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Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is an ongoing pandemic that has affected over 400 million people worldwide and caused nearly 6 million deaths. Hemorrhagic encephalitis is an uncommon but serious complication of COVID-19. The etiology of this disease is multifactorial, including secondary to severe hypoxemia, systemic inflammation, direct viral invasion, hypercoagulability, etc. The clinical spectrum of COVID-19-related hemorrhagic encephalitis is also varied, ranging from leukoencephalopathy with microhemorrhage, acute necrotizing hemorrhagic encephalitis (ANHE) involving the cortex, basal ganglia, rarely brain stem and cervical spine, hemorrhagic posterior reversible encephalopathy syndrome (PRES) to superimposed co-infection with other organisms. We report a case series of three young patients with different presentations of hemorrhagic encephalitis after COVID-19 infection and a review of the literature. One patient had self-limiting ANHE in the setting of mild COVID-19 systemic illness. The second patient had self-limiting leukoencephalopathy with microhemorrhages in the setting of severe systemic diseases and ARDS, and clinically improved with the resolution of systemic illness. Both patients were healthy and did not have any premorbid conditions. The third patient with poorly controlled diabetes and hypertension had severe systemic illness with neurological involvement including multiple ischemic strokes, basal meningitis, hemorrhagic encephalitis with pathological evidence of cerebral mucormycosis, and Epstein–Barr virus coinfection, and improved after antifungal therapy.

Environmental problems were initiated with the rise of human civilization, and they increased with the rise in technology's contribution to human lives. Researchers in the field of architecture believe that regenerative approaches are systems based on aligning architectural design with natural resources to provide positive outcomes. Regenerative design holds significant promise for a new theory of sustainable architecture. The aim of this paper is to provide a theoretical framework for the concept of regenerative architecture and testing materials' effectiveness (thermal, availability, waste, and toxicity) and impacts on shifting towards regenerative architecture. Materials' thermal properties were examined by determining energy consumption through Ecotect as a simulation program. However, other factors were measured by a checklist derived from an intense review of the literature. The results revealed that the existing current buildings in Erbil City do not lie in the regenerative zone. Moreover, the study also shows that material selection plays a significant role in reducing energy consumption and toxicity levels that result from moving architectural design towards regenerative design.

Background Human Rhinovirus (hRV) causes mild, primarily upper respiratory tract symptoms in immunocompetent hosts. However, in immunocompromised patients, it often progresses to a lower respiratory tract infection. Multiple myeloma (MM) patients are immunocompromised due to inherent immunodeficiency and exposure to biologic and chemotherapeutic agents. The complications of hRV infection in MM patients are not well known. In this study, we aim to identify the morbidity and mortality associated with hRV in MM participants. Methods This was a retrospective study, using Arkansas Clinical Registry Database, which identified all MM patients diagnosed with hRV infection by nasopharyngeal multiplex polymerase chain reaction (PCR) in January-December 2019. Duplicates within 30 days were excluded. Patients were followed for 30 days after diagnosis. We assessed the need for hospitalization, intensive care unit (ICU) admission, oxygen administration, mechanical ventilation, and death. We collected their absolute neutrophil (ANC) and lymphocyte count (ALC) within three days of diagnosis and compared values using Mann-Whitney U test. Results We identified 217 MM patients with hRV. Ninety (41%) had prior autologous stem cell transplant, 148 (68%) had received chemotherapy within 30 days. Ninety (41%) had chest imaging, with 11 (12%) having infiltrates. Out of the 217, 69 (31.9%) were admitted, with a mean length of stay of 3 days. 13% of the admitted patients were transferred to the ICU. 65.5% of the admitted patients needed oxygen, and two required mechanical ventilation. The mean ANC and ALC for the admitted group was 3.88 cells/µL and 1.22 cells/µL respectively, compared to 3.57 cells/µL and 1.07 cells/µL in the outpatient group, p=0.6 and 1. Five participants died. Conclusion Human Rhinovirus infection in MM patients was associated with significant morbidity, including hospitalization, ICU care, supplemental oxygen requirement, and even mechanical ventilation in 2 patients. Death was observed within 30 days, although rarely. The mean ALC and ANC were not predictive of the severity of the disease. Recognizing hRV effects on morbidity and mortality could lead to earlier recognition and management of complications in MM patients. Disclosures All Authors: No reported disclosures

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