Laboratory Tests Research Articles

Prostate cancer screening : to be recommended in 2024?

The Prostate Specific Antigen (PSA) blood test is still the only screening tool for prostate cancer. It is recommended between the ages of 50 and 69 as part of a shared decision making process between a patient and his or her doctor using a decision aid, as the test carries a significant risk of overdiagnosis. If a patient wishes to be screened, either because he is at higher risk, or because he places greater importance on a modest reduction in cancer-related mortality, the frequency of screening depends on his age, family history, and whether he is part of a high-risk group. The use of multiparametric MRI after a positive PSA result can reduce the number of biopsies and, consequently, the risk of overdiagnosis.

Epidemiology of Emergency Department Visits for Children With Clinically Significant Cardiovascular Disease.

The aim of the study is to determine the epidemiology, cost, and factors associated with hospital admission, deterioration if hospitalized, and mortality for children with a history of clinically significant cardiovascular disease (CVD) presenting to pediatric emergency departments (EDs). Using the Pediatric Health Information System, we performed a retrospective analysis of ED encounters of children ≤17 years old with clinically significant CVD between 2016 and 2021. Patients were included if they had a cardiovascular complex chronic condition, defined by ICD diagnosis, and procedure codes. We assessed the primary diagnosis, admission rate, ICU transfer rate (as a marker of disease progression), mortality, resource utilization, and costs. We conducted multivariable analyses to identify risk factors for admission, ICU transfer, and mortality. There were 201,551 ED visits (mean 33,592 ± 3354 per year) among 129,938 children with clinically significant CVD. Most ED encounters had a primary diagnosis of a circulatory (21.1%) or respiratory (19.7%) illness. Seventy-six percent of visits had at least one blood test or imaging study conducted. The overall admission rate was 59.7%, with 28.7% admitted to the ICU, and 6.2% transferred to the ICU after the first 24 hours. The median costs for encounters resulting in admission were $13,605 in US 2023 dollars. In multivariable analyses, younger age, a greater number of noncardiac complex chronic conditions, and CVD type were associated with increased odds of admission, ICU transfer after 24 hours, and mortality (all P < 0.05). ED visits for children with clinically significant CVD lead to substantial resource utilization, including frequent hospitalization, ICU level of care, and costs. This baseline data aids in the development of prospective studies to inform the appropriate ED management for children with clinically significant CVD.

Robotized Mobile Platform for Non-Destructive Inspection of Aircraft Structures

The robotization of the non-destructive inspection of aircraft is essential for improving the accuracy and duration of performed inspections, being an integral part of inspection and data management systems within the currently developed NDT 4.0 concept. In this paper, the authors presented the design and testing of a universal mobile platform with interchangeable sensing systems for the non-destructive inspection of aircraft structures with various angles of inclination. As a result of the performed studies, a low-cost approach of automation of existing measurement devices used for inspection was proposed. The constructed prototype of the mobile platform was equipped with eddy current testing probe and successfully passed both laboratory and environmental tests, demonstrating its performance in various conditions. The presented approach confirms the effectiveness of the automation of the inspection process using climbing robots and defining the directions of possible development of automation in non-destructive testing in aviation.

Alternate materials for the capture and quantification of gaseous oxidized mercury in the atmosphere

Abstract. Methodologies for identifying atmospheric oxidized mercury (HgII) compounds, including particulate-bound HgII (HgII(p)) and gaseous oxidized mercury (HgII(g)), by mass spectrometry are currently under development. This method requires preconcentration of HgII for analysis due to high instrument detection limits relative to ambient HgII concentrations. The objective of this work was to identify and test materials for quantitative capture of HgII from the gas phase and to suggest potential surfaces onto which HgII can be collected, thermally desorbed, and characterized using mass spectrometry methods. From the literature, several compounds were identified as potential sorbent materials and tested in the laboratory for uptake of gaseous elemental mercury (Hg0) and HgII(g) (permeated from a HgBr2 salt source). Chitosan, α-Al2O3, and γ-Al2O3 demonstrated HgII(g) capture in ambient air laboratory tests, without sorbing Hg0 under the same conditions. When compared to cation exchange membranes (CEMs), chitosan captured a comparable quantity of HgII(g), while ≤90 % of loaded HgII(g) was recovered from α-Al2O3 and γ-Al2O3. When deployed in the field, the capture efficiency of chitosan decreased compared to CEMs, indicating that environmental conditions impacted the sorption efficiency of this material. The poor recovery of HgII from the tested materials compared to CEMs in the field indicates that further identification and exploration of alternative sorbent materials are required to advance atmospheric mercury chemistry analysis by mass spectrometry methods.

Numerical analysis of soil reinforced by sand columns using different installation methods

This study involves a finite element numerical simulation of laboratory tests conducted on small-scale models. The tests involved the installation of columns using different techniques: without soil displacement and without column compaction (WR-NC), and without soil displacement but with column compaction (WR-WC). The reinforced soil masses were then subjected to a uniform 150 kPa load. A comparison between the numerical and experimental results showed excellent agreement, validating the simulation. Following this validation, a parametric analysis was carried out to examine the effects of the various parameters on the behavior of the reinforced soil masses. In the first method, three different column diameters were analyzed, focusing on the effects of diameter (area replacement ratio), column length, and geogrid containment benefits. In the second method, three levels of compaction pressure were applied during the column installation. The study evaluated the impact of column installation techniques on the behavior of the reinforced masses. The findings indicate that settlement reduction is proportional to the increase in area replacement ratio and column length. Additionally, confining the columns with geogrid was shown to be effective in further reducing settlements. The results also revealed that increasing compaction stress leads to greater radial expansion of the columns, which densifies and stiffens the surrounding soil, thereby reducing settlement. Overall, the study concludes that column installation techniques significantly influence the behavior of reinforced soil masses.

Closure of buccosinusal communication with rotation of a palatal flap: case report

An buccosinusal communication is an abnormal pathway between the oral cavity and the maxillary sinus. It is usually caused by surgical procedures such as the extraction of premolars and maxillary molars, due to the proximity of the roots to the floor of the maxillary sinus. The aim of this study is to report a surgical treatment for the closure of an buccosinusal communication with the advancement of a palatal flap. The patient was a 45-year-old female adult with no systemic comorbidities and no allergies. She reported pain in the left cheek and nasal discharge. Intraoral examination revealed an area of fistula in the region of element 26 measuring approximately 4-5mm. The CT scan showed a hyperdense image in the left maxillary sinus suggestive of sinus infection and a hypodense image in the region corresponding to the alveolus of element 26, suggestive of an buccosinusal communication. Initially, preoperative laboratory tests were requested and antibiotic therapy was prescribed. Intra- and extra-oral antisepsis, infiltration anesthesia were performed, fistulectomy, demarcation of the palatal flap, incision and full-thickness mucoperiosteal detachment, rotation of the palatal flap to obliterate the fistula and stabilization of the fistula using single-stitch sutures in the raw donor region with fibrin sponges under the suture, for later installation of surgical cement to help protect the wound. The patient is well, with complete closure of the communication and no evidence of post-operative complications.

A systematic approach of correct laboratory commissioning: special procedural features for medical laboratories using the example of specialised forms of care

Abstract Since the complexities of commissioning medical laboratory tests have grown continuously as a result of the increase in specialised forms of care, this article aims to create a practice-oriented structure of the legal and procedural requirements and to illustrate these using case studies – specifically using the example of so-called ambulatory medical specialist care (ASV) in accordance with Par. 116b SGB V and selected selective contracts in accordance with Par. 140a SGB V. Even if the system of correct laboratory billing described in our previous articles has remained largely valid, we believe that structuring specialised forms of care in the outpatient sector would be particularly helpful. In addition to our previous articles on the system of correct laboratory billing, it is shown that laboratory commissioning must also be systematically correct and that all parties involved in the process (doctor’s surgeries, clinics, medical laboratories and insured persons) will benefit from this. In doing so, we are developing a system for correct laboratory ordering that leads to an improvement in process quality and process simplification when functionalised via so-called “order/entry”- or automated registration systems.

Predictive modeling of COVID-19 mortality risk in chronic kidney disease patients using multiple machine learning algorithms

The coronavirus disease 2019 (COVID-19) has a significant impact on the global population, particularly on individuals with chronic kidney disease (CKD). COVID-19 patients with CKD will face a considerably higher risk of mortality than the general population. This study developed a predictive model for assessing mortality in COVID-19-affected CKD patients, providing personalized risk prediction to optimize clinical management and reduce mortality rates. We developed machine learning algorithms to analyze 219 patients’ clinical laboratory test data retrospectively. The performance of each model was assessed using a calibration curve, decision curve analysis, and receiver operating characteristic (ROC) curve. It was found that the LightGBM model showed the most satisfied performance, with an area under the ROC curve of 0.833, sensitivity of 0.952, and specificity of 0.714. Prealbumin, neutrophil percent, respiratory index in arterial blood, half-saturated pressure of oxygen, carbon dioxide in serum, glucose, neutrophil count, and uric acid were the top 8 significant variables in the prediction model. Validation by 46 patients demonstrated acceptable accuracy. This model can serve as a powerful tool for screening CKD patients at high risk of COVID-19-related mortality and providing decision support for clinical staff, enabling efficient allocation of resources, and facilitating timely and targeted management for those who need the relevant interference urgently.

Can New Advanced Clinical Parameters Be Used in the Diagnosis of Vitamin B12 Deficiency?

The measurement of vitamin B12 levels has low sensitivity for the diagnosis of vitamin B12 deficiency, therefore, clinicians may prefer to decide the deficiency with the patient's clinic. In this study, the diagnostic values of the classical and advanced clinical complete blood count parameters were investigated to find a new marker in the diagnosis of vitamin B12 deficiency. 150 adult volunteers were included in the study and volunteers were divided into two groups according to their vitamin B12 levels (with or without vitamin B12 deficiency) and hemoglobin levels (with or without anemia). The differences and correlations of laboratory test results between groups were examined. Equivalent of reticulocyte hemoglobin, equivalent of erythrocyte hemoglobin and delta-hemoglobin were found significant differences between groups with or without vitamin B12 deficiency. Hypo-hemoglobinised red cells and hyper-hemoglobinised red cells were found significant difference between groups with or without anemia. Significant positive correlations were found between vitamin B12 levels and equivalent of reticulocyte hemoglobin, equivalent of erythrocyte hemoglobin and delta-hemoglobin. Significant positive correlations were found between hemoglobin levels and macrocytic red blood cells, equivalent of reticulocyte hemoglobin, equivalent of erythrocyte hemoglobin, delta hemoglobin and hyper-hemoglobinised red cells; negative correlations with microcytic red blood cells and hypo-hemoglobinised red cells. It is suggested that these advanced clinical parameters of complete blood count analysis may be used to determine vitamin B12 deficiency.

Hemophagocytic lymphohistiocytosis caused by multiple infections during primary chemotherapy for pediatric acute lymphoblastic leukemia: a case report

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory disorder that occurs as a consequence of immune dysregulation. HLH can be primary (familial or non-familial) or secondary to infection, autoimmune disease or malignancy. Malignancy-associated HLH is often accompanied by hematologic and lymphoid neoplasms. This report describes the case of a 3-year-old girl with an initial diagnosis of acute lymphoblastic leukemia who subsequently developed HLH during primary chemotherapy. She was admitted with a pulmonary infection, and initial blood tests showed thrombocytopenia and anemia. Whole-exome sequencing of gene and whole transcriptome RNA sequencing data indicated mutations of UNC13D. The hospital course was complicated by multiple infections, altered mental status and acute respiratory distress syndrome. HLH secondary to multiple infections that achieved remission following targeted therapy with ruxolitinib, in conjunction with corticosteroids and other complementary treatments. This report provides a synopsis of the diagnostic and treatment procedures implemented in this case.

Post-colonoscopy upper gastrointestinal malignancies in positive immunochemical fecal occult blood test patients: An Australian data linkage study.

In immunochemical fecal occult blood test (iFOBT) positive subjects, colonoscopy screening can detect colorectal cancers and advanced adenomas, yet most iFOBT-positive subjects find no relevant lower gastrointestinal lesions. Limited data are available on upper gastrointestinal (UGI) cancer risk in iFOBT-positive patients. This study investigated the incidence of UGI malignancies diagnosed within 3years post-colonoscopy after a positive iFOBT. Retrospective analysis of iFOBT-positive patients aged 50-75years who underwent a colonoscopy at a single institution. All patients with a diagnosis of UGI cancer within 3years post-colonoscopy were identified by linking with the Queensland Cancer Register. This was used to compare to the geographical population aged 50-74years based on the Australian Bureau of Statistics and Queensland Cancer Council data. From 1748 eligible participants, 0.23% (95% confidence interval [CI] 0.06-0.58) were diagnosed with UGI cancer within 3years post-colonoscopy. This indicates an esophageal cancers rate of 114.42 per 100000 (95% CI 100.56-298.28) and gastric cancer rate of 57.21 per 100000 (95% CI 55.76-261.12). Of the patients with a UGI cancer, 75% would have had an unexplained iFOBT. Annual incidence for the same geographic region, ages, and period for the combined esophageal and gastric cancer was 36.08 per 100000 (95% CI 32.87-39.52). Among individuals with a positive iFOBT in a bowel cancer screening program, the rates of gastric and esophageal cancers were 2.7 and 7.5 times higher than the general population. Adding gastroscopy to a colonoscopy for iFOBT-positive patients in cancer surveillance programs may be justifiable.

Urethral obstruction in a ram with a periurethral abscess: clinical findings, diagnostic imaging and pathology

BackgroundUrethral obstruction is a common and life-threatening condition in male small ruminants.Case presentationThis case report describes a 3-year old 103 kg Zwartbles breeding ram, presented with the complaint of straining, suspected to have an urethral obstruction. The work-up included clinical examination, laboratory analyses, ultrasound imaging, (contrast) radiography and urine examination. At presentation, blood analysis revealed a respiratory alkalosis, hyperkalaemia and mild azotaemia. On transabdominal ultrasound an enlarged bladder (diameter 11 cm) and free fluid surrounding the right kidney were observed. Treatment of the animal included tube cystostomy, intravenous perfusion, antimicrobial treatment, ammonium chloride and NSAIDs. No indications for urolithiasis were found on ultrasound, radiography, or urine examination. As no improvement was seen despite 16 days of therapy, a contrast radiograph of the urinary tract, as well as reproductive exam were conducted. Positive anterograde urethrogram showed a contrast filled cavitary lesion at the caudal aspect of the pelvic urethra. The reproductive ultrasonography revealed the same large urethral distention or abscess compressing the pelvic urethra, as well as severe testicular degeneration in both testis. The results of the contrast radiograph and the reproductive exam lead to the decision to euthanize the animal, as the animal would not be capable of breeding. Computed tomography was performed post-mortem, which showed close relation between the cavitary lesion and the left bulbourethral gland. Pathology revealed a lymphoplasmacytic to suppurative infection at the level of the urogenital tract, chronic interstitial nephritis and a perirenal to cortical abscess of the right kidney as well as a periurethral abscess. As for the reproductive system, multifocal interstitial inflammatory infiltrates were seen on the entire system. Marked fibrosis and atrophy was seen at the level of the testes and both epididymides.ConclusionsA periurethral abscess should be included in the differential diagnosis for an urethral obstruction in small ruminants. The extensive medical imaging, together with the ante-mortem and post-mortem findings, makes this a good reference case for diagnosticians confronted with urethral problems in a ram.

Prediction of Severe Acute Pancreatitis at a Very Early Stage of the Disease Using Artificial Intelligence Techniques, Without Laboratory Data or Imaging Tests: The PANCREATIA Study.

To evaluate machine learning models' performance in predicting acute pancreatitis severity using early-stage variables while excluding laboratory and imaging tests. Severe acute pancreatitis (SAP) affects approximately 20% of acute pancreatitis (AP) patients and is associated with high mortality rates. Accurate early prediction of SAP and in-hospital mortality is crucial for effective management. Traditional scores such as APACHE-II and BISAP are complex and require laboratory tests, while early predictive models are lacking. Machine learning (ML) has shown promising results in predictive modelling, potentially outperforming traditional methods. We analysed data from a prospective database of AP patients admitted to Vall d'Hebron Hospital from November 2015 to January 2022. Inclusion criteria were adults diagnosed with AP according to the 2012 Atlanta classification. Data included basal characteristics, current medication, and vital signs. We developed machine learning models to predict SAP, in-hospital mortality, and intensive care unit (ICU) admission. The modelling process included two stages: Stage 0, which used basal characteristics and medication, and Stage 1, which included data from Stage 0 and vital signs. Out of 634 cases, 594 were analysed. The Stage 0 model showed AUC values of 0.698 for mortality, 0.721 for ICU admission, and 0.707 for persistent organ failure. The Stage 1 model improved performance with AUC values of 0.849 for mortality, 0.786 for ICU admission, and 0.783 for persistent organ failure. The models demonstrated comparable or superior performance to APACHE-II and BISAP scores. The ML models showed good predictive capacity for SAP, ICU admission, and mortality using early-stage data without laboratory or imaging tests. This approach could revolutionise AP patients' initial triage and management, providing a personalised prediction method based on early clinical data.

Assessment of genotoxicity biomarkers in neotropical fish species from streams of the Ivinhema River basin located in sugarcane cultivation areas

The Ivinhema River basin has experienced the greatest expansion of sugarcane cultivation in the state of Mato Grosso do Sul, Brazil. Theassessment of water quality through physical and chemical parameters and ecotoxicological studies, employing both bioindicators collected in situ and laboratory tests, provides more robust results for this region. In this context, the objective of this study was to analyze the composition and structure of the landscape around the sampling sites located in three streams (Vitória, Rosário, and Piravevê) belonging to the Ivinhema River basin to evaluate the impacts of sugarcane cultivation expansion on water quality and genotoxicity biomarkers in situ and ex situ using native fish species. Inthe sampling sites in the Rosário and Vitória streams, sugarcane is the main land use, while in the Piravevê stream, pasture areas represent the main land use. The acidic pH observed in the Vitória and Rosário streams seems to be related to the application of fertilizers and the fertigation in the sugarcane crop. Two species of detritivorous and five of omnivorous fishes were collected. A higher frequency of genotoxic damage was identified in detritivorous fish species. In the genotoxicity tests with Astyanax lacustris, the most frequent nuclear alteration induced by the water samples from all sampling sites was nuclear invagination. Our results indicated that the expansion of the sugarcane ridge in the Ivinhema River basin may cause negative impacts on the aquatic environment and native biota. These results contribute to the generation of data and information that can be used for public hearing requests that aim to discuss and review many aspects of legislation regarding agricultural activities around streams, as well as the need for restoration and management programs in these areas in order to conserve biodiversity.

External Validation of an Electronic Health Record-Based Diagnostic Model for Histological Acute Tubulointerstitial Nephritis.

Accurate diagnosis of acute tubulointerstitial nephritis (AIN) often requires a kidney biopsy. We previously developed a diagnostic statistical model for predicting biopsy-confirmed AIN by combining four laboratory tests after evaluating over 150 potential predictors from the electronic health record. Here, we validate this diagnostic model in two biopsy-based cohorts at Johns Hopkins Hospital (JHH) and Yale, which were geographically and temporally distinct from the development cohort, respectively. We analyzed patients who underwent kidney biopsy at JHH and Yale University (2019-2023). We assessed discrimination (AUC) and calibration using previously derived model coefficients and recalibrated the model using an intercept correction factor that accounted for differences in baseline prevalence of AIN between development and validation cohorts. We included 1982 participants: 1454 at JHH and 528 at Yale. JHH (5%) and Yale (17%) had lower proportions of biopsies with AIN than the development set (23%). The AUC was 0.73 (0.66-0.79) at JHH and 0.73 (0.67-0.78) at Yale, similar to the development set (0.73 (0.64-0.81)). Calibration was imperfect in validation cohorts, particularly at JHH, but improved with application of an intercept correction factor. The model increased AUC of clinicians' prebiopsy suspicion for AIN by 0.10 to 0.77 (0.71-0.82). An AIN diagnostic model retained discrimination in two validation cohorts but needed recalibration to account for local AIN prevalence. The model improved clinicians' ability to predict AIN.

Healthcare utilisation patterns and drivers amongst inflammatory bowel disease patients in the outpatient clinic.

Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, impose an escalating burden on healthcare systems globally, with a rising prevalence contributing to increased costs. This study explored healthcare utilisation patterns and its drivers amongst IBD patients in an outpatient clinic. A longitudinal cohort study was conducted at a Dutch academic teaching hospital. IBD patients (n = 180) were followed for 1 year and were categorised based on disease activity and consultation frequency. Healthcare utilisation was assessed through consultations and laboratory tests. Patient-reported outcomes and biochemical disease activity were measured, and subsequently the reasons for consultations were analysed. The frequency of outpatient healthcare utilisation exceeded the recommended IBD care guidelines by two-fold. Comorbidities were the leading reason for consultations (40.4%), followed by remission induction, medication changes and pending test results. Moreover, clinical disease activity, reported problems with self-care, daily activities and pain were predictive of an increase in annual consultations. This study identified factors influencing healthcare utilisation in IBD outpatients. Personalised care pathways using eHealth technologies have the potential to reduce unnecessary consultations and optimise resource allocation.

Optimizing anemia management using artificial intelligence for patients undergoing hemodialysis

Patients with end-stage kidney disease (ESKD) frequently experience anemia, and maintaining hemoglobin (Hb) levels within a targeted range using erythropoiesis-stimulating agents (ESAs) is challenging. This study introduces a gated recurrent unit-attention-based module (GAM) for efficient anemia management among patients undergoing chronic dialysis and proposes a novel alert system for anticipating the need for red blood cell transfusions. Data on demographic characteristics, dialysis metrics, drug administration, laboratory tests, and transfusion history were retrospectively collected from patients undergoing hemodialysis at Kangwon National University Hospital between 2017 and 2022. After preprocessing, a final dataset of 252 patients was used for model training. Our model functions in two major phases: (1) Hb level prediction and ESA dose recommendation and (2) transfusion alert framework. The GAM model outperformed traditional machine learning algorithms, including linear regression, XGBoost, and multilayer perceptron, in predicting Hb levels (R-squared value = 0.60). The model also demonstrated a recommendation accuracy of 0.78 compared to that of clinical experts, indicating a high degree of concordance with the ESA dosing recommendations. Additionally, the model exhibited considerably high accuracy (0.99) for transfusion alarms. Thus, the GAM model holds promise for improving anemia management in patients with ESKD by optimizing ESA dosages and providing timely transfusion alerts.

Association of hypoalbuminemia with hospitalization and mortality in hemodialysis patients with COVID-19.

Hypoalbuminemia is associated with poor nutritional status and inflammatory response in infectious diseases. It is commonly observed in COVID-19 patients. The aim of this study is to assess the association of serum albumin with hospitalization and mortality in dialysis patients with COVID-19. We retrospectively collected 250 dialysis patients, with and without COVID-19. Demographic characteristics, clinical symptoms, and laboratory tests on admission or the confirmation of COVID-19 were collected. Univariate logistic regression model was used to evaluate the association of various factors with hospitalization and death in these patients. A total of 250 patients were included between December 1, 2022, and February 1, 2023, in our dialysis center. Among them, 218 were dialysis patients with COVID-19, and 32 were without COVID-19. Ten patients died due to COVID-19, and 8 patients had clinical data. In dialysis patients with COVID-19, a significant difference in serum albumin levels was observed between outpatients (37.28 ± 4.01 g/L) and hospitalized patients (33.42 ± 3.82 g/L), as well as between survivors (37.12 ± 4.07 g/L) and non-survivors (31.92 ± 2.52 g/L). Univariate logistic regression showed that the reduced albumin levels were associated with an increased risk of hospitalization and mortality in dialysis patients with COVID-19. Our study revealed that reduced serum albumin is associated with an increased risk of hospitalization and mortality in dialysis patients with COVID-19. Low serum albumin levels suggest a poor prognosis and nutritional support may improve clinical outcomes.

Long COVID and recovery from Long COVID: quality of life impairments and subjective cognitive decline at a median of 2 years after initial infection

BackgroundRecovery from SARS CoV-2 infection is expected within 3 months. Long COVID occurs after SARS-CoV-2 when symptoms are present for more than 3 months that are continuous, relapsing and remitting, or progressive. Better understanding of Long COVID illness trajectories could strengthen patient care and support.MethodsWe characterized functional impairments, quality of life (QoL), and cognition among patients who recovered from SARS-CoV-2 infection within 3 months (without Long COVID), after 3 months (Recovered Long COVID), or remained symptomatic (Long COVID). Among 7305 patients identified with previous SARS-CoV-2 infection between March 2020 and December 2021, confirmed in the medical record with laboratory test or physician diagnosis, 435 (6%) completed a single self-administered survey between March 2022 and September 2022. Multi-domain QoL and cognitive concerns were evaluated using PROMIS-29 and the Cognitive Change Index-12.ResultsNearly half the participants (47.7%) were surveyed more than 2 years from initial infection (median = 23.3 months; IQR = 18.6, 26.7) and 86.7% were surveyed more than 1 year from infection. A significantly greater proportion of the Long COVID (n = 215) group, (Current and Recovered combined), had moderate-to-severe impairment in all health domains assessed compared to those Without Long COVID (n = 220; all p < 0.05). The Recovered Long COVID group (n = 34) had significantly lower prevalence of fatigue, pain, depression, and physical and social function impairment compared to those with Current Long COVID (n = 181; all p < 0.05). However, compared to patients Without Long COVID, the Recovered Long COVID group had greater prevalences of fatigue, pain (p ≤ 0.06) and subjective cognitive decline (61.8% vs 29.1%; p < 0.01). Multivariate relative risk (RR) regression indicated Long COVID risk was greater for older age groups (RR range 1.46–1.52; all p ≤ 0.05), those without a bachelor’s degree (RR = 1.33; 95% CI = 1.03–1.71; p = 0.03), and those with 3 or more comorbidities prior to SARS-CoV-2 infection (RR = 1.45; 95% CI = 1.11–1.90; p < 0.01).ConclusionsLong COVID is associated with long-term subjective cognitive decline and diminished quality of life. Clinically significant cognitive complaints, fatigue, and pain were present even in those who reported they had recovered from Long COVID. These findings have implications for the sustainability of participation in work, education, and social activities.

A Simple Test Ratio APRI (AST to Platelet Ratio Index) as a Useful Tool for Cirrhosis: A Study from Bir Hospital, Nepal

Background Liver cirrhosis is a leading cause of morbidity and mortality worldwide, including Nepal. Liver biopsy, the gold standard for fibrosis assessment, is invasive and carries risks. The Aspartate Aminotransferase to Platelet Ratio Index (APRI) offers a non-invasive, cost-effective alternative. However, data on its utility in Nepalese populations are limited.  Objective To evaluate the diagnostic performance of APRI as a non-invasive marker of cirrhosis in Nepalese patients, determining its sensitivity, specificity, and predictive values.  Methods This cross-sectional study enrolled 58 cirrhotic patients and 58 healthy controls at Bir Hospital from April 2019 to January 2020. Clinical examinations, laboratory tests, and ultrasonography were performed. APRI with a cut-off of 0.5 was evaluated using SPSS version 23, applying chi-square and ANOVA tests.  Results Among 116 participants, APRI at a 0.5 cut-off demonstrated 88.3% sensitivity, 82.5% specificity, 90.1% positive predictive value, and 70.2% negative predictive value (p = 0.002, 95% CI).  Conclusion APRI is a reliable non-invasive tool for diagnosing liver fibrosis in cirrhotic patients, offering high sensitivity and specificity. It is practical for bedside use, especially in resource-limited settings.