Following an episode of severe brain inflammation from fentanyl inhalation, a man successfully recovered with the help of a multidisciplinary team at OHSU, as detailed in BMJ Case Reports. This case serves as a warning about the impact of opioids on society. (Artist’s concept.) Credit: SciTechDaily.com
Case study highlights added danger of illicit fentanyl, especially to first-time users.
The man arrived unconscious and near death.
Previously healthy with no known medical history, the 47-year-old arrived by ambulance to the emergency department at Oregon Health & Science University on February 25, 2023. He was found collapsed in his hotel room, where he was staying during a business trip. As clinicians began administering life-saving treatment, they searched for the cause.
Unprecedented Diagnosis
In a case report published online today (April 29, 2024) in the journal BMJ Case Reports, clinicians laid out the surprising and unprecedented diagnosis: toxic leukoencephalopathy by <span class="glossaryLink" aria-describedby="tt" data-cmtooltip="
fentanyl
Fentanyl is a synthetic opioid drug that is similar to morphine but is 50 to 100 times more potent. It is used to treat severe pain, such as pain from cancer or surgery, and is typically administered via injection or transdermal patch. Fentanyl can also be used recreationally, and its use has been linked to a significant increase in opioid overdose deaths in recent years. Due to its high potency, fentanyl can be dangerous even in small doses, and its use should be closely monitored by a healthcare provider.
In other words, inhaling fentanyl caused large sections of white matter in the patient’s brain to become inflamed to the point where he had lost consciousness and risked irreversible loss of brain function, or possibly death.
Medical experts had documented previous cases caused by inhaling heroin, but the OHSU patient is believed to be the first documented case involving inhalation of illicit fentanyl. The lead author of the study says it should be taken as a warning about the danger of a substance that is cheap, readily available, and 50 times more potent than heroin.
Societal Impact and Awareness
“Opioid use, especially fentanyl, has become very stigmatized,” said lead author Chris Eden, M.D., now a second-year resident in internal medicine in the OHSU School of Medicine who was part of the patient’s treatment team. “This is a case of a middle-class man, in his late 40s, with kids, who used fentanyl for the first time. It demonstrates that fentanyl can affect everyone in our society.”
Although this is the first documented case, Eden said it’s likely other cases simply weren’t recognized due in part to the fact that relatively little is known about the syndrome’s physiology. In addition, he said hospitals haven’t traditionally included fentanyl in their standard urinalysis drug screens.
At the same time, fatal and nonfatal overdoses due to fentanyl and other opioids are all too common.
“We know very well the classic opiate side effects: respiratory depression, loss of consciousness, disorientation,” Eden noted. “But we don’t classically think of it causing possibly irreversible brain damage and affecting the brain, as it did in this case.”
Magnetic resonance imaging revealed inflammation in the brain. However, the patient’s lingering loss of consciousness, memory and function could have been due to any number of causes — stroke, carbon monoxide exposure or metabolic disease among them. Ultimately, a nonstandard drug test revealed the presence of fentanyl in his system.
Slow Recovery
Fortunately for the patient, he slowly recovered after 26 days in the hospital, followed by a stay in a skilled nursing facility to help regain his speech and function. He is now home with his family in the Seattle area and back to work. To this day, he has no memory of the episode.
The successful outcome involved wraparound treatment with numerous clinicians and support at Oregon’s academic health center and single largest hospital, all operating with a patient-centered approach.
“This case involved internal medicine, neurology, neuroradiology, and palliative care physicians, in addition to nurses, social workers, discharge planners, physical therapists, dieticians, and pharmacists,” Eden said. “I’m proud of these multidisciplinary teams at OHSU working together to take care of complex patients, both from a medical and social perspective.”
Personal Reflections
Today’s publication in BMJ Case Reports also includes a perspective from the patient.
“I have regrets often about what I did to myself, my wife, and my family,” he said. “I’m grateful to all the doctors, nurses, and EMTs who saved my life, and the therapists who got me back to a functioning member of society.”
Reference: “Clinical and neuroradiographic features of fentanyl inhalation-induced leukoencephalopathy” 29 April 2024, BMJ Case Reports. DOI: 10.1136/bcr-2023-258395
In addition to Eden, co-authors include Duna Alkhalaileh, D.O., M.P.H., David Pettersson, M.D., and Alan Hunter M.D., of OHSU; and Asad Arastu, M.D., previously of OHSU and now with Penn Medicine.
It looks like Kieran Trippier is on his way to Dubai after a Toon fan spotted the right-back preparing to depart Newcastle airport today.
Newcastle supporter @Doddsy228904442 posted a photo of the 33-year-old leaving duty free before catching a flight to the Middle East.
Speaking for Saturday’s matchday programme, Trippier said he was taking ‘extra precautions’ on his delayed comeback from a calf injury that’s kept him out for two months, but added that he hopes to be ‘back soon.’
Newcastle take on his former club Burnley on Saturday, but it seems highly unlikely the defender returns at Turf Moor following his midweek trip to Dubai.
As ever, plenty of theories have emerged on social media. Some wonder if he’s been given extra time off to ensure he’s fit for this summer’s Euros – which could be his last major international tournament – and play some part in our run in, while reported interest from the Middle East has others questioning if his trip is transfer related after links to a January exit. Personally, I can’t see it being the latter.
Who knows, but hopefully our vice captain is back soon for his, Newcastle’s and England’s sake.
Is the future of software development an AI-powered IDE? GitHub’s floating the idea.
Ahead of its annual GitHub Universe conference in San Francisco early this fall, GitHub announced Copilot Workspace, a dev environment that taps what GitHub describes as “Copilot-powered agents” to help developers brainstorm, plan, build, test and run code in natural language.
Jonathan Carter, head of GitHub Next, GitHub’s software R&D team, pitches Workspace as somewhat of an evolution of GitHub’s AI-powered coding assistant Copilot into a more general tool, building on recently introduced capabilities like Copilot Chat, which lets developers ask questions about code in natural language.
“Through research, we found that, for many tasks, the biggest point of friction for developers was in getting started, and in particular knowing how to approach a [coding] problem, knowing which files to edit and knowing how to consider multiple solutions and their trade-offs,” Carter said. “So we wanted to build an AI assistant that could meet developers at the inception of an idea or task, reduce the activation energy needed to begin and then collaborate with them on making the necessary edits across the entire corebase.”
At last count, Copilot had over 1.8 million paying individual and 50,000 enterprise customers. But Carter envisions a far larger base, drawn in by feature expansions with broad appeal, like Workspace.
“Since developers spend a lot of their time working on [coding issues], we believe we can help empower developers every day through a ‘thought partnership’ with AI,” Carter said. “You can think of Copilot Workspace as a companion experience and dev environment that complements existing tools and workflows and enables simplifying a class of developer tasks … We believe there’s a lot of value that can be delivered in an AI-native developer environment that isn’t constrained by existing workflows.”
There’s certainly internal pressure to make Copilot profitable.
Copilot loses an average of $20 a month per user, according to a Wall Street Journal report, with some customers costing GitHub as much as $80 a month. And the number of rival services continues to grow. There’s Amazon’s CodeWhisperer, which the company made free to individual developers late last year. There are also startups, like Magic, Tabnine, Codegen and Laredo.
Given a GitHub repo or a specific bug within a repo, Workspace — underpinned by OpenAI’s GPT-4 Turbo model — can build a plan to (attempt to) squash the bug or implement a new feature, drawing on an understanding of the repo’s comments, issue replies and larger codebase. Developers get suggested code for the bug fix or new feature, along with a list of the things they need to validate and test that code, plus controls to edit, save, refactor or undo it.
Image Credits: GitHub
The suggested code can be run directly in Workspace and shared among team members via an external link. Those team members, once in Workspace, can refine and tinker with the code as they see fit.
Perhaps the most obvious way to launch Workspace is from the new “Open in Workspace” button to the left of issues and pull requests in GitHub repos. Clicking on it opens a field to describe the software engineering task to be completed in natural language, like, “Add documentation for the changes in this pull request,” which, once submitted, gets added to a list of “sessions” within the new dedicated Workspace view.
Image Credits: GitHub
Workspace executes requests systematically step by step, creating a specification, generating a plan and then implementing that plan. Developers can dive into any of these steps to get a granular view of the suggested code and changes and delete, re-run or re-order the steps as necessary.
“If you ask any developer where they tend to get stuck with a new project, you’ll often hear them say it’s knowing where to start,” Carter said. “Copilot Workspace lifts that burden and gives developers a plan to start iterating from.”
Image Credits: GitHub
Workspace enters technical preview on Monday, optimized for a range of devices, including mobile.
Importantly, because it’s in preview, Workspace isn’t covered by GitHub’s IP indemnification policy, which promises to assist with the legal fees of customers facing third-party claims alleging that the AI-generated code they’re using infringes on IP. (Generative AI models notoriously regurgitate their training datasets, and GPT-4 Turbo was trained partly on copyrighted code.)
GitHub says that it hasn’t determined how it’s going to productize Workspace, but that it’ll use the preview to “learn more about the value it delivers and how developers use it.”
I think the more important question is: Will Workspace fix the existential issues surrounding Copilot and other AI-powered coding tools?
An analysis of over 150 million lines of code committed to project repos over the past several years by GitClear, the developer of the code analysis tool of the same name, found that Copilot was resulting in more mistaken code being pushed to codebases and more code being re-added as opposed to reused and streamlined, creating headaches for code maintainers.
Elsewhere, security researchers have warned that Copilot and similar tools can amplify existing bugs and security issues in software projects. And Stanford researchers have found that developers who accept suggestions from AI-powered coding assistants tend to produce less secure code. (GitHub stressed to me that it uses an AI-based vulnerability prevention system to try to block insecure code in addition to an optional code duplication filter to detect regurgitations of public code.)
Yet devs aren’t shying away from AI.
In a StackOverflow poll from June 2023, 44% of developers said that they use AI tools in their development process now, and 26% plan to soon. Gartner predicts that 75% of enterprise software engineers will employ AI code assistants by 2028.
By emphasizing human review, perhaps Workspace can indeed help clean up some of the mess introduced by AI-generated code. We’ll find out soon enough as Workspace makes its way into developers’ hands.
“Our primary goal with Copilot Workspace is to leverage AI to reduce complexity so developers can express their creativity and explore more freely,” Carter said. “We truly believe the combination of human plus AI is always going to be superior to one or the other alone, and that’s what we’re betting on with Copilot Workspace.”
Microsoft announced the new MSTest SDK built on top of the MSBuild Project SDK system. This SDK improves the experience of testing with MSTest. There are such features as easier usage of MSTest Runner extensions, support running tests in Native AOT mode and better default suggestions.
To get started with MSTest SDK, it is needed to create a MSTest project (or update an existing one) and replace the content of the .csproj file. It is possible to use any target framework supported by MSTest.
net8.0
</Project
One of the advantages of MSTest SDK is easier usage of MSTest Runner extensions. To help a developer select the right extensions or control updates and alignments between the extensions, Microsoft introduced a new concept of “profiles”. The new SDK provides three profiles: Default, AllMicrosoft and None.
Using MSTest SDK assures developers that their test project is aligned with the patterns that are provided by the main types of applications such as ASP.NET Core, Razor or Windows Desktop. It will use the default suggestions that the MSTest team makes for the test projects.
Furthermore, MSTest supports running tests in Native AOT mode. When using the MSTest SDK, it will be automatically detected if developers are publishing to AOT. All required test suites and configurations will be transparently changed to fit this specialized mode. More information about testing with Native AOT is available here.
Below the official announcement appeared a question if there is an easy way to support running tests both with and without native AOT. Amaury Levé, a senior software engineer at Microsoft, answered:
Yes. MSTest SDK is the perfect fit for such a use case. By simply providing the PublishAot MSBuild property, we would change all needed references for you. So you can easily do 2 calls to the test execution command (dotnet test, dotnet exec, dotnet run or calling the exe), one with and the other without the property.
Microsoft and IBM have open-sourced on git the 1988 operating system MS-DOS 4.0 under the MIT License. In addition to the source code for MS-DOS 4, the public git repository contains unreleased beta Multitasking DOS binaries, the ibmbio.com source, and the scanned PDFs of the Multitasking MS-DOS 4.0 (MT-DOS) documentation.
MS-DOS 4.0 was notable for its support of FAT16 hard disk partitions greater than 32 MB and the addition of the MS-DOS Shell. MS-DOS 4.0 however was originally supposed to include multi-tasking capabilities. As its product specification mentions:
MS-DOS 4.0 is a multitasking operating system, developed from and downwardly compatible with MS-DOS 3.0. It supports true multitasking as well as multiple current screen image facility which gives the user the illusion of and benefits from many independent computers. Further, MS-DOS 4.0 allows most existing MS-DOS 2.0 applications to run without changing the MS-DOS 4.0 multitasking environment.
To ease the transition from 8086/8088 line of processors to the (then) new 286 processor without disrupting the installed base, Multitasking MS-DOS targeted two-way compatibility:
Microsoft resolves this situation by providing both upward and downward compatibility. The new environment is designed to allow old programs to run unchanged (upwardly compatible) and to allow most programs written for the new environment to run under the old environment (downwardly compatible).
The PC architecture supports up to 640K of memory. This is not nearly enough; just the DOS, a network package, a windows package, and Lotus Symphony will consume the entire memory. A software solution must be found to this hardware problem.
Ultimately, the multitasking version of MS-DOS was only licensed by a few European OEMs. IBM declined the product, concentrating instead on improvements to MS-DOS 3.x and their new joint development with Microsoft to produce OS/2.
In North America, what came to be released as MS-DOS 4.0 did not include multitasking and was quickly followed by an MS-DOS 4.01 release to fix issues many had reported. As a matter of fact, the now open-sourced MS-DOS 4.0 notably featured significantly higher memory usage (92 KB of RAM) than previous and posterior versions, at a time in computing history when RAM was scarce. One developer who compared miscellaneous MS-DOS versions commented:
Personally, I would not recommend any version of DOS lower than PC-DOS 3.30 / MS-DOS 3.31 unless you can live with the severe limitations with regard to disk support. I also wouldn’t recommend any version of 4.x, as it is notoriously buggy.
MS-DOS 4.0 was an awful operating system. […] How awful? Popular programs of the day – such as WordPerfect 5.1, Lotus 1-2-3, and Doom – always broke on it. You’d be in the middle of a task, and, bang, your program would freeze completely. Long before we got to know and hate Windows’ Blue Screen of Death, MS-DOS 4.0 horrified PC users.
That was mainly because MS-DOS 4.0 used an enormous 92KB of RAM.
According to Microsoft, the interested reader may run MS-DOS 4.0 directly on an original IBM PC XT, a newer Pentium, and within the open source PCem and 86box emulators.
MS-DOS (Microsoft Disk Operating System) is an adaptation of QDOS (Quick and Dirty Operating System) by its developer Tim Paterson destined to be the operating system for the IBM Personal Computer. MS-DOS 1.0 shipped on IBM PC in July 1981 and was till 1990 the most used operating system on Compatible PCs.
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MongoDB’sMDB short percent of float has risen 15.19% since its last report. The company recently reported that it has 3.76 million shares sold short, which is 5.99% of all regular shares that are available for trading. Based on its trading volume, it would take traders 3.73 days to cover their short positions on average.
Why Short Interest Matters
Short interest is the number of shares that have been sold short but have not yet been covered or closed out. Short selling is when a trader sells shares of a company they do not own, with the hope that the price will fall. Traders make money from short selling if the price of the stock falls and they lose if it rises.
Short interest is important to track because it can act as an indicator of market sentiment towards a particular stock. An increase in short interest can signal that investors have become more bearish, while a decrease in short interest can signal they have become more bullish.
As you can see from the chart above the percentage of shares that are sold short for MongoDB has grown since its last report. This does not mean that the stock is going to fall in the near-term but traders should be aware that more shares are being shorted.
Comparing MongoDB’s Short Interest Against Its Peers
Peer comparison is a popular technique amongst analysts and investors for gauging how well a company is performing. A company’s peer is another company that has similar characteristics to it, such as industry, size, age, and financial structure. You can find a company’s peer group by reading its 10-K, proxy filing, or by doing your own similarity analysis.
According to Benzinga Pro, MongoDB’s peer group average for short interest as a percentage of float is 6.44%, which means the company has less short interest than most of its peers.
MongoDB, Inc. (NASDAQ:MDB – Get Free Report)’s stock price dropped 2.9% during mid-day trading on Monday . The company traded as low as $370.22 and last traded at $372.62. Approximately 291,808 shares traded hands during trading, a decline of 79% from the average daily volume of 1,369,759 shares. The stock had previously closed at $383.80.
Wall Street Analyst Weigh In
MDB has been the subject of several analyst reports. Needham & Company LLC restated a “buy” rating and set a $465.00 target price on shares of MongoDB in a report on Thursday. KeyCorp cut their target price on shares of MongoDB from $490.00 to $440.00 and set an “overweight” rating on the stock in a report on Thursday, April 18th. Redburn Atlantic reiterated a “sell” rating and set a $295.00 price target (down from $410.00) on shares of MongoDB in a report on Tuesday, March 19th. Guggenheim increased their price target on shares of MongoDB from $250.00 to $272.00 and gave the company a “sell” rating in a research report on Monday, March 4th. Finally, Tigress Financial boosted their price objective on shares of MongoDB from $495.00 to $500.00 and gave the company a “buy” rating in a research report on Thursday, March 28th. Two research analysts have rated the stock with a sell rating, three have given a hold rating and twenty have issued a buy rating to the stock. Based on data from MarketBeat, MongoDB currently has a consensus rating of “Moderate Buy” and an average target price of $443.86.
The firm has a market capitalization of $27.09 billion, a P/E ratio of -149.98 and a beta of 1.19. The company has a fifty day simple moving average of $379.60 and a 200 day simple moving average of $391.08. The company has a quick ratio of 4.40, a current ratio of 4.40 and a debt-to-equity ratio of 1.07.
MongoDB (NASDAQ:MDB – Get Free Report) last announced its quarterly earnings results on Thursday, March 7th. The company reported ($1.03) earnings per share (EPS) for the quarter, missing analysts’ consensus estimates of ($0.71) by ($0.32). The firm had revenue of $458.00 million during the quarter, compared to the consensus estimate of $431.99 million. MongoDB had a negative return on equity of 16.22% and a negative net margin of 10.49%. On average, equities analysts expect that MongoDB, Inc. will post -2.53 EPS for the current fiscal year.
Insider Activity at MongoDB
In other news, CRO Cedric Pech sold 1,430 shares of the business’s stock in a transaction on Tuesday, April 2nd. The stock was sold at an average price of $348.11, for a total value of $497,797.30. Following the completion of the transaction, the executive now owns 45,444 shares in the company, valued at $15,819,510.84. The transaction was disclosed in a document filed with the Securities & Exchange Commission, which can be accessed through the SEC website. In other news, CRO Cedric Pech sold 1,430 shares of the firm’s stock in a transaction dated Tuesday, April 2nd. The shares were sold at an average price of $348.11, for a total transaction of $497,797.30. Following the sale, the executive now owns 45,444 shares of the company’s stock, valued at approximately $15,819,510.84. The sale was disclosed in a legal filing with the SEC, which is accessible through this hyperlink. Also, CAO Thomas Bull sold 170 shares of the business’s stock in a transaction that occurred on Tuesday, April 2nd. The shares were sold at an average price of $348.12, for a total transaction of $59,180.40. Following the transaction, the chief accounting officer now directly owns 17,360 shares of the company’s stock, valued at $6,043,363.20. The disclosure for this sale can be found here. Insiders sold 91,802 shares of company stock valued at $35,936,911 over the last 90 days. Corporate insiders own 4.80% of the company’s stock.
Hedge Funds Weigh In On MongoDB
A number of institutional investors and hedge funds have recently modified their holdings of the company. Transcendent Capital Group LLC bought a new stake in MongoDB during the fourth quarter valued at about $25,000. Blue Trust Inc. grew its stake in shares of MongoDB by 937.5% during the 4th quarter. Blue Trust Inc. now owns 83 shares of the company’s stock valued at $34,000 after acquiring an additional 75 shares during the period. BluePath Capital Management LLC purchased a new stake in MongoDB in the 3rd quarter worth approximately $30,000. AM Squared Ltd bought a new stake in MongoDB during the 3rd quarter worth approximately $35,000. Finally, Cullen Frost Bankers Inc. purchased a new position in MongoDB during the third quarter valued at approximately $35,000. 89.29% of the stock is currently owned by hedge funds and other institutional investors.
MongoDB, Inc, together with its subsidiaries, provides general purpose database platform worldwide. The company provides MongoDB Atlas, a hosted multi-cloud database-as-a-service solution; MongoDB Enterprise Advanced, a commercial database server for enterprise customers to run in the cloud, on-premises, or in a hybrid environment; and Community Server, a free-to-download version of its database, which includes the functionality that developers need to get started with MongoDB.
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Before you consider MongoDB, you’ll want to hear this.
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AI may be impressive, but it’s not revolutionary yet, MongoDB’s CEO said.
Dev Ittycheria said we need to see more integration of AI with practical applications.
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At least one executive thinks AI still has a ways to go for it to truly change the way we work and communicate in a big way.
“My life has not been transformed by AI,” MongoDB CEO Dev Ittycheria said in an interview with TechCrunch. “Yes, maybe I can write an email better through all those assistants, but it’s not fundamentally transformed my life. Whereas the internet has completely transformed my life.”
That’s not to say that Ittycheria is dismissing the potential of AI to eventually revolutionize the workplace, but the value of any new technology accrues “at the bottom layer first,” he told the tech publication.
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Ittycheria said that the “real value” of AI will come once existing platforms like OpenAI’s ChatGPT are fully integrated into more practical, everyday applications. Helping people develop applications — and those built on top of AI models — is MongoDB’s “business,” he added. The database software firm has its own AI-powered projects in the mix, including its Atlas suite of data services.
AI services will have to incorporate “real-time data” to make them transformative to the average person, Ittycheria said.
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“Maybe something’s happening in the stock market, maybe it’s time to buy or sell, or it’s time to hedge,” he told TechCrunch. “I think that’s where we will start seeing much more sophisticated apps, where you can embed real-time data along with all the reasoning.”
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AI may be impressive, but it’s not revolutionary yet, MongoDB’s CEO said.
Dev Ittycheria said we need to see more integration of AI with practical applications.
AI-powered solutions need to incorporate real-time data into their responses to be the most useful, he added.
Advertisement
At least one executive thinks AI still has a ways to go for it to truly change the way we work and communicate in a big way.
“My life has not been transformed by AI,” MongoDB CEO Dev Ittycheria said in an interview with TechCrunch. “Yes, maybe I can write an email better through all those assistants, but it’s not fundamentally transformed my life. Whereas the internet has completely transformed my life.”
That’s not to say that Ittycheria is dismissing the potential of AI to eventually revolutionize the workplace, but the value of any new technology accrues “at the bottom layer first,” he told the tech publication.
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Ittycheria said that the “real value” of AI will come once existing platforms like OpenAI’s ChatGPT are fully integrated into more practical, everyday applications. Helping people develop applications — and those built on top of AI models — is MongoDB’s “business,” he added. The database software firm has its own AI-powered projects in the mix, including its Atlas suite of data services.
Advertisement
AI services will have to incorporate “real-time data” to make them transformative to the average person, Ittycheria said.
“Maybe something’s happening in the stock market, maybe it’s time to buy or sell, or it’s time to hedge,” he told TechCrunch. “I think that’s where we will start seeing much more sophisticated apps, where you can embed real-time data along with all the reasoning.”
The strength reported by Microsoft (MSFT) and Google (GOOG) (GOOGL) in their respective cloud computing units last week could have positive implications for the broader cloud computing software industry as a whole, investment firm Baird said.
“Strong data points to kick off earnings season from both Azure and Google Cloud, which should be directionally positive for our cloud data leaders – SNOW, MDB, DDOG and DT – boosting those stocks to end the week,” analysts at the investment firm said, referencing Snowflake (NYSE:SNOW), MongoDB (NASDAQ:MDB), Datadog (NASDAQ:DDOG) and Dynatrace (NYSE:DT).
Snowflake was up 0.8% in mid-day trading, while MongoDB, Datadog and Dynatrace fell at least 1% each.
A consensus of analysts expects Seattle-based Amazon to earn $0.83 on revenue of $142.56B in sales when it reports on April 30, implying a rise of 11.9% during the quarter.
Investors will also look into capital expense for the quarter, especially after the company said it anticipates spending for 2024 to increase year-over-year, primarily driven by increased infrastructure to support AWS growth and additional investments in generative AI among others.
MongoDB is slated to host an investor event on May 2, followed by Datadog, which will discuss its first-quarter results on May 7. Snowflake is set to discuss its first-quarter results of fiscal 2025 on May 22.
Dynatrace has not yet set a date, according to its investor relations website.