecdotal evidence that patients with Parkinson's disease (PD) treated with amantadine and who test positive for COVID-19 often do not develop clinical manifestations of COVID-19. Objective(s): to compare the clinical course of COVID-19 in patients with PD who took or did not take amantadine sulfate. Patients and methods. A prospective continuous study included 142 patients with PD who were treated in Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy in Kazan from October 2021 to January 2022. Patients filled out a proprietary internally developed questionnaire. Results and discussion. Out of 142 individuals with PD COVID-19 occurred in 77 (54.2%), of which 52.0% had a mild course, 39.0% had a moderate course, 2.6% had a severe course, and in 6.5% the severity of the disease has not been established. Deterioration after COVID-19 infection was noted by 36% of patients: the appearance or increase in motor fluctuations (41%), increased tremor, stiffness or slowness (31%), the appearance of "exhaustion" of the effect of a single dose of levodopa (13%), the appearance or increased dyskinesia (21%), hallucinations (3.5%). Patients taking amantadine sulfate had PD much longer (11.5+/-5.62 years versus 5.12+/-3.24 years) and had a more pronounced (III-IV) stage of the disease. These patients were more likely to experience mild COVID-19 (in 60.87% of cases), in contrast to patients not receiving amantadine sulfate (only in 48.15% of cases). There was no correlation between the severity of COVID-19 and levodopa intake. Conclusion. The results of the study showed that patients with PD taking amantadine sulfate are more likely to have a mild course of COVID-19.Copyright © 2022 Ima-Press Publishing House. All rights reserved.

The Predictive Ability of the Existential Vacuum and Death Anxiety in Psychological Hardiness Among Elderly.

This research paper aimed to identify the level of psychological hardiness, the level of death anxiety, and the level of existential vacuum among the elderly, also the role of the predictive ability of death anxiety and existential vacuum in the psychological hardiness of the elderly at the governorates of Tafilyah and Ma'an in light of the Corona pandemic in Jordan. The descriptive-analytical approach was utilized. sample consists (500) elderly, that were selected by a simple random approach. Then the needed statistical measure was operated to achieve the required results. The results indicated a low level of psychological hardiness, a high level of death anxiety, and an existential vacuum in the elderly. The results show a suitable predictive ability for each of death anxiety and the existential vacuum in reducing psychological hardiness. The research paper recommended the necessity of rehabilitating the elderly in Jordan regarding the mental and psychological aspects.

Neurological Signs in a General Neurology Face to Face Clinic during the Covid-19 Pandemic

During the Covid-19 pandemic attempts have been made to manage patients with neurological symptoms remotely without a neurological examination. To determine the prevalence of neurological signs we prospectively assessed 101 consecutive patients who were a referred to a general neurology clinic. Three patients did not attend, leaving 98 patients (58 female, 40 male, mean age 51.0 years, standard deviation 19.9 years. 37 patients had neurological signs. (Cognitive impairment n=3, spastic tetraparesis n=1, spastic hemipa- resis n=2, hemianopia n=1, ataxia n=1, gait apraxia n=1, postural tremor n=2, bradykinesia and rigidity n=9, functional tremor n=4, anosmia n=1, combined upper and lower motor neuron signs, n=2, radicular distribution numbness n=1, distal symmetrical weakness and hypoaesthesia n=5, peripheral nerve hypo- aesthesia n=2, fatigability and lid lag n=2.) Our data showed that a large proportion of general neurology patients had neurological signs.

Case Presentation Competition, 5 Back to Basics

Serotonin syndrome associated with clozapine withdrawal and concurrent selective serotonin reuptake inhibitor (SSRI) use has previously been reported. A 56-year-old female with schizophrenia was admitted for pyrexia, rigidity, and altered mental state after her second dose of clozapine restart. She had discontinued her long-term clozapine 2 weeks prior. She developed ventilatory failure, reduced consciousness, eye deviation, and worsening rigidity, requiring ICU support. Examination showed a right upper motor neurone syndrome with absent ankle reflexes. She had raised inflammatory markers and creatine kinase. Serum neuropathy, encephalitis screen, and COVID PCR were negative. Respiratory investigations were unfruitful. MRI head and spine did not show brain or cord signal change to correlate to signs. Lumbar puncture showed a quiet CSF, negative culture, viral PCR, and encephalitis antibodies. EEG showed bihemispheric background slowing. Despite clinical improvement, repeat examination showed persistent signs. She was diagnosed with serotonin syndrome after developing a bilateral tremor. Treatment with cyproheptadine correlated with an improvement in her signs, cognitive state, and EEG. Serotonin syndrome can present with reversible neuromuscular signs. With clozapine withdrawal, it can require a prolonged time course of recovery in contrast with classical serotonin syndrome. Cyprohepta- dine can cause agranulocytosis and this delays clozapine restart.

Glial fibrillary acidic protein astrocytopathy in a patient with recent mRNA SARS-CoV-2 vaccination: COVERSHEET

Background: Literature describing triggers of GFAP astrocytopathy (GFAP-A) is limited. We report a case of GFAP-A in a patient with recent messenger ribonucleic acid (mRNA) severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) vaccination and discuss the possible pathogenesis. Case description: A 45-year-old gentleman presented with features of meningoencephalitis 31 days after the first dose and 4 days after the second dose of mRNA SARS-CoV-2 vaccination. He sequentially developed brainstem/cerebellar, autonomic and cord dysfunction. Cerebrospinal fluid was positive for GFAP autoantibody. Clinical improvement occurred after intravenous methylprednisolone and immunoglobulins. Conclusion(s): Although we are uncertain of a causal link of GFAP-A to mRNA vaccine, indirect activation of an underlying dysregulated immune milieu is plausible.Copyright © 2021 The Author(s)

comparative effectiveness of remotely delivered biopsychosocial interventions for the treatment of osteoarthritic pain. A network meta - analysis

Purpose: Osteoarthritis (OA) can cause pain, discomfort, stiffness and progressively limit your ability to perform everyday tasks. Currently, there is no cure for OA, hence most patients experience chronic pain. Evidence suggests a shared mechanism between chronic pain and mental disorders. Patients living with OA- related chronic pain and depression have complex needs due to high rates of persistent physical and mental health symptoms, issues around inadequate pain relief, risks with opioid use, frequent lack of access to primary care, 80% unemployment rates, and complicated family/social relationships. Thus, they require physical, cognitive, and social treatments delivered by a multidisciplinary team that integrates physical and mental health approaches. The pandemic posed a major challenge for patients with osteoarthritis. Public health measures postponed non-emergency in-person treatment programs. People suffering from osteoarthritis are typically older which makes them more vulnerable to SARS-COV-2 infection. Telemedicine is a method that enables remote or virtual appointments between patients and health care practitioner. While remote care offers a wide range of benefits it is unclear if these interventions can provide similar effects with face-to-face care. In this study, we aimed to evaluate the effectiveness of remote biopsychosocial interventions in comparison to sham, traditional, or alternative remote treatments in patients with osteoarthritic pain and mental health symptoms using a network meta-analysis approach. Method(s): Eligible studies were randomized trials of remote biopsychosocial interventions that included at least one treatment arm provided remotely/virtually and compared to an alternative (sham, non-intervention, face-to-face treatment or alternative virtual/remote intervention). Patients had OA-related chronic musculoskeletal pain and at least 60% of participants had a mental health comorbidity or the analysis was disaggregated by mental health comorbidity. The primary outcome of interest was pain intensity at 12-weeks follow-up. Secondary outcomes were depression levels, dropouts/withdrawals and any adverse or serious adverse events reported. Potential mediators extracted were patient characteristics such as mean age, sex/gender and duration of symptoms/follow-up. We extracted data from the closest timepoint to 12-weeks follow-up for all outcomes. We critically appraised the included trials with the Cochrane risk of bias tool. Effect estimates were presented as standardized mean differences (SMD) and were comparisons between remote interventions and wait-list control. For all estimates, we reported the medians with corresponding 95% credibility intervals (CrIs) from the 2.5th and 97.5th percentile of the posterior distribution. The prespecified minimal clinically important between-group difference was -0.37 SD units. We estimated the probability of the effect of remote interventions of being superior to facilitate the interpretation of estimated treatment effects. We used a Bayesian random-effects network meta-analysis model. Analysis was conducted with OpenBUGS and STATA 16.0. Result(s): Overall, 21 trials with 4,426 patients with OA were included in this network meta-analysis. We identified 11 different interventions (combination or alone) such as usual care, exercise, education, cognitive behavioural therapy (CBT) guided or unguided delivered in different remote formats (internet, tele, mobile application or face-to-face). At 12-weeks follow-up, internet-delivered exercise (SMD -0.25, 95%Crl -0.59 to -0.09), Tele-CBT (SMD -0.22, 95%Crl -0.56 to 0.12) and a combination of Tele-CBT with education plus exercise (SMD -0.25, 95%Crl -0.66 to 0.15) had more pronounced treatment effects on pain reduction compared to wait-list control and 94%, 92% and 90% probability of being superior (respectively). For depression outcomes, a combination of tele-CBT with education plus exercise, had more pronounced treatment effects (SMD -0.31 95%Crl -1.16 to 0.53) when compared to wait-list-control and 86% pr bability of being superior. Conclusion(s): Internet-delivered exercise, Tele-CBT, and a combination of Tele-CBT with education plus exercise displayed higher probability of being superior than the other interventions, and had more pronounced effects in reducing pain intensity and depression levels when compared to wait-list control. However, none of these interventions excluded the null threshold.Copyright © 2023

Immunotherapy-responsive recurrent extensive white matter disease without neuronal or glial surface antibodies: A case report

Background: Acute disseminated encephalomyelitis (ADEM) is classically considered as a monophasic immune-mediated demyelinating disorder. A relapse can occur in children but extremely rare in adults. Case-report: A 57-year-old man presented with fulminant ADEM-like episode without proceeding viral illness. Neurological deficits rapidly developed associated with extensive demyelinating brain lesions with vasogenic edema. After the initiation of aggressive immunotherapy, his symptoms resolved, but he relapsed twice during 26-month observation period;one was a mild episode characterized by rapidly evolving MRI lesions without development of symptoms, and the other was a fulminant ADEM-like episode similar to the first one. The second fulminant episode occurred only 2 days after getting a flu shot despite no clinical or radiological relapse when he received COVID-19 vaccinations. The patient's symptoms and extensive brain MRI lesions improved after the initiation of aggressive immunotherapy at the early stage. No autoantibodies against neuronal surface (such as GABA A receptor) or glial surface antigens (aquaporin 4, or myelin oligodendrocyte glycoprotein) were identified in either serum or CSF. Conclusion(s): Extensive white matter lesions can occur without neuronal or glial surface antibodies, recurrent fulminant ADEM-like episode can develop even in an adult patient, and flu shot may provoke fulminant ADEM-like episode.Copyright © 2022

Behavioral inflexibility in fragile X syndrome: Accounts from caregivers and self-advocates.

Introduction: Behavioral difficulties in individuals with fragile X Syndrome (FXS) are one of the primary reasons families seek medical and psychological support. Among these, behavioral inflexibility is very common, and when left untreated, can negatively impact quality of life for the individuals with FXS and their families. Behavioral inflexibility refers to the difficulty in changing one's behaviors based on environmental demands or social contexts, thus impeding daily functioning, opportunities for learning, and social interactions. In addition to the individual and family impact, behavioral inflexibility is often recognized as a defining phenotype of FXS and appears to be specific to FXS when compared to other genetic forms of intellectual disability. Despite the pervasiveness and severity of behavioral inflexibility in FXS, there are limited measures that adequately assess behavioral inflexibility in FXS. Methods: We conducted semi-structured virtual focus groups with 22 caregivers, 3 self-advocates, and 1 professional to gather key stakeholders' perspectives on and experiences of inflexible behavior observed in FXS. Audio-recordings from focus groups were transcribed using NVivo, then verified and coded. Two trained professionals reviewed codes to extract primary themes. Results: Six themes were extracted: (1) Intolerance of change, (2) Intolerance to uncertainty, (3) Repetitive interests and behaviors, (4) Family impact, (5) Change in behavior across the lifespan, and (6) Impact of the COVID pandemic. Our findings show common examples of these themes included intolerance to disruption to routine, perseverative questioning, watching the same things over and over, and caregivers having to extensively pre-plan for events. Discussion: The purpose of the current study was to gain key stakeholders' perspectives via focus groups to elicit information and understand patterns of inflexible behaviors in FXS, with the goal of developing a disorder-specific measure to accurately assess behavioral inflexibility across the lifespan and in response to treatment. We were able to capture several phenotypic examples of behavioral inflexibility in FXS as well as their impact on individuals with FXS and their families. The wealth of information gained through our study will aid in our next steps of item generation for measure development of Ratings of Inflexibility in Genetic Disorders associated with Intellectual Disability - Fragile X Syndrome (RIGID-FX).

Remote scoring models of rigidity and postural stability of Parkinson's disease based on indirect motions and a low-cost RGB algorithm.

Background and objectives: The Movement Disorder Society's Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III) is mostly common used for assessing the motor symptoms of Parkinson's disease (PD). In remote circumstances, vision-based techniques have many strengths over wearable sensors. However, rigidity (item 3.3) and postural stability (item 3.12) in the MDS-UPDRS III cannot be assessed remotely since participants need to be touched by a trained examiner during testing. We developed the four scoring models of rigidity of the neck, rigidity of the lower extremities, rigidity of the upper extremities, and postural stability based on features extracted from other available and touchless motions. Methods: The red, green, and blue (RGB) computer vision algorithm and machine learning were combined with other available motions from the MDS-UPDRS III evaluation. A total of 104 patients with PD were split into a train set (89 individuals) and a test set (15 individuals). The light gradient boosting machine (LightGBM) multiclassification model was trained. Weighted kappa (k), absolute accuracy (ACC ± 0), and Spearman's correlation coefficient (rho) were used to evaluate the performance of model. Results: For model of rigidity of the upper extremities, k = 0.58 (moderate), ACC ± 0 = 0.73, and rho = 0.64 (moderate). For model of rigidity of the lower extremities, k = 0.66 (substantial), ACC ± 0 = 0.70, and rho = 0.76 (strong). For model of rigidity of the neck, k = 0.60 (moderate), ACC ± 0 = 0.73, and rho = 0.60 (moderate). For model of postural stability, k = 0.66 (substantial), ACC ± 0 = 0.73, and rho = 0.68 (moderate). Conclusion: Our study can be meaningful for remote assessments, especially when people have to maintain social distance, e.g., in situations such as the coronavirus disease-2019 (COVID-19) pandemic.

Multisystem inflammatory syndrome associated with COVID-19 in children: Risk factors of severe life-threatening course of the disease

Background/Purpose: Multisystem inflammatory syndrome in children (MIS-C), associated with COVID-19 infection is a life-threatening condition, required intensive care. The aim of this study was to determine risk factors for severe/life-threatening course of MIS-C. Method(s): The retrospective study included 166 children (99 male, 67 female), aged from 4 months to 17 years (median 8.2 years), who met the WHO criteria for MIS-C. The criterion of severity was the fact of the ICU admission. The analysis of the obtained data was performed using the STATISTICA software package, version 10.0 (StatSoft Inc., USA). Result(s): To assess the factors associated with the severe course of MIS-C, patients were divided into two groups: those who were hospitalized in the ICU (n = 84;50.6%), and those who did not (n = 82;49.4%). Patients with a more severe course of MIS-C were significantly older. They had a high frequency of signs such as rash, edema, hepatomegaly, splenomegaly, neurological and respiratory symptoms. Hypotension/shock and myocardial damage were much more common in patients hospitalized in the ICU. Among the laboratory changes there were significant differences in the levels of hemoglobin, leukocytes and platelets, CRP, creatinine, troponin and D-dimer. The presence of macrophage activation syndrome was higher in patients, admitted in the ICU. Children, required intensive care required high dose corticosteroids and IVIG more often (table 1). FIGURE: 1) The first symptoms of progeria in infancy: scleroderma-like changes in the skin of the lower extremities and stiffness of knee joints at the age of 2 months. 2) Girl at the age of 3 years 5 months. Almost total alopecia with the absence of eyebrows and eyelashes. Pronounced venous pattern in the forehead, nasal bridge and nasolabial triangle. Conclusion(s): MIS-C is potentially a severe life-threatening condition, in which more than half (50.6%) of patients needed the ICU admission. The main factors determining the severity of MIS-C were: cardiovascular, resiratory and central nervous system disorders. It has been found that factors such as hepatomegaly, splenomegaly, D-dimer >2568 ng/ml, troponin >10 pg/ml, make it possible to identify a group of patients with high risk of severe MIS-C who may potentially need hospitalization in the ICU.

The headache of diagnosing cerebellitis

Case Report:We describe a case of a non-verbal 5-yearold patient with autism and global developmental delay who presented with headache, nausea, vomiting, and decreased oral intake and found to have acute cerebellar syndrome/cerebellitis secondary to COVID-19 infection. Method(s): Chart Review. Summary of Results: A 5-year-old male with autism spectrum disorder and global developmental delay presented with one week history of headache, nausea, and non-bilious, non-bloody emesis. Despite intravenous fluid resuscitation and anti-emetic treatment, the patient continued to have persistent emesis with decreased oral intake and urine output. Physical exam findings were notable for aniscoria with right pupil larger than left, fixed upward gaze deviation, horizontal nystagmus, and nuchal rigidity. Patient was able to move all extremities spontaneously with normal tone and without rigidity or hyperreflexia. A complete blood cell count was consistent with the following: WBC 17.29 K/uL, hemoglobin level 12.8 g/dL, hematocrit 38.9%, and platelet count 482 K/ uL. C-reactive protein <4.0 mg/L and procalcitonin 0.12 ng/mL. CT Head on hospital day one showed no acute intracranial abnormality. Due to the patient's acute neurological changes, MRI brain was obtained and revealed patchy areas of hyperintensity in both the cerebellar hemispheres with moderate swelling of the cerebellum causing narrowing of the posterior fossa extra-axial cerebrospinal fluid (CSF) spaces. In addition, there was obstruction of the cerebral aqueduct due to extrinsic mass effect by the swollen cerebellum. CSF studies were notable for the following: 148 total nucleated cells with 75% lymphocytes and 17% monocytes and 2 red blood cells, protein was elevated at 113 mg/dL, and glucose was normal at 52 mg/dL. Meningitis and encephalitis panel was without any acute findings. Other laboratory testing was negative for tuberculosis, syphilis, chlamydia, HIV, and EBV. The patient tested positive for COVID-19 virus about one month prior to the onset of symptoms. Imaging and laboratory results in the setting of obstructive hydrocephalus with associated symptoms of nausea, emesis, headache, and upward gaze deviation are consistent with acute cerebellar syndrome, or cerebellitis. Due to obstructive hydrocephalus and inflammation of the cerebellum, patient was started on high-dose steroids, and neurosurgery placed external ventricular drain (EVD). The patient worked closely with physical medicine and rehabilitation as well as speech therapy, physical therapy, and occupational therapy to make a full recovery following this illness. Conclusion(s): Headache, nausea, and vomiting are often seen as benign findings;however, it is important to obtain specific details regarding the timing of symptoms, especially in the setting of a non-verbal patient. Because inflammation of the cerebellum can lead to hydrocephalus and potential herniation, prompt diagnosis is crucial to prevent long term effects of cerebellitis. Copyright © 2023 Southern Society for Clinical Investigation.

A diagnostic conundrum: case of acute appendiceal abscess mimicking multisystem inflammatory syndrome in children in a toddler

Case Report: Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) can commonly present with gastrointestinal symptoms of abdominal pain, vomiting, or diarrhea. These symptoms along with high fever and elevated inflammatory markers can often mask underlying gastrointestinal inflammation and lead to a diagnostic dilemma. Case Presentation: We report a case of a 16-month-old with a history of exposure to SARS-Cov-2 virus, who presented with fever, cough, vomiting, and decreased activity. Her initial workup showed neutrophil-predominant leukocytosis with elevated CRP, ferritin, NTProBNP, and fibrinogen. Serology was positive for COVID-19 IgG antibodies, strongly favoring a diagnosis of MIS-C. Initial CT of the abdomen showed findings consistent with mild enteritis. Intravenous immunoglobulin was not administered as leukocytosis and all inflammatory markers except CRP improved during the course of her hospital stay with parenteral antibiotics, but she remained febrile with worsening abdominal symptoms. She then developed classic symptoms of peritonitis with tenderness and rigidity. Ultrasound of abdomen was inconclusive due to overlying bowel gas. Repeat CT of the abdomen showed multiple intra-abdominal abscesses with the largest rim enhancing lesion in the right lower quadrant. Her presentation was consistent with acute appendiceal abscess due to perforated appendix that improved with CT guided drainage and three weeks of intravenous antibiotics. She was then discharged and planned for an interval appendectomy after two weeks. [Figure presented] Conclusion(s): Symptoms of appendiceal abscess can mimic MIS-C. This case underscores the importance of considering appendicitis in the differential diagnosis in patients with MIS-C. Appendicitis can be missed in toddlers. Hence, clinical suspicion and repeat imaging is key for early diagnosis in this age group. CT Abdomen and Pelvis with intravenous and oral contrast showing findings of perforated, complicated acute appendicitis, with multiple abscesses. Copyright © 2023 Southern Society for Clinical Investigation.

Generation Of Macro-scale And Mature Lung Organoids Through Engineering Cell Microenvironment

Purpose/Objectives: <Most used lower respiratory tract models consist of cell monolayers which lack of tissue and organ level response and of in-vivo phenotype. Ex-vivo lung tissues have short viability and limited availability. Lung organoids, which recapitulates better the 3D cellular complex structures, architecture, and in-vivo function, fail to reach maturity even after 85 -185 days of culture. Therefore, these models have a limited use to study fetal lung diseases. Other lung models, consist of only one structure of the lower track, such as bronchial tubes or alveoli, but fail to recapitulate the whole organ structure. In this work, cell microenvironment was used to promote the self-organization of epithelial and mesenchymal cells into macro-structures, aiming to mimic the whole and adult lower respiratory tract model> Methodology: <Different parts of the microenvironment were considered to create a compliant matrix. Alginate-Gelatin hydrogels were used for 3D encapsulation of mesenchymal origin cells. This hydrogel provided a stiffness like the one on the lung. Base membrane zone proteins were used to induce the attachment and guidance of epithelial cells into 3D structures. The interactions between both cell types, further guided them into lung fate. The morphology of resulting organoids was analyzed using immunostaining and confocal microscopy, LSM710, with the purpose of evaluate polarization, protein markers, and different cell populations. Quantitative PCR was performed to evaluate and compare the expression of lung fate genes with traditional cell monocultures.> Results: <The engineered microenvironment and protocol development done in this work resulted in macro-scale structures, in which branching morphogenesis occurred at day 21. Different structures were identified in the organoid including bronchial tube, bronchioles, and alveoli. Polarization of the organoids was confirmed by visualization of E-cadherin, and ZO-1. Expression of Surfactant Protein B and C into the organoids confirmed the presence of alveolar type II cells, which are only present in the later development stage. Surfactant Protein B, Transmembrane protease, serine 2, TMPRSS-2, and Angiotensin-converting enzyme 2, ACE2 were found to be significantly higher expressed into the organoids in comparison with traditional epithelial cells monolayers.> Conclusion/Significance: <Growth factors are normally used to induce the fate of stem cells into lung organoids;however, these fail to reach maturity. Here, we developed a new methodology to induce the formation of the organoids based on the cell microenvironment. The resulting organoids require less time for development. The initial stage of adult cells can be modulated through culture conditions induce a 3D structure like the adult lung. As such, these organoids have the potential to be used for modeling adult diseases and to develop specific models from patient cells, which is one step forward to personalized medicine. SFTPB is one of the main proteins which facilitates the breathing process. Its high expression into our model may indicate that breathing occurs into our lung organoids. The higher expression of TMPRSS-2 and ACE2 into the organoids has a major significance in the field of virology since both proteins are the mainly entrance of SARS-CoV-2, and influenza H1N1.>.

A CASE OF COMMON VARIABLE IMMUNODEFICIENCY (CVID) COMPLICATED BY GRANULOMATOUS LYMPHOCYTIC INTERSTITIAL LUNG DISEASE (GLILD) TRIGGERED BY RECENT COVID-19 INFECTION

SESSION TITLE: Unique Inflammatory and Autoimmune Complications of COVID-19 Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Common variable immunodeficiency (CVID) is a primary immunodeficiency disorder characterized by low serum IgG, IgA and/or IgM, and poor specific antibody production. CVID is estimated to affect as many as 1 in 25,000 individuals. Chronic lung disease is a common problem in patients with CVID. About 10-20% of patients have lymphocytic infiltrates and/or sarcoid-like granulomas, with several histological findings, termed granulomatous and lymphocytic interstitial lung disease (GLILD). CASE PRESENTATION: Patient is a 61-year-old Caucasian woman with a history significant for CVID in remission who presented to the Pulmonary Clinic with a chief compliant of dyspnea of exertion (DOE). Patient was not suffering from any respiratory complaints until the diagnosis of severe COVID-19 pneumonia 4 months prior. For the following months, patient was slowly improving but was still suffering from severe DOE that has negatively impacted her quality of life. Patient has a remote history of smoking, having quit 10 years ago. Patient denied any joint pain, stiffness, swelling, skin rash, muscle ache, or weakness. No known history of SLE, Rheumatoid Arthritis, or other collagen vascular disorders had been reported. Patient denied any exposure to birds. Physical exam was significant only for bilateral basal rales with no wheezing or crackles. No skin rash, joints deformities, or clubbing was noticed. Laboratory studies revealed ESR was 17 with a CRP of 10.6. Negative ANA, SM, RNP, and SSA/SSB antibodies. Her Immunoglobulins levels were low with IgG 382 (nl > 610) and IgA < 2 (nl > 85). Her PFT revealed severe restrictive process with TLC 46% of predicted and severe reduction in DLCO at 35%. CT chest revealed diffuse central groundglass opacities, and interstitial thickening with traction bronchiectasis. Lung biopsy via VATS revealed lung parenchymal with focal, noncaseating granulomas, foci of focal interstitial lymphocytic infiltration and fibrosis;features consistent with Granulomatosis-Lymphocytic Interstitial Lung Disease (GLILD). Systemic steroid initiated and for the following weeks patient reports significant improvement in DOE. Her PFT at 3 month follow up showed significant improvement in FVC (5% increase), TLC (11% increase), and DLCO (5% increase). DISCUSSION: The respiratory manifestations of CVID follow two main mechanisms: injury due to acute or recurrent infections and damage due to poorly understood immune-mediated processes. Severe COVID-19 results in dysregulated immune and inflammatory response that can worsen an underlying lung disease. Previous cases have been reported about CVID with GLILD complicated with COVID-19 infection but not vice versa. CONCLUSIONS: To our knowledge, this is a rare case of CVID complicated by GLILD triggered by recent COVID-19 infection. However, little is known about the association between COVID-19 infection and GLILD and further investigation is needed. Reference #1: Ho HE, Mathew S, Peluso MJ, Cunningham-Rundles C. Clinical outcomes and features of COVID-19 in patients with primary immunodeficiencies in New York City. J Allergy Clin Immunol Pract. 2020;S2213–2198(20):31102–8. Reference #2: Prasse A, Kayser G, Warnatz K. Common variable immunodeficiency-associated granulomatous and interstitial lung disease. Curr Opin Pulm Med. 2013;19:503–9. Reference #3: Cunningham-Rundles C, Bodian C. Common variable immunodeficiency: clinical and immunological features of 248 patients. Clin Immunol. 1999;92:34–48. DISCLOSURES: No relevant relationships by husam nayef No relevant relationships by Arshia Vahabzadeh No relevant relationships by Zaid Yaqoob No relevant relationships by Mohammad Zalt

Psychological distress associated with acculturation in Latinx youth

There are various areas in the United States whose geographic location makes for unique rural communities, distanced from cities in more urban or industrialized regions. One such place is the population of Presidio, Texas, a rural community of approximately 5,000 people with the nearest cities being approximately 250 miles away. Existing research attempts to define acculturation through the lens of Latino or Hispanic cultures, otherwise known as Latinx, often failing to address specific subcultural groups within this cultural classification and disregarding the inter- and within cultural differences that may be impacted by regional differences (Michaels, 2014). Latinx, or Latino/Latina, is the umbrella term used for individuals of Latin descent. Populations of Mexican American adolescents residing in rural communities are believed to be uniquely affected by the acculturation or enculturation processes (Michaels, 2014). Acculturation refers to the process of integrating and adopting the values, customs, norms, attitudes, and behaviors of the dominant host culture (Nair et al., 2018). This happens when two or more cultures meet requiring an individual to adapt (Nair et al., 2018). Like acculturation, enculturation refers to socialization but is the individual process. A person learns the dynamics of their surrounding culture and acquires values and norms appropriate or necessary in that culture, like a child being born into a specific culture who naturally learns the culture's dynamics (Lorenzo-Blanco et al., 2012). As part of this process, the influences that limit, direct, or shape the individual (whether deliberately or not) include parents, other adults, peers, exposure to media, school settings, and so on. Several studies suggest gender roles may play a significant role in the way females and males respond to the acculturation process, resulting in differences in mental health outcomes (Revilla, 2008;Diaz & Bui, 2017). This study used the Brief Acculturation Rating Scale for Mexican Americans-II (ARSMA) and the Patient-Reported Outcomes Measurement System (PROMIS) to determine if psychological well-being is associated with levels of acculturation (ARSMA, n.d.;PROMIS, n.d.). The study focused on a group of students believed to be affected by the acculturation process due to disadvantages related to cultural factors or race. These students have been identified as English Language Learners (ELL) that participate in Limited English Proficiency programs in public school systems. By investigating Mexican American youth between ages 13 and 17 who reside in a rural border community, this study focused on this specific cultural group rather than the general Latinx population. Ultimately, the goal of the present study was to identify gender differences in acculturation and psychological well-being within Mexican American ELL youth residing in a rural border-town community. Due to obstacles related to the COVID-19 pandemic, the researcher was unable to gather a large enough sample to yield statistical significance. (PsycInfo Database Record (c) 2022 APA, all rights reserved)