Predominant Abnormality Research Articles

Post-COVID-19 tomographic abnormalities.

BACKGROUND: The prevalence of persistent respiratory symptoms tends to be low in patients with a longer recovery time after COVID-19. However, some patients may present persistent pulmonary abnormalities.OBJECTIVE: To evaluate the prevalence of tomographic abnormalities 90 days after symptom onset in patients with COVID-19 and compare two chest high-resolution computed tomography (HRCT) analysis techniques.METHODS: A multicentre study of patients hospitalised with COVID-19 having oxygen saturation <93% on room air at hospital admission were evaluated using pulmonary function and HRCT scans 90 days after symptom onset. The images were evaluated by two thoracic radiologists, and were assessed using software that automatically quantified the extent of pulmonary abnormalities.RESULTS: Of the 91 patients included, 81% had at least one pulmonary lobe with abnormalities 90 days after discharge (84% were identified using the automated algorithm). Ground-glass opacities (76%) and parenchymal bands (65%) were the predominant abnormalities. Both chest HRCT technical assessments presented high sensitivity (95.9%) and positive predictive value (92%), with a statistically significant correlation at baseline (R = 0.80) and after 90 days (R = 0.36).CONCLUSION: The prevalence of pulmonary abnormalities on chest HRCT 90 days after symptom onset due to COVID-19 was high; both technical assessments can be used to analyse the images.

Evaluation of Morphological, Clinical, and Prognostic Significance of Nucleophosmin Gene Mutation in de novo Acute Myeloid Leukemia

Introduction: Nucleophosmin 1 (NPM1) is a molecular chaperone protein. Mutation of NPM1 gene is identified to be one of the most predominant molecular abnormalities in acute myeloid leukemia (AML). Among the genetic mutations, NPM1 along with FMS-like tyrosine kinase 3 (FLT3) mutations lead to poor prognosis and unfavorable outcomes in patients with AML. Methods: This was a retrospective study conducted for 2 years at a leading cancer care center in India. A total of 10 patients were identified to be NPM1 positive in 50 identified AML patients. Results: In 10 NPM1-positive patients, eight patients were female. All were adults with a median age of 39.3 years. The majority of the patients were presented with Auer rod (7/10) and intranuclear cup-like inclusions (7/10) with increased number of blasts in peripheral blood smear (77.88%). Lymphadenopathy was absent in all patients. Morphological analysis has shown blast cells with a cup shape and prominent nucleoli with indentation. Whereas, immunophenotyping analysis has shown lower positivity of cluster of differentiation 34 (12%) and lack of human leukocyte antigen-DR expression (34%). Conclusion: The presence of NPM1 mutations alone without FLT3 mutations in patients with AML was observed to have a better prognosis of the disease. Early identification of such mutations by morphological and immunophenotyping analysis can play a vital role in treatment initiation at the earliest for better prognosis and clinical outcomes without much delay.

Biomarker discovery and development for frontotemporal dementia and amyotrophic lateral sclerosis.

Frontotemporal dementia refers to a group of neurodegenerative disorders characterized by behaviour and language alterations and focal brain atrophy. Amyotrophic lateral sclerosis is a rapidly progressing neurodegenerative disease characterized by loss of motor neurons resulting in muscle wasting and paralysis. Frontotemporal dementia and amyotrophic lateral sclerosis are considered to exist on a disease spectrum given substantial overlap of genetic and molecular signatures. The predominant genetic abnormality in both frontotemporal dementia and amyotrophic lateral sclerosis is an expanded hexanucleotide repeat sequence in the C9orf72 gene. In terms of brain pathology, abnormal aggregates of TAR-DNA-binding protein-43 are predominantly present in frontotemporal dementia and amyotrophic lateral sclerosis patients. Currently, sensitive and specific diagnostic and disease surveillance biomarkers are lacking for both diseases. This has impeded the capacity to monitor disease progression during life and the development of targeted drug therapies for the two diseases. The purpose of this review is to examine the status of current biofluid biomarker discovery and development in frontotemporal dementia and amyotrophic lateral sclerosis. The major pathogenic proteins implicated in different frontotemporal dementia and amyotrophic lateral sclerosis molecular subtypes and proteins associated with neurodegeneration and the immune system will be discussed. Furthermore, the use of mass spectrometry-based proteomics as an emerging tool to identify new biomarkers in frontotemporal dementia and amyotrophic lateral sclerosis will be summarized.

Effect of Aloe vera (Barbadensis Mill) on Letrozole Induced Polycystic Ovarian Syndrome in Swiss Albino Mice.

ABSTRACTBackground:Polycystic ovarian syndrome (PCOS) is the predominant endocrine abnormality in premenopausal women characterised by hyperandrogenism, ovulatory dysfunction, metabolic disturbances such as, insulin resistance and obesity.Aim:The key objective of this study was to evaluate the efficacy of Aloe vera as a treatment drug to identify the factors among female Swiss albino mice (PCOS) models displaying ovarian and metabolic abnormalities and serum sex steroids that are associated with insulin sensitivity.Study Setting and Design:The laboratory breed 4 months adult virgin female Swiss albino mice showing regular estrous cycle and weighing about 20–30 g were employed in present study under CPCSEA guidelines with ethical clearance from the institutional ethical committee. These mice were categorized into two groups with 10 mice in each as control and test animals.Materials and Methods:The mice which were categorised into two groups with 10 mice in each. Carboxy methyl cellulose control and letrozole were induced for 21 days followed by 30 days treatment with distilled water for control, Diane as standard drug and Aloe vera gel formulation. Body weight, estrous cycle, biochemical estimations, hormone assay and histopathology were the parameters studied.Statistical Analysis:IBM SPSS version 20.0 was used for the mean and standard error calculations of biochemical and antioxidants estimation.Results:During the induction period, we observed a significant increase in the body weight, decrease in the number of estrous cycle, and the concomitant increase in diestrous. The biochemical estimations showed changes in the regular activity; hormonal imbalance was observed in hormone assay and cyst formation was also observed in the histopathological study. After the treatment of Aloe vera and Diane, all the parameters showed considerable good results.Conclusion:The findings of the current study provide a baseline data for designing further investigations on the therapeutic benefits of Aloe vera as an adjunct therapy in the management of PCOS.

Prevalence, Pattern and Predictors for Dyslipidemia of Chinese Women With Polycystic Ovary Syndrome.

Objective: To investigate the prevalence, pattern and risk predictors for dyslipidemia among Chinese women with polycystic ovary syndrome (PCOS).Study Design and Methods: A total of 1,000 women diagnosed as PCOS by modified Rotterdam criteria were enrolled in 27 hospitals across China in a randomized controlled trial. Anthropometric, metabolic parameters, sex hormone, and lipid levels were measured at the baseline visit. Dyslipidemia was defined according to total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) level. Independent t-test and logistic regression were used to identify predictors for dyslipidemia. Area under the receiver operating characteristic curve (AUC) was calculated.Results: A total of 41.3% of the women had dyslipidemia, and the prevalence of abnormal TC, LDL-C, HDL-C, and TG were 8.6, 9.1, 26.9, and 17.5%, respectively. Logistic regression found that age, waist circumference, insulin, follicle-stimulating hormone, and sex hormone-binding globulin were independent predictors for dyslipidemia. When combining these predictors, the AUC was 0.744. The cut-off points were age >28.5 years, waist circumference >86.5 cm, insulin >96.0 pmol/L, follicle-stimulating hormone <5.6 mIU/mL, and sex hormone-binding hormone <31.0 nmol/L, respectively.Conclusion: Dyslipidemia was common in Chinese women with PCOS, and low HDL-C level was the predominant lipid abnormality. Age, waist circumference, follicle-stimulating hormone, insulin and sex hormone-binding globulin were predictive for dyslipidemia among Chinese women with PCOS.

Microstructural profiles of thalamus and thalamocortical connectivity in patients with disorder of consciousness.

Thalamus and thalamocortical connectivity are crucial for consciousness; however, their microstructural changes in patients with a disorder of consciousness (DOC) have not yet been thoroughly characterized. In the present study, we applied the novel fixel-based analysis to comprehensively investigate the thalamus-related microstructural abnormalities in 10 patients with DOC using 7-T diffusion-weighted imaging data. We found that compared to healthy controls, patients with DOC showed reduced fiber density (FD) and fiber density and cross-section (FDC) in the mediodorsal, anterior, and ventral anterior thalamic nuclei, while fiber-bundle cross-section (FC) was not significantly altered in the thalamus. Impaired thalamocortical connectivity in the DOC cohort was mainly connected to the middle frontal gyrus, anterior cingulate gyrus, fusiform gyrus, and sensorimotor cortices, including the precentral gyrus and postcentral gyrus, with predominant microstructural abnormalities in FD and FDC. Correlation analysis showed that FC of the right mediodorsal thalamus was negatively correlated with the level of consciousness. Our results suggest that microstructural abnormalities of thalamus and thalamocortical connectivity in DOC were mainly attributed to axonal injury. In particular, the microstructural integrity of the thalamus is a vital factor in consciousness generation.

KMT2A Rearrangements Are Associated with Lineage Switch Following CD19 Targeting CAR T-Cell Therapy

KMT2A Rearrangements Are Associated with Lineage Switch Following CD19 Targeting CAR T-Cell Therapy

Subtypes of gestational diabetes and future risk of pre-diabetes or diabetes.

BackgroundRecent studies have suggested that gestational diabetes (GDM) is a heterogeneous condition with distinct subtypes determined by whether the predominant metabolic abnormality is impaired insulin sensitivity or deficient insulin secretion. However, it is not known if the elevated future risk of pre-diabetes/diabetes associated with GDM varies according to these subtypes. Thus, we sought to evaluate maternal metabolic function in the 1st year postpartum in relation to GDM subtypes.MethodsIn this prospective cohort study conducted in Toronto, Canada, 613 women underwent GDM screening by oral glucose tolerance test (OGTT) in pregnancy, followed by repeat OGTT at both 3-months and 12-months postpartum between 09/2003 and 03/2016. The antepartum OGTT identified 3 groups of women: GDM with predominant sensitivity defect (GDM-sensitivity), GDM with predominant secretion defect (GDM-secretion), and non-GDM.FindingsAntepartum findings persisted after pregnancy, with lower insulin sensitivity in GDM-sensitivity (Matsuda index; HOMA-IR) and lower insulin secretion in GDM-secretion (Stumvoll first-phase; insulinogenic index (IGI)) at both 3-months and 12-months (all p<0.005). Beta-cell compensation (Insulin Secretion-Sensitivity Index-2; IGI/HOMA-IR) was lower in both GDM subtypes compared to non-GDM (all p<0.0005) but did not differ between GDM-sensitivity and GDM-secretion. Similarly, both subtypes exhibited higher post-challenge glycemia on OGTT at 3-months and 12-months than non-GDM (all p<0.0005) but did not differ from one another. The prevalence of pre-diabetes/diabetes was higher in both GDM-sensitivity (30.9%; 95%CI: 21.7–41.2) and GDM-secretion (27.6%; 16.7–40.9) than in non-GDM (10.4%; 7.7–13.6) at 12-months (both p<0.005), with no difference between GDM subtypes (p = 0.75).InterpretationBeta-cell dysfunction, glycemia and incident pre-diabetes/diabetes do not vary between GDM subtypes in the 1st year postpartum.FundingCanadian Institutes of Health Research; Diabetes Canada

Clinical and genetic spectrum of 104 Indian families with central nervous system white matter abnormalities.

Genetic disorders with predominant central nervous system white matter abnormalities (CNS WMAs), also called leukodystrophies, are heterogeneous entities. We ascertained 117 individuals with CNS WMAs from 104 unrelated families. Targeted genetic testing was carried out in 16 families and 13 of them received a diagnosis. Chromosomal microarray (CMA) was performed for three families and one received a diagnosis. Mendeliome sequencing was used for testing 11 families and all received a diagnosis. Whole exome sequencing (WES) was performed in 80 families and was diagnostic in 52 (65%). Singleton WES was diagnostic for 50/75 (66.67%) families. Overall, genetic diagnoses were obtained in 77 families (74.03%). Twenty-two of 47 distinct disorders observed in this cohort have not been reported in Indian individuals previously. Notably, disorders of nuclear mitochondrial pathology were most frequent (9 disorders in 20 families). Thirty-seven of 75 (49.33%) disease-causing variants are novel. To sum up, the present cohort describes the phenotypic and genotypic spectrum of genetic disorders with CNS WMAs in our population. It demonstrates WES, especially singleton WES, as an efficient tool in the diagnosis of these heterogeneous entities. It also highlights possible founder events and recurrent disease-causing variants in our population and their implications on the testing strategy.

Role of Chest CT in COVID-19.

In December 2019, a disease attributed to a new severe acute respiratory syndrome coronavirus 2, and named coronavirus disease 2019 (COVID-19), broke out in Wuhan, China and has spread rapidly throughout the world. CT has been advocated in selected indications as a tool toward rapid and early diagnosis. The CT patterns of COVID-19 include ground glass opacities GGO, consolidation, and crazy paving. Additional signs include a “rounded morphology” of lesions, vascular enlargement sign, nodules, and fibrous stripe. Signs of healing and organization include subpleural bands, a reticular pattern, reversed halo sign and traction bronchiectasis. Cavitation and tree in bud signs are absent and pleural effusions are rare. There is a high incidence of pulmonary embolism associated with COVID-19. CT findings in COVID-19 appear to follow a predictable timeline with maximal involvement approximately 6–11 days after symptom onset. The stages of evolution include early stage (days 0–4) with GGO being the predominant abnormality, progressive stage (days 5–8) with increasing crazy paving; and peak stage (days 9–13) with predominance of consolidation and absorption phase (after day 14) with gradual absorption of consolidation with residual GGO and subpleural bands. CT findings in COVID-19 have a high sensitivity and low specificity, determined to be 98% and 25% in a retrospective study of 1014 patients. The low specificity of CT for the diagnosis of COVID-19 pneumonia is due to the overlap of CT findings with other viral pneumonias and other infections, lung involvement in connective tissue disorders, drug reaction, pulmonary edema, and hemorrhage.

Left ventricular diastolic dysfunction in primary hypertension and ischemic heart disease-evaluation by doppler echocardiography

Background: Congestive heart failure caused by a predominant abnormality in diastolic function is both common and causes significant morbidity and mortality. The objective of the study was to evaluate application of doppler echocardiography in determining left ventricular diastolic dysfunction in ischemic heart disease and essential hypertension.Methods: Present study is based on analysis of 75 patients of hypertension and 60 patients of IHD (UA, AMI, IMI) admitted to Bapuji and Chigateri general hospital during December 2019 to November 2020. Detailed history and physical examination were done. Every patient was subjected to ECG, CXR, routine investigations and Doppler Echo cardiography.Results: A total of 75 patients of primary hypertension were studied. 37 patients showed diastolic dysfunction with E/A ratio &lt;1, with increased atrial filling fraction. Out of 37 patients, 24 showed LVH and 13 cases did not have LVH. A total of 60 patients of ischemic heart disease were studied. 23 patients showed diastolic dysfunction with E/A ratio &lt;1, with increased atrial filling fraction and prolonged isovolumetric relaxation time.Conclusions: Our findings suggest that myocardial damage in patients with HTN and IHD affects diastolic dysfunction before systolic dysfunction. Doppler echocardiography is a valuable non-invasive method to detect left ventricular diastolic impairment and the intentional assessment of diastolic function is advisable for early detection of LV dysfunction before clinical symptoms appear.

Clinico-Hematological and cytogenetic spectrum of adult myelodysplastic syndrome: The first retrospective cross-sectional study in Iranian patients

BackgroundMyelodysplastic syndrome (MDS), a heterogeneous group of hematopoietic malignancy, has been shown to present different cytogenetic abnormalities, risk factors, and clinico-hematological features in different populations and geographic areas. Herein, we determined the cytogenetic spectrum and clinico-hematological features of Iranian MDS patients for the first time.MethodsThis prospective cross-sectional study was conducted on 103 patients with MDS in Ahvaz, southwest of Iran, from 2014 to 2018. Clinical presentations, complete blood counts (CBC), and bone marrow (BM) biopsy samples were assessed. Perls' staining was used to evaluate BM iron storage. The cytogenetic evaluation was performed using the conventional G banding method on the BM.ResultsPatients’ median age was 62.3 (ranged from 50–76), and the majority were male (72.8%). The most common clinical symptom at the time of admission was fatigue (n = 33) followed by pallor (n = 27). The most common subgroup was MDS-Multi Lineage Dysplasia (MDS-MLD) (n = 38, 36.8%), followed by MDS-Single Lineage Dysplasia (MDS-SLD) (n = 28, 18.4%). A normal karyotype was observed in 59 patients (57.3%), while 44 patients (42.7%) had cytogenetic abnormalities. Trisomy 8 (+ 8) was the most common cytogenetic abnormality (n = 14) followed by del 17p (n = 9) and monosomy 7 (− 7) (n = 7). Twelve patients (11.65%) were transformed to AML.ConclusionOur data betokened that among our MDS patients, Trisomy 8 is the predominant cytogenetic abnormality, and MDS-MLD and MDS-SLD are the most common of subtypes. Noteworthy, the male: female ratio was slightly higher in Iran than in previous reports from other parts of the world. Our study is the first report of the clinical, hematological, and cytogenetic spectrum of MDS patients in Iran

Role of cation-exchange high-performance liquid chromatography in detection of hemoglobinopathies- a study of 500 cases in a tertiary care hospital

Background: Abnormalities of hemoglobin synthesis are among the most common inherited disorders. Cation exchange high-performance liquid chromatography offers a reliable tool for early, accurate detection thereby aiding in the prevention and management of thalassemia major and various hemoglobinopathies. &#x0D; Materials and methods: This was a retrospective study carried out in the Department of Pathology, GCSMC Hospital and Research center, Ahmedabad over six years from August 2013 to August 2019. 500 cases were studied for the identification of various hemoglobin disorders in patients referred for screening and detection of hemoglobinopathies.Results: Abnormal hemoglobin fractions were seen in 104/500 (20.8%) cases. The β thalassemia trait was the predominant abnormality with a total of 69 cases (66.3%). β thalassemia major, β thalassemia intermedia, Hb D Punjab- β thalassemia, Acquired Hb F and Hereditary persistence of fetal hemoglobin/δβ thalassemia trait was found in 1 case (0.96%) each. Sickle cell heterozygous was found in 9 cases (8.6%), Sickle cell homozygous in 5 cases (4.8%), and Sickle-ß thalassemia in 6 cases (5.8%). Other variants detected included Hb Q India heterozygous and Hb D Punjab heterozygous in 3 cases (2.9%) each and 2 cases (1.9%) of Hb E heterozygous and Hb J each. &#x0D; Conclusions: Cation exchange high-performance liquid chromatography is an ideal and widely used methodology for routine clinical laboratory because of the simplicity of the automated system. The majority of the abnormal cases are diagnosed with it except a few inconclusive cases for which molecular and genetic studies are required.

Dual-energy CT evidence of pulmonary microvascular occlusion in patients with sickle cell disease experiencing acute chest syndrome

PurposeAcute chest syndrome (ACS), defined by the presence of a chest radiographic opacity in sickle cell disease patients experiencing respiratory symptoms is a leading cause of death in these patients. The etiology is ACS is not well understood however pulmonary microvascular occlusion has been postulated to be a major pathophysiologic driver. Our study aims to assess the value of dual-energy CT (DECT) as a marker of pulmonary microvascular occlusion. Materials/methodsA search tool was used to identify CT angiography studies from 1/1/2017 to 9/15/2019 with any variation of the phrases “Acute chest syndrome” and “Sickle cell”. These studies were manually reviewed for the use of DECT technique. An age-matched control group was created. DECT pulmonary blood volume (PBV) maps were reviewed semi-quantitatively for the presence of iodine defects and the number of involved bronchopulmonary segments were scored. Other recorded values included type of parenchymal opacities, diameter of main pulmonary artery (MPA) and presence of right ventricular dilatation. Mean values between cases and controls were compared using a two-sample t-test. ResultsNine sickle cell DECT cases with PBV maps and nine age-matched controls were evaluated. Bronchopulmonary segments with iodine defects were significantly higher in cases vs controls (mean: 4.7 vs 0.3, p < 0.003). PBV defects were more extensive than parenchymal findings. MPA diameter was higher in cases (2.9 cm) vs control (2.4 cm), P < 0.03. ConclusionsDECT demonstrates abnormal PBV in sickle cell patients, often the predominant abnormality identified early, and likely reflects the presence of pulmonary microvascular occlusion.

Prevalence, multimodality imaging characterization, and mid-term prognosis of quadricuspid aortic valves: an analysis of eight cases, based on 160 004 exams performed during 12 years in a tertiary care hospital.

Quadricuspid aortic valve (QAV) is a rare abnormality, which may cause aortic regurgitation (AR) requiring surgical intervention in some patients. The characteristics associated with aortic valve functional degeneration in patients with QAV are still unknown. The aim of this study is to describe QAV prevalence, characterize the disease by multimodality imaging, evaluate predictors of severe AR, and assess mid-term prognosis. Retrospective search in imaging exams database of one tertiary centre, for patients diagnosed with QAV between January 2007 and September 2019. QAV was characterized by cardiac computed tomography, transthoracic/transoesophageal echocardiography, and cardiac magnetic resonance. A total of 160 004 exams were reviewed and eight patients with QAV were identified (50% men, mean age 53.5 ± 10.7 years). The prevalence of QAV was 0.005%. During a median follow-up of 52 months (interquartile range 16-88), there were no deaths. Seven patients (88%) had pure AR (three severe, one moderate, and three mild) and one patient (12%) had moderate AR and moderate aortic stenosis. Three patients (38%) with severe AR underwent valve surgery (two replacements and one repair). Analysis of predictors of severe AR was not statistically significant. QAV is a rare congenital cardiac defect, with a prevalence of 0.005% in our study. Its predominant functional abnormality was regurgitation and about one-third of the patients required aortic valve surgery. Multimodality imaging may play a pivotal role in assessing patients with QAV with significant valve dysfunction or associated congenital heart disease and improve their treatment strategy.

Pattern of Electrolyte Abnormalities in Preterm Low Birth Weight Neonates

Prematurity and low birth weight contributes to 27.8% of neonatal deaths in rural areas of Bangladesh. Fluid, electrolyte and metabolic abnormalities are the commonest derangements encountered in preterm infants due to their renal immaturity and relatively immature skin. Premature infant are at increased risk of developing dehydration or overhydration4. Therefore, high index of suspicion, prompt recognition and thorough understanding of common electrolyte abnormalities are necessary to improve neonatal outcome. Appropriate fluid and electrolyte management is essential for better neonatal outcome.&#x0D; Objectives: To identify the serum electrolytes abnormalities in preterm low birth weight neonates.&#x0D; Methodology: It was a cross- sectional study and carried out in the Department of Neonatology, Dhaka Medical College Hospital, Dhaka between January 2017 to August 2017. Information was collected who gave consent and participated in the study willingly. The sample size was 50. Patients admitted in the above mentioned hospital and after meeting the inclusion and exclusion criteria a simple random sampling technique was applied for selecting the study subjects.&#x0D; Results: Fifty preterm LBW neonates fulfilling the inclusion criteria were studied during this study period. Abnormal electrolytes were documented in 20(40%) out of 50 preterm LBW neonates and electrolyte status was normal in 30(60.0%) cases. Of 20 neonates who had abnormal electrolytes, hyperkalemia was the predominant electrolyte abnormality found in 8(16.0%) neonates, hyponatremia was found in 7(14.0%), hypokalemia in 3(6.0%) and hypernatremia 2(4.0%).&#x0D; Conclusion: Electrolyte abnormalities are common in preterm LBW neonates. So, identification of electrolyte abnormalities and proper management of fluid and electrolytes and close monitoring are important.&#x0D; J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 145-148

Radiographic features of COVID-19 infection at presentation and significance of chest X-ray: Early experience from a super-specialty hospital in India

Background:Due to the relative early lockdown in India, relative greater availability of reverse transcription polymerase chain reaction (RT-PCR) testing, and mandate to admit all positive corona virus disease 2019 (COVID-19) patients, the protocol in our hospital is to perform a baseline chest X-ray (CXR) at the time of admission and for follow up. There are currently limited publications demonstrating the radiographic findings and the role of CXR of COVID-19 patients at presentation.Aims:Evaluatethe radiographic findings on CXR in COVID-19 patients at presentation. Recommend a guideline for its judicious use.Settings and Design:Retroprospective study performed on RT-PCR confirmed COVID-19 patients admitted in our hospital between March 31,2020 to May 25, 2020. The study included symptomatic and asymptomatic patients. CXR was performed for218 patients.Materials and Methods:Portable bedside CXR was performed. The CXRs were evaluated by three radiologists to record the findings and grade the disease. All variables were expressed as mean, ranges, counts, and percentages.Results:157 patients (72%) were symptomatic and 61 (28%) were asymptomatic. 104 CXRs (48%) were abnormal (97 in symptomatic (62%) and fourin asymptomatic (6%)). 74 patients (47%) in the symptomatic group had known comorbidities and of these, 62 (84%) had abnormal CXR. 97 CXRs (93%) had bilateral findings and 87 CXRs (84%) had peripherally predominant abnormalities. The lower zone was the most common area of involvement (73%). Ground glass opacity (GGO) was the most common finding (94%–98 CXRs). Mild disease was seen in 56 (54%).Conclusion:CXR can be used to assess symptomatic COVID-19 patients at presentation and to grade the severity of disease. It may be avoided in asymptomatic patients.

Pattern of electrolytes in a cohort of critically ill COVID-19 patients

Background: Coronavirus disease 2019 (COVID-19) is a potentially fatal disease with multisystem involvement. Several studies have reported various electrolyte abnormalities at admission in patients who progress to the severe form of COVID-19. This study evaluated the electrolyte pattern in confirmed and critically ill COVID-19 patients.&#x0D; Methods: This cross sectional study was carried out in the department of critical care medicine of BIRDEM General Hospital, Dhaka, Bangladesh, from 1st July to 10th November, 2020. Total 70 RT-PCR positive, critically ill COVID-19 patients, were enrolled. Patients’ demographic profile, clinical features, admission electrolyte report, length of ICU stay and outcome were documented in case record forms.&#x0D; Results: In this cohort, total 70 RT-PCR positive COVID-19 cases (male 41, female 29, mean age 62.9 ± 13.3years) were enrolled. Fifty eight (82.85%) patients had different electrolytes abnormalities including hyponatraemia (54, 77.1%), hypokalaemia (35, 50%), hypocalcaemia (20, 28.6%) and hypomagnesaemia (11,15.7%). Regarding clinical symptoms, 98.6% (n=69) had respiratory distress, 97.1% (n=68) had cough, 94.3% (n= 66) had history of fever and 10.0 % (n=7) presented with unconsciousness. Diabetes mellitus (DM) was the most common co morbidity (94.3%).Mean length of ICU stay were 6.4 ± 3.4 days, where 48.57% (n=34) survived and 51.42% (n=36) died. Among 36 death cases, 33 patient (91.7%) had hyponatraemia (p value=0.003), which was statistically significant.&#x0D; Conclusion: In this study, we found that, hyponatraemia was the most predominant electrolyte abnormality. Among 36 death cases, around 92% had hyponatraemia. Like other studies, it showed that various electrolyte imbalances seem to have an impact on disease process. So, base line electrolyte assessment would be beneficial for evaluating the risk of severity of COVID-19. So, more study of electrolytes in COVID-19 cases with multi center approach is needed.&#x0D; Birdem Med J 2020; 10, COVID Supplement: 46-50

Chest radiography patterns of COVID-19 pneumonia in Kumasi, Ghana.

To document the pattern of chest radiographic findings in coronavirus disease 2019 (COVID-19) patients with moderate to severe disease. Retrospective cross-sectional study. The study site was Komfo Anokye Teaching Hospital (KATH) located at Bantama in Kumasi, the capital town of the Ashanti Region. It is the second largest hospital in the country and the major referral site for Ashanti region and the northern part of the country. The hospital hosts a highly infectious isolation unit (HIIU) for COVID-19 patients with moderate to severe infections and receives referred cases from the region and within the hospital. The study involved 27 patients admitted to the HIIU at KATH with COVID-19 infection who underwent chest X-ray as part of their investigations. The study enrolled 12 males and 15 females. The common comorbidities were hypertension and diabetes. Chest x-ray findings in most of the patients (81.5%) revealed ground-glass opacities while a few of them (18.5%) had lung consolidations without ground-glass opacities. For those with ground-glass opacities, eight (29.6%) had superimposed consolidation. All the participants had positive chest x-ray findings. The chest x-ray findings in the 27 COVID-19 positive patients with moderate to severe disease on admission at the KATH HIIU enrolled in this study showed significant pulmonary abnormalities. The predominant pulmonary abnormalities were bilateral peripheral ground-glass opacities with the lower lung zones being mostly affected. Funding from the Radiology Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana.

Dysregulated adipokine secretory profile is associated with endothelial dysfunction in human obesity

Abstract Adipokines have been postulated as the potential mediators of the relationship between excess adiposity and vascular dysfunction. In obese patients, vascular dysfunction, characterized by impaired vasodilator responsiveness and/or increased endothelin (ET)-1-dependent vasoconstriction, is, in turn, a predominant abnormality in the atherogenic process. We hypothesized, therefore, that in human obesity vascular dysfunction could be associated with changes in circulating concentrations of adipokines. To test this hypothesis, we compared plasma levels of a panel of adipokines (Luminex assay) in lean subjects (n=42) and obese patients (n=134), and tested their relationship with the forearm flow response (strain-gauge plethysmography) to intra-arterial infusion of endothelium-dependent (acetylcholine; ACh) and -independent (sodium nitroprusside; SNP) vasodilators or ETA receptor antagonism (BQ-123, 10 nmol/min). Compared to lean subjects (n=42), obese patients (n=134) had higher plasma levels of chemerin (4.0±0.1 vs. 2.9±0.2 ng/ml; P&amp;lt;0.001), adipsin (2.1±0.1 vs. 2.7±0.1 μg/ml; P&amp;lt;0.001), leptin (8.1±0.4 vs. 24.4±1.8 ng/ml; P&amp;lt;0.001), and visfatin (7.4±0.8 vs. 8.3±0.3 ng/ml; P=0.015); by contrast, no group difference was observed in circulating levels of adiponectin (3.3±0.3 vs. 3.3±0.1 μg/ml; P=0.78) and retinol-binding protein 4 (57.5±2.5 vs. 64.0±4.1 μg/ml; P=0.13). The forearm flow responses to both ACh and SNP were significantly lower in obese patients (12.6±0.6 ml/min/dl and 11.7±0.3 ml/min/dl, respectively) than in lean controls (18.8±1.4 ml/min/dl and 15.1±0.7 ml/min/dl, respectively; all P&amp;lt;0.001). The vasodilator response to BQ-123, by contrast, was higher in obese (53.7±4.5% increase from baseline) than in lean subjects (18.5±7.3%; P&amp;lt;0.001). Similarly, plasma insulin levels were higher in obese (14.9±0.8 μU/ml) than in lean subjects (6.8±0.7 μU/ml; P&amp;lt;0.001). At the linear regression analyses, a significant inverse correlation was found between circulating levels of visfatin and the vasodilator response to ACh (R=0.22; P=0.03); no linear association, however, was observed between the response to ACh and the other measured adipokines (all P&amp;gt;0.05); similarly, no correlation was seen between plasma adipokines and the vasodilator response to SNP (all P&amp;gt;0.05). On the other hand, a significant linear relationship was observed between the vasodilation elicited by B-123 and plasma levels of chemerin (R=0.30, P=0.012) and adipsin (R=0.38, P&amp;lt;0.001), but not those of the other adipokines (all P&amp;gt;0.05). In conclusion, circulating concentrations of selected adipokines, such as visfatin, chemerin and adipsin, are variably associated with obesity-related decrease in endothelium-dependent vasodilation and increase in ET-1-dependent vasoconstriction. These findings are consistent with the notion that adipokines may influence vascular dysfunction and make these molecules promising targets for prevention. Funding Acknowledgement Type of funding source: None