Possible unrecognised liver injury is associated with mortality in critically ill COVID-19 patients.

BACKGROUND: Coronavirus disease (COVID-19) with acute respiratory distress syndrome is a life-threatening condition. A previous diagnosis of chronic liver disease is associated with poorer outcomes. Nevertheless, the impact of silent liver injury has not been investigated. We aimed to explore the association of pre-admission liver fibrosis indices with the prognosis of critically ill COVID-19 patients. METHODS: The work presented was an observational study in 214 patients with COVID-19 consecutively admitted to the intensive care unit (ICU). Pre-admission liver fibrosis indices were calculated. In-hospital mortality and predictive factors were explored with Kaplan-Meier and Cox regression analysis. RESULTS: The mean age was 59.58 (13.79) years; 16 patients (7.48%) had previously recognised chronic liver disease. Up to 78.84% of patients according to Forns, and 45.76% according to FIB-4, had more than minimal fibrosis. Fibrosis indices were higher in non-survivors [Forns: 6.04 (1.42) versus 4.99 (1.58), p < 0.001; FIB-4: 1.77 (1.17) versus 1.41 (0.91), p = 0.020)], but no differences were found in liver biochemistry parameters. Patients with any degree of fibrosis either by Forns or FIB-4 had a higher mortality, which increased according to the severity of fibrosis (p < 0.05 for both indexes). Both Forns [HR 1.41 (1.11-1.81); p = 0.006] and FIB-4 [HR 1.31 (0.99-1.72); p = 0.051] were independently related to survival after adjusting for the Charlson comorbidity index, APACHE II, and ferritin. CONCLUSION: Unrecognised liver fibrosis, assessed by serological tests prior to admission, is independently associated with a higher risk of death in patients with severe COVID-19 admitted to the ICU.

Air density dependence of the soft X-ray PTW 34013 ionization chamber.

PURPOSE: We studied the dependence on air density of the response of the PTW 34013 ionization chamber, recently upgraded for dosimetry control of low energy X-ray beams. METHODS: Measurements were performed by changing the pressure conditions inside a pressure chamber. The behavior of the measurements against the air density inside this chamber was analyzed. X-ray beams generated with 50, 70, 100, 150 and 200 kVp and the two electrometer polarities were considered. RESULTS: For all beams studied, measurements corrected with the conventional temperature and pressure factor showed a residual dependence on the air density that was described with a linear function of the air density. For the 50 and 70 kVp beams, corrected measurements remained ∼1% smaller than the value found at standard pressure/temperature conditions, for both electrometer polarities and for the air density range typical in clinical conditions. For air densities smaller than the standard one, measurements found for 100, 150 and 200 kVp beams were below or above the value found at standard pressure and temperature when the negative or positive electrometer polarities were used, respectively. The differences with the measurements at standard conditions were less than 1% for the 100 kVp beam and below 4% for the other two beams. CONCLUSIONS: The PTW 34013 ionization chamber showed a dependence on the air density that is not properly described with the usual temperature and pressure correction factor. This residual dependence is negligible for low energy beams, for which this chamber is recommended, but is more substantial for beams with energy above 80 kVp.

Characterization of the PTW SourceCheck ionization chamber with the Valencia lodgment for (125)I seed verification.

In brachytherapy using (125)I seed implants, a verification of the air kerma strength of the sources used is required. Typically, between 40 and 100 seeds are implanted. Checking all of them is unaffordable, especially when seeds are disposed in sterile cartridges. Recently, a new procedure allowing the accomplishment of the international recommendations has been proposed for the seedSelectron system of Elekta Brachytherapy. In this procedure, the SourceCheck ionization chamber is used with a special lodgment (Valencia lodgment) that allows to measure up to 10 seeds simultaneously. In this work we analyze this procedure, showing the feasibility of the approximations required for its application, as well as the effect of the additional dependence with the air density that shows the chamber model used. Uncertainty calculations and the verification of the approximation needed to obtain a calibration factor for the Valencia lodgment are carried out. The results of the present work show that the chamber dependence with the air density is the same whether the Valencia lodgment is used or not. On the contrary, the chamber response profile is influenced by the presence of the lodgment. The determination of this profile requires various measurements due to the nonnegligible variability found between different experiments. If it is considered, the uncertainty in the determination of the air-kerma strength increases from 0.5% to 1%. Otherwise, a systematic additional uncertainty of 1% would occur. This could be relevant for the comparison between user and manufacturer measurements that is mandatory in the case studied here.

G.R.I.T.S.: the southern subculture of violence and homicide offenses by girls raised in the South.

The southern subculture of violence is a theoretical perspective that has been examined by numerous scholars in an attempt to explain the high rates of violence in the Southern United States. Research over the past several decades has converged on a few explanations for this violence, including a culture of honor, a frontier mentality, and a presence of evangelical Protestantism. The primary focus of this research has been on either male offending or race disaggregated offending. The influence of the southern subculture of violence on female offending has only recently come to the forefront and has concentrated on relatively recent time periods (1990s to present). The present study examines the effect of southern culture on female-perpetrated homicides in the 1970s, a time when female offending was on the rise. Utilizing a southern subculture of violence index, our county-level negative binomial regression analysis finds that in counties with more Southern-born residents and a higher presence of evangelical Protestantism, female homicide offending is higher. Implications of these results and avenues for future research are discussed.

Gastric surgery and restraint from food as triggering factors of eating disorders in morbid obesity.

UNLABELLED: Obese patients may share some clinical features with anorexia nervosa patients because they risk developing an eating disorder when they diet. Methods and Results Some common etiological, psychological, and social factors have been proposed for both disorders. We present two cases of patients suffering from morbid obesity who, after weight loss, presented an intense fear of regaining weight and developed anorexic-like symptoms. In the first case, the symptoms appeared after gastric reduction surgery. In the second case, a strict diet was the triggering factor. DISCUSSION: This paper stresses the need for psychiatric evaluation of all patients with morbid obesity who seek treatment in clinical settings, in order to identify the factors that may lead to psychiatric complications.