COVID-19 and acute pancreatitis clinical outcomes among hospitalized patients in the United States: A propensity matched analysis of national inpatient sample.

BACKGROUND: Pancreatitis is one of the leading causes of gastrointestinal-related hospitalization, with significant morbidity and mortality. SARS-COV-2 virus can access the pancreas via angiotensin-converting enzymes and can cause direct and indirect injury to the pancreatic parenchyma. The objective of this study to understand clinical outcomes of hospitalized patients with COVID-19 with and without pancreatitis utilizing National Inpatient Sample database. METHODS: We utilized the United States National Inpatient Sample database to study clinical outcomes in hospitalized patients with COVID-19 infection (a total of 1,659,040 hospitalized patients with 10,075 (0.6 %) with pancreatitis) between January 1 to December 31, 2020, along with propensity matching. RESULTS: While after propensity matching, we did not find a statistical difference in in-hospital mortality amongst COVID-19 patients with pancreatitis compared to COVID-19 patients without pancreatitis (13.2 % vs 10.3 %, adjusted odds ratio: 0.7 [95 % CI 0.5-1], p = 0.11). Patients with COVID-19 and pancreatitis had more episodes of septic shock, higher incidence of acute kidney injury and acute kidney injury requiring hemodialysis. We also found an increased prevalence of NASH cirrhosis, alcohol liver cirrhosis, and a lesser incidence of pulmonary embolisms in the COVID-19 with pancreatitis cohort. CONCLUSION: Worse in-hospital outcomes, including increased incidence of septic shock, acute kidney injury, and acute kidney injury requiring hemodialysis in hospitalized patients with COVID-19 infection and pancreatitis, emphasize the need for more research to understand the effect of COVID-19 disease in hospitalized patients with pancreatitis and in the role of vaccination to improve long term outcome in this patient population.

Carbon Dioxide Gas Sensor Based on Polyhexamethylene Biguanide Polymer Deposited on Silicon Nano-Cylinders Metasurface.

In this paper, we have numerically investigated a metasurface based perfect absorber design, established on the impedance matching phenomena. The paper comprises of two parts. In the first part, the device performance of the perfect absorber-which is composed of silicon nano-cylindrical meta-atoms, periodically arranged on a thin gold layer-is studied. The device design is unique and works for both x-oriented and y-oriented polarized light, in addition to being independent of the angle of incidence. In the second part of the paper, a CO2 gas sensing application is explored by depositing a thin layer of functional host material-a polyhexamethylene biguanide polymer-on the metasurface. The refractive index of the host material decreases due to the absorption of the CO2 gas. As a result, the resonance wavelength of the perfect absorber performs a prominent blueshift. With the help of the proposed sensor design, based on metasurface, the CO2 gas concentration range of 0-524 ppm was detected. A maximum sensitivity of 17.3 pm/ppm was acquired for a gas concentration of 434 ppm. The study presented in this work explores the opportunity of utilizing the metasurface perfect absorber for gas sensing applications by employing functional host materials.

Subwavelength Grating Double Slot Waveguide Racetrack Ring Resonator for Refractive Index Sensing Application.

In this paper, a racetrack ring resonator design based on a subwavelength grating double slot waveguide is presented. The proposed waveguide scheme is capable of confining the transverse electric field in the slots and the gaps between the grating segments. This configuration facilitates a large light-matter interaction which elevates the sensitivity of the device approximately 2.5 times higher than the one that can be obtained via a standard slot waveguide resonator. The best sensitivity of the design is obtained at 1000 nm/RIU by utilizing a subwavelength grating double slot waveguide of period 300 nm. The numerical study is conducted via 2D and 3D finite element methods. We believe that the proposed sensor design can play an important role in the realization of highly sensitive lab-on-chip sensors.

Low-repetition rate femtosecond laser writing of optical waveguides in KTP crystals: analysis of anisotropic refractive index changes.

We report on the direct low-repetition rate femtosecond pulse laser microfabrication of optical waveguides in KTP crystals and the characterization of refractive index changes after the thermal annealing of the sample, with the focus on studying the potential for direct laser fabricating Mach-Zehnder optical modulators. We have fabricated square cladding waveguides by means of stacking damage tracks, and found that the refractive index decrease is large for vertically polarized light (c-axis; TM polarized) but rather weak for horizontally polarized light (a-axis; TE polarized), this leading to good near-infrared light confinement for TM modes but poor for TE modes. However, after performing a sample thermal annealing we have found that the thermal process enables a refractive index increment of around 1.5x10(-3) for TE polarized light, while maintaining the negative index change of around -1x10(-2) for TM polarized light. In order to evaluate the local refractive index changes we have followed a multistep procedure: We have first characterized the waveguide cross-sections by means of Raman micro-mapping to access the lattice micro-modifications and their spatial extent. Secondly we have modeled the waveguides following the modified region sizes obtained by micro-Raman with finite element method software to obtain a best match between the experimental propagation modes and the simulated ones. Furthermore we also report the fabrication of Mach-Zehnder structures and the evaluation of propagation losses.

Orthogonal mode couplers for plasmonic chip based on metal-insulator-metal waveguide for temperature sensing application.

In this work, a plasmonic sensor based on metal-insulator-metal (MIM) waveguide for temperature sensing application is numerically investigated via finite element method (FEM). The resonant cavity filled with PDMS polymer is side-coupled to the MIM bus waveguide. The sensitivity of the proposed device is ~ - 0.44 nm/°C which can be further enhanced to - 0.63 nm/°C by embedding a period array of metallic nanoblocks in the center of the cavity. We comprehend the existence of numerous highly attractive and sensitive plasmonic sensor designs, yet a notable gap exists in the exploration of light coupling mechanisms to these nanoscale waveguides. Consequently, we introduced an attractive approach: orthogonal mode couplers designed for plasmonic chips, which leverage MIM waveguide-based sensors. The optimized transmission of the hybrid system including silicon couplers and MIM waveguide is in the range of - 1.73 dB to - 2.93 dB for a broad wavelength range of 1450-1650 nm. The skillful integration of these couplers not only distinguishes our plasmonic sensor but also positions it as a highly promising solution for an extensive array of sensing applications.

Inpatient outcomes of inflammatory bowel disease in hospitalized patients with COVID-19: analysis of a nationally representative sample.

Purpose: To compare the risks of adverse outcomes, including mortality, gastrointestinal bleeding, and venous thromboembolism, between COVID-19 patients with inflammatory bowel disease (IBD) and those without IBD. Methods: We analyzed data from the National Inpatient Sample between January and December 2020. The study included adult patients with Crohn's disease (CD) and ulcerative colitis (UC) who contracted COVID-19. Inpatient outcomes were compared between the IBD and non-IBD COVID-19 cohorts. Results: Out of 1,050,045 COVID-19 hospitalizations, 0.28% had CD (2954 patients) and 0.26% had UC (2794 patients). After adjusting for confounding factors, UC patients had a significantly higher risk of deep vein thrombosis compared to non-IBD patients, with an adjusted odds ratio (aOR) of 2.55 (P < 0.001). However, CD patients did not show a significant association with deep vein thrombosis (aOR 1.29, P = 0.329). There were no significant associations between IBD patients (both UC and CD) and pulmonary embolism, nonvariceal gastrointestinal bleeding, or in-hospital mortality. UC patients had a longer average hospital stay (8.25 days) compared to non-IBD patients (adjusted mean difference 0.89, P = 0.007). Healthcare resource utilization was similar among the three groups. Conclusion: Our national study on COVID-19 hospitalizations indicates that patients with IBD have comparable rates of gastrointestinal bleeding, pulmonary embolism, and mortality as those without IBD. However, patients with UC hospitalized with COVID-19 have a higher risk of deep vein thrombosis than COVID-19 patients hospitalized without UC. Further research is needed to better understand the relationship between COVID-19 and IBD.

Henoch-Schonlein Purpura, an Unusual Presentation of Acute Myeloid Leukemia.

BACKGROUND/AIM: Acute myeloid leukemia (AML) is a hematologic malignancy that accounts for most annual deaths from leukemias in the United States. Although rare, cutaneous manifestations may be the first clinical sign of AML. Henoch Schonlein Purpura (HSP), as a manifestation of AML, has an unknown incidence. Here, we present a case of HSP as the presenting manifestation of AML. CASE REPORT: A 58-year-old woman presented to the Emergency Department with a rash and itching of all her extremities. The rash began on her thighs and arms a month prior and gradually spread distally. On presentation, she appeared alert and was hemodynamically stable. Skin examination revealed palpable purpura and plaques, with petechiae involving all extremities. Admission labs revealed a hemoglobin and hematocrit of 8 g/dl and 24% respectively. The white blood cell count was 1.23 k/mcl, absolute neutrophil count was 0.31 k/mcl, and platelets were 172,000 k/mcl. A broad work-up was carried out. Subsequently, skin and bone marrow biopsies were performed. Skin biopsy was positive for vascular immune reactivity with IgA, consistent with HSP. The bone marrow biopsy revealed hypocellular marrow with atypical blast infiltrates constituting 10-15% of cellularity, indicating AML. The patient was transferred to malignant hematology service where and started on induction chemotherapy for AML. CONCLUSION: Prompt diagnosis and treatment of AML is crucial for better clinical outcomes. Our case suggests that HSP can be a rare presenting manifestation of AML. It is important to consider hematologic malignancy in patients presenting with HSP in the right clinical context as part of differential diagnosis.

Human tracking robotic camera based on image processing for live streaming of conferences and seminars.

There are numerous scenarios where the photographer is in difficulty and unable to capture or shoot video as required. This could be due to several factors such as limited space, decreased visibility, and an obstacle in the way. Therefore, this project implements the idea to capture and shoot video of the desired subject through an automatically controlled robotic camera with no need for a photographic bloke. The system comprises functions such as detection, tracking, live streaming, and video/audio recording along with the features of Radio-Frequency-Identification (RFID). Therefore, this robotic camera will detect the desired subject, track and focus it with the help of its position driven through movable motors sensing the RFID tag in case the object is non-stationary. The video/audio will be recorded on a computer along with the live streaming available on an Android-based device. The Viola-Jones algorithm of the image processing technique is used to detect the particular subject features and C for accessing the movable camera protocols. The RFID transmitter and receiver are used to sense the RFID card and serve the purpose to track the subject using the algorithms of image processing, with the advantage of ignoring other obstacles between the camera and the detected subject. Thus, adding a novel functionality to the existing systems, that lacks the feature of focusing the camera on the subject, when an obstacle is detected in between. The live streaming is achieved wirelessly through an open-source platform X-operating system, Apache, MySQL, Php, Perl (XAMPP). The idea is verified through concluded arrangements in self-made scenarios in response to the speed, distance, light, and background noise of the detected subject, which delivered encouraging results. Therefore, the designed system can be used for live conferences, seminars, and other multimedia-required arrangements.

COVID-19 and Clostridioides difficile Coinfection Outcomes among Hospitalized Patients in the United States: An Insight from National Inpatient Database.

The incidence of Clostridioides difficile infection (CDI) has been increasing compared to pre-COVID-19 pandemic levels. The COVID-19 infection and CDI relationship can be affected by gut dysbiosis and poor antibiotic stewardship. As the COVID-19 pandemic transitions into an endemic stage, it has become increasingly important to further characterize how concurrent infection with both conditions can impact patient outcomes. We performed a retrospective cohort study utilizing the 2020 NIS Healthcare Cost Utilization Project (HCUP) database with a total of 1,659,040 patients, with 10,710 (0.6%) of those patients with concurrent CDI. We found that patients with concurrent COVID-19 and CDI had worse outcomes compared to patients without CDI including higher in-hospital mortality (23% vs. 13.4%, aOR: 1.3, 95% CI: 1.12-1.5, p = 0.01), rates of in-hospital complications such as ileus (2.7% vs. 0.8%, p < 0.001), septic shock (21.0% vs. 7.2%, aOR: 2.3, 95% CI: 2.1-2.6, p < 0.001), length of stay (15.1 days vs. 8 days, p < 0.001) and overall cost of hospitalization (USD 196,012 vs. USD 91,162, p < 0.001). Patients with concurrent COVID-19 and CDI had increased morbidity and mortality, and added significant preventable burden on the healthcare system. Optimizing hand hygiene and antibiotic stewardship during in-hospital admissions can help to reduce worse outcomes in this population, and more efforts should be directly made to reduce CDI in hospitalized patients with COVID-19 infection.

Paxlovid with Caution: Novel Case of Paxlovid-Induced Tacrolimus Toxicity in a Cardiac Transplant Patient.

Tacrolimus is commonly used as a prophylactic against acute rejection in transplant patients. Tacrolimus toxicity has numerous presentations that have been well documented in the literature and can be induced by a wide variety of agents. We present a novel case of tacrolimus toxicity in a cardiac transplant patient induced by outpatient treatment for COVID-19 pneumonia with ritonavir-nirmatrelvir, which was successfully treated with phenytoin therapy. LEARNING POINTS: Ritonavir-nirmatrelvir is a newly approved antiviral therapy for COVID-19 to prevent hospitalization and is increasingly prescribed in the outpatient setting.Thorough assessment of drug interactions prior to starting ritonavir-nirmatrelvir can prevent tacrolimus toxicity in patients with solid organ transplants.Phenytoin increases the metabolism of tacrolimus and can be safely utilized to treat tacrolimus toxicity.

Antibiotic Stewardship in Patients With Acute Bronchitis: A Case Report of Doxycycline-Induced Esophagitis.

Acute bronchitis is a self-limiting disease, characterized by mild constitutional symptoms and a cough lasting two to three weeks. The disease usually occurs secondary to viruses; therefore, only symptomatic and supportive care is advised for the patients. Despite the recommended guidelines, most patients are prescribed antibiotics. Here, we present a case of a 38-year-old female who presented to the hospital with a sudden onset of severe epigastric pain. The patient recently started a 10-day course of doxycycline for acute bronchitis. She was admitted, evaluated, and diagnosed with doxycycline-induced esophagitis, and managed accordingly. This report highlights how excessive use of antibiotics is leading to adverse effects, antibiotic resistance, increased health care costs, and invasive testing. It also emphasizes the importance of antibiotic stewardship.

Dividing the Topological Charge of a Laguerre-Gaussian Beam by 2 Using an Off-Axis Gaussian Beam.

In optical computing machines, many parameters of light beams can be used as data carriers. If the data are carried by optical vortices, the information can be encoded by the vortex topological charge (TC). Thus, some optical mechanisms are needed for performing typical arithmetic operations with topological charges. Here, we investigate the superposition of a single-ringed (zero-radial-index) Laguerre-Gaussian (LG) beam with an off-axis Gaussian beam in the waist plane. Analytically, we derive at which polar angles intensity nulls can be located and define orders of the optical vortices born around these nulls. We also reveal which of the vortices contribute to the total TC of the superposition and which are compensated for by the opposite-sign vortices. If the LG beam has a TC of m, TC of the superposition is analytically shown to equal [m/2] or [m/2] + 1, where [] means an integer part of the fractional number. Thus, we show that the integer division of the TC by two can be done by superposing the LG beam with an off-axis Gaussian beam. Potential application areas are in optical computing machines and optical data transmission.

Acute Respiratory Distress Syndrome and the Use of Inhaled Pulmonary Vasodilators in the COVID-19 Era: A Narrative Review.

The Coronavirus disease (COVID-19) pandemic of 2019 has resulted in significant morbidity and mortality, especially from severe acute respiratory distress syndrome (ARDS). As of September 2022, more than 6.5 million patients have died globally, and up to 5% required intensive care unit treatment. COVID-19-associated ARDS (CARDS) differs from the typical ARDS due to distinct pathology involving the pulmonary vasculature endothelium, resulting in diffuse thrombi in the pulmonary circulation and impaired gas exchange. The National Institute of Health and the Society of Critical Care Medicine recommend lung-protective ventilation, prone ventilation, and neuromuscular blockade as needed. Further, a trial of pulmonary vasodilators is suggested for those who develop refractory hypoxemia. A review of the prior literature on inhaled pulmonary vasodilators in ARDS suggests only a transient improvement in oxygenation, with no mortality benefit. This narrative review aims to highlight the fundamental principles in ARDS management, delineate the fundamental differences between CARDS and ARDS, and describe the comprehensive use of inhaled pulmonary vasodilators. In addition, with the differing pathophysiology of CARDS from the typical ARDS, we sought to evaluate the current evidence regarding the use of inhaled pulmonary vasodilators in CARDS.

Generation of Complex Transverse Energy Flow Distributions with Autofocusing Optical Vortex Beams.

Optical vortex (OV) beams are widely used for the generation of light fields with transverse energy flow inducing orbital motion of the nano- and microparticles in the transverse plane. Here, we present some new modifications of OV beams with autofocusing properties for shaping complex transverse energy flow distributions varying in space. The angular component of the complex amplitude of these beams is defined by the superpositions of OV beams with different topological charges. The proposed approach provides a convenient method to control the three-dimensional structure of the generated autofocusing OV beams. The control of the transverse distribution of an autofocusing beam provides a wide variety of generated fields with both rotating and periodic properties, which can be used in the field of laser manipulation and laser material processing. Thus, the obtained numerical results predict different types of motion of the trapped particles for the designed OV autofocusing beams. The experimental results agree with modeling results and demonstrate the principal possibility to shape such laser beams using spatial light modulators.

Co-Occurrence of Systemic Lupus Erythematosus and Autoimmune Polyendocrine Syndrome II: Is There a Pathologic Link?

Autoimmune polyendocrine syndrome type II (APS II) is a rare endocrine disorder that involves the adrenal gland (Addison's disease), thyroid (autoimmune thyroiditis), pancreas (type 1 diabetes), and other non-endocrine organs. Herein, we report a case of a 58-year-old woman with a past medical history of systemic lupus erythematosus (SLE) and Addison's disease, who initially presented with nocturia, polyuria, abnormal sweating, fatigue, hair thinning, heat and cold intolerance, and progressive darkening of the skin for the last few months. After a thorough evaluation, she was diagnosed with autoimmune thyroiditis, and thus, she met the criteria for APS II. This report highlights the unusual presentation of APS II in a patient with SLE. We also discuss common pathophysiological mechanisms that can explain the concurrence of SLE and APS II in this patient.

Bessel Beam: Significance and Applications-A Progressive Review.

Diffraction is a phenomenon related to the wave nature of light and arises when a propagating wave comes across an obstacle. Consequently, the wave can be transformed in amplitude or phase and diffraction occurs. Those parts of the wavefront avoiding an obstacle form a diffraction pattern after interfering with each other. In this review paper, we have discussed the topic of non-diffractive beams, explicitly Bessel beams. Such beams provide some resistance to diffraction and hence are hypothetically a phenomenal alternate to Gaussian beams in several circumstances. Several outstanding applications are coined to Bessel beams and have been employed in commercial applications. We have discussed several hot applications based on these magnificent beams such as optical trapping, material processing, free-space long-distance self-healing beams, optical coherence tomography, superresolution, sharp focusing, polarization transformation, increased depth of focus, birefringence detection based on astigmatic transformed BB and encryption in optical communication. According to our knowledge, each topic presented in this review is justifiably explained.