Healthcare researchers have been working on mortality prediction for COVID-19 patients with differing levels of severity. A rapid and reliable clinical evaluation of disease intensity will assist in the allocation and prioritization of mortality mitigation resources. The novelty of the work proposed in this paper is an early prediction model of high mortality risk for both COVID-19 and non-COVID-19 patients, which provides state-of-the-art performance, in an external validation cohort from a different population. Retrospective research was performed on two separate hospital datasets from two different countries for model development and validation. In the first dataset, COVID-19 and non-COVID-19 patients were admitted to the emergency department in Boston (24 March 2020 to 30 April 2020), and in the second dataset, 375 COVID-19 patients were admitted to Tongji Hospital in China (10 January 2020 to 18 February 2020). The key parameters to predict the risk of mortality for COVID-19 and non-COVID-19 patients were identified and a nomogram-based scoring technique was developed using the top-ranked five parameters. Age, Lymphocyte count, D-dimer, CRP, and Creatinine (ALDCC), information acquired at hospital admission, were identified by the logistic regression model as the primary predictors of hospital death. For the development cohort, and internal and external validation cohorts, the area under the curves (AUCs) were 0.987, 0.999, and 0.992, respectively. All the patients are categorized into three groups using ALDCC score and death probability: Low (probability < 5%), Moderate (5% < probability < 50%), and High (probability > 50%) risk groups. The prognostic model, nomogram, and ALDCC score will be able to assist in the early identification of both COVID-19 and non-COVID-19 patients with high mortality risk, helping physicians to improve patient management.
INTRODUCTIONWater-pipe (WP) smoking is the most common method of tobacco consumption in the Middle-East and is rapidly spreading on a global scale. Although, water-pipe smoking is linked to various diseases, such as emphysema and various types of cancers, its effect on testosterone levels has yet to be investigated. This study explores the effect of water-pipe smoking on serum testosterone levels in males in Qatar.METHODSIn this cross-sectional sample within a cohort study, we retrieved data for a total of 1000 male volunteers from the Qatar BioBank (QBB) project. A self-reported questionnaire was used to determine the water-pipe smoking status of participants. Moreover, participants were stratified based on the frequency of smoking. Total testosterone and sex hormone binding globulin (SHBG) were measured clinically, whereas free testosterone and bioavailable testosterone were calculated using Vermeulen’s equation. Hormone values of 541 males (277 water-pipe smokers and 264 non-smokers) were compared using multiple regression analysis based on water-pipe smoking status after adjusting for confounding factors.RESULTSNo statistically significant difference was observed between WP smokers and non-water-pipe smokers in the likelihood of having lower or higher total testosterone, after adjustment for confounding factors. Similar results were found in free testosterone, bioavailable testosterone, and sex hormone binding globulin (all p>0.05). When compared with the reference group, both light and heavy water-pipe smokers had a similar likelihood of circulating low total testosterone levels (OR=0.83, 95% CI: 0.46–1.49; and OR=0.80, 95% CI: 0.43–1.49; respectively).CONCLUSIONSOur results reveal, for the first time, that there is no significant change in total testosterone, free testosterone, bioavailable testosterone and sex hormone binding globulin in waterpipe smokers compared to non-water-pipe smokers. Therefore, we believe that further studies are needed to confirm the effect of water-pipe smoking on testosterone in different populations.
Background: Serum ferritin is an acute phase protein and elevated levels of ferritin have been associated with the pathogenesis of many inflammatory infectious viral diseases. Dengue is a mosquito-borne tropical infection that caused by the dengue virus. TNFα and interleukin 1α, another proinflammatory cytokine, transcriptionally induce the H-chain of ferritin. Therefore, serum ferritin can be used as a prognostic marker for dengue severity.Methods: This is a case control study conducted between July 2017 to December 2018.Results: On the 3rd day of fever, the median values of serum ferritin in dengue, fever without warning signs, with warning signs, and severe dengue were 513.5 ng/ml, 1002 ng/ml and 2352.4 ng/ml respectively. On the 7th day of fever, the median values were 474 ng/ml, 900 ng/ml, and 2949 ng/ml respectively. Serum ferritin 1247 ng/ml on day 3 has a sensitivity of 96.4% and specificity of 91% for prediction of severity. Area under the curve for serum ferritin on day 3 was 0.963 (95% confidence limit: 0.934-0.991). Serum ferritin 1050 ng/ml on day 7 has a sensitivity of 98.2 % and specificity of 93% for prediction of severity. Area under the curve for serum ferritin on day 7 was 0.977 (95% confidence limit: 0.957-0.998).Conclusions: Elevation of serum ferritin was significantly seen in those with severe dengue. Serum ferritin can be used as a prognostic marker for dengue severity. Day 3 serum ferritin can be used as a prognostic marker for dengue severity.
Invited Review introduCtion Origin and nomenclatureThere has been a considerable controversy regarding the origin of water pipe smoking. While some believe its origin can be traced back to ancient India when it was invented by a physician Hakim Abul Fath during the reign of Emperor Akbar as a less harmful method of tobacco use, others suggest that it was first used in South Africa, Persia, Ethiopia, and other countries. The latter belief was supported by the fact that more ancient traces of water pipe smokes were found in Southern or Eastern Africa. [1][2][3] Regardless of its origin, trade routes seem to have helped disseminate the practice throughout parts of Asia and the Middle East. [4] Water pipe smoking has been recognized in different countries by different names. [5] Many of these names are of Indian, Turkish, Uzbek, Persian, or Arab origin. "Narghile" (a name commonly used in Turkey, Lebanon, Syria, Greece, and Palestine) is derived from the Persian word nārgil or "coconut." "Shisha" is from the Persian word shishe or "glass." "Hashishe" is also an Arabic word for grass, which may have been another way of saying tobacco. Hookah is an Arabic name, meaning a small box, pot, or jar. Both names refer to the original methods of constructing the smoke/ water chamber part of the hookah. "Shisha" is the name that is more commonly used in Egypt. In Iran, it is called ghalyoun or ghalyan and in Pakistan it is referred to as huqqa. [5]
Inguinal hernia repair is one of the most common procedures performed in general surgery. Approximately 20 million hernia surgeries are performed every year worldwide. Conventionally, hernial repair is carried out with the open Lichtenstein technique; however, laparoscopic and robotic inguinal hernia repairs have been developed as a minimally invasive alternative to the classic Lichtenstein repair. The prosthetic mesh can be placed by totally extraperitoneal and transabdominal pre-peritoneal approaches. Choosing the best technique for repairing an inguinal hernia is a challenge because the available data are contradictory. However, a growing number of studies have claimed that robotic-assisted hernia repair is not only feasible and safe, but it is associated with outcomes that are comparable to those obtained with laparoscopy and open surgery, including shorter hospital stay, and fewer complications. The aim of the review article is to provide an overview of the current practice of inguinal hernia repair, with a focus on the advances in robotic-assisted inguinal hernia repair, as well as the advantages and disadvantages of this surgical procedure compared to the laparoscopic technique in view of the current reports in the literature.
The aim of this study was to identify probable intermediate biomarkers of disturbed pathways and their link between smoking. Methods Un-stimulated whole saliva and serum samples were collected from a total of 30 systemically healthy participants with periodontally healthy smokers (S) (n=15) and nonsmokers (n=15). Periodontal indices (plaque index, gingival index, probing depth, bleeding on probing, clinical attachment level) were recorded to confirm periodontal health. Saliva was purified, and a total of 28 amino acids and metabolites were analyzed by liquid chromatographymass spectrometry (LC-MS/MS). Smoking status was validated measuring serum cotinine levels. Intergroup comparisons were assessed using the Mann Whitney U test. Results When 28 amino acids were evaluated, smokers had statistically significantly higher cystathionine levels than non-smokers (p <0.05). Conclusions Saliva cystathionine is associated with smoking in periodontally healthy individuals, and is possibly related to altered sulfuration pathway.
Background: Coagulopathy is the most common manifestation in cases of haemotoxic snake bites. The most common coagulopathy associated with snake envenoming worldwide is venom-induced consumption coagulopathy (VICC). The existence of overlapping clinical syndromes of VICC and thrombotic microangiopathy (TMA) in snake envenoming is the likely reason for the mistaken idea that snake bite causes disseminated intravascular coagulation (DIC). This study aims to look into the exact type coagulopathy in haemotoxic snake envenomation.Methods: Prospective observational study was conducted from January 2017 to January 2018 at a tertiary care centre in Odisha.Results: Out of 54, 23 (42.6%) cases were having DIC and 31 (57.4%) cases were not confirmed to be having DIC. In DIC group there was significantly delayed hospitalization (46.3±28.5 hours) when compared to group B (13.5±11.1 hours, p<0.05). Mean anti-snake venom (ASV) requirement in DIC group was significantly higher (28.3±14) than in those DIC is not confirmed (11.13±3.1, p<0.05). 21.7% cases in DIC group had kdigo stage III AKI compared to 3.3%cases of group B. 13% cases of DIC group required hemodialysis when compared to 3.2% cases of group B.Conclusions: Early hospitalisation (preferably <12 hours and not >24 hours), early ASV administration are important to prevent full blown DIC and more serious complications. Most of the non DIC cases appears to be DIC in evolution but not confirmed to diagnosis by DIC scoring system as they reached hospital early before the development of frank DIC. TMA has not been found in this study. However further studies are needed to ascertain the exact cause of coagulopathy in non DIC group.
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