A Case of Lactobacillus casei Endocarditis Associated With Probiotic Intake in an Immunocompromised Patient.

Probiotics are microorganisms, typically bacteria, similar to beneficial microbiota found in the human gut, usually consumed as dietary supplements or fermented foods. Although probiotics are generally safe, several cases of bacteremia, sepsis, and endocarditis associated with probiotics have been reported. Here we report a rare case of Lactobacillus casei endocarditis in a 71-year-old female, immunocompromised due to chronic steroid intake, who presented with a productive cough and low-grade fever. Blood cultures grew L. casei resistant to vancomycin and meropenem. Transesophageal echocardiography showed mitral and aortic vegetations; valve replacement was done after successfully removing vegetations. She was treated with a six-week course of daptomycin and recovered.

A Thorn in his Side

History: A 20 year old D1 men's basketball player with a history of COVID the month prior presented with worsening low back pain. He denied any injury, but reported the pain started as low back discomfort after a basketball game the week prior. He noted a progression and radiation of pain down his right lower extremity to his toes. He had tried physical therapy and dry needling, as well as cyclobenzaprine and naproxen from team physicians with mild improvement. The pain worsened and he went to the ED for evaluation. He was afebrile and had a lumbar radiograph with no acute fracture, grade 1 anterolisthesis of L5 on S1. He was discharged home with norco. Over the next 2 days, he developed chills and in the context of his worsening back pain, his team physicians ordered an MRI. Physical Exam: BMI 26.9 Temp 97.9degree Heart rate: 73 Respiratory rate 14 BP: 124/64 MSK: Spine- Intact skin with generalized pain over lumbar area, worse over the right paraspinal musculature. 5/5 strength of bilateral lower extremity flexion and extension of his hips, knees, and plantar and dorsiflexion of ankles and toes. Bilateral intact sensibility in the sciatic, femoral, superficial, and deep peroneal, sural, and saphenous nerve distributions. Slightly diminished sensibility over the right deep peroneal nerve distribution compared to left. 2/4 patellar and achilles DTRs. No clonus, downgoing Babinski sign. Positive straight leg raise at 45 degrees with the right lower extremity. Differential Diagnosis: 141. Sciatica 142. Lumbar Muscle Strain 143. Disk Herniation 144. Spondylolisthesis 145. Vertebral Osteomyelitis Test Results: CBC:WBC10, HGB13.2, neutrophils 75.7% (red 45%-74%). Unremarkable CMP. CRP =7.31, ESR 23 Blood culture negative, throat culture negative. TB test negative. COVID test negative. Flu test negative. Urine culture and UDS negative. HIV test negative. Procalcitonin of 0.07. IR guided aspiration and bacterial Culture yielded MSSA. MRI w/contrast: showing L1-L4 facet edema concerning for infectious spondylitis, intramuscular, and epidural abscess. Final Diagnosis: Acute intramuscular abscess, vertebral osteomyelitis, with epidural abscess. Discussion(s): Vertebral osteomyelitis is a serious but quite rare disease in the immunocompetent, elite athlete population. Staphylococcus Aureus is the culprit a majority of the time, with only 50% of cases showing neurologic symptoms. This case was unique given the proximity to a dry needling treatment which is the only explainable vector of infection, normal blood cultures in this disease which hematogenously spreads, negativeHIV and other infectious disease testing, and otherwise benign history. Early recognition of this disease yields better outcomes and reduces incidence of severe debility. 5% to 10%of patients experience recurrence of back pain or osteomyelitis later on in life. Outcome(s): Patient was hospitalized and started on Cefepime and Vancomycin. Had an echocardiogram revealing changes consistent with athlete's heart without signs of vegetation on his cardiac valves. Neurosurgery declined to treat surgically. He continued to improve until he was ultimately discharged on hospital day 4 with a picc line and Nafcillin and was later changed to oral augmentin per ID. Follow-Up: By his 6 week follow-up visit with infectious disease and the team physicians, his back pain had completely resolved and was cleared to start a return to play protocol. There was no progression of disease since starting antibiotics, and no recurrence of back pain since treatment.

Disaster Risk Reduction for Resilience: Disaster Risk Management Strategies

This book is part of a six-volume series on Disaster Risk Reduction and Resilience. The series aims to fill in gaps in theory and practice in the Sendai Framework, and provides additional resources, methodologies and communication strategies to enhance the plan for action and targets proposed by the Sendai Framework. The series will appeal to a broad range of researchers, academics, students, policy makers and practitioners in engineering, environmental science and geography, geoscience, emergency management, finance, community adaptation, atmospheric science and information technology.This volume offers the international guidelines and global standards for resilient disaster risk reduction and lessons learned from disasters, particularly the COVID-19 and Cholera pandemics. A resilient health system and an effective disaster risk management Index are then suggested. The book further emphasizes urban resilience strategies with local authorities, adaptation strategies for urban heat at regional, city and local scales, and lessons from community-level interventions. Also addressed are coastal erosion, displacement and resettlement strategies. Land use planning and green infrastructure are suggested as tools for natural hazards reduction. Human security in times of climate change and urban heat at regional, city and local scales is discussed for an integrated action, with case studies based in Manila, Burkina Faso, Chad, Mauritania, Niger, Senegal, Nigeria, India, Spain, and Ghana. Structure design for cascading disasters resulting from mining and flooding is presented and sustainable smart city planning using spatial data is recommended. © Springer Nature Switzerland AG 2022.

Tropheryma Whipplei Endocarditis: A Diagnosis In Hindsight

Description of case: We report a case of Tropheryma whipplei endocarditis, a rare cause of bloodculture-negative infective endocarditis (BCNIE). Due to its rarity and lack of availability of diagnostic tests in district hospitals, the diagnosis remains challenging. The objective of this case report is to increase physician awareness of this pathogen. A 61-year-old man presented to the Emergency Department with central chest pain at rest. A 12-lead ECG demonstrated ST- segment depression in V4-V6 leads, and his serial troponin levels were raised. He was commenced on treatment for acute coronary syndrome and transferred to the Coronary Care Unit. An echocardiogram showed a 15mm x 15mm vegetation in the aortic valve with mild aortic regurgitation. His initial microbiology workup, which included two sets of blood cultures (pre-antibiotics), MRSA screen & COVID-19 PCR, was negative. He was transferred to a cardiothoracic centre four days later. Pre-operative CT coronary angiogram showed severe three vessel coronary artery disease. He underwent triple coronary artery by-pass grafts and tissue aortic valve replacement. During early post-op recovery, he had fever episodes and an elevated C-reactive protein of 280 mg/L but normal white cell counts. He was treated with intravenous Tazocin for hospital-acquired pneumonia and discharged on doxycycline. Two weeks post-discharge, he had a positive 16S/18S PCR for Tropheryma whipplei on molecular analysis of the aortic valve. He was treated for Whipples endocarditis with a 4-week course of IV Ceftriaxone, followed by a 12-month course of oral Cotrimoxazole. The patient has reported doing well since the surgery. Discussion(s): Molecular assay with PCR of the heart valve is the mainstay of diagnosing Whipple's endocarditis. There have been 5 previously reported cases of Whipple's endocarditis in the United Kingdom in our knowledge. It is likely under-reported because of a reliance on tissue diagnosis. Preceding intestinal manifestations and arthralgia should raise its clinical suspicion for timely workup. Physician awareness of Whipple's Endocarditis is paramount in investigating for this pathogen.

Preface

International Conference on Geospatial Science for Digital Earth Observation (GSDEO 2021)The international conference on "Geospatial Science for Digital Earth Observation” (GSDEO) 2021 was successfully held on a virtual platform of Zoom on March 26th and 27th, 2021. The conference was jointly organized by the Indian Society of Remote Sensing (ISRS), Kolkata chapter, and the Department of Geography, School of Basic and Applied Sciences, Adamas University. Due to the non-predictable behaviour of the COVID-19 second wave, which imposed restrictions on organizing offline events, the GSDEO (2021) organizing committee decided to organize the conference online, instead of postponing the event.Remotely sensed data and geographic information systems have been increasingly used together for a vast range of applications, which include land use/land cover mapping, water resource management, weather forecasting, environmental monitoring, agriculture, disaster management, etc. Currently, intensive research is being carried out using remotely sensed data on the geoinformatics platform. New developments have led to dynamic advances in recent years. The objective of the international conference on Geospatial Science for Digital Earth Observation (GSDEO 2021) was to bring the scientists, academicians, and researchers, in the field of geo-environmental sciences on a common platform to exchange ideas and their recent findings related to the latest advances and applications of geospatial science. The call for papers received an enthusiastic response from the academic community, and over 100+ participants from 50+ colleges, universities, and institutions participated in the conference. In total 50+ research papers had been presented through the virtual Zoom conference platform in GSDEO 2021.The conference witnessed the presentation of research papers from diverse applied fields of geospatial sciences, which include the application of geoinformatics in geomorphology, hydrology, urban science, land use planning, climate, and environmental studies. There were four sessions namely, TS 1: Geomorphology and Hydrology, TS 2: Urban Science, TS 3: Social Sustainability and Land Use Planning, and TS 4: Climate and Environment. Each session was further subdivided, into two parts, namely Technical Session 1-A and 1-B. Each sub-session had been designed with one keynote speech and 5 oral presentations. Oral sessions were organized in two parts and offered through live and pre-recorded components based on the preference of the presenters. The presentation session was followed by a live Q&A session. The session chairs moderated the discussions. Similarly, poster sessions were organized in three parts and offered e-poster, live, and pre-recorded components. The best presenter of each sub-session received the best paper award.Dr. Prithvish Nag, Ex-Director of NATMO & Ex Surveyor General of India delivered the inaugural speech, and Dr. P. Chakrabarti, Former Chief Scientist of the DST&B, Govt. of West Bengal delivered a special lecture after the inaugural session. Eight eminent keynote speakers, Prof. S.P. Agarwal from the Indian Institute of Remote Sensing, Prof. Ashis Kumar Paul from Vidyasagar University, Prof. Soumya Kanti Ghosh from the Indian Institute of Technology, Kharagpur, Prof. L. N. Satpati from the University of Calcutta, Prof. R.B. Singh from the University of Delhi, Dr. A.K. Raha, IFS (Retd), Prof. Gerald Mills from the University College Dublin and Prof. Sugata Hazra from Jadavpur University enriched the knowledge of participants in the field of geoinformatics by their informative lectures. The presentations and discussions widely covered the various spectrums of geoinformatics and its application in monitoring natural resources like vegetation mapping, agricultural resource monitoring, forest health assessment, water, and ocean resource management, disaster management, land resource management, water and climate studies, drought vulnerability assessment, groundwater quality monitoring, accretion mapping and the use of geospatial sci nce in studying morphological, hydrological, and other biophysical characteristics of a region etc. Application of geoinformatics in predicting urban expansion, urban climate, disaster management, healthcare accessibility, anthropogenic resource monitoring, spatial-interaction mapping, and, sustainable regional planning were well-discussed topics of the conference.List of Committees, photos are available in the pdf.

Effect of vegetation and land surface temperature on NO2 concentration: A Google Earth Engine-based remote sensing approach

With the increasing tension on the global sustainable environment in the urban areas, it is essential to monitor the airborne pollutants and understand the underlying factors that can trigger the situation in a worst-case scenario. Because of its cramped living conditions, excessive coal and fuel usage, and rapid deforestation, the southeast Asian region has historically had worse air quality than the rest of the world. The economic hubs of India and Bangladesh, in particular, have drawn so much attention away from rural regions that unrestrained urbanization is becoming controversial for planners, engineers, and stakeholders in sustainable development. This research combines the two main Asian capital regions, Delhi and Dhaka. It analyzes the change in nitrogen dioxide (NO2) concentration, land surface temperature (LST), and vegetation dynamics across three years (2019-2021) for summer and winter. The NO2 concentration data from Sentinel-5P has been extracted using Google Earth Engine (GEE), and Landsat-8 imagery was utilized for LST, Normalizer Vegetation Index (NDVI), and Enhance Vegetation Index (EVI). The statistical analysis has been carried out by dividing the research regions into one sq. km grid (1512 grids for Delhi and 1485 grids for Dhaka). According to descriptive research, Dhaka's condition is worse than Delhi's, with significant vegetation loss with LST and NO2 concentrations rising. In both research regions, the NO2 concentration is high throughout the winter. The Pearson correlation value demonstrates a negative association between total NO2 concentration and mean NDVI and EVI values and a positive relationship between total NO2 concentration and mean LST. The data have been further assessed using linear regression, which overlaps the correlation result with a maximum R-squared value of 0.2998 for NO2 and EVI in winter 2019.

Measures of Greenspace Exposure and Their Association to Health-Related Outcomes for the Periods before and during the 2020 Lockdown: A Cross-Sectional Study in the West of England

Greenspaces are argued to be one of the important features in the urban environment that impact the health of the population. Previous research suggested either positive, negative, or no associations between greenspaces and health-related outcomes. This paper takes a step backward to, first, explore different quantitative spatial measures of evaluating greenspace exposure, before attempting to investigate the relationship between those measures and health-related outcomes. The study uses self-reported health data from an online cross-sectional survey conducted for residents in the West of England. This yielded data of greenspace use, physical activity, wellbeing (ICECAP-A score), and connectedness to nature for 617 participants, divided into two sets: health outcomes for the period before versus during the 2020 lockdown. The study uses the participants' postcodes (provided in the survey) to calculate eleven spatial measures of greenspace exposure using the software ArcGIS Pro 2.9.5. A total of 88 multivariate regression models were run while controlling for eleven confounders of the participants' characteristics. Results inferred 57 significant associations such that six spatial measures of greenspace exposure (NDVI R200m, NDVI R300m, NDVI R500m, Network Distance to nearest greenspace access, Euclidean Distance to nearest greenspace access, and Euclidean Distance to nearest 0.5 ha doorstep greenspace access) have significant association to at least one of the four health-related outcomes, suggesting a positive impact on population health when living in greener areas or being closer to greenspaces. Moreover, there are further significant associations between the frequency of use of greenspaces and increasing physical activity or feeling more connected to nature. Still, the residents' patterns of using greenspaces significantly changed during versus before lockdown and has impacted the relationships between health outcomes and the greenspace exposure measures.

Effective Screening and Texture Segmentation of Green Vegetation Cover Based on UAV Images

As an important part of the ecosystem, green vegetation coverage is crucial to people's sensory and mental health. Using reliable data sets to classify and identify the green vegetation cover on the land surface and explore its spatial distribution law can provide important reference for the work of regional ecosystem managers and urban planners. The optimization of effective screening methods for green vegetation coverage areas is an important requirement to measure the surface vegetation status. UAV aerial images feature high definition, large scale, small area and high up-to-dateness. However, at present, there are few studies based on the reliable UAV aerial image system to identify green vegetation cover and further explore its spatial changes. In this study, 701 residential neighborhoods in Beijing were taken as the research objects, and the green vegetation of 7,695 sample points was identified by UAV. The green vegetation coverage was measured, and the spatial distribution pattern of green vegetation in different land surface areas was quantitatively compared. The results show that the image processing method proposed in this paper can effectively detect the boundary of green vegetation cover area from UAV aerial images, the correlation of texture segmentation is good, and the segmentation performance is better than other methods. The distribution of green vegetation cover in the research target area is uneven, with 63.79% of the research area having relatively low (Level 2) and medium (Level 3) green vegetation coverage, which indicates that the green vegetation coverage area in the research area is insufficient to meet the needs of regional ecosystem development. The characteristics of green vegetation cover in 16 districts in the study area are different, showing different spatial distribution patterns;except Xicheng District, there are 211 points without landscape in the area covered by green vegetation in 15 districts. The results can provide support for urban land surface planning and management.

What Is the Optimal Pk/Pd Target for Beta-Lactam Therapy of Infective Endocarditis? A Systematic Review

Aim: To elucidate the factors that influence beta-lactam pharmacokinetic (PK) and pharmacodynamic (PD) variability in infective endocarditis (IE) and to examine optimal PK/PD target parameters for therapy. Background(s): Beta-lactam antibiotics are the mainstay of therapy for most bacterial causes of IE. Traditionally considered as agents with a broad therapeutic index there has been increasing recognition that standard doses may be subtherapeutic or toxic in critically ill patients. Optimising therapy for efficacy requires an established PK/PD target associated with clinical and microbiological cure. Method(s): Clinical and laboratory in vivo animal or human studies examining PK and/or PD of beta-lactam antibiotics in IE were eligible. Ovid MEDLINE, Embase and Cochrane Central Registry were searched using defined terms. Two authors reviewed s and full texts using Covidence software. Result(s): 62 articles were selected for review and synthesis. We identified 45 animal studies investigating the broad categories of beta-lactam diffusion into vegetations, PK/PD determinants of outcome, mode of antibiotic delivery and synergistic impact of agents. 17 human case studies/series totalling 347 participants reported antibiotic serum concentrations and clinical outcomes. Findings generally supported the importance of time-dependent killing for beta-lactams but heterogeneous data limited the determination of an optimal PK/PD target for IE treatment. Conclusion(s): Beta-lactam PK and PD in endocarditis is variable and specific to the particular antibiotic-organism combination. Timedependent killing is important, consistent with non-endocarditis studies, but there is little agreement on optimal drug exposure. Clinical studies examining various PK/PD targets in endocarditis patients are required to further inform drug selection and dosing.Copyright © 2023 Southern Society for Clinical Investigation.

Role of the neighborhood environment in psychological resilience

Psychological resilience of residents is an important but often neglected component of community and urban resilience. This study explores what neighborhood environment features contribute to better psychological resilience. Using a survey conducted in Greater Melbourne during a COVID-19 pandemic lockdown, we examined the role of the neighborhood physical and social environments in mitigating the psychological shock of the pandemic. Overall, we found that suburban residents are more resilient in mental health than those in the inner city. In particular, the mental health of residents living in middle-density suburbs is least likely to be severely impacted. We further found that neighborhood walkability, vegetation cover, and social cohesion all contribute to better psychological resilience. Walkability and social cohesion influence psychological resilience indirectly through affecting the perceived risks of COVID-19 infection and satisfaction with neighborhood during the lockdown, whereas neighborhood greenery has a direct and beneficial effect on psychological resilience. These findings imply that planning interventions to improve neighborhood walkability and greenness, and foster social cohesion may help improve the psychological resilience of local residents, and hence promote urban resilience. These findings also support middle-density development, which promotes walkability and proximity to nature, as well as a close-knit community. © 2023 Elsevier B.V.

Beach litter in three South American countries: A baseline for restarting monitoring and cleaning after COVID-19 closure.

The COVID-19 pandemic caused that most countries established the closure of many beaches, affecting the scientific monitoring of thousands of coastal sectors. This article shows the status of beach litter in South America before and after COVID-19 closure. The data were obtained during the years 2019, 2020 and 2022 on 25 beaches using a technique BLAT-QQ. The results show that cigarette butts were the most frequent type of litter, meanwhile Brazil should improve cleanliness of general gross litter and gross polystyrene. Colombia gross vegetation litter and small vegetation litter, and Ecuador organic litter from animals. The results shown in qualitative and quantitative manner facilitate their understanding for managers, scholars and activists interested on beach litter monitoring. This baseline is useful to analyse regional and worldwide marine litter trends with the purpose to start or restart monitoring of tourist beaches from a science-based method.

Percutaneous Thrombectomy Using Angiovac System as a Diagnostic and Therapeutic Tool in Managing Right Atrial Mass in a High-Risk Patient

Background Right atrial (RA) masses often pose a dilemma in accurate diagnosis and management. We describe a challenging case of a large mobile RA mass in a febrile cancer patient. Case A 36-year-old female with newly diagnosed breast cancer on chemotherapy for 4 months via Port-A-Cath presented initially with COVID-19 pneumonia but continued to have persistent fever and dyspnea. A CT of the chest ruled out pulmonary embolism but showed an incidental RA mass. Echocardiography confirmed a large (2.7 x 1.6 cm), pedunculated mobile mass in the RA, attached to the free wall near the Eustachian valve (Fig.1). For a suspected thrombus, anticoagulation was initiated and a percutaneous thrombectomy using AngioVac was attempted. The mass was tightly attached to the atrial wall and too large to suction, resulting in only partial extraction of multiple tumor-like masses. Decision-making In addition to catheter-related thrombus and COVID-19 infection-related thrombus in transit, possibilities of myxoma, metastasis and fungal vegetation were considered due to its atypical features. A week later, pathology confirmed the diagnosis of an organized thrombus. Surgery was deferred and instead a repeat AngioVac using a larger aspiration catheter successfully aspirated the entire RA mass without complications. Conclusion Percutaneous aspiration of RA masses can prove to be of both diagnostic and therapeutic use, especially in high-risk patients. It can help avoid invasive surgical intervention in clinical dilemmas. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Multiple Monitoring Stations in Big Cities: First Example of Three Spore Traps in Rome

(1) Background: Rome is a municipality with an area of 1287 km2 and presents floristic-vegetational complexity that is reflected in the composition of aerospora, which are responsible for pollinosis. The presence of airborne pollen can be detected by pollen monitoring. The large extent of the city's territory makes it possible to verify possible changes in pollen composition in different sites of the city. With this in mind, a study was conducted to assess the differences in airborne pollen concentration, considering phenological and production indicators at three different sites in the city. (2) Methods: Pollen data of eight taxa were considered, Alnus spp., Castanea sativa Miller, Cupressaceae-Taxaceae, Olea europaea L., Platanaceae, Poaceae, Quercus spp., and Urticaceae, during 2020 and 2021, using three monitoring samplers. The airborne pollen concentration and the seasons of the three centers were calculated and compared with each other. (3) Results: The diversity between the three samplers shows a phenological succession in accordance with the microclimatic diversity present in the city. The heterogeneity of the airborne pollen concentration reflects the floristic-vegetational diversity, while qualitative and quantitative parameters indicate a homogeneous flowering trend reflecting the seasonality of the various species. (4) Conclusions: The present work and the Italian geographic context suggest the need for a greater number of sampling points to guarantee a true localization of the data. Having several sampling stations also contributes to the protection of health and green areas, which are difficult to manage, conserve, and maintain.

SURFACE URBAN HEAT ISLAND IN MOSCOW DURING THE COVID-19 PANDEMIC LOCKDOWN IN 2020

The influence of the COronaVIrus Disease 2019 (COVID-19) pandemic lockdown (the period of strict quarantine measures) in the spring of 2020 on the ‘Surface Urban Heat Island' (SUHI) geographical phenomenon in Moscow has been studied. For this purpose, we used the measurements of the surface temperature TS made by Moderate Resolution Imaging Spectroradiometer (MODIS) radiometer installed on Terra and Aqua satellites. As a result, TS during the 2020 lockdown, both in the city and surrounding rural zone, was found lower than at the same calendar time in the previous 20 years due to the relatively cold spring. The SUHI intensity as the difference between TS inside Moscow and the surrounding rural zone around it during the lockdown was also lower than usual (on average in the previous 20 years), but this decrease is relatively small and nonsignificant. The Normalized Difference Vegetation Index (NDVI) in Moscow and Moscow region during the lockdown was close to its usual values, but the leaf area index (LAI) was significantly lower than its average values in the previous 20 years. Thus, the weakening of the SUHI during the lockdown in 2020 was caused mostly by lower heat loss due to transpiration in the rural zone. This was associated with the slowdown in vegetation development as a result of the cold spring. Besides, an additional possible reason was the reduction of human activity due to the collapse of many anthropogenic heat sources in the city. According to long-term MODIS data, the SUHI intensity in Moscow and the surface temperature in Moscow region, as well as the NDVI and LAI values, do not demonstrate statistically significant long-term trends in the spring season over the past 21 years, despite climate changes. In spring, during faster snow melting in cities, when it still persists in the rural zone, the SUHI intensity can be record high (up to 8 ºC). © 2022, Russian Geographical Society. All rights reserved.

Health and Well-Being Benefits of Outdoor and Indoor Vertical Greening Systems: A Review

Green spaces have become the most threatened by urban growth, and the decline in these areas is a main cause of environmental and social problems with implications for human health and well-being. Vertical greenery systems have been proposed as a solution to restore the connection between the city and nature, particularly in compact and dense cities, where horizontal space is limited. This paper provides a literature review to examine the influence of outdoor and indoor vertical greenery systems on human health and well-being. The Web of Science and Scopus databases were chosen to survey peer-reviewed documents published until October 2022. A total of 73 documents were selected by the search. Over 71% of the documents were published over the last four years, and most of them focused on the environmental and thermal benefits of vertical greenery systems. Although these benefits could bring health and well-being outcomes, they were not objectively measured and quantified. Other additional gaps and guidelines for future research were also identified and discussed. This review could be helpful for researchers and urban planners in developing vertical greenery to create healthy and more sustainable cities.

Streptococcus Anginosus Causing Infective Endocarditis - a Rare Case of Multiple Splenic Infarctions

Background Information on infective endocarditis (IE) caused by the Streptococcus anginosus (S. anginosus) group is scarce. We present a case of IE with multiple splenic septic infarcts that was further complicated by renal involvement and osteomyelitis, caused by S. anginosus in a patient with diabetes. Case 58-year-old male with diabetes presented with fever and bilateral flank pain. His CT showed splenomegaly with multiple splenic infarctions and symmetric bilateral perinephric stranding indicative of nephritis. His Labs showed leukocytosis and two blood culture sets grew S.anginosus. Transesophageal echocardiogram confirmed vegetations on aortic valve (1.3 x 1.0 cm)(Image A, red arrow) and mitral valve (1.4 x 1.0 cm)(Image B, blue arrow). Lumbar spine MRI showed L2-3 vertebral osteomyelitis. [Formula presented] Decision-making Due to patient's normal oxygen saturation and clear lung auscultation and imaging, COVID-19 was ruled out. The etiology of his fever was diagnosed as S. anginosus IE, as evidenced by his vegetations and positive cultures. The patient started on IV antibiotics and IV fluids and was transferred to another facility to receive aortic and mitral bioprostheses. Conclusion This, to the best of our knowledge, is the first documented case of S. anginosus with splenic and renal involvement. The presence of multiple splenic infarcts in immunocompromised patients, in this case in someone with diabetes, should raise suspicion for the presence of vegetations and the diagnosis of S. anginosus IE.Copyright © 2023 American College of Cardiology Foundation

Recurrent Embolic Strokes in a Young Patient - a Case of Late Tavr Thrombosis and Endocarditis

Background Late complications of transcatheter aortic valve replacement (TAVR) are uncommon. We present a patient two-years post TAVR with recurrent strokes. Case A 56-year-old male with history of TAVR and pacemaker first presented with left-sided weakness found to have acute right MCA strokes and COVID. TTE showed a non-thickened valve with normal gradients and device interrogation revealed no arrhythmias. Six months later, he presented with acute left MCA strokes as well as new murmur, leukocytosis, and splenic infarcts on CT. TTE demonstrated a prosthetic aortic valve mean gradient of 43mmHg. TEE confirmed leaflet thrombosis with severe prosthetic aortic stenosis and mobile thrombus (Figure 1). Multiple sets of blood cultures were negative. Decision-making He was first treated with therapeutic anticoagulation but switched to broad spectrum antibiotics with increasing evidence for infection. He underwent Ross procedure with intra-operative evidence of multiple aortic root abscesses (Figure 1). PCR sequencing of the vegetation revealed staphylococcus species related to S. Haemolyticus. His course may be best explained by embolic stroke caused by progressive TAVR thrombosis in the setting of COVID-associated coagulopathy and subsequent superinfection leading to endocarditis and septic emboli. Conclusion Late TAVR thrombosis and endocarditis are rare complications. TAVR patients presenting with stroke merit prompt evaluation with dedicated echocardiographic imaging. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

COVID-19 lockdown effect on land surface temperature and normalized difference vegetation index

Coronavirus disease (COVID-19) has changed the human lifestyle just like a disaster in 2020. Many people died throughout the world due to its severe attack. Lockdown is the most common term used in today's life to prevent the adverse effect of COVID-19. However, during the lockdown period, a significant improvement in the urban environment was noticed in almost every part of the world. During the lockdown period, the decrease in the number of running vehicles and moving people on the road lowers the pollution level and it has a direct positive impact on the urban environment. The study examines the changes found in land surface temperature (LST) and normalized difference vegetation index (NDVI) during the lockdown period in Raipur city, India with the earlier periods (2013-19) to compare the environmental status. The results indicate that the LST is reduced and NDVI is increased significantly during the lockdown period, and the negativity of the LST-NDVI correlation is increased remarkably. The study also shows a better ecological status of the city during the lockdown period. The study is useful for environmental strategists and urban planners.

Looks Like a Vegetation but It Is Not Endocarditis

Background Myxomas are the second most common primary cardiac tumor (PCT) but overall have a low incidence rate. They usually arise from the interatrial septum whereas infective endocarditis (IE) vegetations frequently develop where there is turbulent blood flow, i.e., on the atrial side of the atrioventricular valves. Case A 75 year old male presented with fatigue, shortness of breath (SOB), myalgias and lower extremity edema for 2 weeks. His vital signs were stable and he was afebrile. Blood cultures were negative, WBC was normal, COVID-19 test was negative, and troponin was mildly elevated. TEE showed an ejection fraction of 20% with a large mitral valve (MV) mass (Figure 1A,B). Decision-making The mass was surgically resected and the MV was replaced (Figure 1C). On pathologic evaluation, the mass was confirmed to be a myxoma. The patient was later discharged without complication. Conclusion Clinical features of myxoma can overlap with IE including fever, malaise, SOB, and other signs of valvular obstruction or embolization. About 5% of myxomas originate from the MV and the differential diagnosis for an intra-atrial mass should include IE, PCT, metastatic tumors, and intracardiac thrombus. On echocardiography, myxomas appear irregularly frond-like or grape-cluster in shape. They are typically nonhomogeneous and can have areas of calcifications (Figure 1A). Both TEE and TTE are the mainstay for diagnosis of intracardiac masses and TEE specifically assists in guiding surgical excision. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

GIS-based spatial distribution analysis of water quality assessment using water pollution index of Yamuna river at Delhi

Pollution is one of the leading risk factors for the deterioration of the environment, mankind's poor health, and endangerment of the plant kingdom. The exploration of water pollution levels through a new remote sensing model "Water Pollution Index” makes this study unique, which is derived from the weighted overlay technique using land surface temperature, Chlorophyll Index, NCAI, and backscattering values from Sentinel 1, Sentinel 2, and Landsat 8 data sets. This chapter is concerned with the qualitative study of water pollution of the Yamuna river stretch, Delhi. To substantiate the results, sources are taken from different published papers and ground surveys. The objective is to define the pollution level and its contributing factors, algae blooming, sewage debris, coronavirus disease 2019 (COVID-19) shutdown impact, and rain in different seasons for two consecutive years, 2019 and 2020. A noticeable difference is found in the annual result indicating less pollution in 2020 especially in premonsoon data compared to 2019. © 2023 Elsevier Inc. All rights reserved.