Association between D-Dimer levels and mortality in patients with coronavirus disease 2019 (COVID-19): a systematic review and pooled analysis.

BACKGROUND: Several observational studies have reported elevated baseline D-dimer levels in patients hospitalized for moderate to severe coronavirus disease 2019 (COVID-19). These elevated baseline D-dimer levels have been associated with disease severity and mortality in retrospective cohorts. OBJECTIVES: To review current available data on the association between D-Dimer levels and mortality in patients admitted to hospital for COVID-19. METHODS: We performed a systematic review of published studies using MEDLINE and EMBASE through 13 April 2020. Two authors independently screened all records and extracted the outcomes. A random effects model was used to estimate the standardized mean difference (SMD) with 95% confidence intervals (CI). RESULTS: Six original studies enrolling 1355 hospitalized patients with moderate to critical COVID-19 (391 in the non-survivor group and 964 in the survivor group) were considered for the final pooled analysis. When pooling together the results of these studies, D-Dimer levels were found to be higher in non-survivors than in-survivors. The SMD in D-Dimer levels between non-survivors and survivors was 3.59µg/L (95% CI 2.79-4.40µg/L), and the Z-score for overall effect was 8.74 (P<0.00001), with a high heterogeneity across studies (I2=95%). CONCLUSIONS: Despite high heterogeneity across included studies, the present pooled analysis indicates that D-Dimer levels are significantly associated with the risk of mortality in COVID-19 patients. Early integration of D-Dimer testing, which is a rapid, inexpensive, and easily accessible biological test, can be useful to better risk stratification and management of COVID-19 patients.

[Obesity and the severity of asthma crisis]. / Obésité et sévérité de la crise d'asthme.

INTRODUCTION: Obesity is associated with inflammatory processes, which could influence the airway inflammation that is found in patients with asthma. Obesity may thus have a role in the development of asthma. However, the role of obesity in the severity of acute asthma has not been well described. PATIENTS AND METHODS: We performed a retrospective study, which included 77 patients hospitalized for acute asthma. Two groups of patients were formed according to their body mass index (BMI): group 1 consisting of 59 patients with a BMI inferior to 30 kg/m(2) and group 2 consisting of 18 patients with a BMI superior or equal to 30 kg/m(2). These two groups were compared according to demographic factors, clinical features and the spirometric severity of asthma. RESULTS: The mean age was 43 ± 17.4 years with a sex-ratio 0.57 (28 men/49 women). Thirty-one percent of these patients had a severe asthma attack requiring hospitalization in intensive care in four patients with the use of mechanical ventilation in two patients. The comparison between obese and non-obese patients did not show a significant difference in the severity of asthma. CONCLUSION: Although a contribution of obesity to the manifestation and severity of asthma is commonly recognized, the present data to not confirm the impact of obesity on the severity of acute attacks.

[Anxiety-depressive disorders and bronchiectasis]. / Troubles anxiodépressifs et dilatation des bronches.

INTRODUCTION: Bronchiectasis is a chronic lung disease that may be associated with anxiety-depressive disorders affecting the quality of life of patients. Detecting these anxiety-depressive disorders may be necessary in the support and overall management of a patient with bronchiectasis. AIMS: To evaluate the prevalence of anxiety and depression in patients with bronchiectasis and to investigate the possible correlation between the severity of the disease and the importance of these psychological disorders. PATIENTS AND METHODS: This was a prospective study that included 53 patients with stable bronchiectasis and without other comorbidities. All the patients underwent a complete clinical examination, spirometry and chest computed tomography. All the 53 patients responded to the Hospital Anxiety and Depression Scale (HAD) questionnaire. RESULTS: Anxiety was present in 22.7% of patients and depression in 20.8%. Subjects who had an anxiety disorder had symptoms primarily of dyspnoea (P=0.001), a low FEV (P=0.04) and respiratory failure at a stage requiring home oxygen therapy (P=0.009). A similar comparison of patients with and without depressive disorder again found a high prevalence of dyspnea (P=0.003), a low FEV (P=0.04), and chronic respiratory failure in the depressive patients. CONCLUSION: Symptoms of depression and anxiety are common in patients with bronchiectasis and appear to be associated with dyspnoea. Early detection is necessary in the context of the overall management of these patients.

[Right upper lobe pulmonary agenesis]. / Agénésie pulmonaire lobaire supérieure droite.

INTRODUCTION: Pulmonary agenesis is a rare congenital anomaly. Other cardiovascular, gastrointestinal, musculoskeletal, and urogenital system anomalies can be observed in association with it. CASE REPORT: A 24-year-old female patient presented to our clinic with a history of cough and chest pain with an abnormal chest X-ray. Physical examination was normal. Chest X-ray, CT-Scan and endoscopy led to the diagnosis of right upper lobe pulmonary agenesis. CONCLUSION: The diagnosis of pulmonary malformations like agenesis or hypoplasia can be delayed and may not occur until adulthood. Once the diagnosis has been established medical follow up is mandatory.

[Smoking habits and severity of obstructive sleep apnea hypopnea syndrome]. / Tabagisme et sévérité du syndrome d'apnées hypopnées obstructives du sommeil.

INTRODUCTION: Smoking habits have many adverse health effects. The effect of tobacco on obstructive sleep apnea hypopnea syndrome is well-documented but the effect on the severity of this syndrome has not been completely established. AIM OF THIS STUDY: Evaluate the effect of tobacco on the severity of sleep apnea hypopnea syndrome. PATIENTS AND METHODS: During 4 years 307, patients were referred to our department for a suspicion of obstructive sleep apnea hypopnea syndrome. Among these patients, only 151 patients had an obstructive sleep apnea syndrome confirmed by nocturnal polygraph. Smoking status, clinical and spirometric data were determined in these 151 patients. RESULTS: Among these 151 patients, 101 were non-smokers and 50 current smokers. The apnea and hypopnea index (AHI) were higher among current smokers than non-smokers (42.96/h versus 28.77/h; P<0.0001). The percent of patients who had a not severe obstructive sleep apnea syndrome were higher among non-smokers than current smokers patients (P=0.009). Current smokers were 3.7 times more likely having severe obstructive sleep apnea hypopnea syndrome than non-smokers (OR=3.7; P=0.001). CONCLUSION: Smoking habits seems to be associated with the severity of obstructive sleep apnea syndrome that's why smoking cessation is very important in the treatment of obstructive sleep apnea hypopnea syndrome.

Incisive suture (fissure) in the human fetus: radiographic and histologic study.

OBJECTIVE: An anatomic study, in man, of the structure commonly known as the incisive suture (sutura incisiva) or incisive fissure has been performed to determine whether this structure belongs to the morphofunctional concept of a facial suture. MATERIAL: Eighteen palates of human fetuses of 9 weeks to 29 weeks after conception. METHOD: Anatomic, radiographic examination of the palate. Histologic study of sagittal and parasagittal sections of the palates (3 mm each). RESULTS: The histologic aspect is that of a facial suture, with very poor vascularization. This suture is partial, limited laterally by osseous trabeculae. CONCLUSIONS: This particular suture, whose function in growth of the palatal process of the maxilla is discussed, could represent the phylogenetic vestige of the incisive-maxillary suture present in all nonhuman mammals.

Contrasted frequencies of p53 accumulation in the two age groups of North African nasopharyngeal carcinomas.

EBV-associated nasopharyngeal carcinomas (NPCs) from Southeast Asia and North Africa have many common clinical and biological characteristics. However, they differ with regard to their age distribution. In Asia, NPC mainly affects patients in the 4th or 5th decade of their life, whereas in North Africa an additional peak of incidence is found between the ages of 10 and 20. The p53 gene is rarely mutated in NPC. However, several groups have reported a consistent accumulation of p53 in Asian NPCs. To determine whether p53 was also accumulated in North African NPCs, we investigated its expression, by immunohistochemistry, in a series of 90 Tunisian biopsies. Bc12 and CD95, two proteins involved in the regulation of cell survival and apoptosis, were investigated in the same study. We found accumulation of p53 in 81% of the cases for patients over 30 years of age, but in only 38% of specimens for younger patients (P = 0.00013). There was a trend toward a higher frequency of Bc12 detection in patients over 30, but it was not statistically significant. CD95 expression was detected in all biopsies, generally at a high level, even at advanced stages of the disease. The changing frequency of p53 accumulation, below and over 30, suggests that NPC cells often achieve malignant transformation through different pathways in both age groups.

Maxillary ossification in a series of six human embryos and fetuses aged from 9 to 12 weeks of amenorrhea: clinical implications.

An anatomic controversy exists concerning the number of nuclei of ossification of the maxilla in human embryos and fetuses. Many authors have described two maxillary ossification nuclei, an incisor nucleus and a maxillary nucleus properly so-called. Some of these have explained congenital labiomaxillary clefts by a defect of bony fusion between these two ossification nuclei. Others consider that there is only a single nucleus for maxillary ossification. In order to settle this question we performed a histologic study in six heads of embryos and fetuses aged from 9 to 12 weeks of amenorrhea (WA) to demonstrate the presence of one or more sites of maxillary ossification at the earliest stages. Our study revealed, on each side, a single zone of maxillary ossification, present from 9 WA, in the form of a sheet of osteoid tissue situated in close contact with the dental lamina. Maxillary ossification then progressed in the lateromedial direction, preserving a median transverse and ventral mesenchymal septum. This septum may constitute the phylogenetic remnant of an ancestral premaxilla.

Case series of uterine rupture and subsequent pregnancy outcome.

OBJECTIVE: TO review the incidence of ruptured uterus at Women's Hospital, Hamad Medical Corporation (HMC), highlight the management approach of suture repair in relation to maintaining the patient's future fertility, and study subsequent pregnancy outcome and the risk of recurrent uterine rupture. METHODS: Case notes were reviewed for every patient with a ruptured uterus at the Women's Hospital in Doha for a period of 15 years, from 1 January 1983 to 31 December 1997. RESULTS: There were 17 cases of ruptured uterus. The incidence of ruptured uterus was calculated to be 0.012%; eight (47%) of these occurred in patients with previous cesarean scars, while nine cases (52.9%) were grand multiparas (5 or more). In nine cases (52.9%), uterine rupture was associated with oxytocin use, and four patients (23.5%) were associated with prostaglandin E2 (PGE2) use. The ruptures occurred in the posterior uterine wall in one patient, the scar of a classical cesarean section in another, and in the lower segment in the remainder. Fetal heart abnormalities were observed in all cases in which the uterus ruptured during labor. Abdominal hysterectomy was performed in eight cases (47%). The remaining nine patients had suture repair, two with sterilization, and the other seven without sterilization. Six of these subsequently became pregnant, for a total of ten babies, all delivered by cesarean section. CONCLUSION: Even though rupture of the uterus was rare in our study, its occurrence should be suspected when there are sudden fetal heart abnormalities during labor or unexpected antepartum or postpartum hemorrhage. Suture repair should be considered whenever possible to maintain the patient's future fertility.

Rupture of the pregnant uterus--a 21-year review.

OBJECTIVES: To review the incidence of ruptured uteri at the Women's Hospital, Hamad Medical Corporation (HMC) and to analyze the causative factors of uterine rupture with a view to its prevention and to highlight the management approach taken to preserve the patient's reproductive potential. METHODS: Case notes were reviewed for all patients (except for eight which were not available) with a ruptured uterus at the Women's Hospital in Doha for a period of 21 years from 1 July 1977 to 30 June 1997, relevant data relating to the clinical features characteristics of labor, operative procedures, and maternal perinatal outcome were assessed. RESULTS: There were 31 cases of ruptured uteri. The incidence of ruptured uteri was calculated to be 0.017%, 23 cases being available for the study. Ten cases (43.5%) occurred in patients with previous cesarean scars, while 13 cases (56.5%) were grand multiparous (para 5 or more). In 10 cases (43.5%) uterine rupture was associated with oxytocin use, and four cases (18.2%) were associated with PGE2 use. The ruptures occurred in the lower segment of 19 cases (90.9%). Fetal heart abnormalities were observed in all cases except one in which the uterus ruptured during labor. Abdominal hysterectomy was performed in 15 cases (65.2%). The remaining eight patients had suture repair, two of them had suture repair with sterilization and the other six cases (26.1%) had suture repair without sterilization. Five of them became pregnant and were delivered by cesarean section. CONCLUSIONS: Even though rupture of the uterus was rare in our study, its occurrence should be suspected when there are sudden fetal heart abnormalities during labor or unexpected postpartum shock. Suture repair should be considered whenever possible in order to maintain the patient's future fertility.

[Evolutive morphology of the olfactory bulb in man and certain non-human mammals]. / Morphologie évolutive du lobe olfactif chez l'Homme et quelques Mammifères non humains.

Human and comparative anatomy of the olfactory lobe and the anterior floor was studied in 241 patients and 27 specimens (2 human fetuses, 4 specimens from adult humans, 11 non human primates and 10 carnivorous mammals). Macroscopic morphology and imaging data (CT-scan, 3D) reconstruction and magnetic resonance imaging) were obtained at the same time. The results obtained provide radiographic knowledge of the olfactory bulb ontogenesis and a basis for recognizing inborn or acquired pathology of the olfactory bulb. Evidence was also obtained for distinguishing between macrosmatic and microsmatic criteria in mammals.

Reconstruction of the aortic arches of a 28-day human embryo (stage 13) using the Born technique.

We present a reconstruction of the aortic arches of a human embryo at stage 13. Only a few original observations have been reported during the last 110 years and only two with three-dimensional reconstructions. The reconstruction technique originated in 1885. Modern computerized reconstruction techniques have no evident advantages and are more expensive. Aortic arch malformations are responsible for disorders which cannot be understood without a knowledge of their embryology. The embryonic aortic system is a typical example of Haeckel's law of recapitulation. A human embryo at stage 13 was prepared in 5 mm sagittal sections so as to reconstruct the entire dorsal aorta, the second (transient) arch, the third and fourth arches, and the sixth arches responsible for the pulmonary artery, pharynx, larynx and tracheoesophageal axis. They are only 5 pairs of arches in man. At this stage, the most important vessel is represented by the dorsal aorta with a cerebral route, due to predominance of the development of the central nervous system and its vascularisation over other organs. Vascularisation of the lower limbs appears before their macroscopic development and is probably one of the factors responsible for their growth. Many such reconstructions are necessary if conclusions are not to be based on too few specimens to be sound. A better knowledge of embryology lead to a new understanding of aortic arch malformations.

Gynaecological malignancies in Qatar.

Gynaecological malignancies constitute 6.88% (144 of 2092) of all malignant lesions in Qatar over a 15 year period (1979-1993). Cancer of the cervix was the most common with 54.86% followed by ovarian cancer 22.91%, endometrium 15.97%, vulva and vagina 2.75% and 2.08% respectively. Malignancies of the corpus uteri were rare. No tumours of the Fallopian tubes were registered during the study period. Early marriage, frequent coitus started early in life and increasing number of pregnancies were predisposing factors for the genesis of cancer of the cervix. As in some other developing countries, cervical and ovarian neoplasms tend to occur in the younger age group. Germ cell and gonadal stromal tumours were rare in Qatar and this may suggest rarity of these tumours in women of Arab and Indian subcontinent descent. Increasing number of pregnancies seems to protect against ovarian cancer. Abortions and age at menarche do not influence the incidence of gynaecological malignancies. Our findings provide an adequate data base for planning of gynaecological cancer education, screening programmes and resource allocation in Qatar.

[Human ontogeny of the left colon. Fetal stage]. / Ontogénèse humaine du côlon gauche. Etape foetale.

Foetal evolution of bowel is the result of unequal growth of its segments and abdominal constraint of pressure. Caecum and appendix on the cranial and right side of intestine torsion differentiate colic anlage. Left colon observations in 20 foetus reveal a dorsal peritoneal fusion between 12 and 17 weeks: Progressive growth of left colon and meso, without dorsal fixation, beyond left kidney and subrenal gland. First mesocolon fixation at the left kidney. A tunnel persist between this fusion and the primitive mesocolon root. Radial advance of peritoneal fusion up to sigmoid mesocolon, with disappearance of the tunnel. Peritoneal fusion confirmed by histology.

[Volvulus of the superior mesenteric area and congenital variation of the colonic fixation. Human Ontogenesis and Physiopathology. Apropos of a case in an adolescent]. / Volvulus du territoire mésentérique supérieur et variation congénitale de fixation colique. Ontogenèse Humaine et Physiopathologie. A propos d'un cas chez un adolescent.

Volvulus of the superior mesenteric territory involving the left and transverse colon is rare. Congenital variations of intestinal fixation have been implicated. We report a case observed in an adolescent which illustrates this hypothesis. There was a fixation of pancreatosplenic region and the left colic angle. The duodenopancreas and the right, transverse and left colon were mobile. Human ontogenesis of the colon could provide a pathophysiologic explanation. During foetal development, the intestine results from unequal growth of the different segments which undergo pressure from the different intra-abdominal contents. The fixation of the different parts of the intestine are independent from each other. Specific circumstances are required for variations in congenital fixation of the colon to led to late events responsible for mechanical volvulus.