Social determinants of health predict readmission following COVID-19 hospitalization: a health information exchange-based retrospective cohort study

Introduction

Since February 2020, over 104 million people in the United States have been diagnosed with SARS-CoV-2 infection, or COVID-19, with over 8.5 million reported in the state of Texas. This study analyzed social determinants of health as predictors for readmission among COVID-19 patients in Southeast Texas, United States.

Methods

A retrospective cohort study was conducted investigating demographic and clinical risk factors for 30, 60, and 90-day readmission outcomes among adult patients with a COVID-19-associated inpatient hospitalization encounter within a regional health information exchange between February 1, 2020, to December 1, 2022.

Results and discussion

In this cohort of 91,007 adult patients with a COVID-19-associated hospitalization, over 21% were readmitted to the hospital within 90  days (n = 19,679), and 13% were readmitted within 30  days (n = 11,912). In logistic regression analyses, Hispanic and non-Hispanic Asian patients were less likely to be readmitted within 90  days (adjusted odds ratio [aOR]: 0.8, 95% confidence interval [CI]: 0.7-0.9, and aOR: 0.8, 95% CI: 0.8-0.8), while non-Hispanic Black patients were more likely to be readmitted (aOR: 1.1, 95% CI: 1.0-1.1, p = 0.002), compared to non-Hispanic White patients. Area deprivation index displayed a clear dose-response relationship to readmission: patients living in the most disadvantaged neighborhoods were more likely to be readmitted within 30 (aOR: 1.1, 95% CI: 1.0-1.2), 60 (aOR: 1.1, 95% CI: 1.2-1.2), and 90  days (aOR: 1.2, 95% CI: 1.1-1.2), compared to patients from the least disadvantaged neighborhoods. Our findings demonstrate the lasting impact of COVID-19, especially among members of marginalized communities, and the increasing burden of COVID-19 morbidity on the healthcare system.

SHORT TERM STUDY ON CLINICAL RELEVANCE AND OUTCOMES OF FOETAL HYDRONEPHROSIS

Background. Hydronephrosis is the most common urinary tract pathology detected on antenatal screening by Ultrasound. The detection of fetal hydronephrosis by ultrasound pres­ents a treatment dilemma to the treating surgeon and parental anxiety. Objective. This study aims to examine the role of serial ultrasounds in antenatally detected fetal hydronephrosis to know the disease progression, and to assess indications and timing of surgery in these patients to preserve renal function. Methods. This is an observational study of 30 cases of foetal hydronephrosis conducted at a tertiary care paediatric surgery centre. A foetal renal pelvic Antero-posterior diameter (APD) >7 mm at 32 weeks of gestation is considered to indicate Foetal hydronephrosis. These patients are followed up for a period of two years from 2018 to 2020. Progression of disease and need for surgical intervention is noted. Results. The study comprised 30 cases of antenatal foetal hydronephrosis (42 renal units). Of 26 renal units with mild hydronephrosis, all are resolved in the post-natal period. Of 10 renal units with moderate hydronephrosis, 3 (30%) resolved and 7 (70%) worsened and required surgical intervention. Of 6 renal units with severe hydronephrosis, all required surgical intervention and underwent surgery between 12 to 18 months of age. Conclusions. These results suggest a grading system with antero-posterior diameter of renal pelvis distinguishes those cases with moderate and severe degrees of hydronephrosis that are at higher risk of surgery.

Cleavage of nicotinamide adenine dinucleotide by the ribosome-inactivating protein from Momordica charantia

The interaction of momordin, a type 1 ribosome-inactivating protein from Momordica charantia, with NADP(+) and NADPH has been investigated by X-ray diffraction analysis of complexes generated by co-crystallization and crystal soaking. It is known that the proteins of this family readily cleave the adenine-ribose bond of adenosine and related nucleotides in the crystal, leaving the product, adenine, bound to the enzyme active site. Surprisingly, the nicotinamide-ribose bond of oxidized NADP(+) is cleaved, leaving nicotinamide bound in the active site in the same position but in a slightly different orientation to that of the five-membered ring of adenine. No binding or cleavage of NADPH was observed at pH 7.4 in these experiments. These observations are in accord with current views of the enzyme mechanism and may contribute to ongoing searches for effective inhibitors.

National clinical guidelines for management of the palatally ectopic maxillary canine

This review summarises updated clinical guidelines produced by the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS). This guideline on the management of the palatally ectopic maxillary canine illustrates the information contained in the recently updated online version. The timely recognition of ectopic canines is important for the overall management of the dentition. This review illustrates five management strategies for ectopic permanent canines: interceptive treatment by extraction of the deciduous canine, surgical exposure and orthodontic alignment, surgical removal of the palatally ectopic permanent canine, auto-transplantation and no active treatment/leave and observe. The current available evidence for each of these management options has been evaluated and awarded a grade used by the Scottish Intercollegiate Guidelines Network.

Impact of tumor size on survival in stage IB (T2N0M0) non-small cell lung cancer (NSCLC)

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Background: Patients with stage IB NSCLC have a relatively poor survival of ∼60% despite adequate surgical resection. The role of adjuvant chemotherapy in this disease remains controversial since the results of the IALT, JBR.10, ANITA and CALGB 9633 trials. It is important to risk stratify patients with Stage IB NSCLC and to offer adjuvant therapies to those at greatest risk for recurrence. Methods: We conducted a retrospective review of 216 consecutive, surgically treated patients with stage IB NSCLC. None of the patients received adjuvant chemotherapy. We studied the association of various clinical factors as well as tumor size and visceral pleural invasion upon tumor recurrence, disease free survival (DFS) and overall survival (OS) at 5 years. Results: Of 216 patients, 135 (62%) were male, 97 (45%) had adenocarcinoma, 115 (53%) had poorly differentiated tumors and the majority (88%) were treated with lobectomy. Visceral pleural invasion was noted in 37 (17%) patients. The 5 year OS and DFS rates were 59% and 54% respectively. Tumor size was = 4cm in 120 (56%) patients, 4.1–5 cm and >5cm in 48 (22%) patients each. The 5 year DFS was 40% and 58% for tumors > 5cm and = 5 cm respectively (p < 0.01). The 5 year OS was 49% and 61% respectively for tumors > 5cm and = 5cm. Pleural invasion was a predictor for DFS in the univariate analysis (p < 0.01) but not for OS. In the multivariable analysis, tumor size = 5cm was the only independent predictor of improved DFS (HR 0.46, C.I. 0.25–.84) and OS (HR=0.43, C.I. 0.23–0.80). Age, gender, histology, differentiation and visceral pleural invasion did not impact upon survival. Conclusions: In stage IB NSCLC, tumors > 5cm in diameter have a significantly worse prognosis. These findings if confirmed in other large series, make a case for subdividing Stage IB NSCLC. Tumor size appears to be the most important factor in risk stratification for patients with stage IB NSCLC. Hence patients with large tumors should be offered adjuvant therapy.

No significant financial relationships to disclose.

Role for Hes1-induced phosphorylation in Groucho-mediated transcriptional repression

Transcriptional corepressors of the Groucho/transducin-like Enhancer of split (Gro/TLE) family regulate a number of developmental pathways in both invertebrates and vertebrates. They form transcription repression complexes with members of several DNA-binding protein families and participate in the regulation of the expression of numerous genes. Despite their pleiotropic roles, little is known about the mechanisms that regulate the functions of Gro/TLE proteins. It is shown here that Gro/TLEs become hyperphosphorylated in response to neural cell differentiation and interaction with the DNA-binding cofactor Hairy/Enhancer of split 1 (Hes1). Hyperphosphorylation of Gro/TLEs is correlated with a tight association with the nuclear compartment through interaction with chromatin, suggesting that hyperphosphorylated Gro/TLEs may mediate transcriptional repression via chromatin remodeling mechanisms. Pharmacological inhibition of protein kinase CK2 reduces the Hes1-induced hyperphosphorylation of Gro/TLEs and causes a decrease in the chromatin association of the latter. Moreover, the transcription repression activity of Gro/TLEs is reduced by protein kinase CK2 inhibition. Consistent with these observations, Gro/TLEs are phosphorylated in vitro by purified protein kinase CK2. Taken together, these results implicate protein kinase CK2 in Gro/TLE functions. They suggest further that this kinase is involved in a hyperphosphorylation mechanism activated by Hes1 that promotes the transcription repression functions of Hes1-Gro/TLE protein complexes.

Giant-cell tumor of bone arising from the falx cerebri. A case report

The histological and ultrastructural features of a giant-cell tumor of bone arising in the falx cerebri of a 27 year-old man are described. The tumor was embedded in the medial aspect of the left frontal lobe and was not attached to any of the bones of the skull. At surgery, the tumor was lightly adherent to the falx and was easily extracted. Histologically, the tumor was composed of mononuclear spindle-shaped and ovoid stromal cells, multinuclear giant cells containing 20-30 nuclei, and foci of osteoid and bone production. Hemorrhagic and cystic areas were also present within the tumor. Ultrastructurally, the spindle-shaped cells resembled fibroblasts and were surrounded by small bundles of collagen fibrils. The ovoid cells contained numerous mitochondria, abundant rough endoplasmic reticulum, vesicles, lysosomes, phagosomes and osseous material in the cytoplasm suggesting their monocyte-macrophage lineage. These cells were closely apposed and displayed evidence of fusion in the form of focal and linear subplasmalemmal densities to form multinucleated giant cells with similar organelles and multiple nuclei. It is suggested that the primary giant cell tumor of the one arose from the metaplastic ossification of the falx. To our knowledge, a giant-cell tumor of bone arising from the falx cerebri has not been previously described.

Extracorporeal shock wave therapy in the management of Peyronie's disease: initial experience

OBJECTIVE

To evaluate prospectively the efficacy of extracorporeal shock wave therapy (ESWT) as a conservative treatment for Peyronie's disease.

PATIENTS AND METHODS

After obtaining ethical committee approval, 37 patients with Peyronie's disease were treated using ESWT. Before treatment the degree of angulation was assessed by artificially inducing an erection with a vacuum device. The severity of pain on erection was assessed using a visual analogue scale (0-5). Each patient was treated with a minimum of three sessions of ESWT (3000 shock waves at an energy density of 0.11-0.17 mJ/mm2) at 3-week intervals. The results were analysed using the Wilcoxon signed-rank test.

RESULTS

Of the 37 patients, 34 completed the protocol; the mean (range) duration of the disease was 19.43 (4-60) months and the mean follow-up 7.5 (5-11) months. Almost half (47%) of the patients reported an improvement in angulation, with a mean reduction of 29.3 degrees (10 degrees -60 degrees ) (P < 0.001); 12 of the 20 (60%) patients with pain on erection reported immediate relief, the mean reduction being 2.3 (1-4) on the visual analogue scale (P < 0.001). There was only minimal bruising at the site of treatment and no major side-effects were reported.

CONCLUSION

ESWT is an effective and safe treatment for Peyronie's disease; the long-term follow-up and results are awaited.

Combinatorial expression patterns of individual TLE proteins during cell determination and differentiation suggest non-redundant functions for mammalian homologs of Drosophila Groucho

The Drosophila protein Groucho is involved in the regulation of cell-determination events during insect neurogenesis and segmentation. A group of mammalian proteins, referred to as transducin-like Enhancer of split (TLE) 1 through 4, share with Groucho identical structures and molecular properties. The aim was to determine whether individual TLE proteins participate in the regulation of cell determination in mammals like their Drosophila counterpart. It is here reported that TLE family members are expressed in combinatorial ways during the in vitro differentiation of mouse P19 embryonic carcinoma cells (a model for neural determination) and rat CFK2 cells (a model for chondrocytic determination). TLE1 is up-regulated and TLE2 and TLE4 are down-regulated to different extents during early stages of differentiation. In contrast, later stages correlate with up-regulation of TLE2 and TLE4, and decreased expression of TLE1. Individual TLE proteins are also expressed in combinatorial as well as complementary patterns during the development of the cerebral cortex and spinal cord of mouse embryos. In particular, TLE1 is robustly expressed in both neural progenitor cells and postmitotic neurons of the outer layers of the cortical plate, whereas TLE4 expression marks preferentially postmitotic neurons of the inner layers. Taken together, these results strongly suggest non-redundant roles for individual TLE proteins during both cell-determination and cell-differentiation events.

Affinity for the nuclear compartment and expression during cell differentiation implicate phosphorylated Groucho/TLE1 forms of higher molecular mass in nuclear functions

The Drosophila protein Groucho is involved in embryonic segmentation and neural development, and is implicated in the Notch signal transduction pathway. We are investigating the molecular mechanisms underlying the function of Groucho and of its mammalian homologues, the TLE ('transducin-like Enhancer of split') proteins. We show that Groucho/TLE1 proteins are phosphorylated. We also show that two populations of phosphorylated Groucho proteins can be identified based on their interaction with the nuclear compartment. More slowly migrating proteins with an apparent molecular mass of roughly 110 kDa interact strongly with the nuclei, while faster migrating proteins displaying molecular masses roughly 84-85 kDa show lower affinity for the nuclear compartment. Similarly, TLE1 proteins with an apparent molecular mass of roughly 118 kDa exhibit higher affinity for the nuclear compartment than do faster migrating forms with apparent molecular masses of 90-93 kDa. Moreover, we show that the nuclear, more slowly migrating, TLE1 proteins are induced during neural determination of P19 embryonic carcinoma cells. These results implicate phosphorylation in the activity of Groucho/TLE1 proteins and suggest that phosphorylated forms of higher molecular mass are involved in nuclear functions. Finally, we show that different TLE proteins respond in different ways to the neural commitment of P19 cells, suggesting that individual members of this protein family may have non-redundant functions.

Management of the unerupted incisor

Failure of eruption of incisors can cause problems in the adult dentition. Early diagnosis is vital, and a number of options are available for treatment. This article sets out guidelines for general dental practitioners managing such teeth.

Oligodendroglial precursor cell susceptibility to hypoxia is related to poor ability to cope with reactive oxygen species

Oligodendrocyte precursors and astrocytes in 2-week-old rat primary glial cultures survived 24 h of anoxia, suggesting both cell types could survive using glycolysis for ATP synthesis; however, when the hypoxia developed gradually, the majority of oligodendrocyte precursor cells died within 24 h of the beginning of the experiment but astrocytes survived. Similarly when cultures were exposed to an atmosphere of 1% oxygen, but not 2% or greater, oligodendrocyte precursors died within 24 h. Much more lipid peroxidation was seen under conditions of hypoxia than under conditions of anoxia suggesting that oligodendrocyte precursors died under the former condition because of free radical-induced damage. Using 5-(and -6)-carboxy-2',7'-dichlorodihydrofluorescein (DCFH) as an intracellular probe of oxidative stress, we have demonstrated directly on living cells that oligodendrocyte precursors have a poorer ability to scavenge free radicals than astrocytes. Furthermore, when free radicals were induced to form in the cells either by cysteine auto-oxidation or menadione redox cycling, oligodendrocyte precursors were more readily damaged than astrocytes. We conclude that oligodendroglial precursor cells are exquisitively sensitive to reactive oxygen species.

TLE expression correlates with mouse embryonic segmentation, neurogenesis, and epithelial determination

The TLE proteins are the mammalian homologues of Groucho, a member of the Drosophila Notch signaling pathway. Notch signaling controls the differentiation of a variety of tissues in invertebrates and vertebrates. We are investigating the role of the TLE genes during mammalian development. We show that TLE 1 and TLE 3 are expressed during a number of cell-determination events, including embryonic segmentation, central and peripheral neurogenesis, and epithelial differentiation. This expression pattern is in agreement with the involvement of Groucho in similar fate choices in Drosophila and suggests that Groucho and TLE proteins perform similar developmental roles. Our results also show that TLE genes are co-expressed during a variety of cell-fate choices with several vertebrate homologues of genes implicated in the Drosophila Notch cascade, suggesting a role for the TLE proteins in mammalian Notch signaling.

Crystal structure of momordin, a type I ribosome inactivating protein from the seeds of Momordica charantia

A type I ribosome-inactivating protein, extracted and purified from M. charantia seeds, was crystallised by vapour diffusion with polyethylene glycol at pH 7.2. X-ray data were collected to 2.1 A resolution and the structure solved by molecular replacement using the A-chain coordinates of ricin. The overall fold of the protein is similar to ricin but there are differences in secondary structure, on the surface and in the active site cleft. These differences are probably due in part to the evolution of the protein without a B-chain partner. The most extensive reorganisation occurs at the C-terminus whereas Tyr70 shows the greatest change in the active site cleft.

Hyperthermic injury of oligodendrocyte precursor cells: implications for dysmyelination disorders

Although 6 h of exposure to 41 degrees C did not affect the viability of oligodendrocyte precursors in culture, a 2-h exposure to 42 degrees C caused them to die. In contrast, astrocytes could tolerate 42 degrees C for at least 6 h. There was an increase in lipid peroxidation following the 42 degrees C insult, particularly in the oligodendrocyte precursors. These findings may be of relevance in understanding certain dysmyelination disorders in humans.

The conformation of deamino-oxytocin: X-ray analysis of the 'dry' and 'wet' forms

Two crystal structures of (1 beta-mercaptopropionic acid) deamino-oxytocin are reported. The 'dry form' in space group C2 has cell dimensions a = 27.08 +/- 0.03, b = 9.06 +/- 0.01, c = 22.98 +/- 0.02 A, beta = 102.06 +/- 0.03 with one deamino-oxytocin and six water molecules per asymmetric unit. The 'wet form' in space group P2(1) has cell dimensions a = 27.27 +/- 0.02, b = 9.04 +/- 0.01, c = 23.04 +/- 0.02 A, beta = 102.24 +/- 0.02, with two deamino-oxytocin and 13 water molecules per asymmetric unit. A local twofold parallel to the monoclinic axis gives a pseudo C2 packing. Initial phases of the 'dry form' were calculated by the heavy-atom method from the isomorphous and anomalous difference Pattersons and anomalous difference Fouier synthesis. The structure was refined by using restrained least-squares at 1.2 A resolution to a crystallographic R = 0.10. The molecular replacement method yielded the P2(1) structure that was refined with geometric restraints to R less than 0.09, by using all data to 1.09 A resolution. Deamino-oxytocin consists of a cyclic tocin ring formed by six amino acids, closed by a disulphide bridge, S1-S6, and held by two trans-annular hydrogen bonds N2-O5 and N5-O2 with a type II turn at residues 3 and 4. A flexible tripeptide tail has a loosely hydrogen-bonded type I beta-turn between N9 and O6. The sulphur of cysteine at position 1 is disordered in all the molecules leading to alternative hands of disulphide. The conformational flexibility of Ile 3, Asn 5, Pro 7 side chains and the disulphide bridge is consistent with previous models of oxytocin in which flexibility is necessary for biological activity.

Severity of nursing-bottle syndrome and feeding patterns in Kuwait

On the basis of extensive clinical experience, a classification scheme for nursing-bottle syndrome (NBS) has been empirically constructed to reflect the progression and severity of the disease. Patients who do not have NBS are assigned a score of zero. Patients with NBS are given a score of 1 if they have caries on the facial or lingual surface of at least one of the primary maxillary incisors and optionally the primary maxillary first molars, a 2 if the buccal surface of one or both of the primary mandibular first molars are also involved, or a 3 if specific multiple surfaces are involved. The feeding pattern classification is as follows: 0 = non abusive, 1 = mildly, 2 = moderately, and 3 = severely abusive. The scoring depends upon the number of feeding times/day, the frequency with which the bottle or breast feeding is given during the might, and the duration of the feeding pattern (in months). Eighty-six cases were reviewed for classification. A chi-square test of a two-way contingency table showed a strong and significant relationship between disease severity and degree of feeding abuse. The findings support the validity of the classification schemes, illustrate the general pattern of NBS progression, and indicate that disease severity is a function of specific combinations of factors.

Crystal structure analysis of deamino-oxytocin: conformational flexibility and receptor binding

Two crystal structures of deamino-oxytocin have been determined at better than 1.1A resolution from isomorphous replacement and anomalous scattering x-ray measurements. In each of two crystal forms there are two closely related conformers with disulfide bridges of different chirality, which may be important in receptor recognition and activation.