| Title | Venue | Year | Impact | Source |
| 6601 | The roles of glycans in the SARS-CoV-2 spike protein | Biophys J | 2022 | | CORD-19 |
| 6602 | A tethered ligand assay to probe SARS-CoV-2:ACE2 interactions | Biophys J | 2022 | | CORD-19 |
| 6603 | Computational studies of the dynamics of SARS-CoV-2 spike, membrane and nucleocapsid proteins | Biophys J | 2022 | | CORD-19 |
| 6604 | Amantadine preferential binding and disordering of phase separated membranes | Biophys J | 2022 | | CORD-19 |
| 6605 | Investigating SARS-CoV-2 ORF7a and BST-2 heterodimerization by molecular dynamics simulations | Biophys J | 2022 | | CORD-19 |
| 6606 | Combining sample expansion and light-sheet microscopy for the volumetric imaging of virus-infected cells with superresolution | Biophys J | 2022 | | CORD-19 |
| 6607 | Catalytic function and substrate specificity of alpha and beta coronavirus papain-like proteases: targeting human NL63, SARS-CoV and SARS-CoV-2 with designed inhibitors | Biophys J | 2022 | | CORD-19 |
| 6608 | Probing key interactions between SARS-CoV-2 spike and heparan sulfate | Biophys J | 2022 | | CORD-19 |
| 6609 | Developing inhibitors of the SARS-CoV-2 main protease | Biophys J | 2022 | | CORD-19 |
| 6610 | Computational investigation of glycosaminoglycan cofactors in SARS-CoV-2 infection dynamics | Biophys J | 2022 | | CORD-19 |
| 6611 | Dimethyl sulfoxide (DMSO) affects activity of SARS-CoV-2 main protease | Biophys J | 2022 | | CORD-19 |
| 6612 | Structural dynamics of prefusion spike protein of SARS-CoV-2 and its variants | Biophys J | 2022 | | CORD-19 |
| 6613 | P28 Multi-system and cavernous sinus inflammatory syndrome presenting with evolving multiple cranial neuropathies following zoledronate infusion CASE REPORT - INTRODUCTION: Bisphosphonates are known to rarely cause multi-system inflammation, including multiple cranial neuropathies. This is possibly via provoking transient cytokine storm. The literature reports bisphosphonate-associated orbital inflammatory syndrome, and one case of retrobulbar optic neuritis following zoledronate. Bisphosphonate manufacturers report conjunctivitis, blurred vision, scleritis, orbital inflammation, uveitis and episcleritis as ocular side effects. Separately, neurological sequalae, including cranial neuropathies, are reported following COVID-19 infection and vaccination. Here, we report the first case of cavernous sinus inflammation temporally related to both zoledronate infusion, and more remotely, to Pfizer-BioNTech COVID-19 vaccination. CASE REPORT - CASE DESCRIPTION: A 76-year-old white man developed fever, bony leg pain – which rendered him unable to walk – and frontal headache, within 8 hours of his first zoledronate infusion for osteoporosis. A few weeks earlier he received his first Pfizer-BioNTech COVID-19 vaccine. His General Practitioner commenced a short course of low-dose oral prednisolone for the episode. One week later, off prednisolone, the headache localised around the left eye. He developed horizontal diplopia associated with abduction deficit. He was diagnosed with left VIth nerve palsy. He was started on high-dose steroids and clopidogrel (with PPI) with neuroimaging to exclude stroke or venous sinus thrombosis. Two weeks later, the diplopia worsened over 4 days, with new left adduction deficit (-2 limitation), left ptosis 1-2mm and anisocoria 0.5-1mm R>L suggestive of partial third nerve palsy and early Horner’s syndrome. Ocular and neurological examinations were otherwise normal. He wore varifocals and had migraines, osteoporosis, and asthma, for which he used inhalers. He worked in visual arts and was an ex-smoker (>50 years) with moderate alcohol intake. Blood results revealed CRP 38mg/L, but otherwise normal inflammation/vasculitis/infection screen; anti-thyroglobulin antibodies were >4000 U/ml; GQ1P, Creatinine Kinase, anti-ganglioside, and Anti-AChR/MuSK antibodies were normal. CT head and Optical Coherence Tomography were unremarkable. An enhanced MRI of the brain and orbits revealed abnormal thickening and T2 hyper-intensity of the left oculomotor nerve, most notably involving the left canalicular portion. The left cavernous sinus also appeared asymmetrically bulky with a rind of abnormal enhancing soft tissue in the left cavernous sinus. Subtle STIR hyper-intensity was also observed in the ipsilateral CN III-innervated extra-ocular muscles. After a 6-week course of tapering prednisolone, the vertical diplopia and leg swelling persisted; the horizontal diplopia and headaches had resolved. By 3 months, there was resolution with mild residual visual changes. CASE REPORT - DISCUSSION: We report a constellation of symptoms relating to multi-system inflammatory syndrome involving the cavernous sinus. There is a lack of epidemiological data on the incidence of this rare presentation in the population. This case has close temporal association to bisphosphonate infusion (<12h) and weaker association to coronavirus vaccination (<3wk). It is difficult to determine whether this is a rare presentation of a known drug reaction, a more delayed presentation of a vaccine reaction or whether these events were coincidental. A further possibility in this case is a combined predisposition resulting from both vaccination and bisphosphonate infusion. This case highlights a wider issue relating to the challenging possibility of ascertainment bias and increased ‘Yellow Card’ reporting of rare presentations during this historic global coronavirus pandemic, which may or may not have any true causal association to vaccination. There is difficulty in disentangling a true vaccine reaction from an unrelated presentation of a rare condition with an unknown baseline incidence rate. This is especially topical given that the majority of the population are receiving the coronavirus vaccination at this time. We also question what a plausible cut-off point would be to propose a temporal relationship for an adverse reaction; in the literature, adverse reactions have been postulated to develop beyond 1 month after the provoking agent. CASE REPORT - KEY LEARNING POINTS: This case highlights the need for urgent assessment, investigations including neurological imaging and consultant input in patients with evolving cranial neuropathy. The priority is to rule out thrombotic, compressive, inflammatory and infectious pathology in the cavernous sinus, venous sinus, orbit and orbital apex. Pathology of the cavernous sinus presents with variable involvement of CN III, IV, V and VI and Horner’s syndrome. A differential for this case would be superior orbital fissure syndrome, which also presents with multiple oculomotor cranial neuropathies; it involves these cranial nerves and the ophthalmic branch of CN V. Orbital apex syndrome is SOF with a loss of vision due to additional CNII involvement. The neuro-radiology differential included inflammatory, infiltrative, granulomatous and neoplastic aetiologies and that there was sufficient existing evidence to exclude brainstem pathology. Through communication between specialties, the temporal relationship was established, and clinical examination and extensive investigation further honed the differential to either inflammatory or vascular. Since it was temporally related to the zolendronate infusion, it seemed plausible it was related. We demonstrate the need for multi-disciplinary collaboration for these patients between rheumatology, ophthalmology and neuro-radiology. | Rheumatol Adv Pract | 2021 | | CORD-19 |
| 6614 | O25 Catastrophic antiphospholipid crisis triggered by anticoagulant switch CASE REPORT - INTRODUCTION: The COVID-19 pandemic led to drastic changes for some patients on warfarin for venous thromboembolic (VTE) disease and atrial fibrillation. Warfarin monitoring necessitates frequent interaction with healthcare workers, which is sufficiently risky for COVID-19 transmission. As a result, selected patients were swapped over to novel oral anticoagulants (NOACs). Our patient was changed without investigating for antiphospholipid syndrome (APLS); it later transpired he was triple antibody positive. He presented in a crisis and we describe his narrative. Patients on warfarin due to presumed unprovoked venous thromboembolic disease should not be swapped to NOACs without completing, or checking, previous antiphospholipid antibody testing. CASE REPORT - CASE DESCRIPTION: A 73-year-old gentleman presented locally in August 2020 with erythema over the anterolateral surface of his left leg. He was initially treated with antibiotics for presumed cellulitis. Within a few days this lesion became necrotic and rapidly spread. At this point, he was transferred to a tertiary rheumatology centre. Within days to weeks, he developed several necrotic lesions affecting his trunk and limbs, with facial sparing noted. Approximately 30—35% of his whole-body surface became involved. He soon developed an oxygen requirement, with CTPA demonstrating lymphocytic interstitial pneumonitis without evidence of pulmonary emboli (PE). Throughout his admission, he had several other pathologies such as hyponatraemia that required level 2 care and severe non-infectious diarrhoea. Skin biopsy identified thrombotic vasculopathy. Serology confirmed triple positive antiphospholipid antibody status and a dsDNA titre of > 400 iU/mL. This was the first-time serology had been undertaken despite a history of three deep vein thrombosis (DVT) episodes and two PE incidents. He had no history of SLE symptoms. His initial management for vasculitis secondary to APLS at the point of limited necrosis consisted of IV methylprednisolone followed by rituximab and PO prednisolone. While there was some delay in the progression of his disease, new areas of necrosis arose, leading to the patient receiving cyclophosphamide. Low molecular weight heparin was used for anticoagulation. This gentleman later developed proteinuria and neurological symptoms, fulfilling the criteria for catastrophic antiphospholipid syndrome. He received plasma exchange, without an improvement. He developed complications from his disease and treatment, including poor wound healing. It became apparent his condition would not improve and active treatments were stopped. He passed away 6 weeks after initial presentation. Prior to his admission to hospital, his warfarin was swapped to a NOAC. This is thought to have been the trigger behind catastrophic thrombosis. CASE REPORT - DISCUSSION: After excluding other conditions such as necrotising fasciitis, this gentleman was rapidly started on IV methylprednisolone to halt any further progression. This is because glucocorticoids have the greatest evidence base for managing this poorly understood acute disease manifestation. After this failed to manage his condition, he was given a further immunosuppressive agent in the form of rituximab. This was used after his serology confirmed triple antibody status. It was hoped this would stop any further immunological mediated disease progression. Oral prednisolone was started at 40 mg at this stage and kept under review with a tapering schedule. Cyclophosphamide was given within a few days of rituximab, with hope of a quicker onset of action. A careful MDT decision was made on these drug choices, particularly regarding their combined use and appreciating their side effect profiles. Cyclophosphamide has evidence behind its use, especially for those with APLS associated with lupus. While he did not develop any infections related to treatment, his condition progressed. Case reports suggest that plasma exchange can be useful in the management of catastrophic antiphospholipid syndrome, so the team recommended this. Consent at this stage became tricky due to his altered mental status, but it was felt he did demonstrate capacity for this specific decision. As his condition did not improve after this level of immunosuppression, the team reached the decision that no other treatments would likely change the outcome. He remained on oral steroids for the remainder of his admission. The other management facet of APLS crises pertains to anticoagulation. Low molecular weight heparin was recommended by the haematologists. His NOAC was stopped after the diagnosis was confirmed. Warfarin was restarted later in his admission given he had been well on this for years. CASE REPORT - KEY LEARNING POINTS: This fascinating case exemplifies the importance of completing an antiphospholipid antibody screen for patients who present with unprovoked venous thromboembolic disease. NOACs are commonly used anticoagulant medications. Several case reports have demonstrated that patients with antiphospholipid syndrome experience breakthrough thromboembolic events when treated with NOACs. The highest risk is associated with history of arterial thrombosis and those with triple positive antibody status. Three clinical trials have either been completed or are in the process of investigating whether NOACs sufficiently prevent thromboembolic disease in these patients. The TRAPS study compared rivaroxaban to warfarin in those with triple antibody positive antiphospholipid syndrome. The study was terminated early given that higher adverse events were observed in the rivaroxaban arm (19%, n = 11/59) versus warfarinised patients (3%, n = 2/61). The RAPS study found no difference in thromboembolic risk and results from the ASTRO-APS study looking into apixaban are awaited. There is insufficient evidence to suggest that NOACs prevent VTE in a similar fashion to warfarin, so many still advocate the use of warfarin. The optimal immune management of this acute complication is not well elucidated, with a shortfall in mechanistic pathological understanding. The conference will generate discussion on this subject matter in detail. During the COVID-19 pandemic, it has been observed for patients to change anticoagulation from warfarin to NOACs. Given NOACs do not require monitoring, this medication change reduces the number of interactions patients have with healthcare services. We postulate this change triggered the crisis in our patient, where we suggest continuation of warfarin would have been ideal. This is due to the history of several unprovoked thromboembolic events without a prior antiphospholipid screen being completed. Dissemination of learning points from this case are imperative to ensure decision-making encompasses patients who may have undiagnosed antiphospholipid syndrome. | Rheumatol Adv Pract | 2021 | | CORD-19 |
| 6615 | P14 A case of myositis in patient with atypical bacterial pneumonia CASE REPORT - INTRODUCTION: Bacterial community-acquired atypical pneumonia is sometimes complicated by myositis or by renal parenchymal disease. They can present with myositis and present with muscle weakness, pain or swelling, and elevated muscle enzymes. We present the case of a patient with lower limb weakness and raised creatinine kinase with atypical pneumonia caused by Legionella pneumophila. CASE REPORT - CASE DESCRIPTION: A 76-year-old Caucasian man, who was previously fit and independent and walked 3 miles every day presented with a 1-week history of progressive leg weakness, and inability to mobilize. He had a fall and was on the floor for 2 hours. He had a background history of hypercholesterolemia and was on atorvastatin for 15 years. On his vital observation, he was found tachypnoeic, tachycardic, and hypoxic. He had a right upper lobe crackle but he didn’t have respiratory symptoms. His muscle power in his leg was 3/5 with carpet burns on knees and elbow. Initial investigation showed raised inflammatory marker CRP 412mg/L, AKI stage 1, and CK 43400 IU/L. His CXR showed dense right upper lobe consolidation. Legionella urinary antigen was positive. Myositis myoblot, ANA, ANCA negative. COVID-19 swab negative. Treated with IV antibiotic, supplemental oxygen, and IV fluid. Transferred to ITU due to worsening of hypoxia and kidney function. Interestingly, the CK level had improved significantly within 48 hours along with clinical improvement in his symptoms. There was no role of steroid or immunosuppressant due to his significant clinical improvement. On day 7 he was off oxygen, kidney function improved, had physiotherapy, and transferred to ward and on day 10 he was ambulant and discharged home. CASE REPORT - DISCUSSION: To date, very few case reports of myositis in a patient with atypical pneumonia have been reported. The mechanism underlying acute myositis in atypical pneumonia is still unknown. The present analysis points out that the organism underlying atypical bacterial pneumonia may occasionally invade the muscle tissue thereby inducing both myositis and secondary kidney damage. CASE REPORT - KEY LEARNING POINTS: We should be aware of this rare complication of atypical pneumonia and the resolution of symptoms that occur with the treatment of pneumonia. This would avoid unnecessary investigation and use of steroid. | Rheumatol Adv Pract | 2021 | | CORD-19 |
| 6616 | P01 Catastrophic antiphospholipid syndrome presenting as diffuse peripheral and central thromboses CASE REPORT - INTRODUCTION: Catastrophic Antiphospholipid Syndrome (cAPS) is the most severe form of antiphospholipid syndrome with a high mortality; it is characterised by multiorgan involvement that develops within a short time frame and usually consists of microvascular thrombosis. We present the case of a 50-year-old lady with recurrent microvascular and macrovascular thromboses who was initially treated with endovascular stents and amputation progressing to require immunosuppression and anticoagulation, to include steroids, rituximab, intravenous immunoglobulin and plasma exchange. CASE REPORT - CASE DESCRIPTION: A 50-year-old lady presented to the Emergency Department with bilateral leg and abdominal pain. Her co-morbidities included type two diabetes, psoriasis, three miscarriages, borderline personality disorder and a heavy smoking history. Clinical examination revealed pulse deficits in the distal lower limbs with gangrene evidence of ischaemia on her toe digits. CT angiogram demonstrated complete thrombus of the Infrarenal abdominal aorta extending to the common iliac and external iliac arteries bilaterally. Thrombolysis ensued and an aortic stent was inserted with symptom relief. Two weeks later readmission occurred with bilateral leg pain; Ultrasound Doppler revealed a tight stenosis at the distal aortic region. Initial management consisted of Intravenous heparin but worsening ischaemia resulted in insertion of kissing stents at the aortic bifurcation. The patient’s pain settled with no residual arterial compromise. One month later the patient was re-admitted with bilateral leg pain and necrotic right toes; this led to a right forefoot amputation. A triphasic bilateral finger colour change was noted with ischaemic pain and livedo reticularis on lower limbs, with a decision to institute Iloprost and methylprednisolone ensued. Antiphospholipid antibodies returned showing triple positivity. Management subsequently included addition of IV rituximab, plasma exchange, IVIG and sildenafil. Two months later the patient was re-admitted with complete lower limb paralysis due to a complete thrombus of the aortic bi-iliac stent; thrombolysis ensued with good result. A further admission 1- month later occurred due to sepsis and an infected necrotic left forefoot resulting in an above knee amputation. No further endovascular stenting was advised to risk of embolic seeding following medical management. CASE REPORT - DISCUSSION: We have described a case of cAPS on a previously asymptomatic female patient who presented with diffuse peripheral and central thromboses. Our patient suffered from intra-abdominal organ infarction and subsequent acute kidney injury, recurrent arterial and venous occlusion over a period of 12 months and previous pulmonary emboli. Livedo reticularis and gangrene were visible cutaneous manifestations of this disorder on our patient. cAPS accounts for less than 1% of APS and has a high mortality of 50% which means early and frequent discussion with specialist centres is important. In addition to the clinical features described in our patient, laboratory features included moderate thrombocytopaenia and evidence of haemolysis (raised bilirubin and LDH). The cAPS registry demonstrates that the majority of patients are female (72%) with a mean age of 37 years, 46% have primary APS, 40% suffer from SLE and 9% from other autoimmune diseases. This patient does not have a secondary autoimmune condition. The most common clinical features to present before cAPS develops include foetal loss, previous DVT or thrombocytopaenia, two of which our patient demonstrated. The prognosis and clinical features of cAPS have been shown to depend on the extent of thrombosis, organs affected and the presence of a systemic immune response from affected tissues. Treatment options available for cAPS consist of multiorgan support, anticoagulation and immunosuppression, in the form of glucocorticoids, rituximab, IV Immunoglobulin and plasma exchange. Our patient required all of these due to accelerating thrombosis as determined by new gangrene, ongoing livedo reticularis rash and thrombocytopenia. CASE REPORT - KEY LEARNING POINTS: Our case demonstrates the importance of keeping a high index of suspicion for cAPS as up to 46% will have this as their first presenting feature of APS — including our patient. On her admission to hospital particular attention was paid to clinical examination which suggested Raynauds and a skin rash consistent with livedo reticularis — this prompted a rheumatology consult, serology testing, starting Iloprost and tertiary centre transfer. The diagnosis was secure with high titre of IgG anticardiolipin antibody, anti Beta-2 glycoprotein 1 antibodies and Lupus Anticoagulant detected — all on two occasions more than 12 weeks apart. Patients may present to surgical specialties in view of peripheral vascular symptoms and signs. It would be appropriate to identify patients with APS early to prevent multiple surgeries or considerations for endovascular stents, as they are frequently not successful. This case highlights the need for discussion and education within the multi-disciplinary setting for patients with APS, including surgical teams. Finally, the risk of immunosuppression for patients who have received rituximab can persist for up to 12 months following treatment and this lady also had the co-morbidity of diabetes. This patient’s risk stratification was high in view of COVID-19 and she was advised to shield until government guidelines ended last year. Currently she is doing well without new symptoms and she will be reviewed at 6 months following rituximab, in the Autumn of 2021. | Rheumatol Adv Pract | 2021 | | CORD-19 |
| 6617 | O23 A series of catastrophic events CASE REPORT - INTRODUCTION: Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening disease occurring in up to 1% of antiphospholipid syndrome (APS) cases. It was first defined in 1992 and remains a difficult to treat entity with a mortality rate of 37%. We describe a patient with systemic lupus erythematosus (SLE) and CAPS presenting with simultaneous multi-organ injuries who was successfully managed with ‘triple’ therapy including cyclophosphamide. CASE REPORT - CASE DESCRIPTION: A 42-year-old female presented to her local hospital with chest pain and worsening vision. She had a background of SLE, triple antibody-positive APS (previous DVT, pregnancy loss and strokes), hypertension, a metallic mitral valve, a previous myocardial infarction and pre-existing visual impairment due to a prior intra-cerebral bleed related to anticoagulation. Examination revealed a faint malar rash, cortical blindness and long tract neurological signs. Her ECG showed ischaemic changes and the admission troponin was significantly raised (3773ng/L). An echocardiogram showed new left ventricular dysfunction and a subsequent cardiac MRI was in keeping with coronary artery disease. Investigations showed an acute kidney injury, newly deranged liver function tests and a raised INR (>11, with no bleeding). Complement was normal with a low dsDNA titre. Urinalysis revealed proteinuria and a protein creatinine ratio measured 176mg/mmol. MRI diffusion weighted brain imaging showed acute bilateral occipital and left fronto-parietal infarcts. She had symptoms of a lupus flare with arthralgia and a butterfly facial rash. COVID-19 PCR tests were negative and she had not been recently vaccinated. She was diagnosed with CAPS and transferred to St Thomas’ hospital intensive care. On arrival, she received 1mg intravenous vitamin K followed by triple therapy for CAPS: an unfractionated heparin infusion, oral prednisolone 40mg daily, 5 days of plasma exchange and, given her background of SLE, she was treated with intravenous cyclophosphamide (according to the EUROLUPUS regimen). Intravenous methylprednisolone was avoided due to a previous hypertensive encephalopathy reaction. She responded rapidly. Her troponin fell from a peak of 5054 to 294ng/L, her creatinine settled at a new baseline (232umol/L) and her liver function normalised. She was switched back to warfarin due to her metallic valve and started on aspirin for cardiovascular secondary prevention. She required physical and occupational therapy due to her strokes but recovered well. CASE REPORT - DISCUSSION: According to the 2003 criteria, CAPS can be classified as definite when there is evidence of: ≥3 organs involved, development of manifestations simultaneously or within a week, confirmation by imaging and/or histopathology of small vessel occlusion and positive antiphospholipid antibodies. Probable CAPS is when 3 out of the 4 criteria are present. In this case, three organs were confirmed to be involved with imaging showing cerebral and cardiac ischaemia. Her creatinine rose from a base of 190 to 289umol/L coupled with a high protein creatinine ratio confirming renal involvement. A Budd-Chiari syndrome was also suspected due to deranged liver function tests and INR, though imaging performed after therapy did not confirm this. A biopsy of any of these four organs was not feasible given the severity of her presentation and coagulopathy. There are no randomised controlled trials but data from the CAPS registry guides treatment and management follows a logical approach: anticoagulation to treat thrombosis, glucocorticoids for inflammation and plasma exchange (or IVIG) to remove the circulating autoantibodies. Triple therapy was associated with a reduced mortality compared to no treatment (28.6% versus 75%, respectively). Following analyses from the CAPS registry we also chose to treat with cyclophosphamide, which is associated with improved survival in patients with SLE. This decision was based on the clinical features of an SLE flare as opposed to serological grounds. There have been reports of rituximab and eculizumab being used successfully in CAPS, though generally as a last resort. As complement activation is seen in animal models of antiphospholipid syndrome thrombosis and rituximab is often used in refractory SLE, they may prove to be promising agents for refractory CAPS. CASE REPORT - KEY LEARNING POINTS: 1. Prompt recognition and early treatment is vital in managing CAPS. 2. Triple therapy with anticoagulation, glucocorticoids and plasma exchange / IVIG is associated with better survival in CAPS. 3. Cyclophosphamide is associated with better survival in patients with CAPS and concomitant SLE. | Rheumatol Adv Pract | 2021 | | CORD-19 |
| 6618 | P13 Finding an answer for an adolescent with back pain CASE REPORT - INTRODUCTION: This is the case of an adolescent referred to rheumatology following 5 years of back pain. After years of trying a number of treatments without much success, the cause was found to be a previously undiagnosed urological pathology. The case highlights awareness of non-rheumatological causes and incidental findings which can redirect a patient towards more appropriate treatment and reduce the potential for long-term adverse health issues and anxiety. CASE REPORT - CASE DESCRIPTION: B was referred age 16 to rheumatology with a 5-year history of lower back pain. She had previously seen paediatricians with symptoms initially attributed to constipation due to intermittent straining and hard stool. However, constipation remedies had not relieved the pain which progressed gradually to a more persistent dull ache with impact on daily activities. Various analgesics (including paracetamol and non-steroidal anti-inflammatories), exercises and acupuncture had not helped. There was no history of recurrent urinary tract infections or symptom correlation with fluid intake, menstruation or bowel habit. No inflammatory features or connective tissue disease symptoms were noted and family history was unremarkable Clinical examination was normal apart from mild tenderness in the lumbar region. Rheumatoid factor was borderline positive (15 iu/mL) with the rest of blood tests normal including renal function, inflammatory markers (CRP, ESR), anti CCP and ANA. She had minimal microscopic haematuria without proteinuria. MRI spine in 2015 was normal. In view of her young age and symptoms affecting daily activities, STIR sequence spinal MRI was requested. This excluded any new or old inflammatory changes but incidentally identified a dilated left pelvi-calyceal system. Renal ultrasound confirmed a grossly hydronephrotic left kidney with hydroureter and minimal renal tissue suggesting longstanding obstruction. No calculi were seen. The patient was referred to urologists. Further investigations (including MRI abdomen) confirmed similar findings and a distal ureteric stricture. A MAG 3 renogram showed a normal right kidney but only 12% functioning of the left kidney. Urologists have advised surgery (removal of left kidney and ureter) which may relieve symptoms or a conservative non-surgical approach (continue analgesia, physiotherapy and monitoring). The patient and her family are relieved to have a possible cause identified and are considering the surgical option due to ongoing flank discomfort. CASE REPORT - DISCUSSION: This was an interesting finding of hydroureter and hydronephrosis causing longstanding back pain presenting to rheumatologists. Until completion of the spondyloarthropathy protocol MRI (STIR images), aetiology had been unclear. Hydronephrosis and hydroureter has no specific age or racial predilection. Signs and symptoms may depend on whether obstruction is acute/chronic. Chronic cases may be asymptomatic or present as a dull discomfort (like this case). Some cases may only present in adulthood with pain precipitated by fluid intake. Blood tests may show impaired kidney function. Post-mortem studies suggest 50% of people have at least one renal abnormality (e.g., renal cysts, duplex ureters) with autopsy series incidence of hydronephrosis reported as 3.1%. Causes include anatomical abnormalities such as vesico-ureteric reflux, urethral strictures (usually present in childhood), calculi, benign prostatic hyperplasia, or intrapelvic neoplasms, pregnancy and infections (e.g., TB). Sudden onset unilateral renomegaly was reported in one case of primary Sjogren’s with lymphocytic interstitial nephritis and positive Sjogren’s autoantibodies. Our patient has no clinical or serological evidence of connective tissue disease. Minor pelvi-calyceal distension can occur as a normal finding in well-hydrated patients and pregnancy. However, significant hydronephrosis requires assessment to determine cause as it may affect long term renal function. Imaging via computed tomography, ultrasound and urograms can help guide further management. In this case the preceding cause and duration of pathology is unknown. Sterile, giant hydronephrosis treatment options include observation and ureteric stent or nephrostomy in patients unfit for surgery. Nephrectomy is advised for pain and recurrent infection in a non-functioning kidney. Complications may include bowel perforation, vascular injury and urine leakage. Both open and minimally invasive procedures have good reported outcomes. The COVID-19 pandemic and exams have affected timing of any elective procedures and the patient understands surgery may or may not offer complete symptom resolution. CASE REPORT - KEY LEARNING POINTS: Non-inflammatory causes of back pain should always be considered in cases of persistent back pain, particularly in young people to ascertain if there is a treatable cause. Hydronephrosis cases can be asymptomatic or present with vague, intermittent, non-specific abdominal symptoms with normal physical examination with or without haematuria. This can cause diagnostic uncertainty and delay referral to urology and appropriate renal investigations . Assessment of renal function (including MAG 3 renogram) is important to guide further management. Surgical interventions (pyeloplasty/nephrectomy) may ease symptoms long term but there is no guarantee of a successful outcome and operative risks need to be considered too. Left undiagnosed, potentially this patient could have had further disruption to daily activities and both physical and mental well being. | Rheumatol Adv Pract | 2021 | | CORD-19 |
| 6619 | Dental Trauma UK: Bish Bash Bosh 2021 | Br Dent J | 2022 | | CORD-19 |
| 6620 | Validity evidence for flourishing as a measure of global wellbeing: a national multicenter study of academic general surgery residents PURPOSE: Physician wellbeing is critical to high-quality sustainable healthcare and optimal patient experience. Few objective measures exist to assay wellbeing (as opposed to just pathology) in surgery, or to evaluate the efficacy of wellbeing interventions. Flourishing (as measured by the Mental Health Continuum, MHC) has been suggested as a concise measure of global wellbeing in surgeons. We aimed to establish validity evidence for flourishing in a large national sample of surgical trainees, explore differences by gender and race, and confirm support for the underlying constructs. METHODS: This cross-sectional study of all General Surgery residents at 16 ACGME-accredited academic programs included an online survey of published measures distributed in February 2021. The Mental Health Continuum (MHC), a three-factor model, assesses emotional, social, and psychological wellbeing and is an established metric of psychosocial thriving in non-physicians. A global score cut-off exists for flourishing which represents high wellbeing. Correlation between flourishing and established measures of risk and resilience in surgery were assessed for validity evidence. Differences by gender and race were explored. A confirmatory factor analysis (CFA) was performed to confirm the three-factor structure in surgical trainees. RESULTS: 300 residents (60% non-male, 41% non-white) responded to the survey. For the overall group, flourishing was significantly positively correlated with all wellbeing resilience factors and negatively correlated with all risk factors. This held true for race and gender subgroups based on interaction analyses. CFA and sensitivity analysis results supported the three-factor structure. CONCLUSIONS: Our findings offer validity evidence for flourishing as a measure of global wellbeing and confirm the three-factor structure of emotional, social, and psychological wellbeing in surgical trainees. Thus, the MHC may be a concise tool for assaying wellbeing, within and across subgroups, and for assessing wellbeing intervention effectiveness within the surgery. | N/A | 2022 | | CORD-19 |
| 6621 | AZD-1222/prednisone: Chronic spontaneous urticaria and rebound effect manifested as pruritic rash and angioedema: case report | N/A | 2022 | | CORD-19 |
| 6622 | The Psychological, Academic and Economic Impact of COVID-19 on College Students in the Epicenter of the Pandemic Initial research has indicated that college students have experienced numerous stressors as a result of the pandemic. The current investigation enrolled the largest and most diverse sample of college students to date (N = 4714) from universities in New York (NY) and New Jersey (NJ), the epicenter of the North American pandemic in Spring 2020. We described the impact on the psychological, academic, and financial health of college students who were initially most affected and examined racial/ethnic group differences. Results indicated that students’ mental health was severely affected and that students of color were disproportionately affected by academic, financial, and COVID-related stressors. Worry about COVID-19 infection, stressful living conditions, lower grades, and loneliness emerged as correlates of deteriorating mental health. COVID-19’s mental health impact on college students is alarming and highlights the need for public health interventions at the university level. | Emerg Adulthood | 2022 | | CORD-19 |
| 6623 | The psychological impact of COVID-19 on police officers Police officers play an important role in protecting the community. During the COVID-19 pandemic, their role has posed a serious threat to their physical and psychological health and well-being. This study was designed to assess the prevalence of anxiety, depression, PTSD and compassion fatigue in police officers and to identify the factors that predict COVID-19-related physical and mental well-being. As part of a regular health surveillance programme, 3863 police officers recorded their physical exposure to COVID-19 and the extent to which COVID-19 had affected their psychological well-being. The study provides suggestions on developing evidence-based well-being interventions for policing. | Police J | 2022 | | CORD-19 |
| 6624 | Critical Care Ultrasound: Fixer Bestandteil der ICU-Visite? | N/A | 2022 | | CORD-19 |
| 6625 | Notkoniotomie bei einem COVID-19-Patienten nach vorangegangener nichtinvasiver Beatmung | N/A | 2022 | | CORD-19 |
| 6626 | Increasing supply chain resilience through efficient redundancy allocation: a risk-averse mathematical model The COVID-19 pandemic has created significant uncertainty in all areas of life, including supply chains (SCs). This paper presents a new risk-averse mixed-integer nonlinear problem mathematical model for the design and planning of a two-echelon resilient SC network. Disruption events, which can partially or completely reduce the available capacity, are included in the model. The model’s objective is to minimise the total costs by determining the optimal facility location and capacity, allocation flows and resilience actions for hedging against disruption risk. A solution procedure is tested through computational experiments, and managerial insights were formed based on a numerical example for several disruption configurations, with a specific case of long-term crises similar to the COVID-19 pandemic. The results showed that recovery activities are the most efficient actions to take for a short-term disruption event. Besides, proactive resilience investment in a protection system and flexibility enhancement allows the SC to handle the disruption period with a limited increase in network building costs and overcapacity. | N/A | 2021 | | CORD-19 |
| 6627 | A modified coronavirus herd immunity optimizer for capacitated vehicle routing problem Capacitated Vehicle routing problem is NP-hard scheduling problem in which the main concern is to find the best routes with minimum cost for a number of vehicles serving a number of scattered customers under some vehicle capacity constraint. Due to the complex nature of the capacitated vehicle routing problem, metaheuristic optimization algorithms are widely used for tackling this type of challenge. Coronavirus Herd Immunity Optimizer (CHIO) is a recent metaheuristic population-based algorithm that mimics the COVID-19 herd immunity treatment strategy. In this paper, CHIO is modified for capacitated vehicle routing problem. The modifications for CHIO are accomplished by modifying its operators to preserve the solution feasibility for this type of vehicle routing problems. To evaluate the modified CHIO, two sets of data sets are used: the first data set has ten Synthetic CVRP models while the second is an ABEFMP data set which has 27 instances with different models. Moreover, the results achieved by modified CHIO are compared against the results of other 13 well-regarded algorithms. For the first data set, the modified CHIO is able to gain the same results as the other comparative methods in two out of ten instances and acceptable results in the rest. For the second and the more complicated data sets, the modified CHIO is able to achieve very competitive results and ranked the first for 8 instances out of 27. In a nutshell, the modified CHIO is able to efficiently solve the capacitated vehicle routing problem and can be utilized for other routing problems in the future such as multiple travelling salesman problem. | N/A | 2021 | | CORD-19 |
| 6628 | Artificial Intelligence and COVID-19: A Systematic umbrella review and roads ahead Artificial Intelligence (AI) has played a substantial role in the response to the challenges posed by the current pandemic. The growing interest in using AI to handle Covid-19 issues has accelerated the pace of AI research and resulted in an exponential increase in articles and review studies within a very short period of time. Hence, it is becoming challenging to explore the large corpus of academic publications dedicated to the global health crisis. Even with the presence of systematic review studies, given their number and diversity, identifying trends and research avenues beyond the pandemic should be an arduous task. We conclude therefore that after the one-year mark of the declaration of Covid-19 as a pandemic, the accumulated scientific contribution lacks two fundamental aspects: Knowledge synthesis and Future projections. In contribution to fill this void, this paper is a (i) synthesis study and (ii) foresight exercise. The synthesis study aims to provide the scholars a consolidation of findings and a knowledge synthesis through a systematic review of the reviews (umbrella review) studying AI applications against Covid-19. Following the PRISMA guidelines, we systematically searched PubMed, Scopus, and other preprint sources from 1st December 2019 to 1st June 2021 for eligible reviews. The literature search and screening process resulted in 45 included reviews. Our findings reveal patterns, relationships, and trends in the AI research community response to the pandemic. We found that in the space of few months, the research objectives of the literature have developed rapidly from identifying potential AI applications to evaluating current uses of intelligent systems. Only few reviews have adopted the meta-analysis as a study design. Moreover, a clear dominance of the medical theme and the DNN methods has been observed in the reported AI applications. Based on its constructive systematic umbrella review, this work conducts a foresight exercise that tries to envision the post-Covid-19 research landscape of the AI field. We see seven key themes of research that may be an outcome of the present crisis and which advocate a more sustainable and responsible form of intelligent systems. We set accordingly a post-pandemic research agenda articulated around these seven drivers. The results of this study can be useful for the AI research community to obtain a holistic view of the current literature and to help prioritize research needs as we are heading toward the new normal. | N/A | 2021 | | CORD-19 |
| 6629 | Blurred lines: comparing room rates, star-ratings and user-generated contents for full-service and select-service hotels The relatively low cost to build select-service hotels coupled with increased competition in this segment has led to innovations that may have blurred the lines between full-service and select-service hotels. This study compares consumer perceptions of select-service and full-service hotels by comparing the best available rates and consumer-generated reviews from two sets of full-service and select-service hotels from Intercontinental Hotel Group and Hilton. This study found that brand, not segment, affected room rate while select-service hotels had significantly higher star-ratings than full-service hotels. For revenue managers, this study indicates that consumers are willing-to-pay a premium for hotels in certain brands. | N/A | 2022 | | CORD-19 |
| 6630 | Towards a Demsetzian Knowledge Theory The paper attempts to outline a general theory of knowledge in economics based on the work of Harold Demsetz. We identify that “knowledge encapsulation” is a key Demsetzian idea that could unite the otherwise fragmented or narrow research on knowledge in economics. The knowledge encapsulation concept holds that mobilizing cognitive resources and acting under full knowledge is costly. This creates an incentive to compress knowledge into an algorithmic form, which can then be transferred in a cost-efficient manner between a multitude of agents. From this idea of Demsetz, we create a simple theoretical model. To prove its generalizability, we extrapolate it onto a wide range of cases, from traditions and superstitions to institutions and division of knowledge. We conclude that knowledge encapsulation applies to an extensive array of phenomena. However, such encapsulation must also be supplemented by adequate enforcement and mechanisms of coping with ex-post consequences of its use. If our analysis is correct, then the Demsetzian theory could be a strong contender for becoming a fruitful alternative research paradigm on knowledge in economics. | N/A | 2022 | | CORD-19 |
| 6631 | Het vaststellen van fysieke activiteit van volwassenen uit 11 landen tijdens de COVID-19 pandemische lockdown Deze studie beschrijft de fysieke activiteit van 11.775 volwassen uit 11 landen tijdens de COVID-19-lockdown en onderzocht factoren die verband houden met fysieke activiteit. Meer dan 40% van de deelnemers was onvoldoende lichamelijk actief voor de lockdown en meer dan 44% rapporteerde een verminderde fysieke activiteit tijdens de lockdown. Deze verschillen waren statistisch-significant in vergelijking met de periode voor de lockdown. Ook het niveau van fysieke activiteit was tijdens de lockdown significant verminderd. Strengere overheidsmaatregelen en hogere depressie- en angstscores resulteerden in minder fysieke activiteit. Uit dit onderzoek werd geconcludeerd dat tijdens een lockdown en vergelijkbare globale noodsituaties het nodig is om mensen aan te sporen tot fysieke activiteit. | N/A | 2022 | | CORD-19 |
| 6632 | Covid-19-vaccine-pfizer-biontech: Injection site soreness and panuveitis: case report | N/A | 2022 | | CORD-19 |
| 6633 | Multiple drugs: Off-label use and no clinical improvement: case report | N/A | 2022 | | CORD-19 |
| 6634 | Escitalopram/midazolam: Lack of efficacy: case report | N/A | 2022 | | CORD-19 |
| 6635 | AZD-1222: Neck lymphadenitis: case report | N/A | 2022 | | CORD-19 |
| 6636 | Dostarlimab/tozinameran: Various toxicities: case report | N/A | 2022 | | CORD-19 |
| 6637 | Remdesivir: Sinus bradycardia: 12 case reports | N/A | 2022 | | CORD-19 |
| 6638 | Tozinameran: Varicella zoster virus meningitis and herpes zoster infections: case report | N/A | 2022 | | CORD-19 |
| 6639 | AZD-1222: Leukocytoclastic vasculitis: case report | N/A | 2022 | | CORD-19 |
| 6640 | Sars-cov-2-vaccine-inactivated-sinovac-biotech: Ocular surface erosion and skin rash following accidental exposure to evaporated vaccine and excipients: 15 case reports | N/A | 2022 | | CORD-19 |
| 6641 | COVID-19-Vaccine-Pfizer-BioNTech: Grave's disease: case report | N/A | 2022 | | CORD-19 |
| 6642 | Tozinameran: Immune thrombotic thrombocytopenic purpura: case report | N/A | 2022 | | CORD-19 |
| 6643 | Heparin: Heparin induced thrombocytopenia: case report | N/A | 2022 | | CORD-19 |
| 6644 | Insulin-glargine/norepinephrine: Lack of efficacy: case report | N/A | 2022 | | CORD-19 |
| 6645 | Remdesivir: Acute kidney injury and elevated ALT level: 2 case reports | N/A | 2022 | | CORD-19 |
| 6646 | Elasomeran/tozinameran: Multiple sclerosis: 5 case reports | N/A | 2022 | | CORD-19 |
| 6647 | Covid-19-vaccine-pfizer-biontech: Unmasking of leprosy: case report | N/A | 2022 | | CORD-19 |
| 6648 | COVID-19-Vaccine-Pfizer-BioNTech: Myopericarditis: 13 case reports | N/A | 2022 | | CORD-19 |
| 6649 | Dexamethasone/remdesivir: Acute pancreatitis: case report | N/A | 2022 | | CORD-19 |
| 6650 | Multiple drugs: Lymphopenia, diminished drug effect and lack of efficacy: case report | N/A | 2022 | | CORD-19 |
