Near Real-time Flood Inundation and Hazard Mapping of Baitarani River Basin using Google Earth Engine and SAR Imagery (preprint)

Flood Inundation mapping and satellite imagery monitoring are critical and effective responses during flood events. Mapping of a flood using optical data is limited due to the unavailability of cloud-free images. Because of its capacity to penetrate clouds and operate in all kinds of weather, synthetic aperture radar is preferred for water inundation mapping. Flood mapping in Eastern India's Baitarani River Basin for 2018, 2019, 2020, 2021, and 2022 was performed in this study using Sentinel-1 imagery and Google Earth Engine with Otsu's algorithm. Different machine-learning algorithms were used to map the LULC of the study region. Dual polarizations VH and VV and their combinations VV×VH, VV + VH, VH-VV, VV-VH, VV/VH, and VH/VV were examined to identify non-water and water bodies. The Normalized Difference Water Index (NDWI) map derived from Sentinel-2 data validated the surface water inundation with 80% accuracy. The total inundated areas were identified as 440.3 km2 in 2018, 268.58 km2 in 2019, 178.40 km2 in 2020, 203.79 km2 in 2021, and 321.33 km2 in 2022, respectively. The overlap of flood maps on the LULC map indicated that flooding highly affected agriculture and urban areas in these years. The approach using the near-real-time Sentinel-1 SAR imagery and GEE platform can be operationalized for periodic flood mapping, helps develop flood control measures, and helps enhance flood management. The generated annual flood inundation maps are also useful for policy development, agriculture yield estimation, crop insurance framing, etc.

Advances and Challenges of the Decade: The Ever-Changing Clinical and Genetic Landscape of Immunodeficiency.

In the past 10 years, we have witnessed major advances in clinical immunology. Newborn screening for severe combined immunodeficiency has become universal in the United States and screening programs are being extended to severe combined immunodeficiency and other inborn errors of immunity globally. Early genetic testing is becoming the norm for many of our patients and allows for informed selection of targeted therapies including biologics repurposed from other specialties. During the COVID-19 pandemic, our understanding of essential immune responses expanded and the discovery of immune gene defects continued. Immunoglobulin products, the backbone of protection for antibody deficiency syndromes, came into use to minimize side effects. New polyclonal and monoclonal antibody products emerged with increasing options to manage respiratory viral agents such as SARS-CoV-2 and respiratory syncytial virus. Against these advances, we still face major challenges. Atypical is becoming typical as phenotypes of distinct genetic disease overlap whereas the clinical spectrum of the same genetic defect widens. Therefore, clinical judgment needs to be paired with repeated deep immune phenotyping and upfront genetic testing, as technologies rapidly evolve, and clinical disease often progresses with age. Managing patients with organ damage resulting from immune dysregulation poses a special major clinical challenge and management often lacks standardization, from autoimmune cytopenias, granulomatous interstitial lung disease, enteropathy, and liver disease to endocrine, rheumatologic, and neurologic complications. Clinical, translational, and basic science networks will continue to advance the field; however, cross-talk and education with practicing allergists/immunologists are essential to keep up with the ever-changing clinical and genetic landscape of inborn errors of immunity.

Hypoparathyroidism Retardation and Dysmorphism syndrome due to mutation in Tubulin-specific chaperone E gene as a cause of combined immune deficiency (preprint)

Background: Hypoparathyroidism, retardation, and dysmorphism (HRD) syndrome is a disease composed of hypoparathyroidism, growth retardation, developmental delay and typical dysmorphic features, caused by Tubulin-specific chaperone E gene mutation. Many patients succumb in infancy due to overwhelming infections mainly caused by Pneumococcu s spp. Knowledge related to the immune system in these patients is scarce. Purpose: To define the immune phenotype of a cohort of HRD patients including cellular, humoral and neutrophil functions. Methods: The study included HRD patients followed at Soroka University Medical Center. Clinical and immunological data were obtained, including immunoglobulin concentrations, specific antibodies titers, lymphocytes subpopulations, lymphocyte proliferation and neutrophil functions. For detailed methods, please see the Methods section in this article's Online Repository. Results: Nine patients (5 females and 4 males) were enrolled, aged 6 months to 15 years. All received Amoxicillin prophylaxis as part of a routine established previously. Three patients had bacteremia with klebsiella , shigella spp. and Candida. Two patients had confirmed Corona Virus associated Disease 19 (COVID19), both died from this infection. All patients had normal to high IgA level, low anti- Pneumococcal antibodies, and reduced frequency of naive B cell with increased frequency of CD21 low /CD27 - B cell. All patients had abnormal T cell population's distribution, including reduced terminally differentiated effector memory CD8, inverted CD4/CD8 ratio, and poor lymphocytes mitogen induced proliferation. Neutrophil Superoxide production and chemotaxis were normal in all patients tested. Conclusion: HRD is a combined immune deficiency (CID) with severe invasive bacterial and viral infections

Peripheral B Cell Deficiency and Predisposition to Viral Infections: The Paradigm of Immune Deficiencies.

In the era of COVID-19, understanding how our immune system responds to viral infections is more pertinent than ever. Immunodeficiencies with very low or absent B cells offer a valuable model to study the role of humoral immunity against these types of infection. This review looks at the available evidence on viral infections in patients with B cell alymphocytosis, in particular those with X-linked agammaglobulinemia (XLA), Good's syndrome, post monoclonal-antibody therapy and certain patients with Common Variable Immune Deficiency (CVID). Viral infections are not as infrequent as previously thought in these conditions and individuals with very low circulating B cells seem to be predisposed to an adverse outcome. Particularly in the case of SARS-CoV2 infection, mounting evidence suggests that peripheral B cell alymphocytosis is linked to a poor prognosis.

Case Report: Convalescent Plasma Achieves SARS-CoV-2 Viral Clearance in a Patient With Persistently High Viral Replication Over 8 Weeks Due to Severe Combined Immunodeficiency (SCID) and Graft Failure.

We describe the unique disease course and cure of SARS-CoV-2 infection in a patient with SCID and graft failure. In absence of a humoral immune response, viral clearance was only achieved after transfusion of convalescent plasma. This observation underscores the necessity of the humoral immune response for SARS-CoV-2 clearance.

SARS-CoV-2 infection associated with hepatitis in an infant with X-linked severe combined immunodeficiency.

X-linked severe combined immunodeficiency (X-SCID) is a disorder of adaptive immunity caused by mutations in the IL-2 receptor common gamma chain gene resulting in deficiencies of T and natural killer cells, coupled with severe dysfunction in B cells. X-SCID is lethal without allogeneic stem cell transplant or gene therapy due to opportunistic infections. An infant with X-SCID became infected with SARS-CoV-2 while awaiting transplant. The patient developed severe hepatitis without the respiratory symptoms typical of COVID-19. He was treated with convalescent plasma, and thereafter was confirmed to have SARS-CoV-2 specific antibodies, as detected with a microfluidic antigen array. After resolution of the hepatitis, he received a haploidentical CD34 selected stem cell transplant, without conditioning, from his father who had recovered from COVID-19. SARS CoV-2 was detected via RT-PCR on nasopharyngeal swabs until 61 days post transplantation. He successfully engrafted donor T and NK cells, and continues to do well clinically.

Outcomes of Combined Percutaneous Tracheostomy and Endoscopic Gastrostomy Tube Placement in COVID-19 Patients (preprint)

Background:A significant number of patients with severe respiratory failure related to COVID-19 require prolonged mechanical ventilation. Minimal data exists regarding the timing, safety, and efficacy of combined bedside percutaneous tracheostomy and endoscopy gastrostomy tube placement in these patients. The safety for healthcare providers is also in question. This study’s objective was to evaluate the effectiveness and safety of combined bedside tracheostomy and gastrostomy tube placement in COVID-19 patients.Methods:This is a single arm, prospective cohort study in patients with COVID-19 and acute respiratory failure requiring prolonged mechanical ventilation who underwent bedside tracheostomy and percutaneous endoscopic gastrostomy tube placement. Detailed clinical and procedural data were collected. Descriptive statistics were employed and time to event curves were estimated and plotted using the Kaplan Meier method for clinically relevant pre-specified endpoints.Results:Fifty-eight patients were included. Nearly 90% of the patients received pronation therapy and 52% of patients underwent extracorporeal membrane oxygenation evaluation. The median total intensive care unit length of stay was 29 days (24.7-33.3) with a median of 10 days (6.3-13.7) post-procedure. Nearly 88% of patients were weaned from mechanical ventilation post-procedure at a median of 9 days (6-12); 94% of these were decannulated. Sixty-day mortality was 10.3%. Almost 90% of patients were discharged alive from the hospital. No transfer out of the intensive care unit was required and a median of 3 healthcare personnel per procedure were present.Conclusions:This study shows that survival of critically ill COVID-19 patients after tracheostomy and gastrostomy was nearly 90%. The time-to-event curves are encouraging regarding time to weaning, downsizing, decannulation and discharge. A combined procedure minimizes the risk of virus transmission to healthcare providers in addition to decreasing the number of anesthetic episodes, transfusions, and transfers patients must undergo.

COVID-19 Medical Vulnerability Indicators: A Local Data Model for Equity in Public Health Decision-Making (preprint)

Objective: To develop indicators of vulnerability for coronavirus disease 2019 (covid-19) infection in Los Angeles County (LAC) by race and neighborhood characteristics. Design: Development of indicators that combines pre-existing medical vulnerabilities with social and built-environment data by zip code tabulation areas (ZTCAs). Setting: Neighborhoods in LAC categorized by race/ethnicity ranked into quintiles by relative vulnerability: Non-Hispanic white; Black; Latinx: Cambodians, Hmong and Laotians combined (CHL); and Other Asians. Data Sources: AskCHIS Neighborhood Edition, American Community Survey 2014-2018, and California Department of Parks and Recreation. Main Outcome Measures: 1) Pre-Existing Health Condition, 2) Barriers to Accessing Healthcare, 3) Built Environment Risk, and 4) CDC's Social Vulnerability. Results: Neighborhoods most vulnerable to covid-19 are characterized by significant clustering of racial minorities, low income households and unmet medical needs. An overwhelming 73% of Blacks reside in the neighborhoods with the two highest quintiles of pre-existing health conditions, followed by Latinx (70%) and CHL (60%), while 60% of whites reside in low or the lowest vulnerable neighborhoods. For the Barriers to Accessing Healthcare indicator, 40% of Latinx reside in the highest vulnerability places followed by Blacks, CHL and other Asians (29%, 22%, and 16% respectively), compared with only 7% of Whites reside in such neighborhoods. The Built Environment Indicator finds CHL (63%) followed by Latinx (55%) and Blacks (53%) reside in the neighborhoods designated as high or the highest vulnerability compared to 32% of Whites residing in these neighborhoods. The Social Vulnerability Indicator finds 42% of Blacks and Latinx and 38% of CHL residing in neighborhoods of high vulnerability compared with only 8% of Whites residing these neighborhoods. Conclusions: Vulnerability to covid-19 infections differs by neighborhood and racial/ethnic groups. Our vulnerability indicators when utilized in decision-making of re-openings or resource distribution such as testing, vaccine distribution, hotel rooms for quarantine and other covid-19-related resources can provide an equity driven data approach for the most vulnerable.

Death Due to COVID-19 in an Infant with Combined Immunodeficiencies.

BACKGROUND: Severe Acute Respiratory Syndrome Coronavirus 2 has affected millions of people, and especially in adult patients with underlying diseases lead to death. Meanwhile pediatric patients with inherited defects of T cell should be prone to viral diseases. CASE PRESENTATION: Herein, we report an infant with severe combined immunodeficiencies, who were affected and died because of COVID-19. CONCLUSION: Considering the importance of finding how immune system can affect the viral infection, presentation of COVID-19 in immune deficient patients can be valuable.