Myocarditis and Pericarditis Following the COVID-19 Vaccination: A Single-Centre Case Seriese (preprint)

The Surveillance of rare adverse events following vaccination, particularly related to COVID-19 vaccines, requires thorough examination. This paper investigates vaccine-associated myocarditis and/or pericarditis (VAMPS), presenting insights into clinical manifestations, management, and outcomes. Conducted at the Prince Sultan Cardiac Center in Saudi Arabia from March 2021 to May 2022, this retrospective case series comprises 20 patients with an average age of 27.9 ± 14.0 years, predominantly males (70%). Pfizer-BioNTech, AstraZeneca, and Moderna vaccines were administered in 74%, 21%, and 5% of cases, respectively, with 53% receiving the second dose, 26% the booster, and 21% the initial dose. Common symptoms included shortness of breath (60%), chest pain (50%), palpitations (40%), premature ventricular contractions (35%), and fever (25%). Cardiac magnetic resonance imaging revealed preserved left ventricular function (80%), subepicardial and/or mid-wall late gadolinium enhancement (65%), and lateral (39%), anterolateral (15%), inferolateral (15%), and anteroseptal (15%) segments affected. Myocarditis, pericarditis, and myopericarditis were diagnosed in 40%, 20%, and 40% of cases, respectively. C-reactive protein was elevated in two-thirds of patients. Recovery was achieved with anti-inflammatory medications, primarily colchicine (72%), aspirin(39%), and ibuprofen (33%). While no fatalities occurred, 30% experienced severe complications, and 15% had minor complications. In conclusion, VAMPS exhibits distinct characteristics and may lead to serious complications. Cardiologists should consider VAMPS in the differential diagnosis for symptomatic patients recently vaccinated against COVID-19, emphasizing the importance of ongoing surveillance and understanding of rare adverse events.

Changes in dynamic electrocardiogram after COVID-19 infection: a self-controlled study (preprint)

Background: Coronavirus disease 2019 (COVID-19) not only causes respiratory system damage, but also cardiovascular system. Previous studies had shown that COVID-19 can cause abnormal changes in ECG, however few studies reported changes in dynamic electrocardiogram before and after COVID-19 infection. Methods: A retrospective review of patients who were first diagnosed with COVID-19 and underwent dynamic electrocardiogram from Fujian Provincial Hospital between January 1, 2023 and April 30, 2023.In which who had received at least once dynamic electrocardiogram between January 1, 2018 and December 20, 2022 were included in our study. The differences of dynamic electrocardiogram before and after COVID-19 infection were compared and analyzed. Results: A total of 144 COVID-19 patients were included(67 males，mean age 56±14.3). After COVID-19, the mean heart rate and minimum heart rate increased, the total number of atrial premature, atrial tachycardia and ventricular premature  contractions bigeminy，the incidence of T wave changes were increased, SDNN, SDNN index, PNN50, HF and LF were decreased(all p< 0.05). Conclusion:Dynamic electrocardiogram showed increased arrhythmia and decreased heart rate variability  after-COVID-19 , indicating that COVID-19 has damage to the cardiovascular system, which can provide reference for clinical diagnosis, treatment and prevention.

Implementation of a practice plan for the outpatient cardiac evaluation of children after acute SARS-CoV-2 infection and a report of outcomes.

SARS-CoV-2 infection has been associated with cardiovascular disease in children, but which children need cardiac evaluation is unclear. We describe our experience evaluating 206 children for cardiac disease following SARS-CoV-2 infection (one of whom had ventricular ectopy) and propose a new guideline for management of these children. Routine cardiac screening after SARS-CoV-2 infection in children without any cardiac signs or symptoms does not appear to be high yield.

Amiodarone-induced organizing pneumonia mimicking COVID-19: a case report.

BACKGROUND: Differential diagnosis of interstitial lung diseases (ILDs) during the COVID-19 pandemic is difficult, due to similarities in clinical and radiological presentation between COVID-19 and other ILDs on the one hand, and frequent false-negative swab results on the other. We describe a rare form of interstitial and organizing pneumonia resembling COVID-19, emphasizing some key aspects to focus on to get the right diagnosis and treat the patient properly. CASE PRESENTATION: A 76-year-old man presented with short breath and dry cough in the midst of the COVID-19 outbreak. He showed bilateral crackles and interstitial-alveolar opacities on X-ray, corresponding on computed tomography (CT) to extensive consolidations with air bronchograms, surrounded by ground glass opacities (GGO). Although his throat-and-nasopharyngeal swab tested negative, the picture was overall compatible with COVID-19. On the other hand, he showed subacute, rather than hyperacute, clinical onset; few and stable parenchymal consolidations, rather than patchy and rapidly evolving GGO; pleural and pericardial thickening, pleural effusion, and lymph node enlargement, usually absent in COVID-19; and peripheral eosinophilia, rather than lymphopenia, suggestive of hypersensitivity. In the past year, he had been taking amiodarone for a history of ventricular ectopic beats. CT scans, in fact, highlighted hyperattenuation areas suggestive of amiodarone pulmonary accumulation and toxicity. Bronchoalveolar lavage fluid (BALF) investigation confirmed the absence of coronavirus genome in the lower respiratory tract; conversely, high numbers of foamy macrophages, eosinophils, and cytotoxic T lymphocytes with low CD4/CD8 T-cell ratio were detected, confirming the hypothesis of amiodarone-induced cryptogenic organizing pneumonia. Timely discontinuation of amiodarone and initiation of steroid therapy led to resolution of respiratory symptoms, systemic inflammation, and radiographic opacities. CONCLUSIONS: A comprehensive analysis of medical and pharmacological history, clinical onset, radiologic details, and peripheral and BALF cellularity, is required for a correct differential diagnosis and management of ILDs in the COVID-19 era.

The Evolution of Digital Trade from NAFTA to USMCA (preprint)

Lack of A Legal Framework:Now that we have the technology and trade agreements to facilitate border-free trades, why not using them. So far, the only major obstacle to the advent of smart contracts is a lack of a legal framework. It is no surprise that the legal structures to regulate the manner in which society utilizes new technologies always lag behind the technologies themselves. The regulatory issues surrounding the advent of online gambling or the distribution of digitized music are good examples. Historically, the agencies tasked with protecting consumers concerning securities and overseeing currency have been slow-footed to catch up to the workings of this complex technology. There have been some early attempts at legislation. Rep. Warren Davidson (R-Ohio), introduced the Token Taxonomy Act in 2018, updating it in April 2019. Early versions of the massive bailout legislation to deal with the COVID-19 pandemic included some forms of a digital dollar to quicken the government aid to the non-banked. In conclusion, AI, smart contracts, cryptocurrencies, and blockchain technologies are no different on the regulatory front. Instead of blocking, it is time to utilize these technologies, to facilitate our across-border trades. Maybe it is time to draft a state-less law to regulate border-free trades in our new mercantile community.IntroductionAt the time of NAFTA’s negotiation, the world appeared to be dividing into regional trading groups like the European Union (EU) and MERCOSUR.10 While global trade talks through the General Agreement on Tariffs and Trade (GATT) Uruguay Round were faltering (1993), the successful conclusion of the Uruguay Round trade negotiations was in peril.11 In fact, other regional agreements grew stronger as the Doha Round of World Trade Organization (WTO), launched in 2001, failed to conclude with an agreement.This Paper analyzes the evolution of trade rules for digital commerce across the North American marketplace, specifically trades governed by the United States-Mexico-Canada Agreement. It explores the manner in which NAFTA treated Intellectual Property (IP) and how USMCA introduced new chapters to protect IP and digital trade data while facilitating digital commerce. Part II explores the history of IP rights protection under NAFTA. Part III reviews the new challenges in the information age that are covered or not covered in United States-Mexico-Canada Agreement. Part IV concludes with a call for more prescriptions of future modern and advanced methods for cross-border finance and data protection. It touches on the application of new technologies like blockchain, artificial intelligence (AI), and smart contracts that can be used for the protection of free trade.Intellectual Property under of North American Free Trade Agreement:Indeed, “NAFTA was a trade agreement that, by reducing tariffs on many goods and services, created the opportunity for North American companies to [utilize] transnational vertical supply chains and better compete in the global marketplace.”27 NAFTA was the first free trade agreement to include an Intellectual Property Rights chapter28 and contained provisions aimed at securing IP rights. The NAFTA Parties were to adopt strict measures against industrial theft, adhere to rules protecting IP,29 and create foreseen consequences for the Violation of IP rights.30 As a result, in order to comply with the dictates of NAFTA, Mexico had to change many of its laws.31 For example, Mexico had to amend Article 27 of its Constitution to address Mexico’s communal landholding doctrine, the ejido.Data Flow between the Parties:“Cross-border data flow” refers to the movement or transfer of information between computer servers across national borders.51 In fact, cross-border data flows are part of, and integral to, digital trade and facilitate the movement of goods, services, people, and finance.Use of Technology to Protect Digital Trade:Businesses across the economy and the country will benefit from FTAs including “Digital Economy.” In areas such as data processing, blockchain, self-driving cars, and quantum technology we have the opportunity to help shape global rules through ambitious digital trade provisions. Moreover, innovations in technology have the potential to enable and disrupt international commerce. For example, the United States-Mexico remittance corridor is one of the largest in the world, with over $30 billion in transactions a year, financial transactions for such a large amount can be very challenging. However, the rapid development of cryptocurrencies has enabled cross-border transactions at just a fraction of the cost and unprecedented speeds, spurring collaboration between crypto innovators in the U.S. and Mexico. The good news is that USMCA provides opportunities for blockchain technology to be deployed and showcased for use cases and eventual scalability.Smart Contract:Blockchain ensures immediate and across-the-board transparency, as transactions added to the blockchain are time-stamped and cannot easily be tampered with. Smart contracts can be used to automate processes, further reducing costs. However, the outside of Blockchain smart contracts retain the same potential problems as centralized databases. Smart contracts represent the next level in the progression of blockchains from a financial transaction protocol to an all-purpose utility. Due to their decentralized and distributed nature and the use of cryptographic techniques, blockchains are said to be highly resilient to cyber-attacks compared to traditional databases – although there is no such thing as perfect resilience. They are pieces of software, not contracts in the legal sense, that extend blockchains’ utility from simply keeping a record of financial transaction entries to automatically implementing terms of agreements. The term “smart contract” is, in fact, a misnomer: smart contracts are neither “smart” (there is no cognitive or artificial intelligence component to them, only the automatic execution of a pre-defined task when certain conditions are met), nor are they contract in a legal sense.

Cardiac involvement in COVID-19 patients: mid-term follow up by cardiac magnetic resonance imaging (preprint)

Background: Coronavirus disease 2019 (COVID-19) induces myocardial injury, either direct myocarditis or indirect injury due to systemic inflammatory response. Myocardial involvement has been proved to be one of the primary manifestations of COVID-19 infection, according to laboratory test, autopsy, and cardiac magnetic resonance imaging (CMRI). However, the middle-term outcome of cardiac involvement after the patients were discharged from the hospital is yet unknown. The present study aimed to evaluate mid-term cardiac sequelae in recovered COVID-19 patients by CMRIMethods: A total of 47 recovered COVID-19 patients were prospectively recruited and underwent CMRI examination in this study. The CMRI protocol consisted of black blood fat-suppressed T2 weighted imaging (BB-T2WI), T2 star mapping, left ventricle cine imaging, pre- and post-contrast T1 mapping, and late gadolinium enhancement (LGE). Myocardium edema and LGE were assessed in recovered COVID-19 patients. The left ventricle (LV) and right ventricle (RV) function and LV mass were assessed and compared with normal controls.Results: Finally, 44 recovered COVID-19 patients and 31 normal controls were included in this study. No edema was observed in any patient. LGE was found in 13 patients. All LGE lesions were located in the middle myocardium and/or sub-epicardium with a scattered distribution. Further analysis showed that LGE-positive patients had significantly decreased left ventricle peak global circumferential strain (LVpGCS), right ventricle peak global circumferential strain (RVpGCS), right ventricle peak global longitudinal strain (RVpGLS) as compared to non-LGE patients (p＜0.05), while no difference was detected between the non-LGE patients and normal controls.Conclusion: Myocardium injury existed in about 30% of COVID-19 patients. These patients had peak right ventricle strain that decreased at the 3-month follow-up. Cardiac MRI can monitor the COVID-19-induced myocarditis progression, and CMR strain analysis is a sensitive tool to evaluate the recovery of left ventricle circumferential contraction dysfunction and right ventricular dysfunction.

COVID19: A Natural Language Processing and Ontology Oriented Temporal Case-Based Framework for Early Detection and Diagnosis of Novel Coronavirus (preprint)

Coronavirus, also known as COVID-19, has been declared a pandemic by the World Health Organization (WHO). At the time of conducting this study, it had recorded over 1.6 million cases while more than 105,000 have died due to it, with these figures rising on a daily basis across the globe. The burden of this highly contagious respiratory disease is that it presents itself in both symptomatic and asymptomatic patterns in those already infected, thereby leading to an exponential rise in the number of contractions of the disease and fatalities. It is therefore crucial to expedite the process of early detection and diagnosis of the disease across the world. The case-based reasoning (CBR) model is an effective paradigm that allows for the utilization of cases’ specific knowledge previously experienced, concrete problem situations or specific patient cases for solving new cases. This study therefore aims to leverage the very rich database of cases of COVID-19 to solve new cases. The approach adopted in this study employs the use of an improved CBR model for state-of-the-art reasoning task in classification of suspected cases of Covid19. The CBR model leverages on a novel feature selection and semantic-based mathematical model proposed in this study for case similarity computation. An initial population of the archive was achieved with 68 cases obtained from the Italian Society of Medical and Interventional Radiology (SIRM) repository. Results obtained revealed that the proposed approach in this study successfully classified suspected cases into their categories at an accuracy of 97.10%. The study found that the proposed model can support physicians to easily diagnose suspected cases of Covid19 base on their medical records without subjecting the specimen to laboratory test. As a result, there will be a global minimization of contagion rate occasioned by slow testing and as well reduce false positive rates of diagnosed cases as observed in some parts of the globe.