Spinal Cord Injury and Autonomic Dysreflexia- A Case Report

Autonomic dysreflexia (AD) is a life threatening condition affecting patients with spinal cord lesions T6 level and above. A 51 year old male with a history of paraplegia due to a C6 spinal cord injury (30 years prior) presented with recurrent debilitating episodic diaphoresis, hypertension, low body temperature, and bradycardia. Previous hospitalizations presumed sepsis from UTI to be the etiology, however on further evaluation his symptoms were consistent with undiagnosed AD. This article describes a unique case presentation and reviews AD in depth, including the etiology, pathophysiology and management

Estimating Emotion Contagion on Social Media via Localized Diffusion in Dynamic Graphs

We present a computational approach for estimating emotion contagion on social media networks. Built on a foundation of psychology literature, our approach estimates the degree to which the perceivers' emotional states (positive or negative) start to match those of the expressors, based on the latter's content. We use a combination of deep learning and social network analysis to model emotion contagion as a diffusion process in dynamic social network graphs, taking into consideration key aspects like causality, homophily, and interference. We evaluate our approach on user behavior data obtained from a popular social media platform for sharing short videos. We analyze the behavior of 48 users over a span of 8 weeks (over 200k audio-visual short posts analyzed) and estimate how contagious the users with whom they engage with are on social media. As per the theory of diffusion, we account for the videos a user watches during this time (inflow) and the daily engagements; liking, sharing, downloading or creating new videos (outflow) to estimate contagion. To validate our approach and analysis, we obtain human feedback on these 48 social media platform users with an online study by collecting responses of about 150 participants. We report users who interact with more number of creators on the platform are 12% less prone to contagion, and those who consume more content of `negative' sentiment are 23% more prone to contagion. We will publicly release our code upon acceptance

Spinal Cord Injury and Autonomic Dysreflexia- A Case Report

Autonomic dysreflexia (AD) is a life threatening condition affecting patients with spinal cord lesions T6 level and above. A 51 year old male with a history of paraplegia due to a C6 spinal cord injury (30 years prior) presented with recurrent debilitating episodic diaphoresis, hypertension, low body temperature, and bradycardia. Previous hospitalizations presumed sepsis from UTI to be the etiology, however on further evaluation his symptoms were consistent with undiagnosed AD. This article describes a unique case presentation and reviews AD in depth, including the etiology, pathophysiology and management

SARS-CoV-2 B.1.617.2 Delta variant replication and immune evasion

Abstract: The B.1.617.2 (Delta) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in the state of Maharashtra in late 2020 and spread throughout India, outcompeting pre-existing lineages including B.1.617.1 (Kappa) and B.1.1.7 (Alpha)1. In vitro, B.1.617.2 is sixfold less sensitive to serum neutralizing antibodies from recovered individuals, and eightfold less sensitive to vaccine-elicited antibodies, compared with wild-type Wuhan-1 bearing D614G. Serum neutralizing titres against B.1.617.2 were lower in ChAdOx1 vaccinees than in BNT162b2 vaccinees. B.1.617.2 spike pseudotyped viruses exhibited compromised sensitivity to monoclonal antibodies to the receptor-binding domain and the amino-terminal domain. B.1.617.2 demonstrated higher replication efficiency than B.1.1.7 in both airway organoid and human airway epithelial systems, associated with B.1.617.2 spike being in a predominantly cleaved state compared with B.1.1.7 spike. The B.1.617.2 spike protein was able to mediate highly efficient syncytium formation that was less sensitive to inhibition by neutralizing antibody, compared with that of wild-type spike. We also observed that B.1.617.2 had higher replication and spike-mediated entry than B.1.617.1, potentially explaining the B.1.617.2 dominance. In an analysis of more than 130 SARS-CoV-2-infected health care workers across three centres in India during a period of mixed lineage circulation, we observed reduced ChAdOx1 vaccine effectiveness against B.1.617.2 relative to non-B.1.617.2, with the caveat of possible residual confounding. Compromised vaccine efficacy against the highly fit and immune-evasive B.1.617.2 Delta variant warrants continued infection control measures in the post-vaccination era

A Study of Carotid Intimomedial Thickness as a Primary Marker of Atherosclerosis in Patients with Rheumatoid Arthritis.

Background: Atherosclerosis is a slowly progressive diffuse degenerative disease of arteries which can lead to various metabolic and cardiovascular complications. However, it can cause early and significant morbidity in patients with Rheumatoid Arthritis (RA) when compared to general population. Indirect evidence of accelerated atherosclerosis in RA comes from studies measuring carotid artery intima media thickness (CIMT). This present study aims to investigate the relationship between carotid intima-media thickness and clinical and metabolic features in rheumatoid arthritis (RA) patients. Methods In this prospective observational case control study, 34 patients with RA having a disease duration of more than 5 years were compared to 34 healthy matched controls. All the patients and controls were asymptomatic for atherosclerosis and had no traditional risk factors for atherosclerosis. Both groups underwent high frequency carotid ultrasound and Doppler examination for CIMT in addition to detailed history, physical examination and measurement of other metabolic parameters. Results The mean ages of RA group and the control group were 48±14.4 and 48.6±14.0 respectively with a female preponderance in the RA group. The groups were comparable for atherogenic biochemical risk indices such as body mass index (BMI), systolic and diastolic blood pressure, random blood sugar, and lipid profile. The RA group had a significant elevation of CRP as compared to the control group (88% vs 15%). The mean CIMT of the RA group was 0.86 ± 0.18 and that of the control group was 0.53 ± 0.15, a difference which was statistically significant (p<0.0001). As the severity of disease increased according to disease activity score (DAS 28), the CIMT in study group also showed an increasing trend. Conclusions RA is a chronic disease associatedd with chronic subclinical inflammation. In view of the consequentr high risk of atherosclerosis seen in these patients CIMT may serve as an early surrogate marker of atherosclerosis. We can identify these high risk subgroups of patients with a simple, reliable, inexpensive, and non-invasive bedside carotid Doppler sonogram even in resource poor countries such as India. In our view physicians should be vigilant to identify and screen regularly for atherosclerosis with CIMT in RA patients, so that prompt early management can prevent the cardiovascular complications

Changes in Myocardial Infarction Guideline Adherence as a Function of Patient Risk An End to Paradoxical Care?

ObjectivesThe goals of this analysis were to determine: 1) whether guideline-based care during hospitalization for a myocardial infarction (MI) varied as a function of patients' baseline risk; and 2) whether temporal improvements in guideline adherence occurred in all risk groups.BackgroundGuideline-based care of patients with MI improves outcomes, especially among those at higher risk. Previous studies suggest that this group is paradoxically less likely to receive guideline-based care (risk–treatment mismatch).MethodsA total of 112,848 patients with MI were enrolled at 279 hospitals participating in Get With The Guidelines–Coronary Artery Disease (GWTG–CAD) between August 2000 and December 2008. We developed and validated an in-hospital mortality model (C-statistic: 0.75) to stratify patients into risk tertiles: low (0% to 3%), intermediate (3% to 6.5%), and high (>6.5%). Use of guideline-based care and temporal trends were examined.ResultsHigh-risk patients were significantly less likely to receive aspirin, beta-blockers, angiotensin-converting inhibitors/angiotensin receptor blockers, statins, diabetic treatment, smoking cessation advice, or cardiac rehabilitation referral at discharge compared with those at lower risk (all p < 0.0001). However, use of guideline-recommended therapies increased significantly in all risk groups per year (low-risk odds ratio: 1.33 [95% confidence interval (CI): 1.22 to 1.45]; intermediate-risk odds ratio: 1.30 [95% CI: 1.21 to 1.38]; and high-risk odds ratio: 1.30 [95% confidence interval: 1.23 to 1.37]). Also, there was a narrowing in the guideline adherence gap between low- and high-risk patients over time (p = 0.0002).ConclusionsAlthough adherence to guideline-based care remains paradoxically lower in those MI patients at higher risk of mortality and most likely to benefit from treatment, care is improving for eligible patients within all risk categories, and the gaps between low- and high-risk groups seem to be narrowing