Validation of the RIM Score-COVID in the Spanish SEMI-COVID-19 Registry

The significant impact of COVID-19 worldwide has made it necessary to develop tools to identify patients at high risk of severe disease and death. This work aims to validate the RIM Score-COVID in the SEMI-COVID-19 Registry. The RIM Score-COVID is a simple nomogram with high predictive capacity for in-hospital death due to COVID-19 designed using clinical and analytical parameters of patients diagnosed in the first wave of the pandemic. The nomogram uses five variables measured on arrival to the emergency department (ED): age, sex, oxygen saturation, C-reactive protein level, and neutrophil-to-platelet ratio. Validation was performed in the Spanish SEMI-COVID-19 Registry, which included consecutive patients hospitalized with confirmed COVID-19 in Spain. The cohort was divided into three time periods: T1 from February 1 to June 10, 2020 (first wave), T2 from June 11 to December 31, 2020 (second wave, pre-vaccination period), and T3 from January 1 to December 5, 2021 (vaccination period). The model's accuracy in predicting in-hospital COVID-19 mortality was assessed using the area under the receiver operating characteristics curve (AUROC). Clinical and laboratory data from 22,566 patients were analyzed: 15,976 (70.7%) from T1, 4,233 (18.7%) from T2, and 2,357 from T3 (10.4%). AUROC of the RIM Score-COVID in the entire SEMI-COVID-19 Registry was 0.823 (95%CI 0.819-0.827) and was 0.834 (95%CI 0.830-0.839) in T1, 0.792 (95%CI 0.781-0.803) in T2, and 0.799 (95%CI 0.785-0.813) in T3. The RIM Score-COVID is a simple, easy-to-use method for predicting in-hospital COVID-19 mortality that uses parameters measured in most EDs. This tool showed good predictive ability in successive disease waves.

Stress radiographic assessment of collateral ligament constraints on the feline tarsocrural joint

INTRODUCTION

This cadaveric study describes the collateral ligament constraints on the feline tarsocrural joint using stress radiography.

METHODS

Thirty-six feline cadaveric hindlimbs free of orthopaedic disease were placed in a custom-made jig and controlled stress radiography was performed before and after transection of one, or both collateral ligaments. Changes in varus and valgus deviation and pronation and supination were measured at three limb angles (extension, 120^o flexion and 90^o flexion).

RESULTS

There was a significant positive percentage change in the mean angle of varus deviation after transection of the fibulocalcaneal ligament at all limb positions (extension: 41%, 120°: 78%, 90°: 63%). There was a significant positive percentage change in the mean angle of varus deviation after transection of the fibulotalar ligament at extension (14%). There was a significant positive percentage change in the mean angle of varus deviation after transection of both fibulocalcaneal and fibulotalar ligaments at all limb positions (extension: 58%, 120°: 67%, 90°: 67%), and in the mean angle of valgus deviation (100%) and supination (89%) at 90 degrees flexion. There was a significant positive percentage change in the mean angle of valgus deviation after transection of the tibiocentral ligament at all limb positions (extension: mean 79%, 120°: 43%, 90°: 49%) and the mean angle of pronation at 120 degrees flexion (10%). There was a significant positive percentage change in the mean angle of varus deviation after transection of the tibiotalar ligament at extension (11%) and at 90 degrees flexion (54%) and in the mean angle of pronation at all limb positions (extension: 11%, 120°: 19%, 90°: 32%). There was a significant positive percentage change in the mean angle of valgus deviation (extension: 255%, 120°: 172%, 90°: 176%) and pronation (extension: 58%, 120°: 134%, 90°: 76%) after transection of the tibiocentral and tibiotalar ligaments at all limb positions and in the mean angle of varus deviation at extension (13%) and 90 degrees flexion (69%).

CONCLUSION

The medial collateral ligaments prevent against excessive valgus deviation and pronation, and the lateral collateral ligaments prevent against excessive varus deviation and supination. At 90 degrees flexion subluxation of the talus occurs on the ipsilateral side of the ligament injury resulting in an additional direction of instability.

Didanosine Therapy in Patients Intolerant of or Failing Zidovudine Therapy

OBJECTIVE:

To examine the effect of didanosine (2′,3′-dideoxyinosine, ddI) on surrogate markers of HIV infection (CD4+ lymphocyte count, p24 antigen) and to evaluate the incidence of adverse effects from ddI.

DESIGN:

This study was performed as a retrospective chart review of patients who were enrolled in Bristol-Myers Squibb's expanded-access program for ddI.

SETTING:

Patient records were obtained from primary care physicians' offices.

PATIENTS:

Twenty-five HIV-infected patients diagnosed with AIDS or AIDS-related complex (ARC) who were intolerant of zidovudine (ZDV) therapy or deteriorating clinically despite ZDV therapy and were eligible for inclusion in the ddI expanded-access program.

INTERVENTION:

ddI was administered orally in a citrate-phosphate buffer every 12 hours. Patients were followed by their private physician on a monthly basis.

MAIN OUTCOME MEASURES:

Laboratory analysis at each month included CD4+ lymphocyte count, hemoglobin, hematocrit, serum amylase, uric acid, serum triglycerides, and p24 antigen. Mean CD4+ cell count, serum amylase, hemoglobin, and uric acid at each month during ddI therapy were compared with baseline concentrations for nine months.

RESULTS:

Patients had received prior ZDV therapy for an average of 15.5 months before starting ddI. Mean CD4+ cell counts increased from 53.9/mm3 at baseline to 72.4/mm3 after 4 months of therapy (p=0.04) but returned to concentrations comparable with those at baseline after 5 months. One case of documented pancreatitis, two cases of suspected pancreatitis, and nine cases of peripheral neuropathy occurred during ddI therapy. The estimated mean cumulative dose for the development of neuropathy was 1.16 g/kg, which is lower than previously reported.

CONCLUSIONS:

Patients who have received prolonged therapy with ZDV or who have low initial CD4+ counts may not have sustained increases in CD4+ counts from ddI therapy. Also, development of peripheral neuropathy may occur at lower cumulative doses in these patient populations.

Common and contrasting genomic profiles among the major human lung cancer subtypes

Lung cancer is the leading cause of cancer mortality worldwide. With the recent success of molecularly targeted therapies in this disease, a detailed knowledge of the spectrum of genetic lesions in lung cancer represents a critical step in the development of additional effective agents. An integrated high-resolution survey of regional amplifications and deletions and gene expression profiling of non-small-cell lung cancers (NSCLC) identified 93 focal high-confidence copy number alterations (CNAs), with 21 spanning less than 0.5 Mb with a median of five genes. Most CNAs were novel and included high-amplitude amplification and homozygous deletion events. Pathogenic relevance of these genomic alterations was further reinforced by their recurrence and overlap with focal alterations of other tumor types. Additionally, the comparison of the genomic profiles of the two major subtypes of NSCLC, adenocarcinoma (AC) and squamous cell carcinoma (SCC), showed an almost complete overlap with the exception of one amplified region on chromosome 3, specific for SCC. Among the few genes overexpressed within this amplicon was p63, a known regulator of squamous cell differentiation. These findings suggest that the AC and SCC subtypes may arise from a common cell of origin and they are driven to their distinct phenotypic end points by altered expression of a limited number of key genes such as p63.

Bernard-Soulier syndrome: common ancestry in two African American families with the GP Ib alpha Leu129Pro mutation

Bernard-Soulier syndrome (BSs) is a rare bleeding disorder characterized by circulating giant platelets, thrombocytopenia, and a prolonged bleeding time. BSs usually has an autosomal recessive inheritance pattern, with a preponderance of Caucasian and Japanese ancestry when the ethnic background has been reported. Underlying this disorder of platelet function is a defect in the platelet glycoprotein (GP) Ib-IX-V complex, composed of four polypeptides, GP Ib alpha, GP Ib beta, GP IX, and GP V. Molecular characterization of individuals with BSs has identified mutations in the GP Ib alpha, GP Ib beta, and GP IX genes responsible for the expressed phenotype. In this study, we report a family of African-American descent, with autosomal recessive BSs showing a point mutation in codon 129 of the GP Ib alpha gene. This mutation, CTC:wild-type to CCC:mutant, is similar to that of another African American family where the resulting leucine to proline substitution in the 5(th) leucine-rich repeat of GP Ib alpha is responsible for the observed BSs phenotype. Comparison of the intragenic polymorphisms of GP Ib alpha, as well as microsatellite markers in a 17.5 cM region of chromosome 17p12 that contains the GP Ib alpha gene, suggests that, although socially unrelated, the Leu129Pro mutation in these two families has a common founder.

Studies in a large family with late-onset Alzheimer disease (LOAD)

A large 10-generation family with late-onset Alzheimer disease (LOAD) inherited as an autosomal dominant trait was evaluated historically, clinically, and genetically. The family origin was traced to a founder couple of French ancestry with approximately 3,000 descendants. Although the transmission of a genetic predisposition to LOAD is demonstrated through male individuals, a predominance of affected women is observed. Currently, 14 individuals, 12 of whom are women, are classified as affected with Alzheimer disease (AD). Among the affected, the age of onset ranged from 55 to 78 years. Genotyping of the apolipoprotein E (APOE) locus demonstrated that homozygotes for the E4 allele (APOE4) developed signs of AD in their late 60s, whereas affected heterozygotes presented with the disease in their 70s. A significantly higher APOE4 frequency was observed in affected family members than in those unaffected (0.79 vs. 0.25, chi 2 = 9.919, p = 0.0016, df = 1). Survival for more than 15 years after diagnosed onset was observed in a number of those affected and can be attributed to an improved environment, including excellent care and management during the disabling phase of illness. Alternatively, it may be an example of the genetic heterogeneity in AD. Complete documentation of large families such as the one presented will facilitate the discovery of the multiple genetic factors involved in the pathogenesis of AD.

Quinine may trigger torsades de pointes during astemizole therapy

Because of serious cardiovascular events, warnings against concomitant use of certain medications with the use of antihistamine (HismanalR have been published and added to product labeling. Quinine, the optical isomer to quinidine, is included in these warnings. We present the case of a patient with only mild electrolyte disturbances who experienced an episode of torsades de pointes after a single dose of quinine while taking astemizole.

Complex chromosome 4, 9, and 22 rearrangement in a patient presenting with AML-FAB M2

Fluorescence in situ hybridization (FISH) and the reverse transcription-polymerase chain reaction (RT-PCR) were used to examine a patient presenting with acute myelogenous leukemia (AML) FAB M2, and a complex t(4;9;22)(p14;q34;q11.2). The patient's clinical course was characterized by an aggressive leukemia, resistant to intensive therapy including allogeneic bone marrow transplantation. FISH analysis, using two chromosome painting probes and a BCR/ABL specific probe, confirmed the cytogenetic observation of a 22q11.2-->4p14 and a 4p14-->9q34 exchange, and revealed the presence of a 9q34-->22q11.2, respectively. In addition, RT-PCR demonstrated the presence of a BCR/ABL transcript derived from the major breakpoint cluster region (M-bcr) of the BCR gene. This transcript has been shown to generate an active 210 kDa tyrosine kinase protein more commonly observed in chronic myelogenous leukemia. Because the presentation of AML with this ABL-->BCR fusion product is a rare event, it would seem likely that the additional complex chromosomal rearrangement involving chromosomes 4, 9, and 22 played a role in the aggressive presentation and clinical behavior of this patient's leukemia.

Alteration of gonococcal protein expression in acidic culture

We grew Neisseria gonorrhoeae under acidic, neutral, and alkaline conditions and noted altered expression of at least 12 outer membrane proteins between 31 and 100 kDa in size. One protein whose expression was upregulated under acidic conditions was gonococcal heat shock protein 63. These proteins may contribute to the pathogenesis of gonorrhea in the urogenital tract.

Comparison of throat culture methods for the recovery of group A streptococci in a pediatric office setting

OBJECTIVE

To compare a single-plate method for the recovery of group A streptococci with other methods that have recently been reported as being significantly more sensitive.

DESIGN

Throat swabs were allowed to dry for 2 to 6 hours before inoculating 5% sheep blood agar plates. Stabs were made into the agar, bacitracin disks were placed on the primary plates, and the cultures were incubated aerobically. Using duplicate throat swabs, the recovery rates of the above method were compared with the following ones: a carbon dioxide-enhanced incubation atmosphere, an anaerobic atmosphere with a selective blood agar medium, and a Todd-Hewitt broth medium.

SETTING

A five-pediatrician office.

PATIENTS

A total of 301 pediatric patients with pharyngitis were evaluated using all comparative methods. In addition, duplicate swabs from 590 pediatric patients were compared with each other using the same single-plate method.

RESULTS

There were no significant differences between any of the methods. The sensitivity of the single-plate method compared with selective plates incubated anaerobically was 96%.

CONCLUSIONS

In a pediatric office setting, a single-plate method using aerobic incubation was adequately sensitive for the recovery of group A beta-hemolytic streptococci. Transport medium, selective medium, carbon dioxide enhancement, and anaerobic incubation did not significantly improve recovery. The present federal regulations that restrict the use of nonselective media and bacitracin disks on primary plates should be reevaluated.

Phenotypic modulation of gonococcal lipooligosaccharide in acidic and alkaline culture

Neisseria gonorrhoeae infects a diverse array of niches in its human host, which expose the organism to dramatic variations in pH. We examined growth and lipooligosaccharide expression of two gonococcal strains in liquid and solid cultures under acidic, neutral, and alkaline conditions. Growth rates in broth were similar under the three conditions, and the pH remained fairly constant throughout the growth cycle. Altered lipooligosaccharide expression at the different pHs was noted in both plate- and broth-grown organisms.

Comparison of an optical immunoassay technique with two culture methods for the detection of group A streptococci in a pediatric office

For detecting group A beta-hemolytic streptococci in an office setting, an optical immunoassay method was compared with two culture methods. The sensitivity and specificity of OIA as compared with 5% sheep blood agar cultures were 91.4% and 95.6%, and as compared with a Todd-Hewitt broth method were 90.4% and 94.1%, respectively.

Protein aggregation and inclusion body formation in Escherichia coli rpoH mutant defective in heat shock protein induction

Mutations in the rpoH gene, encoding sigma 32, an alternative factor required for transcription of the heat shock genes, result in the extensive aggregation of virtually all cellular proteins and formation of inclusion bodies both under stress and non-stress conditions. Inhibitors of protein synthesis suppress this aggregation, suggesting that newly synthesized proteins preferentially aggregate in rpoH mutants. These data suggest that the heat shock proteins are involved in acquisition of the soluble state (i.e. correct conformation) of the bulk of intracellular proteins after their translation.

Population pharmacokinetics of lithium

The population pharmacokinetics of lithium was determined. Psychiatric inpatients who were at least 18 years old, had normal renal function, and were receiving lithium two or three times daily were the subjects of the study; 79 patients met the criteria. Serum lithium concentrations were measured by flame photometry 12 hours after the evening dose. Other data collected included age, gender, race, height, weight, serum creatinine and sodium concentrations, diet, and concurrent drug use. The nonlinear mixed-effects model (NONMEM) program was used to estimate lithium clearance, lithium volume of distribution, and error variability and to determine the influence of patient characteristics on lithium clearance. With the initial model, the mean lithium volume of distribution was 32.8 L and mean lithium clearance was 1.36 L/hr. With an intermediate model, lithium clearance estimates improved on the basis of patient size (weight and body surface area), daily lithium dosage, age, gender, and race. When only the most significant variables--lean body weight and creatinine clearance--were retained, a final model was obtained that yielded a coefficient of variation for lithium clearance of about 24% and gave fairly accurate predictions of steady-state lithium concentrations (coefficient of variation, about 16%). Analysis of lithium pharmacokinetics with the NONMEM program suggested that lean body weight and creatinine clearance are important predictors of lithium clearance.

Comparison of immediate and delayed culture methods for isolation of group A streptococci

Recovery rates of Group A beta-hemolytic streptococci in throat cultures from 300 children were studied using three different methods. The swabs were streaked onto plates immediately, streaked from the same dry swabs held at room temperature for 3 to 6 hours and streaked from swabs held in transport media at room temperature for 3 to 6 hours. The cultures were processed in a pediatric office and interpreted by a microbiologist. The recovery rates were similar for the three methods, but the cultures were easier to interpret when the swabs had been allowed to dry before streaking as a result of a decrease in the normal flora on these plates. In a separate study the recovery of Group A beta-hemolytic streptococci from 187 swabs was identical whether the swabs were streaked at 3 to 6 hours or at 18 to 24 hours.

Comparison of a latex agglutination test and four culture methods for identification of group A streptococci in a pediatric office laboratory

A latex agglutination test and four culture methods for the detection of group A hemolytic streptococci were compared in a pediatric office laboratory. The anaerobic (GasPak) and Detekta-Kit methods produced the highest recovery rates, but aerobic incubation of 5% blood agar plates gave very acceptable results (sensitivity 92%, or 98% if the 1+ positive cultures were eliminated; specificity 100%), and had fewer disadvantages. Delaying inoculation of plates for 2 to 6 hours resulted in significantly greater numbers of strongly positive (3+ and 4+) cultures. The group A selective sheep blood agar media as used in this study offered no advantage. The Culturette test had a sensitivity of 72% and specificity of 98%, compared with the GasPak method, and 77% and 97%, respectively, compared with standard aerobic cultures. Thus it appears too insensitive to be used alone, but might complement culture methods in selected patients.

A comparison of the kinetic properties of phosphoenolpyruvate carboxylase from guard-cell and mesophyll-cell protoplasts of Commelina communis

Some kinetic properties of partially purified phosphoenolpyruvate carboxylase (PEPCase) from guard-cell and mesophyll-cell protoplasts of Commelina communis are described. The PEPCase activity inherent to each cell type was determined and the apparent K m (phosphoenolpyruvate) and K i (malate) were compared. Malate sensitivity was much higher (K i malate 0.4 mol m(-3)) in the extract of guard-cell protoplasts than in that of mesophyllcell protoplasts (K i malate 4.2 mol m(-3)). The stimulation of activity by glucose-6-phosphate in the presence of malate ('deinhibition') was also investigated in extracts from both cell types and was found to be similar to previously reported results with epidermal tissue. The effect of contamination of an extract of guard-cell protoplasts with mesophyll-cell protoplasts was measured in the presence and absence of malate. It was found that a small amount to mesophyll-cell contaminant appears to desensitize the malate inhibition of PEPCase from guard-cell protoplasts. It is concluded that experiments which use epidermal tissue to study guardcell PEPCase may give misleading information as a consequence of mesophyll contamination.

On the activation of symbiotic gratification fantasies as an aid in the treatment of alcoholics

Seventy-two alcoholics being treated at Veritas Villa were divided into an experimental and a control group. In addition to the regular treatment program both groups received four subliminal exposures of a verbal message in each of six sessions over a 2-week period. The messages were MOMMY AND I ARE ONE (experimental) and PEOPLE ARE WALKING (control), administered under double-blind conditions. In keeping with the main hypothesis, the experimental Ss were rated as significantly more involved in treatment. In addition, among the alcoholics who were more symptomatic to begin with, the MOMMY message, when contrasted with the control, lowered anxiety and depression, enhanced self-concept, and reduced alcohol consumption after a 3-month follow-up.

A study of the in-vitro regulation of phosphoenolpyruvate carboxylase from the epidermis of Commelina communis by malate and glucose-6-phosphate

Phosphoenolpyruvate (PEP) carboxylase activity in epidermal extracts of Commelina communis has been compared in the presence of malate and glucose-6-phosphate. The activity of PEP carboxylase was inhibited by increasing malate concentrations at several substrate (PEP) concentrations and changes in both the apparent K m (PEP) and V max values in the presence of malate suggested the occurence of mixed-type inhibiton. In the presence of glucose-6-phosphate no increase in enzyme activity was observed, although there was a slight decrease in the K m (PEP). However, glucose-6-phosphate appeared to alleviate the inhibition caused by malate. The possible implications of these properties in the control of malate production in guard cells is discussed.

Critical weight loss and malnutrition in breast-fed infants

In four infants of primiparous mothers, critical dehydration, hypothermia, and azotemia developed while they were being breast-fed exclusively. Three had significant hypernatremia, one had a perforated duodenal ulcer, and one had transient renal failure. Although the causes of the inadequate nutrition are unclear, these cases emphasize the necessity of close follow-up for breast-fed babies, especially those of primiparous mothers and those in whom there has been excessive weight loss while in the hospital.

Structural and functional aspects of stomata : I. Developmental studies in Polypodium vulgare

Differential cell wall thickening in developing guard cells of Polypodium vulgare L. has been studied with particular reference to guard cell protoplast deformation and the eventual formation of the stomatal pore. Concomitant studies on the development of guard cell chloroplasts and their starch inclusions during ontogeny of the stomatal complex have provided data which have been incorporated into a model to account for the formation of the pore. Guard cell starch inclusions reach a maximum density per unit volume at the same time as the guard cell walls achieve maximum differential thickening. These events coincide with the development of the pore. It is suggested that, whilst pore formation is initiated enzymatically, the mechanical forces required to bring about the separation of the two guard cells are of an osmotic nature derived from starch hydrolysis. The development of the mesophyll in relation to the epidermis is examined in respect of the formation of substomatal chambers.

Lead toxicity effects on indole-3-ylacetic acid-induced cell elongation

In vitro studies of IAA-induced cell elongation in Triticum aestivum have demonstrated that lead causes a large reduction in elongation. Inhibition of elongation can be reduced by increasing the concentration of IAA, or by the addition of calcium. The inhibitory effect appears to be linked with changes in the properties of the cell walls. Experiments are described which show that lead becomes bound strongly to certain chemical substances involved in cell wall architecture.

[Increase of mast cells in the peritoneal cavity of rats treated with atopic patient's serum]

In accordance with the experiments described by the author, the injection of atopic serum and the serum of patients infected with ascaris into the peritoneal cavity of the rats produces after 24 hours an increase in mast cells of the mesentery together with vascular congestion. The experiment was made in the following way: injecting 0.5 ml. of the serum in the peritoneal cavity and the observations were made after 24 hours in the ileum-cecal mesentery. The increase of mast cells is shown to have statistical significance in atopic serum (hay fever and atopic dermatitis) as well as in serum of patients infected with ascaris lumbricoides. The increase of the mast cells is seen particularly in the vascular areas. On the other hand, the injection of non-atopic serum and inactivated atopic serum by heat (56 degrees C, 2 hours) does not produce this increase in mast cells. This phenomenon of the increase of the mast cell population which the atopic serum produces is only observed after 24 hours and not in a shorter time (20 minutes). Also we would emphasize that the increase is due only to the application of the atopic serum without any need to apply the appropriate antigen. The results obtained are as follows:A) 6 control rats--38.6 mast cells/mm2 B) 7 rats + serum of patient with hay fever--88.5 mast cells/mm2 C) 4 rats + inactivated serum (56 degrees C 2 hours) from the same patient with hay fever. 47.0 mast cells/mm2 D) 4 rats + 4 serum from non-atopic persons--38.1 mast cells/mm2 B') 6 rats + 6 serum from patients with hay fever--89.0 mast cells/mm2 C') 4 rats + 4 serums from patients with atopic dermatitis. 108.0 mast cells/mm2 D') 4 rats + 4 serums from patients with ascaris lumbricoides--116.0 mast cells/mm2. Although it is known that the serum from atopic patients and those infected with ascaris lumbricoides has a high level of IgE we cannot be sure that this increase in mast cells in the rat is produced by the human IgE. The true cause of this phenomenon is unknown.

Sensorineural hearing loss and upward spread of masking

Pure-tone auditory thresholds were obtained in quiet and in three levels of masking noise for one normal-hearing group and five groups of subjects with different degrees of sensorineural loss. The masker was a low-pass noise, cut off at 250 Hz. It was presented at overall levels of 77, 97, and 107 dB SPL. Pure-tone thresholds were obtained at test frequencies within and above the masking band. A measure of noise rejection slope was used to describe spread of masking. Degree of loss, configuration of loss, and level of masking noise appear to have marked influences on upward spread of masking patterns in sensorineural subjects.