Serum Cystatin C Levels as a Predictor of Severity and Mortality Among Patients With COVID-19 Infection

INTRODUCTION

The pandemic caused by SARS Corona Virus-2 (COVID-19) has caused widespread mortality globally. The hallmark of the disease is the "cytokine storm," which is caused due to dysregulated immune system activation. Numerous inflammatory markers are used to predict the severity and mortality of the infection. Serum Cystatin C levels are associated with immune responses to exogenous and endogenous antigens. Our study was done to assess serum cystatin C as a marker of severity and mortality among patients admitted with COVID-19 infection.

METHODOLOGY

This cross-sectional study was conducted in a tertiary care center in South India. Sixty-nine patients with mild and severe COVID-19 infection admitted to the hospital were included in the study. Serum Cystatin C levels were estimated at admission. The levels were correlated with disease severity and mortality. Receiver operating characteristic curves (ROCs) was constructed for Cystatin C to predict severity and mortality. The computation of sensitivity, specificity, and positive and negative predictive values was done using optimal cut-off points. SPSS 18 was used for the statistical analysis. Version 18.0 of PASW Statistics for Windows. SPSS Inc., Chicago.

RESULTS

Out of 69 patients, 28 (40.5%) had a mild illness, and 41 patients (59.4%) had severe COVID-19 illness. Mean serum Cystatin C levels measured at the time of admission among patients with mild illness was 1.83 (SD-1.53), and among patients with severe illness was 3.84 (SD- 2.59) (p<0.001). The area under receiver operating characteristic curves (ROC) for serum cystatin C for predicting COVID-19 severity and mortality was 0.904 and 0.768, respectively (p<0.001).

CONCLUSION

Patients with severe COVID-19 disease had considerably higher serum levels of Cystatin C than those with mild COVID-19 illness. Cystatin C levels can be useful for predicting mortality and severity among patients admitted with COVID-19 infection.

Ictal autonomic activity recorded via wearable-sensors plus machine learning can discriminate epileptic and psychogenic nonepileptic seizures

Differentiating epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) is commonly based on electroencephalogram and concurrent video recordings (vEEG). Here, we demonstrate that these two types of seizures can be discriminated based on signals related to autonomic nervous system activity recorded via wearable sensors. We used Empatica E4 Wristband sensors worn on both arms in vEEG confirmed seizures, and machine learning methods to train classifiers, specifically, extreme gradient boosting (XGBoost). Classification performance achieved a predictive accuracy of 78 ± 1.5% on previously unseen data for whether a seizure was epileptic or psychogenic, which is 6 standard deviations above the baseline of 68% accuracy. Our dataset contained altogether 35 seizures from 18 patients out of which 8 patients had 13 convulsive seizures. Prediction of seizure type was based on simple features derived from the segments of autonomic activity measurements (electrodermal activity, body temperature, blood volume pulse, and heart rate) and forearm acceleration. Features related to heart rate and electrodermal activity were ranked as the top predictors in XGBoost classifiers. We found that patients with PNES had a higher ictal heart rate and electrodermal activity than patients with ES. In contrast to existing published studies of mainly convulsive seizures, our classifier focuses on autonomic signals to differentiate convulsive or nonconvulsive semiology ES from PNES. Our results show that autonomic activity recorded via wearable sensors provides promising signals for detection and discrimination of psychogenic and epileptic seizures, but more work is necessary to improve the predictive power of the model.

Hypokalaemic Periodic Paralysis in a Patient with Subclinical Hyperthyroidism: A Rare Case

Thyrotoxic Periodic Paralysis (TPP) is an uncommon disorder. Though many cases of hypokalaemic periodic paralysis are reported in overt hyperthyroidism, hypokalaemic paralysis in subclinical hyperthyroidism is very rare. Subclinical hyperthyroidism is characterised by circulating TSH levels below reference range and normal thyroid hormone levels. We describe a case of 32-year-old Asian male who presented to the emergency department with acute onset weakness and hypokalaemia with no previous history of thyroid disorder or any signs and symptoms suggestive of hyperthyroidism. He was subsequently diagnosed with Graves' disease with subclinical hyperthyroidism.

Spatial distribution of health facilities in Islamabad, Pakistan

There are no comprehensive, spatially referenced databases of public and private health facilities in any of the countries of the Eastern Mediterranean Region. This study in Pakistan was conducted to demonstrate the feasibility of creating a spatially referenced health facility database for a medium-sized city, in a low-cost, non-resource intensive manner and to visualize the spatial relationship between hospitals and clinics in the city of Islamabad. Cumulatively, 166 (77.6% of all clinics mapped) were in close proximity (within 1 km) to a hospital. Repeating such studies elsewhere would help us to better understand different spatial distribution patterns, the reasons for them and the implications for health-care planning.

Road rage and road traffic accidents among commercial vehicle drivers in Lahore, Pakistan

Road rage and road traffic accidents increase the burden of morbidity and mortality in a population. A cross-sectional survey with convenience sampling was conducted among commercial vehicle drivers in Lahore, Pakistan (n = 901) to record their behaviours/experiences regarding road rage and road traffic accidents. Respondents were asked about incidents of shouting/cursing/rude gestures or threats to physically hurt the person/vehicle, by others or themselves, in the previous 24 hours or 3 months, and their involvement in road traffic accidents in the previous 12 months. Auto-rickshaw drivers were significantly more likely to report various road rage experiences/behaviours and involvement in accidents compared with bus and wagon drivers. A total of 112 respondents (12.4%) reported being involved in a road traffic accident in the previous 12 months but traffic police did not record the accident in 52.7% of cases. The results of this study underline the need to improve road safety in Pakistan.

Road rage behaviour and experiences of rickshaw drivers in Rawalpindi, Pakistan

A cross-sectional survey with convenience sampling was conducted among rickshaw drivers in Rawalpindi, Pakistan to study their road rage behaviour and experiences. Cumulatively 318 male drivers participated in this study. The most common forms of road rage reported were: having been shouted at; and having experienced rude gestures from other drivers (78.9% each). Least common forms of road rage reported were: threats of physical hurt or having actually been physically hurt ( < or = 3% each). Rickshaw drivers with shorter driving time (< or = 10 years) had significantly more road rage experiences than those who had been driving for more than 10 years (P < 0.01). There is a need for nationally representative surveys to study road age in commercial vehicle drivers so as to improve road safety in Pakistan.

Prostatic assessment in rats after bilateral orchidectomy and calcitonin treatment

OBJECTIVE

Bilateral orchidectomy is widely used as a treatment in patients with metastatic prostatic cancer, but post-orchidectomy osteoporosis is a common sequel which is commonly treated by postoperative calcitonin injection. Since the increase in the invasiveness of malignant prostatic cells has been attributed to the use of calcitonin, this study was aimed to elucidate the effect of calcitonin on the structure of the prostate after orchidectomy in rats used as mammalian model.

METHODS

A total of 84 adult male albino rats were divided into three groups: Group 1 (12 control rats); Group 2 (36 rats subjected to bilateral orchidectomy); Group 3 (36 rats subjected to bilateral orchidectomy and injected subcutaneously with calcitonin (5 µg/kg) every other day. Six animals of Group 2 and 3 were sacrificed two, four, eight, sixteen and twenty four weeks after orchidectomy. The prostates were removed and processed for morphometric measurements by using the image analyzer computer system.

RESULTS

The present study demonstrated a decrease in the height and apoptosis of the epithelial lining of the prostatic acini. There was also an increase in the interacinar fibromuscular stroma. However, calcitonin administration following orchidectomy limited these changes.

CONCLUSION

Bilateral orchidectomy produced time related atrophic changes in the prostate, while a simultaneous administration of calcitonin inhibits the development of these atrophic changes.

Influence of diabetes on manifestations and treatment outcome of pulmonary TB patients

OBJECTIVE

To understand the influence of diabetes on the clinical and bacteriological aspects and treatment outcome of pulmonary tuberculosis (PTB) patients.

SETTING AND DESIGN

Records of 692 consecutive smear-positive PTB patients admitted to a referral hospital in Riyadh, Saudi Arabia, were reviewed retrospectively. The characteristics of 187 patients with diabetes mellitus (PTB-DM group) were compared to 505 patients without DM (PTB group).

RESULTS

In the PTB-DM group, 65.2% of the patients had numerous acid-fast bacilli (AFB) on sputum smear examination compared to 54.1% in the control group (P = 0.008). Among new cases, PTB-DM patients had a lower prevalence of resistance to any anti-tuberculosis drug (6.4% vs. 16.0%, P = 0.007) and achieved higher sputum conversion rates at the end of 3 months of treatment (98.9% vs. 94.7%, P = 0.013). Favourable outcomes (cured/treatment completed), failure, death and default were comparable in both groups (P = 0.7005).

CONCLUSIONS

PTB-DM patients have a higher pre-treatment bacillary load, a lower prevalence of anti-tuberculosis drug resistance and achieve slightly higher sputum conversion by the end of 3 months of treatment compared to non-diabetic patients. The association of diabetes does not alter the final treatment outcome among PTB patients.

Knowledge and misconceptions about sexually transmitted infections in married women--perspective from Islamabad

OBJECTIVE

To study the knowledge of married women regarding existence of sexually transmitted infection (STI) their complications, treatment seeking, ways of preventing STI acquisition and opinion about sex education in schools/colleges and media.

SETTING

The Mother and Child Health Center, a tertiary care hospital in Islamabad.

METHODS

A cross-sectional survey based on sample of convenience was conducted, using a structured questionnaire with both close and open-ended questions. Trained women physician interviewers conducted the interviews after obtaining verbal consent.

RESULTS

Out of 218 women approached for interviewing, only two refused to participate in the study. The mean age of the respondents was 28.5 years (range 18-53 years). One hundred and sixty-eight (77.8%) respondents had heard/knew about sexually transmitted infections (STIs). Two hundred and ten (97.2%) respondents had heard/ knew about AIDS and out of these 162 (77.1%) knew that it is also transmitted through sexual contact. One hundred and eighty two (84.2%) felt a need for sex education in the media, both print and electronic and 204 (94.4%) respondents said that they would like to learn more about sexually transmitted infections. One hundred ninety four (98.8%) respondents had heard the Latin term Leukorrhoea. Of these 158 (81.5%) thought it was a gynecological disease. Majority thought it caused weakness.

CONCLUSION

Widespread misperceptions were found to exist, which does not augur well for the effective prevention of STIs in the country. Population based studies are required to study the knowledge and epidemiology of STIs, as well as a need for a health education campaign in the country (JPMA 51:389; 2001).

Prevalence of resistance to antituberculosis drugs in Riyadh and a review of previous reports

BACKGROUND

Resistance to antituberculosis drugs is an important cause of treatment failure. We evaluated the prevalence and pattern of antituberculosis drug resistance in the central region of Saudi Arabia, and reviewed previous reports from Saudi Arabia.

MATERIALS AND METHODS

We retrospectively examined the records of sputum smear and culture-positive pulmonary tuberculosis patients admitted consecutively from 1998 through 1999 in a main referral hospital in Riyadh, and analyzed drug sensitivity reports. We also reviewed previous reports on antituberculosis drug resistance in Saudi Arabia.

RESULTS

Of 515 patients with pulmonary tuberculosis, 80 (15.5%) had resistance to at least one antituberculosis drug. Resistance to streptomycin was most frequent (9.7% ), followed by rifampicin (9.5%), isoniazid (4.3%), and ethambutol (0.2%). Resistance to one antituberculosis drug was found in 8.9%, resistance to two drugs in 5.2%, resistance to three drugs in 1.2%, and resistance to four drugs in 0.2%. Multidrug resistance (defined as resistance to at least isoniazid and rifampicin) was found in 1.9% of patients. A literature review including 6114 patients in Saudi Arabia showed that resistance against streptomycin was most common (8.8%), followed by rifampicin (8%), and isoniazid (7.2%). Of the 6114 patients, 6.8% patients were resistant to only one drug, 3.6% were resistant to two drugs, and 3.7% to three drugs.

CONCLUSION

The high prevalence of rifampicin resistance and resistance to multiple drugs in the Riyadh region and in other parts of Saudi Arabia is a major challenge to the control of tuberculosis in this country. Efforts should be made to prevent the emergence of further antituberculosis drug resistance.

Factors predicting persistent sputum smear positivity among pulmonary tuberculosis patients 2 months after treatment

SETTING

Studies have shown that adverse outcomes are more likely in patients showing persistent sputum positivity at the end of 2 months of anti-tuberculosis treatment.

OBJECTIVE

To identify simple clinical, microbiological or radiological factors associated with persistent sputum positivity under national programme conditions.

DESIGN

Sputum smear-positive pulmonary tuberculosis patients admitted in 2 consecutive years to a referral hospital, and who received standard short-course chemotherapy under direct observation, were reviewed retrospectively. Factors associated with persistent sputum smear positivity were analysed.

RESULTS

A total of 514 patients were available for review. Logistic regression analysis showed that age groups 41-60 years and more than 60 years, numerous bacilli on initial sputum smear examination, and presence of multiple cavitary diseases were significant factors associated with persistent sputum positivity at the end of 2 months of treatment (P < 0.0001).

CONCLUSIONS

Identification of high risk factors associated with persistent sputum positivity, such as specific age groups, numerous bacilli on initial sputum smear examination, and presence of multiple cavitary diseases, may be helpful in stratifying the patients according to the risk of adverse outcome, thus allowing greater efficiency in resource utilisation.

Influence of anti-tuberculosis drug resistance on the treatment outcome of pulmonary tuberculosis patients receiving DOTS in Riyadh, Saudi Arabia

OBJECTIVE

To determine the influence of anti-tuberculosis drug resistance existing prior to treatment on the outcome of pulmonary tuberculosis patients receiving standard short-course chemotherapy (SCC) under direct observation under national programme guidelines.

DESIGN

Treatment outcomes of sputum smear- and culture-positive pulmonary tuberculosis patients admitted consecutively from 1998 through 1999 in a referral hospital in Riyadh, Saudi Arabia, were reviewed retrospectively.

RESULTS

A total of 515 patients were reviewed; 139 patients were deported or transferred out. Treatment outcomes and follow-up for about 2 years were analysed for the remaining 376 patients. Among 315 patients with sensitive isolates, 301 achieved favourable outcome, none relapsed or failed, 10 defaulted, one died and three were lost to follow-up at 6 months. Mono-resistance to isoniazid, streptomycin or ethambutol did not influence the treatment outcome. All the 18 patients with mono-resistance to rifampicin were cured, but two relapsed later. Among 39 patients with any rifampicin resistance, 37 patients had favourable outcome and two failed treatment; three later relapsed. Among eight patients with MDR-TB, six had favourable outcome and two failed treatment; one later relapsed. Sputum smear conversion rates at the end of 3 months of treatment in patients with any rifampicin resistance or with multidrug resistance were inferior to those of patients with sensitive strains (89.8% vs. 96.3%, P = 0.016 and 80% vs. 96.3%, P = 0.008, respectively).

CONCLUSIONS

Anti-tuberculosis drug resistance existing prior to treatment, especially rifampicin and multidrug resistance, has an adverse effect on treatment outcome, even with directly observed standard SCC under national programme guidelines.

Knowledge and misconceptions about sexually transmitted infections in married women--perspective from Islamabad

OBJECTIVE

To study the knowledge of married women regarding existence of sexually transmitted infection (STI) their complications, treatment seeking, ways of preventing STI acquisition and opinion about sex education in schools/colleges and media.

SETTING

The Mother and Child Health Center, a tertiary care hospital in Islamabad.

METHODS

A cross-sectional survey based on sample of convenience was conducted, using a structured questionnaire with both close and open-ended questions. Trained women physician interviewers conducted the interviews after obtaining verbal consent.

RESULTS

Out of 218 women approached for interviewing, only two refused to participate in the study. The mean age of the respondents was 28.5 years (range 18-53 years). One hundred and sixty-eight (77.8%) respondents had heard/knew about sexually transmitted infections STIs. Two hundred and ten (97.2%) respondents had heard/knew about AIDS and out of these 162 (77.1%) knew that it is also transmitted through sexual contact. One hundred and eight two (84.2%) felt a need for sex education in the media, both print and electronic and 204 (94.4%) respondents said that they would like to learn more about sexually transmitted infections. One hundred ninety four (98.8%) respondents had heard the Latin term Luekorrhoea. Of these 158 (81.5%) thought it was a gynecological disease. Majority thought it caused weakness.

CONCLUSION

Widespread misperceptions were found to exist, which does not augur well for the effective prevention of STIs in the country. Population based studies are required to study the knowledge and epidemiology of STIs, as well as a need for a health education campaign in the country.

Adolescent's knowledge about AIDS--perspective from Islamabad

OBJECTIVE

To study the adolescent student's knowledge and its sources about AIDS, and its mode of spread in Islamabad.

SETTING

One boys and two girls schools in Islamabad.

METHODS

A cross-sectional survey was conducted, using an anonymous, self-administered, brief Urdu questionnaire which was distributed among 100 boys and 182 girls.

RESULTS

The response rate was 100% and the average age of respondents was 14.6 years in boys and 12 years in girls. Most respondents knew about AIDS and reported television as their main source of knowledge. Most respondents also correctly believed that AIDS patient can pass on the disease to others, however, they had erroneous beliefs about its mode of transmission.

CONCLUSION

This study testifies to the effectiveness of the successful television based health education campaign regarding AIDS in the adolescent boys and girls, in Islamabad.

Hazard perception and occupational injuries in the welders and lathe machine operators of Rawalpindi and Islamabad

OBJECTIVE

To study the prevalence of occupational injuries in the welders and lathe machine operators and their hazard perception.

SETTING

This study was conducted in the welders and lathe machine operators working in the welding and metal working shops in Rawalpindi and Islamabad.

METHODS

A cross-sectional survey was conducted by two trained health interviewers using uniform questionnaire with both close and open-ended questions.

RESULTS

Two hundred and eight welders and 104 lathe machine operators were interviewed. Thirty nine (18.7%) welders and 27 (26%) lathe machine operators reported an injury in the past three months, while 63 (30.3%) welders and 76 (73.8%) lathe machine operators reported sustaining an injury in the past twelve months. However, only half of the welders and 31 (29.8%) lathe machine operators believed that their occupation was hazardous for health.

CONCLUSION

For effective public health policy there is a need preventive education and enforcement of safety regulations for the informal occupational sector in Pakistan.

Domestic violence against women--perspective from Pakistan

OBJECTIVE

Domestic violence is an important public health concern. This study assessed the prevalence and type of domestic violence perpetrated by men on their wives.

SETTING

The study was conducted in a public sector hospital among men accompanying patients.

METHODS

A cross-sectional survey based on a sample of convenience was conducted by the author, using a pre-tested questionnaire with mostly close-ended questions.

RESULTS

All the respondents admitted to ever shouting or yelling at their wives, including while she was pregnant. Twenty-three (32.8%) respondents admitted to ever having slapped their wives and 54 (77.1%) admitted to ever engaging in a non-consensual sex with their wives.

CONCLUSION

Population based studies are required to assess the type, frequency, risk factors and sequel of wife abuse, so as to establish practice guidelines.

Sexual harassment in medical profession--perspective from Pakistan

OBJECTIVE

To assess the extent of Sexual harassment of female nurses by male physicians, patients or patient's relatives.

SETTING

A general hospital in Islamabad.

METHOD

A cross sectional written study through a self administered brief questionnaire.

RESULTS

Male physicians were identified as the major perpetrators of sexual harassment, followed by the patients and their relatives.

CONCLUSION

The nurses and hospital administration need to work together for fostering work environment conducive to healthy environment for effective health care delivery.

Effect of mitral regurgitation on diastolic filling with left ventricular hypertrophy

Earlier studies have suggested that mitral regurgitation (MR) augments early left ventricular (LV) diastolic filling. To determine whether MR affects early diastolic filling in patients with abnormal diastolic filling, transmitral pulsed-wave Doppler recordings were used to study 32 normal subjects, 21 patients with LV hypertrophy, 23 with LV hypertrophy and MR and 15 patients with MR. Patients with MR had increased peak early filling velocities (MR 108 +/- 27 cm/s, normal 80 +/- 16 cm/s, p less than 0.01), peak atrial filling velocities (MR 72 +/- 18 cm/s, normal 55 +/- 12 cm/s, p less than 0.05) and increased deceleration rates (MR 5.0 +/- 1.9 m/s2, normal 3.5 +/- 1.2 m/s2, p less than 0.05). Patients with LV hypertrophy had reduced peak early filling velocities (69 +/- 14 cm/s, p less than 0.05) and increased peak atrial filling velocities (83 +/- 16 cm/s, p less than 0.001). There was also an increase in the atrial filling fraction and reduction in the rapid filling fraction as compared with normal patients. Patients with LV hypertrophy and MR had increased peak early filling velocities (98 +/- 26 cm/s, p less than 0.01 vs normal, p less than 0.001 vs LV hypertrophy patients), increased atrial filling velocities (84 +/- 27 cm/s, p less than 0.001 vs normal), increased deceleration rates (4.4 +/- 2.4 m/s2, p less than 0.05 vs normal) and a normal distribution of diastolic filling. Within the LV hypertrophy and MR group, diastolic filling parameters were similar when patients were subgrouped on the basis of auscultability of MR. MR augments early diastolic filling and may tend to normalize diastolic filling patterns in LV hypertrophy patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Crystal Structure of Ethyltriphenylphosphonium Bis(α,α,α',α'-tetracyanoquinodimethanide)

The crystal structure of the title compound, [EtPh3P]+ [(C12H4N4)2]-, has been established by single-crystal X-ray diffraction methods at 295(1) K and refined by least squares to a residual of 0�039 for 3047 'observed' reflections. Crystals are triclinic, Pī, a 8 �882(7), b 13�522(5), c 15�927(6) �, α 75�34(3), β 96�69(5), γ 100.56(3)�, Z 2. The structure closely resembles that of the methyl-triphenyl-phosphonium and -arsonium analogues, containing tetrads of α,α,α',α'- tetracyanoquino- dimethane* molecules, the molecular planes lying parallel to each other and approximately normal to b.

Disseminating cysticercosis in England

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