Forensic Age Estimation of Individuals from Computed Tomography Analysis of Medial Clavicular Epiphysis in Pakistani Population.

OBJECTIVE: To determine the association of chronological age through ossification of the medial clavicular epiphysis using computed tomography (CT) scan. STUDY DESIGN: An Observational study. Place and Duration of the Study: Dow Institute of Radiology, Dow University Hospital, Karachi, Pakistan, from February 2021 till October 2021. METHODOLOGY: Subjects aged 10-35 years of either gender reported without any clavicular trauma or fracture, no known chronic illness or malignancy, or no congenital bony abnormalities, or any prior surgical intervention to the sterno-clavicular region were included. The fusion of maturity of medial clavicular epiphyses was evaluated on either side by using the five-stage classification system reported by Schmeling. RESULTS: Of 200 patients, a significant increase in the age of the patients was observed with respect to the increase in the stages (p <0.001). When stratified on the basis of gender, a significant increase in age was also observed with respect to the increase in stages (p <0.001). Stage 4 was observed in majority of the patients, i.e., 81 (40.5%), followed by stages 2 and 3 in 35 (17.5%) each, stage 5 in 32 (16%), while stage 1 was observed in 17 (8.5%) patients. An insignificant difference of age was observed with respect to the gender of the patients (p= 0.472, 95% CI -2.91 - 1.35). CONCLUSION: The fusion of the medial clavicular epiphysis showed a considerable degree of variability. Fused clavicles at stage 4 could be observed at age 22 years or less in males while at 21 years or less in females. KEY WORDS: Age estimation, Schmeling method, Medial clavicular epiphysis, Computed tomography.

The Use of Proton Pump Inhibitors and COVID-19: A Systematic Review and Meta-Analysis.

COVID-19 has proved to be a serious, and consequential disease that has affected millions of people globally. Previously, the adverse effects of proton pump inhibitors (PPI) have been observed with increasing the risk of pneumonia and COVID-19. This meta-analysis aims to address the relationship between the use of PPI and the severity of COVID-19 infection. We conducted a systemic literature search from PUBMED, Science Direct, and Cinahl from December 2019 to January 2022. Published and unpublished randomized control trials and cohort studies were included. Review Manager was used for all statistical analyses. In total, 14 studies were included in this systemic review and meta-analysis. Outcomes of interest include: (1) susceptibility of COVID-19 infection and (2) severity of COVID-19 (defined as the composite of poor outcomes: ICU admission, need for oxygen therapy, need for a ventilator, or death), and (3) mortality due to COVID-19. PPI use was marginally associated with a nominal but statistically significant increase in the risk of COVID-19 infection (OR 1.05 [1.01, 1.09]; I2 97%, p = 0.007). PPI use also increased the risk of the composite poor outcome (OR 1.84 [1.71, 1.99]; I2 98%, p < 0.00001) and mortality (OR 1.12 [1.00, 1.25]; I2 84%, p = 0.05) in patients with COVID-19.