Recent reports suggest that prevalence of gastrointestinal (GI) and hepatic manifestations in COVID-19 are higher than initially reported, particularly in Western populations. New York City has arguably been the epicenter of the COVID-19 pandemic in the United States, creating a unique opportunity to further the understanding of this disease. Our objectives were to investigate the prevalence of GI and hepatic manifestations of patients with COVID-19, and explore their effect on the clinical outcomes in these patients.

Introduction The impact of atrial arrhythmias on coronavirus disease 2019 (COVID‐19)‐associated outcomes are unclear. We sought to identify prevalence, risk factors and outcomes associated with atrial arrhythmias among patients hospitalized with COVID‐19. Methods An observational cohort study of 1053 patients with severe acute respiratory syndrome coronavirus 2 infection admitted to a quaternary care hospital and a community hospital was conducted. Data from electrocardiographic and telemetry were collected to identify atrial fibrillation (AF) or atrial flutter/tachycardia (AFL). The association between atrial arrhythmias and 30‐day mortality was assessed with multivariable analysis. Results Mean age of patients was 62 ± 17 years and 62% were men. Atrial arrhythmias were identified in 166 (15.8%) patients, with AF in 154 (14.6%) patients and AFL in 40 (3.8%) patients. Newly detected atrial arrhythmias occurred in 101 (9.6%) patients. Age, male sex, prior AF, renal disease, and hypoxia on presentation were independently associated with AF/AFL occurrence. Compared with patients without AF/AFL, patients with AF/AFL had significantly higher levels of troponin, B‐type natriuretic peptide, C‐reactive protein, ferritin and d ‐dimer. Mortality was significantly higher among patients with AF/AFL (39.2%) compared to patients without (13.4%; p < .001). After adjustment for age and co‐morbidities, AF/AFL (adjusted odds ratio [OR]: 1.93; p = .007) and newly detected AF/AFL (adjusted OR: 2.87; p < .001) were independently associated with 30‐day mortality. Conclusion Atrial arrhythmias are common among patients hospitalized with COVID‐19. The presence of AF/AFL tracked with markers of inflammation and cardiac injury. Atrial arrhythmias were independently associated with increased mortality.

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Background The independent prognostic value of troponin and other biomarker elevation among patients with coronavirus‐19 (COVID‐19) are unclear. We sought to characterize biomarker levels in patients hospitalized with COVID‐19 and develop and validate a mortality risk score. Methods and Results An observational cohort study of 1053 patients with COVID‐19 was conducted. Patients with all of the following biomarkers measured: troponin‐I (TnI), B‐type natriuretic peptide, C‐reactive protein, ferritin and D‐dimer (n = 446) were identified. Maximum levels for each biomarker were recorded. Primary endpoint was 30‐day in‐hospital mortality. Multivariable logistic regression was used to construct a mortality risk score. Validation of the risk score was performed using an independent patient cohort (n = 440). Mean age of patients was 65.0 ± 15.2 years and 65.3% were men. Overall, 444 (99.6%) had elevation of any biomarker. Among tested biomarkers, TnI ≥ 0.34 ng/ml was the only independent predictor of 30‐day mortality (adjusted OR 4.38; P < 0.001). Patients with a mortality score using hypoxia on presentation, age and TnI elevation, age (HA 2 T 2 ) ≥ 3 had a 30‐day mortality of 43.7% while those with a score < 3 had mortality of 5.9%. Area under the receiver operating characteristic curve of the HA 2 T 2 score was 0.834 for the derivation cohort and 0.784 for the validation cohort. Conclusions Elevated troponin and other biomarker levels are commonly seen in patients hospitalized with COVID‐19. High troponin levels are a potent predictor of 30‐day in‐hospital mortality. A simple risk score can stratify patients at risk for COVID‐19‐associated mortality.

PurposeHearing loss (HL) is the most common sensory disorder in children. Prompt molecular diagnosis may guide screening and management; especially in syndromic cases when HL is the single presenting feature. Exome sequencing (ES)is an appealing diagnostic tool for HL as the genetic causes are highly heterogeneous.MethodsES was performed on a prospective cohort of 43 probands with HL. Sequence data were analyzed for primary and secondary findings. Capture and coverage analysis was performed for genes and variants associated with HL.ResultsThe diagnostic rate using ES was 37.2% compared to 15.8% with clinical HL panel. Secondary findings were discovered in three patients. For 247 genes associated with HL, 94.7% of the exons were targeted for capture and 81.7% of these exons were covered at 20× or greater. Further analysis of 454 randomly selected HL-associated variants showed 89% were targeted for capture and 75% were covered at a read depth of at least 20×.ConclusionES has an improved yield to clinical testing and may capture diagnoses not initially considered due to subtle clinical phenotypes. Technical challenges were identified, including inadequate capture and coverage of HL genes. Additional considerations of ES include secondary findings, cost, and turnaround time.

Background: In low and middle-income countries, country specific data is scarce regarding the burden of surgical disease, with most estimates extrapolated from indirect methods. Kilimanjaro Christian Medical Center (KCMC) is the only tertiary referral hospital for a population of over 11 million in Northern Tanzania. This study aims to directly quantify the current orthopaedic burden of disease at KCMC and provide a foundation to estimate the magnitude and potential benefit of improving access to orthopaedic surgical care in the northern regions of Tanzania.

BackgroundMachine learning (ML) is able to extract patterns and develop algorithms to construct datadriven models. We use ML models to gain insight into the relative importance of variables to predict obstructive coronary artery disease (CAD) using the Coronary Computed Tomographic Angiography for Selective Cardiac Catheterization (CONSERVE) study, as well as to compare prediction of obstructive CAD to the CAD consortium clinical score (CAD2). We

There is a near absence of access to orthopaedic surgical care in Northern Tanzania. These findings utilize more precise country and region-specific data and are consistent with prior published global trends regarding surgical access in Sub-Saharan Africa. As the global health community must develop innovative solutions to address the rising burden of musculoskeletal disease and support the advancement of universal health coverage, increasing access to orthopaedic surgical services will play a central role in improving health care in the world's developing regions.