Modulation in serum and hematological parameters as a prognostic indicator of COVID-19 infection in hypertension, diabetes mellitus, and different cardiovascular diseases.

SARS-CoV-2 infection affects and modulates serum as well as hematological parameters. However, whether it modifies these parameters in the existing disease conditions, which help in the erection of specific treatments for the disease, is under investigation. Here, we aimed to determine whether serum and hematological parameters alteration in various diseases, diabetes mellitus (DM), hypertension (HTN), ischemic heart disease (IHD) and myocardial infarction (MI) conditions correlate and signal SARS-CoV-2 infection, which could be used as a rapid diagnosis tool for SARS-CoV-2 infection in disease conditions. To assess the projected goals, we collected blood samples of 1,113 male and female patients with solo and multiple disease conditions of DM/HTN/IHD/MI with severe COVID-19, followed by biochemical analysis, including COVID-19 virus detection by RT-qPCR. Furthermore, blood was collected from age-matched disease and healthy individuals 502 and 660 and considered as negative control. In our results, we examined higher levels of serum parameters, including D-dimer, ferritin, hs-CRP, and LDH, as well as hematological parameters, including TLC in sole and multiple diseases (DM/HTN/IHD/MI) conditions compared to the control subjects. Besides, the hematological parameters, including Hb, RBC, and platelet levels, decreased in the patients. In addition, we found declined levels of leukocyte count (%), lymphocyte (%), monocyte (%), and eosinophil (%), and elevated level of neutrophil levels (%) in all the disease patients infected with SARS-CoV-2. Besides, NLR and NMR ratios were also statistically significantly (p < 0.05) high in the patients with solo and multiple disease conditions of DM/HTN/IHD/MI infected with the SARS-CoV-2 virus. In conclusion, rapid alteration of sera and hematological parameters are associated with SARS-CoV-2 infections, which could help signal COVID-19 in respective disease patients. Moreover, our results may help to improve the clinical management for the rapid diagnosis of COVID-19 concurrent with respective diseases.

Frequency and Causes of Traumatic and Non-traumatic Spinal Injury Reported at Two Major Tertiary Care Hospitals of Khyber Pakhtunkhwa.

Introduction Spinal cord injury, due to traumatic or non-traumatic causes, is a medically challenging and life-disrupting condition. The injury disrupts neural signaling and is a medical emergency requiring immediate treatment that can reduce long-term effects like paralysis or partial disability of the body. It has costly consequences both for individuals and families because it causes not only physical disability but dependency on others. The main objectives of the study were to determine the frequency of spinal injuries, their nature, and their causes. Materials and methods A descriptive exploratory study was conducted in the neurosurgery wards of two major hospitals of Peshawar, Lady Reading Hospital and Hayatabad Medical Complex. Necessary permission was taken from the administration of both hospitals before starting data collection. The duration of the study was three months, from October to December 2014. A total of 768 patients were retrieved from the ward records for 2013, from which a 50% random sample was taken (384 patients) while incomplete patient records were excluded. The data were transferred and recorded on a pre-constructed proforma covering all the required variables of the study. Finally, the data were transferred to SPSS 15 (SPSS Inc., Chicago) for analysis of descriptive statistics. In addition, comparisons were done by gender, hospitals, types of injuries, and causes of injuries. The chi-square test was used to compare groups for significant differences in frequencies, keeping p ≤0.05 as significant. Results Major factors for spinal cord injury were traumatic and non-traumatic. This study revealed that out of the total patients, 35% faced trauma as a cause of spinal disorder out of which 42%, 29%, and 21% were sudden falls, road traffic accidents (RTAs), and weight lifting, respectively. While non-traumatic causes were 52% mostly due to congenital anomalies (24%), stenosis (23%), and tumor (12%). Levels most commonly involved were lumbar (42.3%) followed by patients involving multiple levels (32.52%), L5-S1 (20.87%), thoracic (2.42%), and cervical (1.92%). Conclusions The traumatic injury was the leading cause of spinal cord injury in the present study where RTAs and falls contributed the most. Congenital abnormalities and spinal cord stenosis were more frequent among non-traumatic spinal cord injuries. The surgical approach was the only way of management practiced for spinal cord injuries in both of the tertiary care hospitals.

Microplastic Contamination of Chicken Meat and Fish through Plastic Cutting Boards.

Microplastic contamination was found in fish and chicken bought on the market, in food stores and in chain supermarkets in the Middle East with the contamination ranging from 0.03 ± 0.04 to 1.19 ± 0.72 particles per gram of meat in chicken and from 0.014 ± 0.024 to 2.6 ± 2.8 particles per gram in fish. Only one fish was found to be free of microplastic. The source of the microplastic was established to be the polythene-based plastic cutting board the food was cut on. More microplastic contamination was found in food cut from the bone than in cut fillets when the fillets themselves were prepared on surfaces other than plastic. Washing the fish and chicken before food preparation decreased but did not completely remove the microplastic contamination. The fate of the microplastic in grilled fish was studied. The mechanical properties of typical plastic cutting boards commercially used in the markets were investigated in the form of tensile, hardness, and wear tests. Overall, the plastic cutting boards showed similar wear rates.

Plastic cutting boards as a source of microplastics in meat.

Plastic cutting boards were found to be the source of polythene microplastic contamination in cut meat commercially available at butchers and a supermarket chain in the Middle East, making them also a direct source of microplastic in wastewater. The mean size of the microplastic in the raw meat was 1279.2 ± 835.0 µm, but decreased when the meat was cooked or fried. The microplastic melted during both cooking and frying processes and recrystallised partially upon cooling. Washing the meat for a short time (10 seconds) before preparing it reduced the microplastic contamination insignificantly, and only extensive washing of the meat over longer periods of time (3 min) helped decrease the microplastic count to 0.07 MP/g meat. The composition of the cutting boards was analysed by FT-IR spectroscopy, differential scanning calorimetry and subjected to wear, tensile and hardness tests. From a 3D photo of a spent cutting board, it was calculatedthat 875 g polythene was lost from the cutting board at the end of its lifetime.

Postoperative arginine-enriched immune modulating nutrition: Long-term survival results from a randomised clinical trial in patients with oesophagogastric and pancreaticobiliary cancer.

BACKGROUND & AIMS: Immune modulating nutrition (IMN) has been shown to reduce postoperative infectious complications and length of stay in patients with gastrointestinal cancer. Two studies of IMN in patients undergoing surgery for head and neck cancer also suggested that this treatment might improve long-term survival and progression-free survival. In the present study, we analysed follow-up data from our previous randomised controlled trial of IMN, in patients undergoing surgery for oesophagogastric and pancreaticobiliary cancer, in order to evaluate the long-term impact on survival of postoperative IMN versus an isocaloric, isonitrogenous control feed. METHODS: This study included patients undergoing surgery for cancers of the pancreas, oesophagus and stomach, who had been randomised in a double-blind manner to receive postoperative jejunostomy feeding with IMN (Stresson, Nutricia Ltd.) or an isonitrogenous, isocaloric feed (Nutrison High Protein, Nutricia) for 10-15 days. The primary outcome was long-term overall survival. RESULTS: There was complete follow-up for all 108 patients, with 54 patients randomised to each group. There were no statistically significant differences between groups by demographics [(age, p = 0.63), sex (p = 0.49) or site of cancer (p = 0.25)]. 30-day mortality was 11.1% in both groups. Mortality in the intervention group was 13%, 31.5%, 70.4%, 85.2%, 88.9%, and 96.3% at 90 days, and 1, 5, 10, 15 and 20 years respectively. Corresponding mortality in the control group was 14.8%, 35.2%, 68.6%, 79.6%, 85.2% and 98.1% (p > 0.05 for all comparisons). CONCLUSION: Early postoperative feeding with arginine-enriched IMN had no impact on long-term survival in patients undergoing surgery for oesophagogastric and pancreaticobiliary cancer.

Eosinophilic Fasciitis With a Malignant Outcome.

Eosinophilic fasciitis (EF) is an uncommon localized fibrosing disorder affecting the fascial layers of the human body. To date less than 300 cases of EF have been reported worldwide. Due to the limited prevalence, extensive studying of its pathogenesis and treatment has not yet been established. Furthermore, little is known regarding the long-term prognosis and comorbidities associated with EF. In this case study, we discuss a 72-year-old female patient who was diagnosed with EF and subsequently developed squamous cell carcinoma (SCC) of the skin in areas of previously exposed EF. This case represents the first reported case of SCC of the skin in a patient with previously active EF in the same area of skin.

Diagnostic Performance of Artificial Intelligence-Based Models for the Detection of Early Esophageal Cancers in Barret's Esophagus: A Meta-Analysis of Patient-Based Studies.

Introduction Barret's esophagus (BE) is a precursor of adenocarcinoma of the esophagus. The detection of high-grade dysplasia and adenocarcinoma at an early stage can improve survival but is very challenging. Artificial intelligence (AI)-based models have been claimed to improve diagnostic accuracy. The aim of the current study was to carry out a meta-analysis of papers reporting the results of artificial intelligence-based models used in real-time white light endoscopy of patients with BE to detect early esophageal adenocarcinoma (EEAC). Methods This meta-analysis was registered with the International Prospective Register of Systematic Reviews (PROSPERO; Reg No. CRD42021246148) and its conduction and reporting followed the Preferred Reporting Items for Systematic Review and Meta-Analysis of Diagnostic Test Accuracy (PRISMA-DTA) statement guidelines. All peer-reviewed and preprint original articles that reported the sensitivity and specificity of AI-based models on white light endoscopic imaging as an index test against the standard criterion of histologically proven early oesophageal cancer on the background of Barret's esophagus reported as per-patient analysis were considered for inclusion. There was no restriction on type and year of publication, however, articles published in the English language were searched. The search engines used included Medline, PubMed, EMBASE, EMCARE, AMED, BNI, and HMIC. The search strategy included the following keywords for all search engines: ("Esophageal Cancer" OR "Esophageal Neoplasms" OR " Oesophageal Cancer" OR "Oesophageal Neoplasms" OR "Barrett's Esophagus" OR "Barrett's Oesophagus") And ("Artificial Intelligence" OR "Deep Learning" OR "Machine Learning" OR "Convolutional Network"). This search was conducted on November 30, 2020. Duplicate studies were excluded. Studies that reported more than one dataset per patient for the diagnostic accuracy of the AI-based model were included twice. Quantitative and qualitative data, including first author, year of publication, true positives (TP), false negatives (FN), false positives (FP), true negatives (TN), the threshold of the index test, and country where the study was conducted, were extracted using a data extraction sheet. The Quality Appraisal for Diverse Studies 2 (QUADS-2) tool was used to assess the quality of each study. Data were analyzed using MetaDTA, interactive online software for meta-analysis of diagnostic studies. The diagnostic performance of the meta-analysis was assessed by a summary receiver operating characteristics (sROC) plot. A meta-analysis tree was constructed using MetaDTA software to determine the effect of cumulative sensitivity and specificity on surveillance of patients with BE in terms of miss rate and overdiagnosis. Results The literature search revealed 171 relevant records. After removing duplicates, 117 records were screened. Full-text articles of 28 studies were assessed for eligibility. Only three studies reporting four datasets met the inclusion criteria. The summary sensitivity and specificity of AI-based models were 0.90 (95% CI, 0.83- 0.944) and 0.86 (95% CI, 0.781-0.91), respectively. The area under the curve for all the available evidence was 0.88. Conclusion Collective evidence for the routine usage of AI-based models in the detection of EEAC is encouraging but is limited by the low number of studies. Further prospective studies reporting the patient-based diagnostic accuracy of such models are required.

Extensive Coronary Thrombosis as a Sequelae of COVID-19 Presenting as a STEMI.

Thrombotic complications, in particular ST-elevation myocardial infarction (STEMI), have been described in active Coronavirus disease 2019 (COVID-19) cases. This is a result of systemic inflammation that often leads to endothelial activation, microvascular thrombosis and a hypercoagulable state. However, it is unknown how long patients who have cleared the COVID-19 infection remain at risk for coronary thrombosis as a sequela of disease burden. We present a case of a patient who presented three to four weeks following the initial infection.

A Comprehensive Review on Optimal Welding Conditions for Friction Stir Welding of Thermoplastic Polymers and Their Composites.

Friction stir welding (FSW) and friction stir spot welding (FSSW) techniques are becoming widely popular joining techniques because of their increasing potential applications in automotive, aerospace, and other structural industries. These techniques have not only successfully joined similar and dissimilar metal and polymer parts but have also successfully developed polymer-metallic hybrid joints. This study classifies the literature available on the FSW and FSSW of thermoplastic polymers and polymer composites on the basis of joining materials (similar or dissimilar), joint configurations, tooling conditions, medium conditions, and study types. It provides a state-of-the-art and detailed review of the experimental studies available on the FSW and FSSW between similar thermoplastics. The mechanical properties of FSW (butt- and lap-joint configurations) and FSSW weld joints depend on various factors. These factors include the welding process parameters (tool rotational speed, tool traverse speed, tool tilt angle, etc.), base material, tool geometry (pin and shoulder size, pin profile, etc.) and tool material, and medium conditions (submerged, non-submerged, heat-assisted tooling, cooling-assisted tooling). Because of the dependence on many factors, it is difficult to optimize the welding conditions to obtain a high-quality weld joint with superior mechanical properties. The general guidelines are established by reviewing the available literature. These guidelines, if followed, will help to achieve high-quality weld joints with least defects and superior mechanical properties. Apart from parametric-based studies, the statistical-based studies (e.g., analysis of variance (ANOVA)-based studies) are covered, which helps with the determination of the influential parameters that affect the FSW and FSSW weld joint strength. Also, the optimal ranges of the most influential process parameters for different thermoplastic materials are established. The current work on the development of general guidelines and determination of influential parameters and their operating ranges from published literature can help with designing smart future experimental studies for obtaining the global optimum welding conditions. The gaps in the available literature and recommendations for future studies are also discussed.

Cor Triatriatum Dexter: A Case Report in a 70-Year-Old Male.

Cor triatriatum dexter (CTD) is a rare congenital heart disease resulting from persistence of the right valve of the sinus venosus. The persistent valve forms a membrane that divides the right atrium into a proximal and a distal chamber. This disorder exhibits varying clinical manifestations depending on the degree of partitioning or septation of the right atrium. In asymptomatic patients, the disease may be discovered during surgical procedures, diagnostic testing such as echocardiography, or hemodynamic monitoring. Severe septation abnormalities may cause right-sided heart failure and elevated central venous pressures due to obstruction of the tricuspid valve, right ventricular outflow tract, or inferior vena cava. Here we report a case of CTD in a patient presenting with symptoms of dyspnea and fatigue, followed by a short discussion of the embryology and clinical implications of this congenital disease, as well as current advances in management.

Pulmonic valve infective endocarditis from staph lugdunensis.

Pulmonic valve endocarditis is an extremely rare entity. Only 1.1% of all cases of all infective endocarditis affect the pulmonic valve. Furthermore, it is even more uncommon for such a disease process to occur in a young and healthy individual without risk factors. It takes a unique case of circumstances to have pulmonic valve infective endocarditis to occur. Staph lugdunensis is one uncommonly isolated organism that has the ability to cause infective endocarditis in various atypical manifestations. Here we describe a case of a 20-year-old male who did not possess any of the common risk factors of infective endocarditis, who developed isolated pulmonic valve endocarditis caused by Staphylococcus lugdunensis (S. lugdunensis). Based upon our literature review, only 1 other case of S. lugdunensis endocarditis affective the pulmonic valve has been reported.

Transcatheter Double Valve-in-Valve Replacement of Aortic and Mitral Bioprosthetic Valves.

Transcatheter aortic valve replacement (TAVR) is an evolving method which has become the treatment of choice in high-risk patients with severe aortic stenosis. Unlike TAVR, the experience with transcatheter mitral valve replacement (TMVR) remains at an early stage because of challenges of valve development and possible complications such as valve displacement and subsequent left ventricular outlet tract (LVOT) obstruction. Here we report a case of transcatheter double valve-in-valve replacement (TDVIVR) in a patient with severe mitral and aortic bioprosthetic valve stenosis, followed by an extensive literature review of the latest techniques and challenges in this field.

Noninvasive Treatment Approach of Radial Pseudoaneurysm.

Transradial approach for cardiac catheterization is a viable alternative to transfemoral approach given its ease of access, lessened complication risk, and post procedural comfort for patients. Radial pseudoaneurysm presents as a rare complication in less than 1% of these procedures. The use of external compression banding is an approach that shows promise as a noninvasive attempt towards resolving this complication. However, it has been documented in very few reports. We describe a case of an 82-year-old woman who underwent transradial approach to cardiac catheterization, and developed a radial pseudoaneurysm following the procedure as confirmed by Doppler ultrasonography. We used compressive banding as a technique to attempt to resolve this radial pseudoaneurysm. Following a strict protocol of pneumatic banding, repeat ultrasonography revealed complete resolution of radial pseudoaneurysm. This case highlights a potentially noninvasive technique that could serve as a first-line approach towards resolving this rare phenomenon.

Selective oestrogen receptor antagonists inhibit oesophageal cancer cell proliferation in vitro.

BACKGROUND: Oestrogen receptors (ER) have a well-established role to the initiation, progression and regulation of responses to treatment of breast, prostate, and lung cancers. Previous data indicates altered ER expression in oesophageal cancers (OC). However the role of ER subtypes and ER specific inhibitors in the regulation of OC progression remains unclear. This study sought to assess levels of ERα and ERß in OC. The effects of highly selective ER antagonists on cell proliferation and apoptosis in two OC adenocarcinoma cell lines was also studied. METHODS: ERα and ERß expression profiling in paired normal oesophageal mucosa and tumour tissues (n = 34; adenocarcinoma n = 28; squamous cell carcinoma n = 6) was performed using quantitative reverse transcription polymerase chain reaction (qRT-PCR). Correlation between levels of ER with the clinico-pathological features for OC was determined. The effect of selective ER antagonists on proliferation of OE33 and OE19 OC cell lines was studied. RESULTS: ERα and ERß mRNA expression was significantly higher (p < 0.05) in tumour tissues relative to their paired normal mucosa and correlated inversely with survival outcome (p < 0.05). Upregulation of ERα mRNA correlated with higher pathological T-stage (p < 0.05) and lymph node metastasis (p < 0.05) while ERß mRNA upregulation correlated with positive vascular invasion (p < 0.05). A significant concentration-dependent inhibition of proliferation in OE33 and OE19 cell lines was induced by a highly-selective ERα antagonist (MPP) and an ERß specific antagonist (PHTPP) (p < 0.05). Moreover, anti-oestrogens induced cell death through stimulation of apoptotic caspase activity. CONCLUSION: These findings indicate that the ER system is involved in OC progression and thus may provide a novel target for the treatment of OC.

A review on gastric diverticulum.

The gastric fundal diverticulae are rare. They can present with variable symptoms. We are enclosing a literature review on gastric fundal diverticulum. Lessons have emerged which may help in the management of this rare condition in future.

Accidental finding of a toothpick in the porta hepatis during laparoscopic cholecystectomy: a case report.

INTRODUCTION: Unintentional ingestion of a toothpick is not an uncommon event. Often the ingested toothpicks spontaneously pass through the gut without sequelae. However, serious complications can happen when these sharp objects migrate through the gastrointestinal wall. CASE PRESENTATION: In the current report, we describe the case of a 37-year-old Caucasian woman with an incidental finding of a toothpick in the porta hepatis during laparoscopic cholecystectomy for symptomatic gall stones. CONCLUSION: Toothpick ingestion is not an uncommon event and can predispose patients to serious complications. In this particular case, the toothpick was only discovered at the time of unrelated surgery. Therefore, it was important during surgery to exclude any related or missed injury to the adjacent structures by this sharp object.

Probing the link between oestrogen receptors and oesophageal cancer.

BACKGROUND: Human oesophageal carcinoma is considered to be one of the most aggressive malignancies and has a very poor prognosis. The incidence of oesophageal cancer shows a gender bias and is higher in males compared with females, the ratio between males and females varying from 3:1 to 7:1. This sex ratio is not entirely attributable to differences in the prevalence of known risk factors between the sexes. The potential role of oestrogen receptors (ER) in oesophageal cancer has been debated for several years but the significance of the receptors in this cancer remains unknown. Most of the work has been based on immunohistochemistry and has not been validated with other available techniques. The inconsistencies in the published literature on the link between ER expression and oesophageal cancer warrant a thorough evaluation of the potential role of ERs in this malignancy. Even the expression of the two ER isoforms, ERalpha and ERbeta, and its implications for outcome of treatments in histological subtypes of oesophageal tumours is ill defined. The aim of this article is to provide updated information from the available literature on the current status of ER expression in oesophageal cancer and to discuss its potential therapeutic role. METHODS AND RESULTS: We performed a comprehensive literature search and analysed the results regarding ER expression in oesophageal tumours with special emphasis on expression of different oestrogen receptors and the role of sex hormones in oesophageal cancer. This article also focuses on the significance of the two main ER subtypes and mechanisms underlying the presumed male predominance of this disease. CONCLUSION: We postulate that differential oestrogen receptor status may be considered a biomarker of poor clinical outcome based on tissue dedifferentiation or advanced stage of the disease. Further, if we can establish the importance of oestrogen and its receptors in the context of oesophageal cancer, then this may lead to a new future direction in the management of this malignancy.

A pre-operative elevated neutrophil: lymphocyte ratio does not predict survival from oesophageal cancer resection.

BACKGROUND: Elevated pre-operative neutrophil: lymphocyte ratio (NLR) has been identified as a predictor of survival in patients with hepatocellular and colorectal cancer. The aim of this study was to examine the prognostic value of an elevated preoperative NLR following resection for oesophageal cancer. METHODS: Patients who underwent resection for oesophageal carcinoma from June 1997 to September 2007 were identified from a local cancer database. Data on demographics, conventional prognostic markers, laboratory analyses including blood count results, and histopathology were collected and analysed. RESULTS: A total of 294 patients were identified with a median age at diagnosis of 65.2 (IQR 59-72) years. The median pre-operative time of blood sample collection was three days (IQR 1-8). The median neutrophil count was 64.2 x 10-9/litre, median lymphocyte count 23.9 x 10-9/litre, whilst the NLR was 2.69 (IQR 1.95-4.02). NLR did not prove to be a significant predictor of number of involved lymph nodes (Cox regression, p = 0.754), disease recurrence (p = 0.288) or death (Cox regression, p = 0.374). Furthermore, survival time was not significantly different between patients with high (>or= 3.5) or low (< 3.5) NLR (p = 0.49). CONCLUSION: Preoperative NLR does not appear to offer useful predictive ability for outcome, disease-free and overall survival following oesophageal cancer resection.

A review on delayed presentation of diaphragmatic rupture.

Diaphragmatic rupture is a life-threatening condition. Diaphragmatic injuries are quite uncommon and often result from either blunt or penetrating trauma. Diaphragmatic ruptures are usually associated with abdominal trauma however, it can occur in isolation. Acute traumatic rupture of the diaphragm may go unnoticed and there is often a delay between the injury and the diagnosis. A comprehensive literature search was performed using the terms "delayed presentation of post traumatic diaphragmatic rupture" and "delayed diaphragmatic rupture". The diagnostic and management challenges encountered are discussed, together with strategies for dealing with them. We have focussed on mechanism of injury, duration, presentation and site of injury, visceral herniation, investigations and different approaches for repair. We intend to stress on the importance of delay in presentation of diaphragmatic rupture and to provide a review on the available investigations and treatment methods. The enclosed case report also emphasizes on the delayed presentation, diagnostic challenges and the advantages of laparoscopic repair of delayed diaphragmatic rupture.

Is harmonic scalpel an effective tool for oesophagectomy?

INTRODUCTION: Use of electrocautery in oesophagectomy is standard; however, the introduction of the harmonic scalpel (HS) and its use has changed the methodology of oesophagectomy in recent years. We have assessed the efficiency of HS in oesophageal cancer surgery. The parameters studied were blood loss, transfusion rates, and postoperative complications. METHODS: Our cohort included 142 patients who underwent elective oesophagectomy from January 1999 to December 2004. The control group was the patients undergoing electrocautery oesophagectomy (n=98) between 1999 and 2002. Furthermore, 44 patients who were operated with the HS were included in the study group. RESULTS: The numbers of units transfused were significantly less in HS group (median 0) in comparison with controls (median 2), p=0.003. Median blood loss in HS and the controls was 500 and 700 ml respectively (p=0.123). Mortality in HS group was 2.27%compared to 3.06% in controls (p=0.14). The complication (principally respiratory) rate was only 13.6% of patients in HS group compared to 17.3% in the controls. CONCLUSION: Our study shows that HS reduces transfusion rates and postoperative complications, highlighting it as a safe and effective alternative to traditional electrocautery.