Relapse of Monoclonal Gammopathy of Renal Significance after mRNA Covid-19 vaccination: a case report (preprint)

Introduction This case report represents, to our knowledge, the first suspected case of Light Chain Deposition Disease (LCDD) relapse associated with mRNA COVID-19 vaccination. It must be made clear that timing is the only link between the vaccination and the relapse of LCDD, and since millions of individuals received these vaccines, an event like this may be due to chance. At the same time, this case report may be an entry point into further explorations of the pathogenesis of LCDD, given the mechanism of action of the vaccine and the pathophysiology of the disease, as it is currently understood. Case presentation The 75-year-old female patient of Greek ethnicity was admitted into our clinic for the investigation of worsening renal function that was detected on routine lab examinations two weeks after she received the second dose of the moderna COVID vaccine (mRNA-1273). Rapidly progressive glomerulonephritis and anemia were the most notable findings upon admission. She had a history of Light Chain Deposition Disease (LCDD) which had remained stable under management for four years. Serum protein electrophoresis was performed and showed monoclonal kappa zones, while bone marrow biopsy revealed 5% plasma cell infiltration. All the above, along with other investigations, established the diagnosis of LCDD recurrence. She was started on chemotherapy, which improved her immunological profile but not her renal function. The patient has remained on hemodialysis since. Conclusions The association between mRNA vaccinations and LCDD relapse may be ground for investigations into the pathophysiology of MGRS, given the patient’s previous long-term remission. In this context, we want to stress once again the importance of following standardized routine mandates on COVID vaccination, especially in immunocompromised patients. This case report is not intended to directly inform changes in clinical practice.

MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN COURSE AMID COVID-19 PANDEMIC IN THE REBUBLIC OF BELARUS (preprint)

Resume. In first two years of COVID-19 pandemic, children usually had a mild or asymptomatic form of the disease. However, in rare cases, after suffering COVID-19, children had clinical manifestations similar to incomplete Kawasaki Disease (CD) or toxic shock syndrome. This condition is known as multisystem inflammatory syndrome in children (MIS-C). The purpose of this research was to study clinical and laboratory features and outcomes of multisystem inflammatory syndrome in children who were hospitalized during COVID-19 pandemic. Materials and methods. In 19 months (May 2020 - December 2021) 63 patients with a diagnosis of Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 were observed in the departments of Anesthesiology and Intensive Care of the Healthcare Institution "City Children's Infectious Clinical Hospital" in Minsk, Republic of Belarus. MIS-C was diagnosed on criteria of CDC/WHO, 2020. All calculations were carried out in the statistical package R, version 4.1. The results of the analysis were considered statistically significant with p<0,05. The results of the study. All of 63 children with MIS-C didnt have an acute coronavirus infection. Therefore, it was impossible to determine which strain of SARS-CoV-2 patient exactly had. However, we formed 3 groups of patients based on circulation of the dominant strain of SARS-CoV-2 in Belarus at different times. The 1st group included 40 patients (63,5%) received treatment from 05.25.2020 to 02.21.2021 ("wuhan strains"); the 2nd group - 9 children (14,3%) from 02.23.2021 to 06.13.2021 ("alpha"); the 3rd group - 14 children (22,2%) from 07.01.2021 to 11.19.2021 ("delta"). 47 (74,6%) patients had complete and incomplete Kawasaki Disease phenotype of MIS-C. Nonspecific phenotype was observed in 16 (25,4%) children. It manifested as signs of shock. The mean age didnt differ in study groups. All children had hyperthermic syndrome. Fever reached febrile numbers 3-4 times a day. Average fever duration was 3,2 [1-15] days. The course of MIS-C in children also didnt depend on the circulating strain of the virus. For instance, gastrointestinal dysfunction was observed in all three groups with equal frequency (73%, 78% and 57%, respectively). The only a statistically significant increase was in the number of children with cheilitis. In the 2nd group 8 children (89%) and the 3rd group 13 children (93%) had cheilitis, respectively, p=0,002. Neurological disorders such as headache, hyperesthesia, hallucinations, photophobia were more often observed in the 1st group of children - 19 (48%) cases and less frequently in the 2nd and 3rd group (in 11% and 14% of cases), p=0,022. Pathological blood flow regurgitation was the most common disorder (68-71%). Several biochemical markers of inflammation levels, such as C-reactive protein (CRP) and procalcitonin (PCT), were high. CRP levels were 162 mg/l [130; 245]; 130 mg/l [90; 160]; 130 mg/l [106; 149] in 3 study groups, respectively. In children of the 1st group CRP level was significantly higher, p=0.052. PCT level was higher in patients of the 3rd group (4.2 ng/ml [2,4; 8,8]; 3.9 ng/ml [3,2; 11,9]; 8.7 ng/ml [3,4; 14,1], p=0.625). Conclusion. As a result of the research there wasnt found notable connection between clinical or laboratory features of MIS-C and the dominant circulating strain of SARS-CoV-2 in given time periods. During the circulation of "alpha" and "delta" strains, the only significant differences were decrease of the number of patients with neurological disorders and increase in the frequency of cheilitis, p=0,002. The remaining indicators of organ dysfunction were similar in three groups of children. There was 1 (1,6%) fatal outcome in our study.

Decrease of tear break-up time at Japanese eye clinics during five consecutive years.

The aim of this retrospective chart review study was to evaluate the 5-year trend of ocular surface examination results in participants who visited the eye clinic from 2015 to 2019, underwent corneal and lacrimal examinations, refraction, and intra-ocular pressure measurements, and reported six dry eye-related symptoms. A total of 1468 patients were analyzed. Tear break-up time (BUT) decreased continuously for five consecutive years: 4.76 ± 1.84 s in 2015, 4.57 ± 1.70 s in 2016 (p = 0.999, vs 2015), 4.35 ± 2.06 s in 2017 (p = 0.662), 3.83 ± 2.18 s in 2018 (p < 0.001), and 3.63 ± 2.10 s in 2019 (p < 0.001). The decrease of BUT was more prominent in women than men (p < 0.001) and the correlation coefficient between calendar year and BUT was greater in women than men (p = 0.002). Schirmer test value, strip tear meniscometry value, and corneal staining score did not exhibit significant changes. Prevalence of blurring, photophobia, and pain increased toward 2019 among symptoms surveyed (eye fatigue, blurring, photophobia, dryness, irritation, and pain) and regression analysis indicated blurring (p < 0.001), photophobia (p < 0.001), and pain (p < 0.001) were correlated with BUT. In conclusion, BUT decreased continuously for five consecutive years from 2015 to 2019 and was associated with dry-eye related symptoms.

Corona virus disease 2019-associated Stevens-Johnson syndrome: a case report.

BACKGROUND: To report Stevens-Johnson syndrome (SJS) in a patient with acute pneumonia secondary to SARS-CoV-2 infection. CASE PRESENTATION: A 45-years-old woman with a diagnosis of acute pneumonia secondary to SARS-CoV-2 infection who had received azithromycin and naproxen. Three days after starting the medication, she appeared ill and developed ocular discomfort, photophobia, dysuria, and macular rashes on the trunk and the extremities. On ophthalmological examination, a total epithelial defect was seen in both eyes. According to the examination, Stevens-Johnson syndrome was diagnosed and the patient was admitted to receive systemic and ocular support and medical care. The patient's condition improved during the 3 weeks and recovered from both COVID-19 and SJS life-threatening complications but ocular complications, including the destruction of the meibomian glands, irregularity of the eyelid margin, and corneal scarring remained for the patient. CONCLUSIONS: Although, it is not clear whether the cause of Stevens-Johnson syndrome in COVID-19 patients is the virus itself or whether the use of medication, but patients with COVID-19, especially patients receiving medication, should be screened for symptoms of Stevens-Johnson syndrome.

Real-Time XFEL Data Analysis at SLAC and NERSC: a Trial Run of Nascent Exascale Experimental Data Analysis (preprint)

X-ray scattering experiments using Free Electron Lasers (XFELs) are a powerful tool to determine the molecular structure and function of unknown samples (such as COVID-19 viral proteins). XFEL experiments are a challenge to computing in two ways: i) due to the high cost of running XFELs, a fast turnaround time from data acquisition to data analysis is essential to make informed decisions on experimental protocols; ii) data collection rates are growing exponentially, requiring new scalable algorithms. Here we report our experiences analyzing data from two experiments at the Linac Coherent Light Source (LCLS) during September 2020. Raw data were analyzed on NERSC's Cori XC40 system, using the Superfacility paradigm: our workflow automatically moves raw data between LCLS and NERSC, where it is analyzed using the software package CCTBX. We achieved real time data analysis with a turnaround time from data acquisition to full molecular reconstruction in as little as 10 min -- sufficient time for the experiment's operators to make informed decisions. By hosting the data analysis on Cori, and by automating LCLS-NERSC interoperability, we achieved a data analysis rate which matches the data acquisition rate. Completing data analysis with 10 mins is a first for XFEL experiments and an important milestone if we are to keep up with data collection trends.

Histopathological assessments reveal retinal vascular changes, inflammation, and gliosis in patients with lethal COVID-19 (preprint)

Importance: We are in the midst of the human coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), which is of historic proportions, the likes of which we have not seen in 102 years. Despite being primarily a respiratory virus, COVID-19 can also present with non-respiratory signs, including ocular symptoms as conjunctival hyperemia, chemosis, epiphora, increased secretions, ocular pain, photophobia and dry eye. The virus has also been detected within the anterior chamber and in the ocular fluids suggesting that ocular tissue maybe affected due to Sars-CoV-2 infection. Objective: To assess for histopathological changes within the retina and the choroid and determine the long-term sequelae of the viral infection. Design, Setting, and Participants: 12 donor eyes from COVID-19 positive individuals and similar age matched donor eyes from patients with negative test for SARS-CoV-2 were assessed. Eyes were fixed in 4% paraformaldehyde and 0.5% glutaraldehyde in PBS within 6 hours postmortem. Main Outcomes and Measures: Globes were evaluated with macroscopic, SLO and OCT imaging. Macula and peripheral regions were processed for epon-embedding and immunocytochemistry with markers for SARS-CoV-2 infection, gliosis, inflammation and vasculature. Results: Fundus analysis shows hemorrhagic spots and increased vitreous debris in several of the COVID-19 eyes compared to the control. OCT based measurements indicated an increased trend in retinal thickness in the COVID-19 eyes, however the difference was not statistically significant. Histology of the retina showed presence of hemorrhages and central cystoid degeneration in several of the donors. Whole mount analysis of the retina labeled with markers showed changes in retinal microvasculature, increased inflammation, and gliosis in the COVID-19 eyes compared to the controls. The choroidal vasculature displayed localized changes in density and signs of increased inflammation in the COVID-19 samples. Conclusions and Relevance: In situ analysis of the retinal tissue suggested that there are severe subclinical abnormalities that could be detected in the COVID-19 eyes. This study provides a rationale for evaluating the ocular physiology of patients that have recovered from COVID-19 infections to further understand the long-term effects caused by this virus.

Improper Use of the Germicidal Range Ultraviolet Lamp for Household Disinfection Leading to Phototoxicity in COVID-19 Suspects.

PURPOSE: To report the germicidal range ultraviolet (UV) irradiation-induced phototoxicity because of unprotected exposure to the UV lamps for presumed household disinfection of SARS-CoV-2 in a domestic setting. METHODS: We report on a family of 3 adults who experienced photophobia, intense eye pain, epiphora, blurred vision, and a burning sensation over the face and neck area after a short period of unprotected exposure to the UV germicidal lamps. RESULTS: An initial examination revealed erythema and tenderness over the face and neck area, reduced visual acuity of 6/12, and conjunctival injections bilaterally in all 3 patients. Further assessment at the ophthalmology department 3 days later revealed gradual improvement of visual acuity to 6/6 bilaterally. Slit-lamp examinations revealed few punctate epithelial erosions. Fundal examinations were normal without evidence of solar retinopathy. The patients were diagnosed with germicidal range UV irradiation-induced photokeratitis and epidermal phototoxicity. Lubricants and emollients were prescribed for symptom relief, and the patients were warned against using a UV germicidal lamp for disinfection purposes without appropriate protection. CONCLUSIONS: Although SARS-CoV-2 is structurally akin to SARS-CoV-1 and MERS-CoV, and previous studies demonstrated high levels of inactivation of beta-coronavirus with germicidal-range UV, evidence for its efficacy to inactivate SARS-CoV-2 is lacking. This case report serves to emphasize the potential consequences of phototoxicity from the improper use of UV germicidal lamps for household disinfection and to highlight the fact that UV germicidal lamps currently have no established role in household disinfection of SARS-CoV-2.

Addressing Personal Protective Equipment (PPE) Decontamination: Methylene Blue and Light Inactivates SARS-CoV-2 on N95 Respirators and Masks with Maintenance of Integrity and Fit (preprint)

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has resulted in severe shortages of personal protective equipment (PPE) necessary to protect front-line healthcare personnel. These shortages underscore the urgent need for simple, efficient, and inexpensive methods to decontaminate SARS-CoV-2-exposed PPE enabling safe reuse of masks and respirators. Efficient decontamination must be available not only in low-resourced settings, but also in well-resourced settings affected by PPE shortages. Methylene blue (MB) photochemical treatment, hitherto with many clinical applications including those used to inactivate virus in plasma, presents a novel approach for widely applicable PPE decontamination. Dry heat (DH) treatment is another potential low-cost decontamination method. MethodsMB and light (MBL) and DH treatments were used to inactivate coronavirus on respirator and mask material. We tested three N95 filtering facepiece respirators (FFRs), two medical masks (MMs), and one cloth community mask (CM). FFR/MM/CM materials were inoculated with SARS-CoV-2 (a Betacoronavirus), murine hepatitis virus (MHV) (a Betacoronavirus), or porcine respiratory coronavirus (PRCV) (an Alphacoronavirus), and treated with 10 {micro}M MB followed by 50,000 lux of broad-spectrum light or 12,500 lux of red light for 30 minutes, or with 75{degrees}C DH for 60 minutes. In parallel, we tested respirator and mask integrity using several standard methods and compared to the FDA-authorized vaporized hydrogen peroxide plus ozone (VHP+O3) decontamination method. Intact FFRs/MMs/CM were subjected to five cycles of decontamination (5CD) to assess integrity using International Standardization Organization (ISO), American Society for Testing and Materials (ASTM) International, National Institute for Occupational Safety and Health (NIOSH), and Occupational Safety and Health Administration (OSHA) test methods. FindingsOverall, MBL robustly and consistently inactivated all three coronaviruses with at least a 4-log reduction. DH yielded similar results, with the exception of MHV, which was only reduced by 2-log after treatment. FFR/MM integrity was maintained for 5 cycles of MBL or DH treatment, whereas one FFR failed after 5 cycles of VHP+O3. Baseline performance for the CM was variable, but reduction of integrity was minimal. InterpretationMethylene blue with light and DH treatment decontaminated masks and respirators by inactivating three tested coronaviruses without compromising integrity through 5CD. MBL decontamination of masks is effective, low-cost and does not require specialized equipment, making it applicable in all-resource settings. These attractive features support the utilization and continued development of this novel PPE decontamination method.

Age Detection with Face Mask Using Deep Learning and FaceMaskNet-9 (preprint)

Age detection can be a challenging problem due to the variations in the aging of every individual depending on one’s health, lifestyle, etc. Analyzing the face of humans using computer vision can help in estimating the age of humans as the face holds most of the important attributes. However, the corona virus disease 2019 (COVID-19) pandemic has forced people all over the world to wear face masks to prevent human-to-human transmission of the virus thereby making it difficult to detect the age of the person wearing a mask. The analysis of a human face without a facial mask in the images provided by cameras or webcams is a tedious process as the human face in an image can have variations due to changes in position, orientation, and a lot of other factors such as lighting conditions, image resolution, etc. Thus, analyzing a human face with a facial mask becomes even more difficult as most of the prominent facial attributes such as the nose, wrinkles on cheeks, etc. are not visible due to the face mask. To overcome this problem, we have proposed a system to perform age detection using FaceMaskNet-9, a deep learning network that will detect the age of the person with a face mask. We have used a deep learning-based age detector model for age prediction. The FaceMaskNet-9 used for the process of predicting the age of a person increases the accuracy of the task and precisely classifies people with masked faces into different age groups. Our age detector can be used in CCTV footage, for medical diagnosis, for recommending videos and advertisements according to the target audience, to give extra privileges to people depending on their age and even on social media where there are age restrictions to view or use certain contents on the social platforms.