Hematological parameters to predict post-COVID-19 immune response among vaccinated and nonvaccinated individuals: a retrospective cross-sectional study.

Background: This study finds the changes in the hematological parameters of healthy individuals to predict the immune status against coronavirus disease 2019 (COVID-19) among COVID -19 vaccinated and nonvaccinated individuals. Methods: A comparative cross-sectional study among 210 healthy individuals was conducted. All individuals were divided into three groups, that is, IgG positive, IgG negative, and IgG and IgM positive, based on ELISA. Data analysis was done using SPSS version 25 for Windows. Results: A statistically significant effect was found among the three groups in terms of mean levels of hemoglobin (Hb), hematocrit (Hct), mean corpuscular hemoglobin concentration (MCHC), red blood cells (RBC), RDW-CV, lymphocyte, neutrophil, eosinophils, and basophil count. The study also showed that 52.8% (n=74) had neither taken vaccination nor had any history of previous COVID-19 infection but were IgG antibody positive. Conclusion: There was a statistically significant difference among hematological parameters between immune and nonimmune groups, and it can predict the COVID-19 immune status.

Investigation of electronic, ferroelectric and local electrical conduction behavior of RF sputtered BiFeO3thin films.

Most of the applied research on BiFeO3(BFO) focuses on magnetoelectric and spintronic applications. This calls for a detailed grasp of multiferroic and conduction properties. BFO thin films with (100) epitaxial growth has been deposited on a LaNiO3(LNO) buffered Pt/Ti/SiO2/Si(100) substrate using RF magnetron sputtering. The film formed at 15 mTorr, 570 °C, and with Ar/O24:1 had a reasonably high degree of (100)-preferential orientation, the least surface roughness, and a densely packed structure. We obtained ferroelectric loops with strong polarization (150µC cm-2). The leakage current density is as low as 10-2A cm-2at 100 kV cm-1, implying that space-charge-limited bulk conduction (SCLC) was the primary conduction channel for carriers within BFO films. Local electrical conduction behavior demonstrates that at lower voltages, the grain boundary dominates electrical conduction and is linked to the displacement of oxygen vacancies in the grain boundary under external electric fields. We hope that a deeper understanding of the conduction mechanism will help integrate BFO into viable technologies.

Experimental and computational study on the influence of cobalt substitution on the structural, impedance, electronic, magnetic, and optical properties of pseudobrookite-structured Fe2TiO5.

We report on how Co substitution of the Fe sites of pseudobrookite (Fe2TiO5) influences the crystal structure, high-temperature electric permittivity, impedance, electronic structure, magnetic, and optical properties via experimental and theoretical investigations. The pseudobrookite phase contains two types of octahedral sites, Fe atoms reside on type of the sites while Ti on the others and replacing Fe with Co can have a huge influence on one or more physical properties that can render the material more useful for solar energy applications. X-ray diffraction and high-temperature electric permittivity/impedance were the experimental tools used. A temperature range of 20-300 °C and a frequency range of 100 Hz to 1 MHz were used for studying various types of relaxation mechanism via impedance analysis, including grains, grain boundaries, and interfacial effects. To explore the electronic structure, magnetic, and optical properties from first principles, dispersion-corrected density functional theory (PBE-D2/U) was employed. The structure as well as the electric impedance properties are impacted slightly by the Co substitution of Fe in Fe2TiO5 whereas the electronic structure and magnetic properties are influenced significantly. The bandgap is reduced slightly and the average magnetic moment per Fe ion is reduced upon Co substitution of Fe in Fe2TiO5.

Diagnostic dilemma of celiac disease presenting with weight loss and secondary amenorrhea: A case report.

RATIONALE: Celiac disease (CD) is autoimmune enteropathy affecting the proximal small intestinal mucosa. It is caused by insensitivity to gluten, a protein predominantly presented in wheat. CD is classically associated with gastrointestinal symptoms. The non-classic clinical presentation of CD can present with other organ involvement. Non-human leukocyte antigens genes are associated with atypical forms. PATIENTS CONCERN: We reported a case of 30-year-old female who presented with progressive pallor, amenorrhea, and unexplained weight loss with generalized body weakness. Her body mass index was 20. The patient was having no other systemic manifestations. DIAGNOSIS: This paper reports a case of a female patient having CD without its typical features. Her laboratory evaluation revealed microcytic anemia. Anti-TTg IgA and Anti-TTG IgG antibodies were raised, ferritin and folate were low, and there was mild hyperbilirubinemia. However, follicle-stimulating hormone, luteinizing hormone, and serum estradiol levels were normal. She was diagnosed with a case of anemia resulting from malabsorption caused by CD. INTERVENTIONS: A management plan was devised based on a strict gluten-free diet. The patient received supplements containing folates, iron, calcium, zinc, and vitamins A, D, E, B6, and B12. OUTCOMES: After 3 months of treatment with strict gluten-free diet patient showed remarkable improvement. Her hemoglobin level raised with weight gain. Her normal menstrual cycle was restored with complete resolution of symptoms at 1 year follow-up. LESSONS: The pathogenesis of the atypical CD is multifactorial, but impaired uptake of micronutrients from the duodenum is the most likely cause, even if other common features of classical forms, such as bloating and diarrhea, are absent. Lack of awareness about atypical forms may lead to under-diagnoses of the disease. The physicians should consider the atypical presentations of CD to avoid the under-diagnoses of this multisystem disorder.

Non-Hodgkin's lymphoma masquerading as splenic abscess: A case report.

Background: Non-Hodgkin's lymphoma (NHL) is a monoclonal proliferation of lymphoid cells from B lineage. Although NHLs are primarily hematological tumors of lymph nodes but rarely can involve extranodal sites such as the spleen. Case report: A 29-year-old female patient presented with low-grade fever, cough, anemia, weight loss, tender left hypochondrium, and splenomegaly. A hypodense lesion in the spleen with central necrosis, having strong positivity for common leukocyte antigen (LCA), CD 20, and CD 10, led to a diffuse large B cell lymphoma diagnosis. The patient had an excellent clinical post-splenectomy response to combination chemotherapy and immunotherapy. Conclusion: NHL can present with symptomatic extra-nodal involvement without enlarged lymph nodes.

Effect of substrate orientation on local magnetoelectric coupling in bi-layered multiferroic thin films.

In this study we explore the prospect of strain-mediated magnetoelectric coupling in CoFe2O4-BaTiO3 bi-layers as a function of different interfacial boundary conditions. Pulsed laser deposition fabricated thin films on Nb:SrTiO3(100) and Nb:SrTiO3(111) single crystal substrates were characterized in terms of their peculiarities related to the structure-property relationship. Despite the homogeneous phase formation in both films, transmission electron microscopy showed that the bi-layers on Nb:SrTiO3(100) exhibit a higher number of crystallographic defects when compared to the films on Nb:SrTiO3(111). This signifies an intrinsic relationship of the defects and the substrate orientation. To analyze the consequences of these defects on the overall magnetoelectric coupling of the bi-layered films, piezoresponse force microscopy was performed in situ with an applied magnetic field. The local magnetic field dependence of the piezoresponse was obtained using principal component analysis. A detailed analysis of this dependence led to a conclusion that the bi-layers on Nb:SrTiO3(111) exhibit better strain-transfer characteristics between the magnetic and the piezoelectric layer than those which were deposited on Nb:SrTiO3(100). These strain transfer characteristics correlate well with the interface quality and the defect concentration. This study suggests that in terms of overall magnetoelectric coupling, the Nb:SrTiO3(111) grown bi-layers are expected to outperform their Nb:SrTiO3(100) grown counterparts.

A new (Ba, Ca) (Ti, Zr)O3 based multiferroic composite with large magnetoelectric effect.

The lead-free ferroelectric 0.5Ba(Zr0.2Ti0.8)O3 - 0.5(Ba0.7Ca0.3)TiO3 (BCZT) is a promising component for multifunctional multiferroics due to its excellent room temperature piezoelectric properties. Having a composition close to the polymorphic phase boundary between the orthorhombic and tetragonal phases, it deserves a case study for analysis of its potential for modern electronics applications. To obtain magnetoelectric coupling, the piezoelectric phase needs to be combined with a suitable magnetostrictive phase. In the current article, we report on the synthesis, dielectric, magnetic, and magnetoelectric characterization of a new magnetoelectric multiferroic composite consisting of BCZT as a piezoelectric phase and CoFe2O4 (CFO) as the magnetostrictive phase. We found that this material is multiferroic at room temperature and manifests a magnetoelectric effect larger than that of BaTiO3 -CoFe2O4 bulk composites with similar content of the ferrite phase.

Mobile physician reporting of clinically significant events-a novel way to improve handoff communication and supervision of resident on call activities.

OBJECTIVES: Reporting of clinically significant events represents an important mechanism by which patient safety problems may be identified and corrected. However, time pressure and cumbersome report entry procedures have discouraged the full participation of physicians. To improve the process, our internal medicine training program developed an easy-to-use mobile platform that combines the reporting process with patient sign-out. METHODS: Between August 25, 2011, and January 25, 2012, our trainees entered clinically significant events into i-touch/i-phone/i-pad based devices functioning in wireless-synchrony with our desktop application. Events were collected into daily reports that were sent from the handoff system to program leaders and attending physicians to plan for rounds and to correct safety problems. RESULTS: Using the mobile module, residents entered 31 reportable events per month versus the 12 events per month that were reported via desktop during a previous 6-month study period. CONCLUSIONS: Advances in information technology now permit clinically significant events that take place during "off hours" to be identified and reported (via handoff) to next providers and to supervisors via collated reports. This information permits hospital leaders to correct safety issues quickly and effectively, while attending physicians are able to use information gleaned from the reports to optimize rounding plans and to provide additional oversight of trainee on call patient management decisions.

Operationalizing the internal medicine milestones-an early status report.

BACKGROUND: The internal medicine milestones were developed to advance outcomes-based residency training and will play an important role in the next accreditation system. INNOVATION: As an element of our program's participation in the internal medicine educational innovations project, we implemented a milestones-based evaluation process in our general medicine and pulmonary-critical care rotations on July 1, 2010. MEASURES: Outcomes assessed included survey-rated acceptability to participating faculty, residents, and clinical competency committee members. RESULTS: Faculty and residents agreed that the milestones promoted a common understanding of what knowledge, skills, and attitudes should be displayed at particular points in residents' professional development and enhanced evaluators' ability to provide specific performance feedback. Most residents and faculty members agreed that the milestones promoted fairness and uniformity in the evaluation process. Clinical competency committee members agreed the milestones improved the quality of information available for deliberations and resulted in more uniform promotion standards. Faculty rated the use of too many milestones per form/tool at a mean of 7.3 (where 1 was minimally problematic, and 10 was maximally problematic) and the potential for evaluator fatigue (mean, 8.2) as the most significant challenges to the use of milestones. Eight of 12 faculty members would recommend milestones in other programs; 4 were uncertain. CONCLUSIONS: Despite logistical challenges, educators and trainees found that milestones promoted a common understanding of what knowledge, skills and attitudes should be displayed at particular stages of training; permitted greater specificity in performance feedback; and enhanced uniformity and fairness in promotion decisions.

Physician reporting of clinically significant events through a computerized patient sign-out system.

OBJECTIVES: : Although electronic reporting systems for near-misses and adverse events have been implemented nationwide, physician participation in such systems has typically been very limited. Previous efforts to improve such rates have met with some success but may be costly and time-consuming. To improve events reporting rates at our academic medical center, we incorporated a physician reporting module into the computer software that house officers already use for their daily sign-out routine. METHODS: : During the period between January 1 and June 30, 2009, house staff were asked to report a set of 13 predefined "clinically significant events" such as cardiopulmonary arrests and unexpected transfers to the intensive care unit. Entries were maintained in an administrative data collection module and were reviewed daily by the residency program director and chief residents. RESULTS: : House staff reported approximately 12 incidents per month. A survey of the intern class (the heaviest users of system) showed that the principal barriers to physician reporting at our facility were related to ease of use, time pressure, and fear of disciplinary actions. Information gleaned from the reports has been useful in modifying a number of patient care processes on the medicine service. CONCLUSIONS: : Our experience suggests that if a training program makes it easy for the house officer to report events during routine work duties, by integrating the reporting system into the tools of daily patient care, physicians will become willing participants in the process. A handheld version of such a reporting system holds promise for even greater physician participation in the future.

A multidisciplinary approach for teaching systems-based practice to internal medicine residents.

BACKGROUND: Rapid growth in the complexity of the health care environment (including monitoring systems for health care quality and patient safety) may result in graduating internists not being adequately prepared for the demands the system places on them. In response, the Residency Review Committee for Internal Medicine created the Educational Innovations Project (EIP) to encourage select residency training programs to develop new strategies and methods to meet changing demands in graduate medical education. METHODS: As part of the EIP, our program created an innovative administrative internship. This multiyear curriculum provides systems-based practice training and consists of a series of rotations that take place during the 3 years of internal medicine residency. Each session involves close interaction with the nonphysician personnel who are instrumental in making our institution a functional and cohesive unit. To assess the potential impact of the rotations, we survey senior residents, recent graduates, and faculty educators. In conjunction with the Performance and Patient Experience departments of the hospital, we track several systems-based practice metrics for residents, including compliance with core health care measures, length of stay, and patient satisfaction. RESULTS: Residents recognize the need to develop systems-based practice skills, to readily participate in structured curricula designed to enhance such skills, and to provide leadership in organizing and publishing quality improvement initiatives, and upon graduation, they may lament that they did not receive even more vigorous training in these areas. CONCLUSION: Although internal medicine residencies continue to improve their training in systems-based practice, our experience suggests that an even greater emphasis on these skills may be warranted.

Pathophysiology, diagnosis, and treatment of orthostatic hypotension and vasovagal syncope.

Orthostatic hypotension (OH) occurs in 0.5% of individuals and as many as 7-17% of patients in acute care settings. Moreover, OH may be more prevalent in the elderly due to the increased use of vasoactive medications and the concomitant decrease in physiologic function, such as baroreceptor sensitivity. OH may result in the genesis of a presyncopal state or result in syncope. OH is defined as a reduction of systolic blood pressure (SBP) of at least 20 mm Hg or diastolic blood pressure (DBP) of at least 10 mm Hg within 3 minutes of standing. A review of symptoms, and measurement of supine and standing BP with appropriate clinical tests should narrow the differential diagnosis and the cause of OH. The fall in BP seen in OH results from the inability of the autonomic nervous system (ANS) to achieve adequate venous return and appropriate vasoconstriction sufficient to maintain BP. An evaluation of patients with OH should consider hypovolemia, removal of offending medications, primary autonomic disorders, secondary autonomic disorders, and vasovagal syncope, the most common cause of syncope. Although further research is necessary to rectify the disease process responsible for OH, patients suffering from this disorder can effectively be treated with a combination of nonpharmacologic treatment, pharmacologic treatment, and patient education. Agents such as fludrocortisone, midodrine, and selective serotonin reuptake inhibitors have shown promising results. Treatment for recurrent vasovagal syncope includes increased salt and water intake and various drug treatments, most of which are still under investigation.

A comparison of humanistic qualities among medical students, residents, and faculty physicians in internal medicine.

Humanistic qualities of integrity, respect and compassion are important components of medical education. Studies, however, suggest that students may not perceive their faculty physicians as humanistic. Knowing how the perception of humanistic qualities varies by training level may offer insight on how we teach humanism. In this study, the authors compared humanistic quality scores of fourth-year medical students, internal medicine residents, and attending physicians on a general medicine ward of a teaching hospital. A validated nursing survey to assess humanistic qualities among physicians was distributed to randomly selected nurses on the medicine wards. The survey measured physician relationships with other medical staff, the patient, and family members. Each item was scored on a 5-point Likert scale. Composite scores for physician to staff relationships and physician to patient/family relationships, as well as an overall evaluation score, were compared across levels of physician training. A t test was done to determine statistical significance across training levels. No statistically significant differences were found between internal medicine residents and attending physicians. Subinterns appear to have better perceived qualities of humanism compared with resident and attending physicians. Because resident and attending physicians play an important role in medical education, efforts should be made to improve the perceived humanistic qualities of both resident and attending physicians.