On My Oath.

Most osteopathic medical students will take an oath adopted in 1954 by the American Osteopathic Association. We examine this oath to explore its ethical content by focusing on two specific lines. We conclude that the oath would benefit from scrupulous revision to promote patient-centered care.

Sicyopterus garra Hora, 1925, a valid species of sicydiine goby from the Andaman Islands, India.

Sicyopterus garra Hora, 1925 from the insular streams of South Andaman Islands was synonymized with Sicyopterus microcephalus described from Java, South East Asia and has retained this taxonomic status since then. Recent collections of Sicyopterus from the type locality of S. garra and the examination of syntypes of this species revealed significant morphological and genetic differences from S. microcephalus and the other Sicyopterus species with papillae on upper lip. S. garra is thus a valid species and not a synonym of S. microcephalus. S. garra differs from S. microcephalus in having fewer lateral scales 53-59 vs. 57-68, fewer zigzag series (12-14 vs. 13-16), a longer caudal peduncle length (16-21 vs. 13-17), and by having a high percentage of divergence in COI gene (5.5%-5.8%).

Characteristics and health risk assessment of fine particulate matter and surface ozone: results from Bengaluru, India.

Urban air pollution is a complex problem, which requires a multi-pronged approach to understand its dynamics. In the current study, various aspects of air pollution over Bengaluru city were studied utilizing simultaneous reference-grade measurements (during the period July 2019 to June 2020) of fine particulate matter mass concentration (PM2.5), aerosol black carbon mass concentrations (BC), and surface ozone (O3) concentrations. The study period mean PM2.5, BC, and O3 were observed to be 26.8 ± 11.5 µg m-3, 5.6 ± 2.8 µg m-3, and 25.5 ± 12.4 ppb, respectively. Statistical methods such as principal component analysis, moving average subtraction method, conditional bivariate probability function, and concentration weighted trajectory analysis were performed to understand the dynamics of air pollution over Bengaluru and its long-range transportation pathways. Some of the major findings from the statistical analyses include (i) contrasting association in BC versus O3 and PM2.5 versus O3; (ii) around one-fourth of the observed receptor site BC was contributed by local sources/emissions; and (iii) the source locations potentially contributing to BC and PM2.5 were spatially different. In Bengaluru, long-term exposure to PM2.5 resulted in around 3413, 3393, 1016, and 147 attributable deaths for the health endpoints chronic obstructive pulmonary disorder, ischemic heart disease, stroke, and lung cancer, respectively. Long-term exposure to O3 resulted in around 155 attributable deaths for respiratory diseases, as estimated by the AirQ + model. Finally, the limitations of the study in terms of data availability and analysis have been detailed.

B and T cell epitope-based peptides predicted from clumping factor protein of Staphylococcus aureus as vaccine targets.

Staphylococcus aureus infection is emerging as a global threat because of the highly debilitating nature of the associated disease's unprecedented magnitude of its spread and growing global resistance to antimicrobial medicines. Recently WHO has categorized these bacteria under the high global priority pathogen list and is one of the six nosocomial pathogens termed as ESKAPE pathogens which have emerged as a serious threat to public health worldwide. The development of a specific vaccine can stimulate an optimal antibody response, thus providing immunity against it. Therefore, in the present study efforts have been made to identify potential vaccine candidates from the Clumping factor surface proteins (ClfA and ClfB) of S. aureus. Employing the immunoinformatics approach, fourteen antigenic peptides including T-cell, B-cell epitopes were identified which were non-toxic, non-allergenic, high antigenicity, strong binding efficiency with commonly occurring MHC alleles. Consequently, a multi-epitope vaccine chimera was designed by connecting these epitopes with suitable linkers an adjuvant to enhance immunogenicity. Further, homology modeling and molecular docking were performed to construct the three-dimensional structure of the vaccine and study the interaction between the modeled structure and immune receptor (TLR-2) present on lymphocyte cells. Consequently, molecular dynamics simulation for 100 ns period confirmed the stability of the interaction and reliability of the structure for further analysis. Finally, codon optimization and in silico cloning were employed to ensure the successful expression of the vaccine candidate. As the targeted protein is highly antigenic and conserved, hence the designed novel vaccine construct holds potential against emerging multi-drug-resistant organisms.

Hexameric assembly of the AAA+ protein McrB is necessary for GTPase activity.

McrBC is one of the three modification-dependent restriction enzymes encoded by the Escherichia coli K12 chromosome. Amongst restriction enzymes, McrBC and its close homologues are unique in employing the AAA+ domain for GTP hydrolysis-dependent activation of DNA cleavage. The GTPase activity of McrB is stimulated by the endonuclease subunit McrC. It had been reported previously that McrB and McrC subunits oligomerise together into a high molecular weight species. Here we conclusively demonstrate using size exclusion chromatography coupled multi-angle light scattering (SEC-MALS) and images obtained by electron cryomicroscopy that McrB exists as a hexamer in solution. Furthermore, based on SEC-MALS and SAXS analyses of McrBC and the structure of McrB, we propose that McrBC is a complex of two McrB hexamers bridged by two subunits of McrC, and that the complete assembly of this complex is integral to its enzymatic activity. We show that the nucleotide-dependent oligomerisation of McrB precedes GTP hydrolysis. Mutational studies show that, unlike other AAA+ proteins, the catalytic Walker B aspartate is required for oligomerisation.

Mental Health outcome and Professional quality of Life among Healthcare Worker during COVID-19 pandemic: A (FRONTLINE-COVID) survey.

BACKGROUND: - Health care workers are under a substantial level of psychological impact due to the risk of exposure, workload and moral dilemmas as the nation is on upsurge of COVID-19 cases. Since there are limited research available on this issue from India, we have decided to conduct an online survey to evaluate mental health outcome and professional quality of life among healthcare worker during COVID-19 pandemic. METHODS: - From 25th May to 10th June 2020, a web-based (FRONT-LINE COVID) survey was conducted. Impact of event revised (IES-R), Connor-Davidson Resilience scale (CD-RISC) and Professional Quality of life (ProQOL) and Feeling related questions were administered among Healthcare workers from different departments of hospital. RESULTS: - Among the respondents,218 (52.1%) belongs from the low-risk unit and 200 (47.9%) from the 'high-risk unit' including a higher proportion of nurses 191 (45.7%), female 282(67.5%), aged 31-40 years (48.3%), and married 220 (52.6%). Overall female nurses (P=>0.001), doctors (P=0.02) those were working in an emergency unit (P= <0.001) were at greater risk of psychological distress. Middle-aged (31- 40 years) had a higher level of resilience (p=0.02) contrast to this; working in COVID-19 unit was associated with a lower scale of resilience (p=0.009). Resilience and QoL were an important predictor for psychological distress. CONCLUSION: - Results implicate interventions for stress management and social support among medical staff working in the pandemic.

Les travailleurs de la santé subissent un impact psychologique important en raison du risque d'exposition, de la charge de travail et des dilemmes moraux alors que le pays est face à la recrudescence des cas de COVID-19. Puisqu'il y a peu de recherches disponibles sur cette question en Inde, nous avons décidé de mener une enquête en ligne pour évaluer les résultats en matière de santé mentale et la qualité de vie professionnelle des travailleurs de la santé pendant la pandémie de COVID-19. Du 25 mai au 10 juin 2020, une enquête en ligne (FRONT-LINE COVID) a été menée. L'impact de l'événement révisé (IES-R), l'échelle de résilience Connor-Davidson (CD-RISC) et les questions relatives à la qualité de vie professionnelle (ProQOL) et au ressenti ont été administrées aux travailleurs de la santé de différents départements de l'hôpital. Parmi les répondants, 218 (52,1 %) appartiennent à l'unité à faible risque et 200 (47,9 %) à l'unité à haut risque dont une proportion plus élevée d'infirmières : 191 (45,7 %), de femmes : 282 (67,5 %), l'âge : 31-40 ans (48,3 %) et mariés 220 (52,6 %). Dans l'ensemble, les infirmières (P => 0,001), et les médecins (P = 0,02) qui travaillaient dans une unité d'urgence (P = <0,001) étaient plus à risque de détresse psychologique. Les personnes d'âge moyen (31 à 40 ans) avaient un niveau de résilience plus élevé (p = 0,02); travailler dans l'unité COVID-19 était associé à une échelle de résilience plus faible (p = 0,009). La résilience et la qualité de vie étaient un prédicteur important de la détresse psychologique. Les résultats impliquent des interventions de gestion du stress et de soutien social parmi le personnel médical qui lutte contre la pandémie.

A physician associate-led clinic for people with severe mental illness in the United Kingdom.

OBJECTIVE: To evaluate an enhanced physical health clinic led by physician associates (PAs) for patients with severe mental illness. METHODS: A guidance and data collection tool was developed to support and document the outcomes of the PA-led enhanced physical health clinic. RESULTS: The clinic led to diagnoses of diabetes, hyperlipidemia, and hematologic abnormalities. One patient was started on metformin, two patients started a prediabetes program with their general practitioner, one patient started simvastatin, one patient switched from cigarettes to e-cigarettes, and one patient switched from olanzapine to aripiprazole because of metabolic adverse reactions. Three patients intended to contact the National Health Service for cancer screening for which they were eligible but they had not taken up. CONCLUSIONS: PAs can be integrated into a community mental health multidisciplinary team and support the physical health of people with severe mental illness. Mental health trusts should consider roles for PAs in their workforce planning.

Energy and carbon footprints of sewage treatment methods.

The paper presents energy and carbon footprints of sewage treatment plants (STPs) operating at different scales and using different technology options based on primary data from 50 STPs operating in India and the UK. The study used a combination of fundamental mass-balance approach for energy consumption and the methodology defined by IPCC for the carbon emissions. Small-scale institutional STPs consume twelve times the energy consumed by large-scale municipal STPs, the corresponding energy intensities being 4.87 kWh/m(3) and 0.40 kWh/m(3) respectively. Embodied energy from construction material and chemicals accounted for 46% and 33% of the total energy intensity of the municipal and institutional STPs respectively. The average carbon footprint of large-scale STPs is 0.78 kgCO2eq/m(3) and for small-scale STPs it is 3.04 kgCO2eq/m(3). However, fugitive emissions from large-scale STPs constituted 74% of the total carbon emissions whereas the figure was only 0.05% for small-scale STPs. Average electrical energy intensity in STPs in India is much lower (0.14 kWh/m(3)) than that in the UK (0.46 kWh/m(3)). This is due to the reason that STPs in India do not have resource recovery processes and use solar heat for sludge drying. The paper offers information and insights for designing low carbon strategies for urban waste infrastructure.

The Influence of Obesity on Bone Health in Post-COVID-19 Recovery- Single-Center Experience.

Introduction: The ongoing repercussions of the COVID-19 pandemic include potentially deleterious impacts on bone health. Aim: This research aimed to ascertain the effects of COVID-19 on the bone health of obese and non-obese Indian individuals. Methods: We executed a case-control study enrolling individuals who recovered from COVID-19. Participants were stratified into obese and non-obese groups based on their BMI. Comprehensive assessments encompassed anthropometric evaluations, laboratory tests, and bone mineral density (BMD) measurements using dual-energy X-ray absorptiometry (DEXA). Results: From April to July 2022, we enrolled obese (n = 27, mean BMI = 30.54 ± 4.51 kg/m 2) and non-obese (n = 23, mean BMI = 21.97 ± 2.20 kg/m 2) individuals. The cohort's average age was 36.08 ± 15.81 years, with a male-to-female ratio of 1.6:1. There was a difference in BMD, especially at the total hip, between the two groups. BMD at the spine (L1-L4), the neck of the femur, and ultra-distal radius were consistent across both groups. Weight exhibited a significant positive correlation with BMD at L1-L4 (r = 0.40, p = 0.003) and the left femur total (r = 0.27, p = 0.001). Haemoglobin levels were lower in the obese group compared to their non-obese counterparts (12.3 ± 2.0 vs 13.6 ± 1.9, p = 0.01). Multivariate analysis underscored weight as a crucial predictor for BMD at the spine (L1-L4, p = 0.003) and total hip (p = 0.001). Conclusion: Even with advanced age, obese post-COVID-19 individuals demonstrate a higher bone mineral density (BMD) at the hip than non-obese subjects.

Post-COVID-19 cardio-pulmonary manifestations after 1-year of SARS-CoV-2 infection among Indian population: A single centre, case-control study (OneCoV2 study).

BACKGROUND: The evolving challenge of persistent symptoms post-Coronavirus disease-2019 (COVID-19), particularly debilitating cardio-pulmonary manifestations, necessitates further exploration. Our study aimed to assess the cardio-pulmonary complications in patients a year after hospital discharge from severe COVID-19, contrasting these with findings from a non-COVID group. METHODS: The OneCoV2 study, a prospective, case-control study, was conducted at a tertiary care teaching hospital in northern India. We enrolled 43 subjects, with a mean age of 25.57 ± 7.94 years (COVID group) and 27.30 ± 8.17 years (non-COVID group). Comprehensive tests included pulmonary function tests, cardiac function tests, 6-min walk tests, and laboratory investigations. RESULTS: Significant differences were found in the pulmonary function [forced vital capacity (FVC) (p = 0.037), forced expiratory flow (FEF) 25-75 % (p = 0.013)], and cardiac function [left ventricular ejection fraction (LVEF) (p = 0.032), heart rate (HR) (p = 0.047)], along with the six-minute walk test results between the two groups. In the COVID group, Pearson's correlation showed a negative correlation between FVC and C-reactive protein (CRP) [r = -0.488, p = 0.007] and a positive correlation between the six-minute walk test [r = 0.431, p = 0.003] and HR [r = 0.503, p = 0.013]. CONCLUSIONS: Our data suggest that pulmonary abnormalities are prevalent in COVID patients even after 1-year of hospital discharge. Cardiac biomarkers also show an inclination towards the COVID group. While we found significant correlations involving some parameters like FVC, CRP, HR, and results from the six-minute walk test, we did not find any significant correlations with the other tested parameters in our study.

Burden of COVID-19 pandemic on tuberculosis hospitalisation patterns at a tertiary care hospital in Rajasthan, India: a retrospective analysis.

OBJECTIVE: This study aimed to investigate the burden of the COVID-19 pandemic on tuberculosis (TB) trends, patient demographics, disease types and hospitalisation duration within the Respiratory Medicine Department over three distinct phases: pre-COVID-19, COVID-19 and post-COVID-19. DESIGN: Retrospective analysis using electronic medical records of patients with TB admitted between June 2018 and June 2023 was done to explore the impact of COVID-19 on patients with TB. The study employed a meticulous segmentation into pre-COVID-19, COVID-19 and post-COVID-19 eras. SETTING: National Institute of Medical Science Hospital in Jaipur, Rajasthan, India. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome includes patients admitted to the Respiratory Medicine Department of the hospital and secondary outcome involves the duration of hospital stay. RESULTS: The study encompassed 1845 subjects across the three eras, revealing a reduction in TB incidence during the post-COVID-19 era compared with the pre-COVID-19 period (p<0.01). Substantial demographic shifts were observed, with 5.2% decline in TB incidence among males in the post-COVID-19 era (n=529) compared with the pre-COVID-19 era (n=606). Despite the decrease, overall TB incidence remained significantly higher in males (n=1460) than females (n=385), with consistently elevated rates in rural (65.8%) as compared with the urban areas (34.2%). Extended hospital stays were noted in the post-COVID-19 era compared with the pre-COVID-19 era (p<0.01). CONCLUSION: The study underscores the influence of the COVID-19 pandemic on the TB landscape and hospitalisation dynamics. Notably, patient burden of TB declined during the COVID-19 era, with a decline in the post-COVID-19 era compared with the pre-COVID-19 era. Prolonged hospitalisation in the post-COVID-19 period indicates the need for adaptive healthcare strategies and the formulation of public health policies in a post-pandemic context. These findings contribute to a comprehensive understanding of the evolving TB scenario, emphasising the necessity for tailored healthcare approaches in the aftermath of a global health crisis.

Online Medical Education: Utilization of Google Forms for Remote Active Learning Experiences in a Large Medical School Class During the COVID-19 Pandemic.

Remote delivery of preclinical medical scientific curriculum during the COVID pandemic to a large medical school class (n = 429) provided limited options for active learning. We implemented adjunct Google Forms in a first-year medical school class to provide online, active learning with automated feedback and mastery learning approaches.

Burkholderia cepacia infection associated with sickle cell disease: An uncommon entity.

Burkholderia, a multidrug-resistant Gram-negative bacteria, is an uncommon cause of infection mostly in immunocompromised patients with a clinical profile very similar to tuberculosis. The most common conditions associated with this organism are cystic fibrosis and chronic granulomatous diseases. Bacteremia with it occurs in patients who are chronically ill and associated with significant morbidity and mortality. We are reporting here a case of perisplenic intra-abdominal abscess caused by Burkholderia cepacia in a patient with sickle cell disease (SCD).

Glyptothorax heokheei, a new species of catfish (Teleostei: Sisoridae) from the Brahmaputra River drainage, Arunachal Pradesh, Northeast India.

Glyptothorax heokheei, a new species of sisorid catfish is described from the Brahmaputra River drainage in India. It can be distinguished from all congeners, exceptG. dikrongensis,G. indicus,G. rugimentumandG. obliquimaculatus, in having the unculiferous striae of thoracic adhesive apparatus extending anteriorly onto gular region.Glyptothorax heokheeiis distinguished fromG. dikrongensisandG. obliquimaculatusin having a slender body at the anus, more serrations on posterior margin of pectoral-fin spine, greater number of branched anal fin rays, and the extremity of dorsoposterior margin of adipose fin uniformly convex (vs. sharply angular). It differs fromG. rugimentumin having a chevron-shaped (vs. rhomboidal) thoracic adhesive apparatus, more serrations on posterior margin of pectoral-fin spine, and lacking vertical bars on body.Glyptothorax heokheeidiffers fromG. indicusin having a shorter post-adipose distance, smaller interorbital width, more serrations on posterior margin of pectoral-fin spine and nasal barbel not reaching (vs. reaching) anterior margin of eye.Glyptothorax heokheeiis the fifth species ofthe genuspossessing unculiferous ridges of thoracic adhesive apparatus extending anteriorly onto the gular region.

Outcome of COVID-19 infection and the impact of COVID-19 vaccination in chronic kidney disease patients: A single-center study.

Introduction: Chronic kidney disease (CKD) patients have increased vulnerability to infections including Covid-19. There is limited availability of antiviral in CKD patients. All guidelines have prioritized vaccinations for CKD patients. The variability in immunogenic response is multifactorial in CKD group. We have tried to analyze the outcome of Covid-19 infection and the impact of COVID-19 vaccination [COVAXIN / COVISHIELD] in our cohort. Materials Methods and Statistical Analysis: In a retrospective observational study, 73 cases of Covid-19 positive CKD patients were selected, who were managed as per MOFHW guidelines. The data of first laboratory values and radiological findings were evaluated. Their treatment outcome and stay during hospitalization were studied. All data were later analyzed using STATA 16.1 software. Results: In this study, 73 cases of CKD with Covid-19 were included. There were 38 patients who were vaccinated with at least one dose of the Covid-19 vaccine, while there were 35 patients who were unvaccinated. Out of 38 patients, 20 were vaccinated with 2 doses of Covid-19 while 18 received only one dose. The unvaccinated group was having more hypoxia and raised inflammatory markers, and had more lung involvement [i.e. higher CT severity value] [p value for CTSS-0.0765]. There was a higher mortality rate observed in the unvaccinated group [i.e-65.71%] than the vaccinated group [39.47%] [p-value 0.0249]. Dialysis was needed in 57.50% of the study population either due to failure of conservative management for renal failure or due to maintenance dialysis. The mean duration of hospitalization was 11.47 days with a mortality rate of 52% which is much higher than the reported average data in CKD patients. Conclusion: Vaccination seems to be very helpful in combating the adverse effect of Covid-19 in CKD patients. It also reduces mortality significantly in Covid-19 infected CKD patients.

Résumé Introduction: Il existe une différence entre les sexes dans les caractéristiques démographiques, cliniques et les résultats des patients atteints d'IRA associée à une chirurgie cardiaque et vasculaire. Méthodes: Cette étude rétrospective a eu un total de 88 participants pour lesquels les données socio-démographiques, cliniques et de laboratoire (électrolytes sériques, numération globulaire complète, analyse d'urine et volume d'urine, taux de créatinine et de filtration glomérulaire) des participants ont été prises avant et après l'opération. jours 1, 7 et 30. Résultats: Au total, 88 participants (66 hommes et 22 femmes) ont été étudiés. Les maladies des valves cardiaques étaient plus fréquentes chez les femmes que chez les hommes. L'âge moyen des participants était de 65,9 ± 6,9 ans, avec des hommes de 65,1 ± 7,6 ans et des femmes de 68,3 ± 8,4 ans, P = 0,02. Avant la chirurgie, une proportion significativement plus élevée de femmes avaient un dysfonctionnement rénal par rapport aux hommes, P = 0,003. La chirurgie valvulaire et le pontage coronarien étaient les chirurgies les plus courantes. La proportion de chirurgies d'urgence et d'admissions de moins de 7 jours était significativement plus élevée chez les femmes que chez les hommes, P = 0,04 et P = 0,02 respectivement. La récupération complète de l'IRA était significativement plus élevée chez les hommes, car la récupération partielle et la mort étaient significativement plus faibles chez eux, P = 0,02. Sur les 35 (39,8%) qui ont été dialysés, 85,7% se sont complètement rétablis, 5,7% sont devenus dépendants de la dialyse tandis que 8,6% sont décédés. Conclusion: Les hommes atteints d'IRA étaient plus jeunes que les femmes. Les chirurgies valvulaires étaient les plus courantes. Le dysfonctionnement rénal de base et l'âge avancé étaient des facteurs de risque d'IRA. Après l'opération, l'IRA était plus fréquente chez les hommes qui étaient plus susceptibles de récupérer une fonction rénale complète. L'optimisation de la préparation des patients pourrait réduire l'incidence de CVS-AKI. Mots-clés: Chirurgie cardiaque et vasculaire associée insuffisance rénale aiguë, dialyse, récupération de la fonction rénale, chirurgie valvulaire.

Determination of sputum eosinophil count and serum absolute eosinophil count in patients with bronchial asthma and its correlation with disease severity and response to treatment.

Background: Sputum eosinophils can be used to assess severity of disease and response to treatment in bronchial asthma. Eosinophilic inflammation in the airways can also be marked by blood eosinophilia. In this study, we tried to determine the sputum eosinophil count and serum absolute eosinophil count in patients with asthma and correlate them with disease severity and treatment response. Materials and Methods: It was a cross-sectional intervention study including all consecutive cases with a diagnosis of bronchial asthma based on spirometry and clinical history. An induced sputum sample and blood were sent for eosinophil count to the laboratory. All the patients were started on inhaled corticosteroids and followed up at the end of 1 month with spirometry, sputum eosinophil count and AEC. Statistical Package for the Social Sciences for Windows v20.0 (IBM SPSS Corp.; Armonk, NY, USA) was used for statistical analysis. Results: There was no significant difference in the mean sputum eosinophil count (%) in mild, moderate and severe disease (f = 0.24; P = 0.79) or in AEC (f = 1.48; P = 0.24). At follow-up, all patients with moderate and severe disease showed significant improvement in FEV1 (P = 0.0001). The mean sputum eosinophil count and AEC (%) in the three subgroups was also seen to decrease at the end of the follow-up period (f = 0.08; P = 0.9 and f = 2.75; P = 0.07, respectively). Conclusion: Sputum eosinophils and AEC are important markers of airway inflammation. All our patients showed improvement in FEV1, sputum eosinophil count and AEC after 1 month of treatment thus confirming the role of ICS in the treatment of eosinophilic asthma.

Frailty Predicting Health-Related Quality of Life Trajectories in Individuals with Sarcopenia in Liver Cirrhosis: Finding from BCAAS Study.

The association between frailty and health-related quality of life (HRQoL) among Asian patients with liver cirrhosis and sarcopenia remains largely unexplored. To address this knowledge gap, we conducted a cross-sectional study involving individuals aged 32 to 69 years, all diagnosed with liver cirrhosis. The chronic liver disease questionnaire (CLDQ) was used to assess HR-QoL, the CLDQ score was used as an outcome to measure the factors related to HR-QoL, and the liver frailty index (LFI) was used to assess the frailty status. The association between the frailty status and the CLDQ summary scales was investigated using the correlation coefficient and multiple regression analyses. A total of 138 patients in the frail (n = 62) and non-frail (n = 76) groups with (alcohol: 97; viral: 24; autoimmune: 17; and cryptogenic: 12) were included in the study. Age, CTP score, and model for end-stage liver disease (MELD) sodium were significantly higher in the frail group. In the CLDQ domains, there was a significant difference between the frail and non-frail groups (p value = 0.001). In health-related quality-of-life summary measures, there was a strong negative correlation between frailty and the scores for activities, emotional function, and fatigue (p value = 0.001). When comparing frail to non-frail patients, these characteristics demonstrated significantly increased odds as indicated by their adjusted odds ratios: OR 3.339 (p value = 0.013), OR 3.998 (p value = 0.006), and OR 4.626 (p value = 0.002), respectively.