Software Ltd Research Articles

Icteria interference for 34 clinical chemistry analytes on different analytical platforms: Method or analyzer dependent?

ObjectivesIn this study, we aimed to investigate the effect of increasing bilirubin concentration on 34 commonly measured clinical chemistry analytes on four different analytical platforms. We hypothesized that differences in icteria interference are not only method dependent, but also analyzer dependent. MethodsSerum pool was prepared using leftover samples after routine laboratory blood testing. Serum pool was then spiked with dissolved bilirubin stock. Measurements were performed on all four locations at the same time. All measurements were done in duplicate. Mean value was calculated as: (value1 + value2)/2. Those values were multiplied by corresponding dilution factors obtained during the preparation of icteric samples. For each icteric sample (Ix), bias against native (I0) sample was calculated as ((value Ix– valueI0)/ valueI0) × 100 %. Bias was calculated with actual average values. Obtained bias values were compared against acceptance criteria according to External quality assurance (EQA) providers. Difference in bilirubin concentration across platforms was tested using Friedman ANOVA. P values < 0.05 were considered statistically significant. Data are collected and analyzed in MS Excel 2016 (Microsoft, Redmond, Washington) and MedCalc® Statistical Software version 20.015 (MedCalc Software Ltd, Ostend, Belgium). ResultsMany of the tested parameters demonstrated low sensitivity to icterus interference. The highest sensitivity to icterus was observed for triglycerides, cholesterol, and urate. ConclusionsOur results indicate that while some common icteric interferences were consistent across all tested platforms, others were specific to the analyzer used, even when employing the same analytical methods.

Nutritional assessment of the diets of prisoners in Young Offender Institutions

Adequate nutrition is necessary for overall health and development(1). Prisoners in general lack autonomy over their diet, in addition to being a population with a high risk of poor health outcomes(2, 3). It is important therefore that prisons are offered menus which meet dietary reference values (DRVs), as set by the UK government, aiming for equity with the general population, and that prisoners choose food options that are beneficial for their health. The aim of this study was to conduct a nutritional analysis of prisoners’ food diaries to determine whether dietary recommendations were being met.Seven-day food diaries were collected from prisoners eating the normal food supplied by three young offender institutions in 2009. Food eaten was analysed using DietPlan6 version 6.0 (Forestfield Software Ltd). Individual nutrient data were tested for normality and compared against the UK DRVs and NDNS data from 2008/9 using either the one-sample T-test, or one-sample Wilcoxon Signed Rank Test. Data in the results is presented as (Mean ± SD).There were n=466 diaries analysed, from male participants aged between 16 to 24 years. Twenty- eight nutrients were compared with their respective DRVs by age categories: 16-18y (n=156), 19-24y (n=310), and 16-24y (n=466).For ages 16-24y, chloride (5556 ± 1692mg), folate (302 ± 112ug), iodine (195 ± 81ug), monounsaturated fat (35 ± 10g), potassium (3667 ± 1161mg), sodium (3899 ± 1392mg), sugar (136 ± 73g), riboflavin (2 ± 1mg), vitamin B12 (6 ± 4ug), vitamin C (92 ± 63mg), and zinc (11 ± 3mg) exceeded DRV requirements (P&lt;0.01). Carbohydrates (53 ± 5%E), saturated fat (12 ± 5%E), and sugar (19 ± 9%E) all exceeded their DRVs (P&lt;0.05). Vitamin A (553 ± 531ug) and fibre (15 ± 6g) were found 24% and 18% lower than the DRVs, respectively (P&lt;0.01). Fat (34 ± 5%E), polyunsaturated fat (6 ± 1%E), and protein (14 ± 2%E), as a percent of energy, were below the DRV by 3%, 8%, and 7% respectively (P&lt;0.01). Magnesium (301 ± 107mg) was equal to the DRV (P=0.81).For 16-18, and 19-24 respectively, calcium (1286 ± 928mg; 1337 ± 489mg), copper (1 ± 0.6mg; 2 ± 0.6mg), iron (14 ± 5mg; 15 ± 6mg), niacin (19 ± 7mg; 21 ± 7mg), phosphorus (1545 ± 381mg; 1620 ± 493mg), protein (96 ± 24g; 100 ± 29g), thiamine (2 ± 0.6mg; 2 ± 0.7mg), and vitamin B6 (2.3 ± 0.7ug; 3 ± 0.9ug) exceeded their DRV (P&lt;0.01). For 16-18y, energy (kcals) was equal to the DRV (2748 ± 787kcal, P=0.91). For years 19-24y, energy (kcal) exceeded the DRV (2931 ± 939kcal, P&lt;0.01).This study represents the largest assessment of dietary intake of prisoners and demonstrates that the prison catering, for the most part, met the DRVs. However, sugar, fat, and energy intake exceeded their DRV target, posing clear risks to health by possibly contributing to later obesity, hypertension, Type 2 diabetes and heart disease.

INFLUENCE OF LGALS-3 GENE POLYMORPHISM (rs2274273) ON THE PLASMA LEVELS OF GALECTIN-3 IN WOMEN WITH ESSENTIAL HYPERTENSION AND CHRONIC HEART FAILURE IN RESIDENTS OF THE PODILLYA REGION OF UKRAINE

Background. Individual genetic features can influence to formation of structural and functional changes in organs during EH and encourage the search for biological markers of the state of the myocardium and conclusions about their diagnostic effectiveness.&#x0D; Aim: to improve the early diagnosis of changes in the structure and function of the myocardium and the formation of prerequisites for chronic heart failure (CHF) in women with EH carriers of various polymorphic variants of the LGALS-3 gene (rs2274273), based on galectin-3 plasma level.&#x0D; Materials and methods. 180 postmenopausal women, average age 57,34±0,45, residents of the Podillya region of Ukraine were examined. The main group included 113 women with EH, of which 62 people had EH II, 51 people - EH with CHF C stage according to the ESH 2023 classification. The control group included 67 women without signs of cardiovascular pathology. In addition to the general clinical examination, the research used the enzyme immunoassay method to determine the level of galectin-3 in blood plasma, genotyping of the LGALS3 gene (rs2274273) by means of polymerase chain reaction, and ultrasound of the heart. The statistical processing of the obtained results was carried out using the package of statistical programs SPSS, STATISTICA v. 10.0. Using the MedCalc Software Ltd. Odds ratio calculator (https://www.medcalc.org/calc/odds_ratio.php) the conformity of the frequency distribution of genotypes in the studied population to the Hardy-Weinberg equilibrium was checked and calculated the odds ratio (OR) of the development of left ventricular myocardial hypertrophy (LVH) and CHF on the background of EH. The threshold levels of galectin-3 in blood plasma for the diagnosis of LVH and CHF were calculated using the ROC analysis method.&#x0D; Results. During study the frequency distribution of genotype variants of the galectin-3 gene (rs2274273) among women residents of the Podillya region of Ukraine, it was found that both in people without cardiovascular pathology and in patients with EH II and EH III, the GA genotype predominates, although there is a significant difference between the frequency of occurrence genotypes GA and GG are not noted (p&gt;0.05). The AA genotype variant is significantly less frequent than both the GA and GG genotypes (p&lt;0.01). The frequency distribution of genotype variants corresponds to the Hardy-Weinberg equilibrium. Moreover, the ratio between genotypes in patients of different stages of EH does not reliably differ from that in the control group. However, in EH complicated by CHF among patients with LVEF &lt; 50% A allele carriers significantly predominate compared to GG homozygotes (79.31%, n=23 vs. 20.69%, n=6). In patients with EH, it was found that the concentration of galectin-3 in blood plasma in carriers of the A allele is significantly higher than in carriers of the GG genotype: EH without CHF - 16.82±0.54 ng/ml vs. 12.82±0.54 ng/ml (p&lt;0.01); EH with CHF – 35.70±1.53 ng/ml vs. 25.39±1.38 ng/ml (p&lt;0.001). The threshold levels of galectin-3 plasma concentrations, which indicate the presence of LVH and CHF, are significantly higher in carriers of the A allele than in carriers of the GG genotype.&#x0D; Conclusion. The carriers of the A allele of the LGALS3 gene (rs2274273) have a greater chance of developing CHF with a LVEF &lt; 50% (OR 4.60; 95% CI 1.35 - 15.73 z statistic 2.43 p&lt;0.01 χ2=6 .28; p=0.0122) and correspondingly higher levels of galectin-3 in blood plasma compared to carriers of the GG genotype.

Secondary Polycythemia Associated with COVID-19 Is Associated with Higher Mortality but Does Not Seem to Affect Thrombotic Risk

Introduction Reactive polycythemia (without presence of a chronic myeloproliferative neoplasm (MPN)) is commonly observed among patients with chronic pulmonary disease, whereas its significance in the context of COVID-19 is less well known. We aimed to investigate to what extent might polycythemia at the time of hospital admission affect outcomes of acutely ill COVID-19 patients. Methods We retrospectively evaluated a total of 5872 consecutive hospitalized COVID-19 patients treated in a tertiary referral center, UH Dubrava Zagreb, Croatia, in period 3/2020-6/2021. All patients were of white race and adults. All patients were tested positive for SARS-CoV-2 with either PCR or antigen test in the presence of compatible clinical symptoms. Patients with missing laboratory or clinical information or with prior or subsequently proven MPN were excluded from analysis. Hemoglobin threshold levels defined by the World health organization (WHO) criteria for diagnosis of anemia and the 2008 and 2016 WHO criteria for diagnosis of polycythemia vera (PV) were used to stratify patients into four subgroups (anemia, normal hemoglobin values, 2016 but not 2008 WHO polycythemia vera (PV), and 2008 WHO PV hemoglobin criteria fulfilling patients). Patients were evaluated in regard to baseline clinical characteristics, in hospital mortality, venous (VTE), arterial thrombosis and major bleeding. Due to non-normal distribution, numerical variables were presented as median and interquartile range (IQR). The Kruskal Wallis ANOVA, the chi squared test and the logistic regression were used. P values &amp;lt;0.05 were considered statistically significant. All analyses were performed using the MedCalc statistical software version 22.007 (MedCalc Software Ltd, Ostend, Belgium). Results A total of 5872 COVID-19 patients were analyzed. There were 2575 (43.9%) female and 3297 (56.1%) male patients. Median age was 72 years, median Charlson comorbidity index was 4 points. A total of 4166 (70.9%) patients presented with severe and 897 (15.3%) with critical intensity of COVID-19 symptoms. Median hemoglobin level at the time of admission was 128 g/L, IQR (114-141). A total of 3082 (52.5%) patients presented with normal hemoglobin levels, 2607 (44.4%) with anemia, 158 (2.7%) fulfilled 2016 but not 2008 WHO PV hemoglobin criteria and 25 (0.4%) fulfilled 2008 WHO PV hemoglobin criteria. Patients presenting with polycythemia in comparison to those with normal hemoglobin values were significantly older, were more likely to be of male sex, had higher Charlson comorbidity index, higher leukocytes, lower platelets, higher intensity of COVID-19 symptoms, required higher intensity of oxygen supplementation both at the admission and later during hospitalization (P&amp;lt;0.05 for all analyses). Figure 1 depicts the relationship of belonging to different hemoglobin categories with clinical outcomes. Patients presenting with anemia (OR 1.42, P&amp;lt;0.001), WHO 2016 grade (OR 1.63, P=0.003) and WHO 2008 grade polycythemia (OR 4.98, P&amp;lt;0.001) had increased risk of mortality in comparison to patients presenting with normal hemoglobin values. Anemia was associated with higher VTE (OR 1.34, P&amp;lt;0.006) and major bleeding risk (OR 2.27, P&amp;lt;0.001) in comparison to normal hemoglobin values, whereas no significant association of polycythemia with venous or arterial thrombotic or major bleeding risk was observed. Relationship of anemia, WHO 2016 and WHO 2008 grade polycythemia with increased mortality remained significant after adjusting analyses for age, sex, Charlson comorbidity index, COVID-19 severity and need for mechanical ventilation, all independently predicting inferior outcome (P&amp;lt;0.05 for all analyses). Conclusion Secondary polycythemia in non-MPN COVID-19 patients is associated with high mortality, increasing with higher degree of polycythemia, but does not seem to affect thrombotic or major bleeding risk in comparison to normal hemoglobin values. These observations might help in understanding risks associated with polycythemia and increased blood viscosity in the context of other respiratory diseases. These findings might also translate into the context of MPN and COVID-19, suggesting that blood cells other than erythrocytes might play a more important role regarding thrombotic risk. Future studies are warranted.

Practical application of the CA-62 tumor marker in the initial diagnosis of oncological disease of epithelial origin: assistance to the doctor in interpreting the results

Aim. Demonstration the possibility of practical application of the highly sensitive tumor marker CA-62 in the initial diagnosis in asymptomatic patients with suspected cancer and/or the presence of pathological changes in instrumental studies, as well as describe the criteria for interpreting the results to help the doctor make a decision.&#x0D; Materials and methods. The article used the results and conclusions of blind clinical trials conducted to detect early stages of breast cancer (BC), prostate cancer (PC), colorectal cancer (CRC) and non-small cell lung cancer using the CA-62 tumor marker and other tumor markers. Statistical analysis was performed using the MedCalc program (MedCalc Software Ltd, Belgium). Diagnostic efficiency was assessed in terms of sensitivity, specificity, test accuracy, PPV and NPV, ROC analysis. The significance level was taken as p0.001.&#x0D; Results. The use of the standard cut-off value of 5000 U/ml of the CA-62 tumor marker makes it possible to achieve 97% sensitivity with 95% specificity in stage I BC. The combination of tumor markers CA-62 and CA 15-3 allows achieving 100% specificity in differentiation of BC and benign breast hyperplasia. The use of the CA-62 marker (6500 U/ml) in the gray zone of PSA 2.510 ng/ml improves the accuracy of detecting PC in biopsy from 35 to 93.1% with 90% sensitivity and 97% specificity. The use of a combination of tumor markers (CA-625000 U/ml, CYFRA 21-12.5 ng/ml and CEA5 ng/ml) will allow the doctor to improve the efficiency of differentiating lung cancer from chronic obstructive pulmonary disease. The combined use of markers (CEA3.5 ng/ml) and (CA-625000 U/ml) achieves 100% specificity with 97% sensitivity in detecting early stages of CRC.&#x0D; Conclusion. The article shows the possibilities of using the CA-62 marker, as well as new algorithms for the detection and differentiation of early stages of BC, PC, non-small cell lung cancer and CRC and benign neoplasms using the CA-62 marker in primary diagnosis. The use of the CA-62 tumor marker or its combination with other diagnostic methods can be a useful strategy for a comprehensive assessment of the risk of malignant neoplasms and increasing the diagnostic sensitivity of detecting early stages of cancer.

Polymorphism of the coding gene LGALS-3 rs2274273 as an endogenous factor of the predictive effectiveness of the plasma concentration of galectin-3 in relation to the risk of development of chf on the background of eh in women

Objective. The purpose of the study is to improve the early diagnosis of the development of left ventricular myocardial hypertrophy (LVH) and the formation of prerequisites for chronic heart failure (CHF) in women with essential hypertension, residents of the Podillya region of Ukraine by determining the plasma concentration of galectin-3 in carriers of different polymorphic variants of the LGALS-3 (rs2274273) gene. Material and methods. 180 women of postmenopausal age, average age of 57.34±0.45, residents of the Podillya region of Ukraine, who lived in this territory in the third generation, were examined. The control group consisted of 67 women, average age of 56.43±0.64 years, without signs of cardiovascular pathology and signs of left ventricular hypertrophy (LVH) for other reasons were detected. The main group included 113 women with essential hypertension, of which 62 had essential hypertension with LVH without heart failure (EH II), 51 had essential hypertension with chronic heart failure stage C according to the ESH/ESC 2023 classification. General clinical examination, enzyme immunoassay method for determining the level of galectin-3 in blood plasma, genotyping of the LGALS3 (rs2274273) gene using polymerase chain reaction, and ultrasound of the heart were performed. The statistical processing of the obtained results was carried out using the package of statistical programs SPSS, STATISTICA v. 10.0. Mathematical methods were used: multiple regression stepwise analysis of proportional risks with 95% CI confidence interval, Fisher's linear discriminant analysis with the creation of a mathematical prognostic model, and cluster analysis. Compliance of the frequency distribution of genotypes in the studied populations to the Hardy-Weinberg equilibrium was checked using the MedCalc Software Ltd. Odds ratio calculator. https://www.medcalc.org/calc/odds_ratio.php and calculated the odds ratio (OR) of developing left ventricular myocardial hypertrophy (LVH) and chronic heart failure (CHF).Results. In patients with EH and CHF, carrying the A allele of the LGALS-3 (rs2274273) gene was associated with a more severe degree of diastolic dysfunction and reduced LVEF compared with carriers of the GG genotype, and higher plasma levels of galectin-3 were also recorded, which were associated with a more significant deterioration structural and functional indicators of the myocardium. With the help of cluster analysis, it was found that carriers of the A allele of the LGALS-3 (rs2274273) gene are more likely to be included in unfavorable cluster 1. In contrast, in cluster 2, with a more favorable course of the disease, carriers of the GG genotype and carriers of the A allele occur with almost the same frequency. Conclusions. In postmenopausal women, residents of the Podillya region of Ukraine, carrying the A allele of the LGALS-3 (rs2274273) gene is associated with a more severe course of EH with the development of LVH, a higher concentration of galectin-3 in the blood plasma, and the formation of CHF with reduced LVEF when compared with carriers of the genotype GG.

Prevalence of overweight and obesity and their effect on COVID-19 severity and hospitalization among younger than 50 years versus older than 50 years population: A systematic review and meta-analysis.

Cohort studies have shown that both overweight and obesity have their impact by increasing hospitalization with COVID-19. We conducted a systematic literature search in PubMed, Google Scholar, and MedRxiv databases following the PRISMA guidelines. Statistical analyses were performed using STATA software version 16 MP (Stata Corp, College Station, TX, USA) and Med Calc software version 22.009(Med Calc software Ltd, Ostend, Belgium). The primary outcome was to measure the prevalence of overweight and obesity and their impact on the risk of hospitalization among COVID-19 patients under and above 50 years of age. In total, 184 studies involving 2,365,377 patients were included. The prevalence of overweight was highest among those younger than 50 years of age over those older than 50 years of age, (26.33% vs. 30.46%), but there was no difference in obesity (36.30% vs. 36.02%). Overall, the pooled prevalence of overweight and obesity among hospitalized COVID-19 patients was 31.0% and 36.26%, respectively. Compared with normal weight, the odds of hospitalization with overweight (odds ratio [OR] 2.186, 95% confidence interval [CI] [1.19, 3.99], p < 0.01) and obesity (OR 3.069, 95% CI [1.67, 5.61], p < 0.001) in those younger than 50 years and obesity (OR 3.977, 95% CI [2.75, 5.73], p < 0.001) in the older than 50 years age group were significantly high. The increased prevalence of overweight and obesity among the under 50 years age group and obesity among the older than 50 years age group significantly increased the rate of COVID-19 infections, severity and hospitalization.

Parameters of intra-cardiac hemodynamics in women with essential hypertension and heart failure, carriers of different polymorphic variants of the galectin-3 gene (LGALS-3, rs 2274273)

Annotation. The study aims to improve the prediction and diagnostics of cardiac remodeling, specifically left ventricular myocardial hypertrophy (LVH) in essential hypertension and the development of chronic heart failure (CHF) in carriers of polymorphic variants of the galectin-3 gene (LGALS-3, rs2274273). 180 postmenopausal women, on average aged 58.51±0.45, residents of the Podillya region of Ukraine, were examined. The main group consisted of 113 women with EH, of which 62 had EH II, and 51 had EH III with CHF II A stage. The control group included 67 women without signs of cardiovascular pathology. General clinical examination, enzyme immunoassay method for determining the level of galectin-3 in blood plasma, genotyping of the LGALS3 gene (rs2274273) using polymerase chain reaction, and ultrasound of the heart were performed. Compliance of the frequency distribution of genotypes in the studied populations to the Hardy-Weinberg equilibrium was checked using the MedCalc Software Ltd. Odds ratio calculator. https://www.medcalc.org/calc/odds_ratio.php and calculated the odds ratio (OR) of developing left ventricular myocardial hypertrophy (LVH) and chronic heart failure (CHF). OR = 1 was considered as no association, OR&gt;1 – as a positive association (increased risk of pathology), and OR&lt;1 – as a negative association (reduced risk of pathology). The results were considered reliable at p&lt;0.05. Statistical processing of the obtained results was performed using the SPSS statistical program package, STATISTICA v. 10.0. The reliability of the difference in percentages of quantitative values between groups was calculated according to the χ2 criterion. In postmenopausal women, residents of the Podillya region of Ukraine, without signs of cardiovascular pathology, the following frequency distribution of galectin-3 gene genotype variants (rs2274273) was found: GA – 49.25%, GG – 40.30%, AA – 10.45%, which corresponds to the Hardy-Weinberg equilibrium. The specified ratio does not reliably differ from that in women with EH of different stages. Therefore, the galectin-3 gene polymorphism (rs2274273) is not associated with the risk of EH: OR =0.88; 95% CI 0.47 – 1.63; z statistic 0.417; χ2 =0.1744, p=0.6763. Analysis of the structural and functional parameters of the myocardium in carriers of the A allele shows more pronounced remodeling of the myocardium with eccentric LVH, a more advanced diastolic dysfunction (DD), and lower left ventricular ejection fraction than in GG homozygotes (LVEF 47.63±0.49% vs. 50.61±0.63%, p&lt;0.05). Therefore, the GG genotype of the galectin-3 gene (rs2274273) is a marker of limited changes in the structure of the myocardium in EH.

Bleeding disorders associated with severity of respiratory failure in COVID-19 patients: a prospective observational study

INTRODUCTION: Despite the progress in understanding the pathophysiology of coagulopathy in COVID-19, data about the association and phasing of pathological changes in various parts of the hemostatic system with the development of acute respiratory distress syndrome (ARDS) are insufficient. OBJECTIVE: To determine association between the severity of respiratory failure and pathological changes in the hemostatic system in COVID-19 patients. MATERIALS AND METHODS: A prospective observational study included 204 patients with a confirmed diagnosis of severe and extremely severe COVID-19. Two groups were identified according to disease outcome: fatal (n = 106) and survived (n = 98) groups. To assess dynamics of the clinical picture of the disease and to study the hemostatic profile, time points were determined: I point — the first day — admission to intensive care unit; II point — 3–5 days, III point — 7–10 days after ICU admission. The respiratory index was calculated to assess the severity of respiratory distress syndrome. Statistical data processing was carried out using the statistical software package MedCalc Version 20.110 (MedCalc Software Ltd, Belgium). RESULTS: A 2.15-fold decrease in the respiratory index was determined for fatal outcome in patients with severe and extremely severe COVID-19. The most important hemostatic parameters affecting the severity of respiratory failure are increased Willebrand factor concentration at I point of the study (21 % contribution and inverse correlation), increased plasminogen activator inhibitor type 1 (PAI-1) level on 3–5 days (35 % contribution and direct correlation), and activation of the coagulative component of hemostasis on 7–10 days (78 % contribution and direct correlation). CONCLUSIONS: The severity of respiratory failure in patients with a confirmed diagnosis of severe and extremely severe COVID-19 is gradually associated with endotheliopathy (1 day), inhibition of parietal fibrinolysis (3–5 days) and activation of the coagulative component of hemostasis by 7–10 days of ICU stay.

Focus on software, data acquisition, and instrumentation

Focus on software, data acquisition, and instrumentation

Topical tranexamic acid in intramedullary nailing for the treatment of intertrochanteric fractures in the elderly: A protocol for systematic review and meta-analysis.

Numerous studies have demonstrated that the use of tranexamic acid (TXA) intravenously minimizes bleeding, lowers transfusion rates, and does not raise the risk of complications during major orthopedic surgery. Concerning the effectiveness of the topical application, there are, nevertheless, inconsistent findings. We aimed to develop a protocol for systematic review and meta-analysis on the benefits and safety of topical TXA in intramedullary nailing for the treatment of intertrochanteric fractures in the elderly. PubMed, Embase, and the Cochrane Library will all be searched for randomized controlled trials published from the database inception to October 15, 2022. The primary outcomes will be intraoperative blood loss, hidden blood loss, total blood loss, transfusion rate, transfusion units, operative time, thromboembolic events, and mortality. The risk of bias will be evaluated using the Cochrane risk of bias assessment tool. Review Manager 5.3 will be used for the analysis. The effects and safety of topical TXA in intramedullary nailing for the treatment of intertrochanteric fractures in the elderly will be quantified in this study. The study's findings will assist doctors in determining if topical TXA use is secure and efficient.

The Relationship of Respiratory Rate-Oxygenation (ROX) and Modified ROX Index With High-Flow Nasal Cannula Oxygen Therapy in COVID-19 Patients: An Observational Pilot Study.

Background and aim Respiratory Rate-Oxygenation (ROX) and modified ROX (mROX) indexes have been proposed to detect early high-flow nasal cannula (HFNC) therapy failure. We evaluated the utility and relationship of ROX and mROX indexes in COVID-19 patients started on HFNC oxygen therapy. Methods This pilot study collected data from adult COVID-19 patients requiring HFNC oxygenation from 29 Jan - 29 Jun 2021. The patients were divided into two cohorts based on HFNC therapy success. ROX and mROX were compared using statistical diagnostic testing, including receiver operating characteristics and area under the curve (AUC) using online Epitools (https://epitools.ausvet.com.au/) and MedCalc software (MedCalc Software Ltd, Ostend, Belgium, https://www.medcalc.org/); p<0.05 was considered significant. Results Twenty-seven patients fulfilled the inclusion criteria; 48.15% of therapy failed. The cohort's mean ± standard deviation age was 53.93 ± 10.67 years; 74.1% were male. The accuracy of predicting failure for mean ROX versus mROX at baseline and six-hour values was 59.81 versus 70.68 and 67.42 versus 74.88, respectively (all p>0.05). The AUC for ROX and mROX at baseline and at six hours were statistically indifferent. Only an mROX of 4.05 (mean value) and 3.34 (Youden's J cut-off) had a sensitivity plus specificity at 156% and 163%, respectively. Conclusion Both ROX and mROX at baseline and six hours had fair-to-good accuracies and AUC; the differences were insignificant. Both ROX and mROX had better accuracies at six hours. However, only mROX < 4.05 at six hours fulfilled the sensitivity plus specificity criteria to be a clinically valuable screener.

Indoor Thermal Environment in Different Generations of Naturally Ventilated Public Residential Buildings in Singapore

This study aims to evaluate and compare the indoor air velocities and thermal environment inside different generations of public residential buildings developed by the Housing and Development Board (HDB) of Singapore and analyze the impact of façade design on the indoor thermal environment. To achieve this goal, several case studies were carried out, namely, five typical HDB blocks built in different generations from the 1970s to recent years. Firstly, these five blocks with different façade design features were simulated to obtain the indoor air temperatures for both window-closed and window-open scenarios by using the EnergyPlus V22.2.0 (U.S. Department of Energy) and Design-Builder v6 software(DesignBuilder Software Ltd, Stroud, Gloucs, UK). Meanwhile, the computational fluid dynamics (CFD) simulations were conducted to obtain the area-weighted wind velocities in the corresponding zones to evaluate the indoor thermal comfort. Accordingly, the effects of façade design on indoor air temperatures under both the window-closed and window-open conditions were compared and analyzed. Positive correlations between the facades’ window-to-wall ratio (WWR) and the residential envelope transmittance value (RETV) and Ta were confirmed with statistical significance at a 0.05 level. Furthermore, the indoor thermal comfort based on the wind open scenarios was also investigated. The results indicate that the thermal environment can be greatly improved by implementing proper façade design strategies as well as opening the windows, which could result in an average 3.2 °C reduction in Ta. Finally, some principles were proposed for the façade design of residential buildings in tropical regions with similar climate conditions.

The effects of curcumin supplementation on high-sensitivity C-reactive protein, serum adiponectin, and lipid profile in patients with type 2 diabetes: A protocol for systematic review and meta-analysis.

Type 2 diabetes mellitus (T2DM) is an ensemble of metabolic diseases that has reached pandemic dimensions all over the world. There is a lack of evidence on the contribution of curcumin in the treatment of T2DM. We conducted a protocol for systematic review and meta-analysis to evaluate whether curcumin supplementation is effective and safe in T2DM patients. The systematic review will follow the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols (PRISMA-P). We will obtain studies through PubMed, Cochrane Library, Embase, Web of Science, and Medline databases. In addition, we will also collect 4 databases of China: China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database, and Wan-fang Database. Eligible study conference abstracts and reference lists of manuscripts will be searched. The data collection and analysis will be conducted independently by 2 reviewers. Meta-analysis will be performed using Review Manager software, version 5.3 (Update Software Ltd, Oxford, Oxon, UK). The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. The findings of this systematic review may encourage supplementation of curcumin and its preparation specifically in T2DM patients. Nevertheless, the application of curcumin supplementation in clinical practice should be taken with individual's contributing factors.

Greater Gender Diversity Observed at Orthopaedic Conferences in the Caribbean Than in the United States or England

IntroductionWomen are underrepresented in orthopaedics. Recent studies have shown that women comprise only a very small proportion of all practising orthopaedic surgeons in the United States. One theory that seeks to explain this disparity is the lack of female mentors in orthopaedic surgery. Women are particularly influenced by same-sex mentors, and the paucity of mentors sets up a negative feedback loop that further reduces applications to residency programs. Presentation of scholarly work at conferences increases the visibility of women and represents important opportunities to encourage young female doctors to the speciality. The annual meeting of The Caribbean Association of Orthopaedic Surgeons (TCOS) is a forum that allows regional exposure to young doctors. In the present work, we aim to analyse the gender diversity among presenters at the annual TCOS meetings.MethodsA retrospective analysis of the final programs of TCOS meetings over five years was conducted to determine the sex of the presenter, their roles, and topics. The first author listed on the program was taken as the presenter unless it was otherwise stated. Gender was determined using conventional naming taxonomy. Presenters were classified as podium presenters or moderators and presentations as clinical or non-clinical. We subdivided clinical presentations into seven subspecialty areas. A Chi-squared test was used to calculate differences between groups, with a p-value of < 0.05 representing significance. Statistical tests were performed using Analyse-it for Microsoft Excel 5.40 (Analyse-it Software Ltd).ResultsThere was a total of 195 podium presentations over the study period. During this time, there was a steady increase in the number of presentations by women, with a mean value of 19.5%. Compared with men, women presented fewer clinical papers (52.6%vs 73.9%, p=0.037), presented on more general topics (63.2% vs 31.2%, p=0.007) and were less likely to moderate a session (2.7% vs 97.3%, p=0.014). Presentations by female residents were marginally higher than the mean rate for women overall and were representative of the gender distribution in the resident pool.ConclusionsThere are significantly fewer presentations by women than men at the annual TCOS meetings. Encouragingly, however, there is a positive trend towards greater female presentations over the study period. Our results show that despite being underrepresented, more women are presenting at orthopaedic conferences in the Caribbean than in the United States or England.

Reasons for day of surgery cancellation of orthopaedic cases following a major earthquake in Trinidad and Tobago.

An earthquake in 2018 resulted in irreparable damage to the Port of Spain General Hospital, Trinidad and Tobago, and severely affected orthopaedic services. This study investigates the rate and reasons for cancellation on the day of surgery of orthopaedic cases during the post-earthquake period. We prospectively collected data on all cases scheduled to undergo surgery during the study period. Information was gathered on patient demographics, the number and reasons for cancellation. Data were analysed using Analyse-it for Microsoft Excel 5.40 (Analyse-it Software Ltd). Our results show that 43 patients were cancelled, resulting in a 44.3% cancellation rate. Patients who had their surgery cancelled were older, with a higher American Society of Anesthesiologists class compared with patients whose surgery was not cancelled. Hospital-related factors were found to be responsible for the majority of cancellations. Placed in context, our findings suggest that limited operating time due to the earthquake-induced hospital damage was the principal reason for the high rate of surgery cancellations.

Managing argatroban in heparin-induced thrombocytopenia: Aretrospective analysis of 729 treatment days in 32 patients with confirmed heparin-induced thrombocytopenia.

Managing argatroban in heparin-induced thrombocytopenia: Aretrospective analysis of 729 treatment days in 32 patients with confirmed heparin-induced thrombocytopenia.

Aplikasi Perancangan Informasi Kos Berbasis Android

seek knowledge and earn income by local people but also people from outside Tegal. This of course will make people from inside and outside Tegal look for temporary housing or boarding houses until their education or work is complete. The problem of finding boarding houses for students, employees, and the general public has become a classic problem that appears every year. Surely this is due to the unavailability of good information for boarding house seekers. Currently, the search for boarding houses for students, employees, or the general public still relies on information obtained from friends and other people. This is reversed during the current millennial revolution which is growing i. To find out the location of the desired boarding house, an application is needed which will later be made with the Basic4Android application. Basic4Android programming is a programming language which is one of the easiest to learn and develop until now. Basic4Android is a programming science developed in software and developed by the company Anywhere Software Ltd.

Efficacy and safety of SGLT2 inhibitors in patients with heart failure: A protocol for systematic review and meta-analysis.

Background:Heart failure (HF) prognosis without therapy is poor, however introduction of a range of drugs has improved it. We aimed to perform a protocol for systematic review and meta-analysis on the effects and safety of Sodium-Glucose Transporter 2 inhibitors in HF patients.Methods:This protocol of systematic review and meta-analysis has been drafted under the guidance of the preferred reporting items for systematic reviews and meta-analyses protocols. This study will use the PubMed, Cochrane Library, Embase, Web of Science, and Medline databases. In addition, we will also collect 4 databases of China: China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database, and Wan-fang Database. The risk of bias of included studies is estimated by taking into consideration the characteristics including random sequence generation, allocation concealment, blinding of patients, blinding of outcome assessment, completeness of outcome data, selective reporting and other bias by Cochrane Collaboration's tool. All analyses were performed with Review Manager (RevMan) software, version 5.3 (Update Software Ltd, Oxford, Oxon, UK).Results:The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.Conclusion:Sodium-glucose transporter 2 inhibitors may improve critical outcomes in HF patients, and it is apparently safe.Open Science Framework registration number:https://doi.org/10.17605/OSF.IO/ZKE3Y 10.17605/OSF.IO/MP5SD

Role of Doppler Waveforms in Pregnancy-Induced Hypertension and Its Correlation With Perinatal Outcome.

ObjectivesThe present study aims to measure the role of Doppler waveforms in pregnancy-induced hypertension (PIH) and its relationship with the perinatal outcome.MethodsWe have studied 50 pregnant women with PIH with gestational age (GA) 30-40 weeks for Umbilical Artery (UmA), Middle Cerebral Artery (MCA) and Uterine Artery (UtA) Doppler waveforms. Comparison between the various Doppler indices, i.e., Pulsatility Index (PI), Resistive Index (RI) and S/D ratio, with the severity of the disease and the perinatal outcomes were evaluated using appropriate statistical tests considering a threshold value of p-value <0.05 as significant. The Statistical Package for the Social Sciences (SPSS) version-16 (SPSS Inc, Chicago, USA) and MedCalc software (MedCalc Software Ltd, Ostend, Belgium) were used for data analysis.ResultsHalf (50%) of the cases attributed to the 26 to 30 years age group were at 38 to 40 weeks of gestation. Out of the 50 patients, 68% were primigravida, and 74% had severe PIH. Mean UmA PI, mean MCA PI, mean MCA RI, and mean Cerebro Placental Ratio (CPR) were differed significantly among mild and severe PIH patients (p-value<0.05). Perinatal outcomes in 33 (66%) cases were adverse. The abnormal UmA RI, MCA RI, MCA PI, MCA S/D were significantly linked with poor pregnancy outcomes (p-value <0.05). PIH cases with the presence of early diastolic notch of UtA (p-value <0.01), abnormal PI CPR (p-value <0.001) and S/D CPR (p-value <0.003) were observed to have more adverse outcomes. PI CPR had the highest sensitivity (84.8%), and the existence of early diastolic notch of UtA and MCA-PI were most specific in diagnosing adverse perinatal outcomes.ConclusionCPR-PI is a valuable indicator of adverse perinatal outcomes in PIH. Doppler studies of multiple vessels may help manage high-risk pregnancies as it may provide helpful information about the fetus at risk of hypoxia and placental insufficiency.