At the Heart of the Diagnosis: A Case of Systemic Lupus Erythematosus Presenting as Cardiac Tamponade

Systemic lupus erythematosus (SLE) is a heterogenous, systemic disease characterized by the production of pathogenic autoantibodies against nuclear antigens. Although the most common cardiac manifestation of SLE is pericardial effusions, their progression to cardiac tamponade is rare and has an incidence between 1-3%. We describe a case of a 42-year-old Hispanic woman who presented with severe shortness of breath, vague chest pain, and hemodynamic compromise secondary to cardiac tamponade. The patient\u27s underlying etiology of cardiac tamponade was attributed to a new diagnosis of SLE based on the 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology classification (EULAR/ACR) criteria for SLE. The patient\u27s treatment consisted of a pericardial window and immunosuppressive therapy with corticosteroids, Mycophenolate, and hydroxychloroquine. This case aims to increase awareness of SLE as a possible differential diagnosis of cardiac tamponade in the appropriate clinical setting

A Case of Hemorrhagic Myositis Associated With Prophylactic Heparin Use in Dermatomyositis

Dermatomyositis (DM) is a rare systemic autoimmune disease that is associated with inflammation of the skin and muscles. It typically presents with weakness of the proximal muscles along with characteristic skin lesions such as Gottron\u27s papules and heliotrope rash. One of the most feared complications of this disease is the appearance of spontaneous hemorrhagic myositis, as most reported cases are fatal. The mechanism or risk factors of this condition have not been elucidated; however, prophylactic anticoagulation has been correlated with it in previous case reports, although idiopathic hemorrhagic myositis may also be present. We present a case of spontaneous intramuscular hemorrhage (SIH) in a recently diagnosed DM patient. A 59-year-old Hispanic male with a medical history of recently diagnosed prostate cancer and DM presented to the emergency department (ED) due to worsening anemia. His previous hemoglobin (Hgb) was 9 g/dl, but repeated laboratory tests revealed a level of 6.5 g/dl and later 5.5 g/dl at the ED. On admission, the patient was afebrile, tachycardic, and normotensive, with no overt sign of gastrointestinal bleeding. The physical exam revealed an ecchymosis on the right medial aspect of the thigh, and a digital rectal exam was negative. Computer tomography (CT) of the abdomen and pelvis without contrast was ordered due to suspicion of a retroperitoneal hematoma, revealing an interval development of a right groin complex fluid collection of up to 6 cm, concerning a possible hematoma. The patient did not have any previous vascular procedures in the area but was exposed to deep vein thrombosis (DVT) prophylaxis during the previous admission. Vascular surgery was consulted, and the recommendation was made to proceed with conservative management. On the third day, the patient developed new-onset, left-sided pleuritic chest pain. Upon examination, significant swelling and tenderness were noted in his left pectoral region, which was not present on admission. A CT chest without contrast was ordered due to concerns of underlying hematomas, revealing bilateral thickening of the pectoralis muscles, more on the right side, with a fluid collection of 2.5 cm × 1.3 cm. In addition, there was thickening of the right lateral chest wall muscles in the posterior right trapezius or supraspinatus muscles, most likely from intramuscular hemorrhage. The patient was transferred to the step-down unit for close monitoring. Conservative management was continued with as-needed transfusions for three days until hemoglobin stabilized at 9.8 mg/dL. Once stable, the patient was resumed on steroids and immunosuppressive therapy with posterior resolution of the SIH. SIH has been reported in DM, particularly more prominent in those with anti-MDA-5 antibodies. A case series and literature review showed 60.9% mortality within six months in those presenting with SIH, with a poorer prognosis (80% mortality) in those with deep muscle bleeding versus superficial (25%). There is currently no consensus on the treatment approach, and arterial embolization has not been proven effective. In our patient, conservative management with close surveillance and frequent transfusions helped achieve hemodynamic stability. Clinicians should be more aware of these rare but life-threatening complications in patients presenting with DM

NASAs Mid-Atlantic Communities and Areas at Intensive Risk Demonstration: Translating Compounding Hazards to Societal Risk

Remote sensing provides a unique perspective on our dynamic planet, tracking changes and revealing the course of complex interactions. Long term monitoring and targeted observation combine with modeling and mapping to provide increased awareness of hydro-meteorological and geological hazards. Disasters often follow hazards and the goal of NASAs Disasters Program is to look at the earth as a highly coupled system to reduce risk and enable resilience. Remote sensing and geospatial science are used as tools to help answer critical questions that inform decisions. Data is not the same as information, nor does understanding of processes necessarily translate into decision support for disaster preparedness, response and recovery. Accordingly, NASA is engaging the scientific and decision-support communities to apply remote sensing, modeling, and related applications in Communities and Areas at Intensive Risk (CAIR). In 2017, NASAs Applied Sciences Disasters Program hosted a regional workshop to explore these issues with particular focus on coastal Virginia and North Carolina. The workshop brought together partners in academia, emergency management, and scientists from NASA and partnering federal agencies to explore capabilities among the team that could improve understanding of the physical processes related to these hazards, their potential impact to changing communities, and to identify methodologies for supporting emergency response and risk mitigation. The resulting initiative, the mid-Atlantic CAIR project, demonstrates the ability to integrate satellite derived earth observations and physical models into actionable, trusted knowledge. Severe storms and associated storm surge, sea level rise, and land subsidence coupled with increasing populations and densely populated, aging critical infrastructure often leave coastal regions and their communities extremely vulnerable. The integration of observations and models allow for a comprehensive understanding of the compounding risk experienced in coastal regions and enables individuals in all positions make risk-informed decisions. This initiative uses a representative storm surge case as a baseline to produce flood inundation maps. These maps predict building level impacts at current day and for sea level rise (SLR) and subsidence scenarios of the future in order to inform critical decisions at both the tactical and strategic levels. To accomplish this analysis, the mid-Atlantic CAIR project brings together Federal research activities with academia to examine coastal hazards in multiple ways: 1) reanalysis of impacts from 2011 Hurricane Irene, using numerical weather modeling in combination with coastal surge and hydrodynamic, urban inundation modeling to evaluate combined impact scenarios considering SLR and subsidence, 2) remote sensing of flood extent from available optical imagery, 3) adding value to remotely sensed flood maps through depth predictions, and 4) examining coastal subsidence as measured through time-series analysis of synthetic aperture radar observations. Efforts and results are published via ArcGIS story maps to communicate neighborhoods and infrastructure most vulnerable to changing conditions. Story map features enable time-aware flood mapping using hydrodynamic models, photographic comparison of flooding following Hurricane Irene, as well as visualization of heightened risk in the future due to SLR and land subsidence

Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: a prospective cohort study

INTRODUCTION: Serum creatinine is a late marker of acute kidney injury (AKI). Urine neutrophil gelatinase-associated lipocalin (uNGAL) is an early marker of AKI, where the timing of kidney injury is known. It is unknown whether uNGAL predicts AKI in the general critical care setting. We assessed the ability of uNGAL to predict AKI development and severity in critically ill children. METHODS: This was a prospective cohort study of critically ill children. Children aged between 1 month and 21 years who were mechanically ventilated and had a bladder catheter inserted were eligible. Patients with end-stage renal disease or who had just undergone kidney transplantation were excluded. Patients were enrolled within 24 to 48 hours of initiation of mechanical ventilation. Clinical data and serum creatinine were collected daily for up to 14 days from enrollment, and urine was collected once daily for up to 4 days for uNGAL measurement. AKI was graded using pRIFLE (pediatric modified Risk, Injury, Failure, Loss, End Stage Kidney Disease) criteria. Day 0 was defined as the day on which the AKI initially occurred, and pRIFLEmax was defined as the worst pRIFLE AKI grade recorded during the study period. The χ(2 )test was used to compare associations between categorical variables. Mann-Whitney and Kruskal-Wallis tests were used to compare continuous variables between groups. Diagnostic characteristics were evaluated by calculating sensitivity and specificity, and constructing receiver operating characteristic curves. RESULTS: A total of 140 patients (54% boys, mean ± standard deviation Pediatric Risk of Mortality II score 15.0 ± 8.0, 23% sepsis) were included. Mean and peak uNGAL concentrations increased with worsening pRIFLEmax status (P < 0.05). uNGAL concentrations rose (at least sixfold higher than in controls) in AKI, 2 days before and after a 50% or greater rise in serum creatinine, without change in control uNGAL. The parameter uNGAL was a good diagnostic marker for AKI development (area under the receiver operating characteristic curve [AUC] 0.78, 95% confidence interval [CI] 0.62 to 0.95) and persistent AKI for 48 hours or longer (AUC 0.79, 95% CI 0.61 to 0.98), but not for AKI severity, when it was recorded after a rise in serum creatinine had occurred (AUC 0.63, 95% CI 0.44 to 0.82). CONCLUSION: We found uNGAL to be a useful early AKI marker that predicted development of severe AKI in a heterogeneous group of patients with unknown timing of kidney injury

Systemic and Lower Respiratory Tract Immunity to SARS-CoV-2 Omicron and Variants in Pediatric Severe COVID-19 and Mis-C

Mucosal immunity plays an important role in the control of viral respiratory infections like SARS-CoV-2. While systemic immune responses against the SARS-2-CoV-2 have been studied in children, there is no information on mucosal antibody response, especially in the lower respiratory tract of children coronavirus disease 2019 (COVID-19) and post-infectious multisystem inflammatory syndrome in children (MIS-C) against emerging SARS-CoV-2 variants. Therefore, we evaluated neutralizing antibody responses in paired plasma and endotracheal aspirates of pediatric severe, acute COVID-19 or MIS-C patients against SARS-CoV-2 WA1/2020, as well as against variants of concern (VOCs). Neutralizing antibody responses against the SARS-CoV-2 WA1/2020 strain in pediatric plasma were 2-fold or 35-fold higher compared with the matched endotracheal aspirate in COVID-19 or MIS-C patients, respectively. In contrast to plasma, neutralizing antibody responses against the VOCs and variants of interest (VOIs) in endotracheal aspirates were lower, with only one endotracheal aspirate demonstrating neutralizing titers against the Iota, Kappa, Beta, Gamma, and Omicron variants. In conclusion, our findings suggest that children and adolescents with severe COVID-19 or MIS-C have weak mucosal neutralizing antibodies in the trachea against circulating SARS-CoV-2 Omicron and other VOCs, which may have implications for recovery and for re-infection with emerging SARS-CoV-2 variants

The Claiborne Corridor: Mid-Anchor Business Profiles 2014

The New Orleans Business Alliance and the Mayor’s Office of Place-based Planning are working closely with the Livable Claiborne Communities Initiatives to encourage the maintenance, development and expansion of businesses throughout the city with a special focus on the LCC. The reports that follow identify mid-anchor businesses that have contributed to the social and economic wealth of the City of New Orleans for, in some cases, hundreds of years. The hope is that these businesses will be supported through new City initiatives to improve façades, marketability and expand employment opportunities. The research and resources provided by the students at UNO will support these efforts and hopefully contribute to the reinvestment and redevelopment of the new New Orleans

The Claiborne Corridor: Mid-Anchor Business Profiles 2014

The New Orleans Business Alliance and the Mayor’s Office of Place-based Planning are working closely with the Livable Claiborne Communities Initiatives to encourage the maintenance, development and expansion of businesses throughout the city with a special focus on the LCC. The reports that follow identify mid-anchor businesses that have contributed to the social and economic wealth of the City of New Orleans for, in some cases, hundreds of years. The hope is that these businesses will be supported through new City initiatives to improve façades, marketability and expand employment opportunities. The research and resources provided by the students at UNO will support these efforts and hopefully contribute to the reinvestment and redevelopment of the new New Orleans

The Floodwater Depth Estimation Tool (FwDET v2.0) for improved remote sensing analysis of coastal flooding

Remote sensing analysis is routinely used to map flooding extent either retrospectively or in near-real time. For flood emergency response, remote-sensing-based flood mapping is highly valuable as it can offer continued observational information about the flood extent over large geographical domains. Information about the floodwater depth across the inundated domain is important for damage assessment, rescue, and prioritizing of relief resource allocation, but cannot be readily estimated from remote sensing analysis. The Floodwater Depth Estimation Tool (FwDET) was developed to augment remote sensing analysis by calculating water depth based solely on an inundation map with an associated digital elevation model (DEM). The tool was shown to be accurate and was used in flood response activations by the Global Flood Partnership. Here we present a new version of the tool, FwDET v2.0, which enables water depth estimation for coastal flooding. FwDET v2.0 features a new flood boundary identification scheme which accounts for the lack of confinement of coastal flood domains at the shoreline. A new algorithm is used to calculate the local floodwater elevation for each cell, which improves the tool's runtime by a factor of 15 and alleviates inaccurate local boundary assignment across permanent water bodies. FwDET v2.0 is evaluated against physically based hydrodynamic simulations in both riverine and coastal case studies. The results show good correspondence, with an average difference of 0.18 and 0.31&thinsp;m for the coastal (using a 1&thinsp;m DEM) and riverine (using a 10&thinsp;m DEM) case studies, respectively. A FwDET v2.0 application of using remote-sensing-derived flood maps is presented for three case studies. These case studies showcase FwDET v2.0 ability to efficiently provide a synoptic assessment of floodwater. Limitations include challenges in obtaining high-resolution DEMs and increases in uncertainty when applied for highly fragmented flood inundation domains.</p

A Phase 2a clinical trial of Molnupiravir in patients with COVID-19 shows accelerated SARS-CoV-2 RNA clearance and elimination of infectious virus

Molnupiravir (800 mg dose) accelerated SARS-CoV-2 RNA clearance in patients with COVID-19 compared to placebo