If the Test Fits: Diagnosis to Aid in the Treatment of Influenza.

Influenza is a significant cause of morbidity and mortality worldwide, presenting with lethal complications such as acute respiratory distress syndrome (ARDS). Multiple ways to diagnose influenza include rapid antigen tests, flu polymerase chain reaction (PCR), and respiratory viral panels or multiplex PCR. However, they have different sensitivities and specificities. We present a case of a 70-year-old female who was admitted to the ICU for ARDS and had a high pretest probability of influenza. She had an initial rapid flu antigen test that was negative and a negative flu PCR. However, she tested positive for influenza A (H1N1) with a respiratory viral panel. We as physicians should take into consideration the different sensitivities and specificities diagnostic tests have and consider retesting patients who have a negative test in the context of a high pretest probability. We should also remember to begin antiviral therapy early in a patient with high suspicion of influenza with a severe clinical presentation despite not having a confirmed diagnosis.

On the Efficient Delivery and Storage of IoT Data in Edge-Fog-Cloud Environments.

Cloud storage has become a keystone for organizations to manage large volumes of data produced by sensors at the edge as well as information produced by deep and machine learning applications. Nevertheless, the latency produced by geographic distributed systems deployed on any of the edge, the fog, or the cloud, leads to delays that are observed by end-users in the form of high response times. In this paper, we present an efficient scheme for the management and storage of Internet of Thing (IoT) data in edge-fog-cloud environments. In our proposal, entities called data containers are coupled, in a logical manner, with nano/microservices deployed on any of the edge, the fog, or the cloud. The data containers implement a hierarchical cache file system including storage levels such as in-memory, file system, and cloud services for transparently managing the input/output data operations produced by nano/microservices (e.g., a sensor hub collecting data from sensors at the edge or machine learning applications processing data at the edge). Data containers are interconnected through a secure and efficient content delivery network, which transparently and automatically performs the continuous delivery of data through the edge-fog-cloud. A prototype of our proposed scheme was implemented and evaluated in a case study based on the management of electrocardiogram sensor data. The obtained results reveal the suitability and efficiency of the proposed scheme.

Cardiovascular Disease Risk and Outcomes in Patients Infected With SARS-CoV-2.

Cardiovascular involvement is one of the end-organ complications commonly reported in coronavirus disease 2019 (COVID-19). It has also been postulated to be an independent risk factor for increased mortality in COVID-19-infected patients. With such a significant effect of COVID-19 on the cardiovascular system and vice versa, it is pivotal for physicians to observe this association closely for improving management and understanding prognosis in these patients. Here, we present three patients and describe their baseline cardiac risk factors, the cardiac complications they developed in association with COVID-19 infection, and their varying outcomes.

Female reproductive energetics in mantled howler monkeys (Alouatta palliata): A follow-up study.

OBJECTIVE: Reproduction entails several challenges to primate females, among which energetic costs are remarkable at certain stages of the reproductive cycle. Still, females may use behavioral and physiological strategies to cope with those challenges. We had previously reported covariation between female energetic condition through the reproductive cycle and time-budget adjustments in mantled howler monkeys (Alouatta palliata). Accordingly, we suggested that behavioral flexibility allowed coping with the energetic challenges of reproduction. Subsequent evidence from the same population, however, suggested otherwise, so we performed a follow-up study on the variation in female reproductive energetics based on a larger sample of females. METHODS: We studied 48 free-ranging adult females at Los Tuxtlas (Mexico). We assessed energy balance via urinary C-peptide concentrations (2717 urine samples), behavioral energy intake and expenditure (5728 sampling hours), and physiological energy expenditure via fecal triiodothyronine metabolites (fTH3; 3138 fecal samples). RESULTS: We found that energy balance varied among reproductive states: (a) cycling was a period of low C-peptide concentrations; (b) the highest C-peptide concentrations occurred during gestation; and (c) the beginning of lactation marked a notable decrease in C-peptide concentrations, which then improved at mid-lactation to again decline at lactation offset. These peaks and valleys in energy balance did not seem to be associated with variation in energy acquisition but were rather mirrored by activity levels and fTH3 during lactation. DISCUSSION: Energy balance was not preserved through the reproductive cycle, supporting previous contentions that the reproductive performance of female mantled howler monkeys may be energetically constrained. The contrast between these and results that we have previously reported, highlights the importance of conducting follow-up studies to continually improve our understanding of the reproductive energetics of primate females.

Características epidemiológicas, clínicas, pre y posnatales de los neonatos, hijos de madre con la Covid-19, y del seguimiento hasta los 14 días post alta, en Lima-Perú / Pre and post-natal epidemiological and clinical features of neonates born from mothers infected with COVID-19 and 14-day follow-up post discharge in Lima, Peru

RESUMEN Objetivo: Describir las características clínicas prenatales y post natales de los neonatos hijos de madres con la Covid-19, y seguimiento hasta los 14 días post alta. Material y métodos: Estudio tipo observacional, serie de casos, censal de los neonatos nacidos en el Hospital Guillermo Almenara Irigoyen, hijos de madres con la Covid-19, que nacieron durante la cuarentena decretada por el gobierno peruano. Los neonatos se dividieron en 2 grupos: con la prueba PCR nasofaríngea positiva o no y se observó si alguna de estas características estuvieron asociadas con la presentación de esta prueba positiva. Resultados: Hubieron 201 gestantes con diagnóstico de Covid-19 por prueba rápida y que tuvieron 206 neonatos. De ellos, 4 neonatos tuvieron la PCR nasofaríngea positiva y 202, negativa. La edad materna fue menor en el grupo con la prueba positiva, pero no hubo diferencia respecto al tipo de parto: césarea, fueron a termino, con adecuado peso al nacer y ningún sexo predominó. Doscientos cinco (99,51%) neonatos salieron de alta en la primera semana de vida; 181 (90,05%) neonatos con PCR nasofaríngea negativa y los 4 neonatos con prueba positiva fueron seguidos por 2 semanas; ninguno presentó síntomas y el tipo de lactancia fue mixta. Conclusiones: Los neonatos hijos de madres con la Covid-19, tendrían una mínima posibilidad de contraer esta enfermedad. Y su desarrollo prenatal y post natal no se vería afectado, a pesar de incluso tener la prueba PCR nasofaríngea positiva.

SUMMARY Objective: To describe prenatal and post-natal clinical features of neonates born from mothers with COVID-19 including 14-day follow-up post discharge. Methods: Case series of neonates attended at Hospital Guillermo Almenara born from mothers infected with COVID-19 during the lockdown implemented by the Peruvian government. Neonates were divided in two groups based on positivity of the nasopharyngeal PCR test. Results: 201 pregnant women with COVID-19 diagnosed by rapid tests who delivered 206 neonates were identified; 4 of these neonates had positive nasopharyngeal PCR tests. Pregnants infected with COVID-19 were younger than non-infected, but no differences were observed in route of delivery, sex of the newborn and body weight at birth. Two hundred and five neonates were discharged one week after birth ;181 neonates with negative nasopharyngeal negative PCR tests and 4 neonates with a positive PCR test were followed for 14 days, none presented symptoms and received mixed lactation. Conclusions: Neonates born from mother infected with COVID-19 had minimal risk of getting the infection and their pre and post-natal development will not be affected despite of having a positive PCR test.

24 Hours: A Case of Multiorgan Failure Associated With COVID-19.

Coronavirus has caused thousands of deaths due to several mechanisms of injury including acute kidney injury (AKI). Most of the patients have a fast progression of the disease leading to death in the second week of hospital admission, however, here we have a case of a 58-year-old female who died in less than 24 hours of admission due to severe metabolic acidosis, acute respiratory distress syndrome (ARDS) and renal failure.

Damned If You Drain, Damned If You Don't: A Case of Pericardial Decompression Syndrome.

Pericardial decompression syndrome (PDS) is an unusual clinical scenario with a reported incidence of 5% in all surgical or percutaneously managed pericardial tamponade patients. It is defined as a paradoxical hemodynamic instability leading to left ventricular (LV), right ventricular (RV), or biventricular dysfunction. An 84-year-old female with a history of a chronic pericardial effusion presented with symptoms of tamponade. She had had multiple prior admissions with an extensive and unyielding workup for the etiology of her pericardial effusion. During the present admission, a transthoracic echocardiogram (TTE) confirmed an augmenting pericardial effusion causing cardiac tamponade. She underwent a pericardial window with the removal of 1.2 liters of serous fluid. Postoperatively, she went into cardiogenic shock from right heart failure. Unfortunately, there also was re-accumulation of the pericardial effusion and worsening hemodynamic instability. Due to her poor prognosis, she was transitioned to comfort care. Although the etiology of PDS is unknown, it has been theorized to be caused by an imbalance of sympathetic-parasympathetic states after a rapid decompression. Currently, there are no clear guidelines or recommendations regarding the quantity of fluid that can be removed safely. More awareness leading to a more cautious and staged pericardial drainage might be the required solution.

Diabetes Mellitus: An Unrecognized Complication in the Management of Patients With Mental Illness.

Psychiatric patients can have undiagnosed illness due to difficulties accessing the health care system and the lack of guidelines regarding screening recommendations for them. The following case describes a 36-year-old male who presented with a hyperglycemic emergency in the setting of undiagnosed diabetes mellitus.