Evaluation of diseases complicating long COVID: A retrospective chart review (preprint)

Purpose Evidence for the pathogenesis and treatment of post-acute coronavirus disease 2019 (COVID-19) (long COVID) is lacking. As long COVID symptoms are predicted to have an impact on the global economy, clarification of the pathogenesis is urgently needed. Our experiences indicated that some symptoms were complicated by diseases established before the COVID-19 pandemic.Methods Using a retrospective, cross-sectional study, we aimed to evaluate the diseases complicating long COVID. Using the medical records of patients with confirmed severe acute respiratory syndrome coronavirus 2 infection exhibiting residual symptoms lasting ≥ 60 days post-infection who visited our clinic in January 2021–February 2023, we investigated the symptoms and diseases observed. We identified diseases that occurred after COVID-19 infection and excluded those that were exacerbations of existing diseases. Results: During the first visit, the most common symptoms reported in a total of 798 patients were fatigue (523 patients), anxiety (349 patients), and lack of motivation (344 patients). Complicating diseases were observed in 452 patients (57%). There were 115, 65, and 60 patients with postural tachycardia syndrome, postural syndrome without tachycardia, and mood disorders, respectively. Some diseases requiring immediate treatment included pulmonary thromboembolism, purulent shoulder arthritis, cerebellopontine angle tumors, myasthenia gravis, and cervical myelopathy.Conclusion All symptoms that occur after COVID-19 infection should not be treated as long COVID. Similar to normal medical treatment, a list of differential diagnoses should be maintained based on symptoms to obtain definitive diagnoses.

Time Dependent Dihedral Angle Oscillations of the Spike Protein of SARS-CoV-2 Reveal Favored Frequencies of Dihedral Angle Rotations (preprint)

The spike protein of SARS-CoV-2 is critical to viral infection of host cells which ultimately results in COVID-19. In this study we analyze the behavior of dihedral (phi and psi) angles of the spike protein over time from molecular dynamics and identify that the oscillations of these dihedral angles are dominated by a few discrete, relatively low frequencies in the 23-63 MHz range with 42.96875 MHz being the most prevalent frequency sampled by the oscillations. We further observe that upon tallying the populations of each individual frequency for all residues along the frequency spectrum, there is a regular alternation between high and low population counts along the increasing frequency values in the spectrum. This alternation of the counts becomes less pronounced and ultimately stabilizes as the frequency values increase. These observations thus suggest a regularity and propensity in the spike protein's dihedral angles to avoid similar oscillation population counts between vicinal frequencies. We also observe that for amino acids that are least abundant in the S protein, there are certain frequencies at which the dihedral angles never oscillate, in contrast to relatively abundant amino acids that ultimately cover the entire spectrum. This suggests that the frequency components of dihedral angle oscillations may also be a function of position in the primary structure: the more positions an amino acid is found in, the more frequencies it can sample. Lastly, certain residues identified in the literature as constituting the inside of a druggable pocket of the spike protein, as well as other residues identified as allosteric sites, are observed in our data to have distinctive time domain profiles. This motivates us to propose residues from our dynamic data, with similar time domain profiles, which may be of potential interest to the vaccine and drug design communities, for further investigation. Thus our findings indicate that there is a particular frequency domain profile for the spike protein, hidden within the time domain data, and this information, perhaps with the suggested residues, might provide additional insight into therapeutic development strategies for COVID-19 and beyond.

Experience with Telemedicine in a Tertiary Academic Otologic Clinic During the COVID-19 Pandemic.

OBJECTIVE: To examine the utility of telemedicine in a tertiary otologic practice. STUDY DESIGN: Retrospective case series. SETTING: Tertiary neurotology clinic. PATIENTS: Consecutive adult patients presenting via video visit between January 2020 and January 2021. INTERVENTIONS: Televideo modality to conduct visits with patients seeking evaluation for new concerns, second opinions, or routine follow-up for established conditions. MAIN OUTCOME MEASURES: Success of the televideo visit defined by the televideo visit being sufficient for determining a definitive plan and not requiring deferment of recommendations for a subsequent in-person visit. RESULTS: A total of 102 televideo visits were performed among 100 unique patients. Of those, 92 (90.2%) visits were for second opinions or evaluation of new concerns, most commonly for vestibular schwannoma (n = 32, 31.4%), followed by sensorineural hearing loss (n = 20, 19.6%). Other visits were conducted for early postoperative follow-up and established general follow-up. In 91.2% of cases (n = 93), patients were successfully evaluated and provided recommendations from the initial video visit. All visits with patients having a diagnosis of meningioma (n = 7), and nearly all with vestibular Schwannoma (97%, n = 31) and sensorineural hearing loss (95%, n = 19) were successful. Of the 79 patients offered surgery as one potential treatment option, 31 patients underwent surgery at our institution by time of review. Patients with unsuccessful visits (n = 9, 8.8%) were advised to schedule additional in-person diagnostic imaging, vestibular testing, or cochlear implant candidacy evaluation to establish a more definitive care plan. CONCLUSION: Virtual televideo visits were successful for a high percentage of selected patients seen at a tertiary neurotology practice, particularly those seeking evaluation of vestibular schwannoma or sensorineural hearing loss.

Endoscopic Endonasal Eustachian Tube Obliteration as a Treatment for Tension Pneumocephalus After Translabyrinthine Resection of Vestibular Schwannoma.

OBJECTIVE: Cerebrospinal fluid leak and pneumocephalus are rare but potentially devastating complications associated with translabyrinthine resection of cerebellopontine angle masses. Persistent pneumocephalus despite proximal eustachian tube (ET) obliteration is rare. We describe, to our knowledge, the first report of successful management of tension pneumocephalus by endoscopic endonasal ET obliteration using a novel V-loc (Covidien; Medtronic, Minneapolis, MN) suture technique. PATIENTS: A 63-year-old man presented with altered mental status 10 months after translabyrinthine excision of a left cerebellopontine angle vestibular schwannoma measuring 2.8 × 2.9 × 3.3 cm. Computed tomography demonstrated diffuse ventriculomegaly and new pneumocephalus along the right frontal lobe, lateral ventricles, and third ventricle, and air within the left translabyrinthine resection cavity. INTERVENTION: The patient underwent left-sided endoscopic endonasal ET obliteration using 2-0, 9-inch V-loc suture. MAIN OUTCOME MEASURE: Postoperatively, the patient's mental status improved with a decrease in size of the lateral and third ventricles on computed tomography. CONCLUSION: Endoscopic endonasal ET obliteration, a technique previously applied to recalcitrant cerebrospinal fluid leaks, is a safe and reasonable alternative to reentering the original surgical site for patients with pneumocephalus after lateral skull base surgery. Utilizing a V-loc suture for this technique instead of a traditional suture may improve procedural ease and speed.

Modified Mackenzie Sound Equation and CVOA Algorithm Based UASN Routing in Dissolved Gases with Divergent Wind Environment to Reduce Propagation Delay (preprint)

In Underwater Acoustic Sensor Network (UASN), routing and propagation delay is affected through various water column environment effects in each node such as temperature, salinity, depth, gases, divergent and rotational wind. High sound velocity increases the transmission rate of packets and high dissolved gases in the water environment increase sound velocity. High dissolved gases and sound velocity environment in water column provide high transmission rates among UASN nodes. In this paper, the Modified Mackenzie Sound equation calculates sound velocity in each node for energy-efficient routing. Golden Ratio Optimization Method (GROM) and Gaussian Process Regression (GPR) predict propagation delay of each node in UASN from dataset which consists of Mackenzie Sound equation calculated sound velocity based on temperature, salinity, depth, dissolved gases. Dissolved gases, rotational and divergent winds, and stress play major problems in UASN, increases propagation delay and energy consumption. Predicted values from GPR and GROM lead to node selection and among selected nodes Corona Virus Optimization Algorithm (CVOA) routing is performed. The proposed GPR-CVOA and GROM-CVOA algorithm solves the problem of propagation delay and consumes less energy in nodes based on appropriate tolerant delays in transmitting packets among nodes during high rotational and divergent winds. From simulation results, CVOA Algorithm performs better than traditional DF and LION algorithms.