Utility of Serum Procalcitonin and Its Clearance in Predicting Outcomes in COVID-19 Patients.

Introduction Identification of coronavirus disease 2019 (COVID-19) patients at risk of worse clinical outcomes is crucial to improving patient care. Various biochemical markers have been used to predict outcomes in such patients. We aimed to evaluate the role of serum PCT (procalcitonin) and the utility of PCT clearance (PCTc) in predicting the outcome of patients with COVID-19 illness. Methods We prospectively included 39 patients with severe or critical COVID-19 illness with an age equal to more than 18 years. In addition to routine baseline investigations, serum PCT was measured at admission (PCT1) and day 5 of hospitalization (PCT2). PCTc was calculated using the formula [Formula: see text]. Results We observed that serum PCT at admission was significantly higher in non-survivors (median: 1.9 ng/ml IQR: 0.51-4.23) compared to survivors (median 0.35 (IQR: 0.1-1.2), p 0.002). On serial serum-PCT estimation, non-survivors had persistently elevated serum-PCT (median PCT1:1.9 ng/ml (IQR: 0.51-4.23) to median PCT2: 1.9ng/ml (IQR: 0.83-2.72), p 0.51) than survivors (median PCT1:0.35ng/ml (IQR: 0.1-1.19) to median PCT2: 0.15ng/ml (IQR: 0.05-0.29), p 0.01). However, no difference in serum PCTc was observed between the two groups (median: 35.3% (IQR: 12.5-84.9) in survivors vs. 71.7% (33.3-91.7) in non-survivors, p = 0.165). Conclusion Serum PCT is a potential biochemical marker that could predict outcomes in COVID-19 patients. Measurement of serial serum PCT and estimation of PCT clearance may serve as better predictors than a single value; however, well-designed studies are required to identify the definite role of serum PCT in COVID-19 patients of varying severity.

Addition of Mask to High-flow Nasal Oxygen: A Strategy to Improve Oxygenation in Hypoxemic Respiratory Failure Secondary to COVID-19.

PURPOSE: High-flow nasal cannula (HFNO) reduces the need for invasive mechanical ventilation in COVID-19 patients with hypoxemic-respiratory failure. During HFNO entrainment of room air dilutes the delivered fractional inspiratory oxygen (FiO2), thereby preventing improvement in oxygenation. The placement of a mask over HFNO to improve oxygenation has provided conflicting results. We aimed to determine and compare the effect of placing various mask types over HFNO on oxygen saturation (SPO2). MATERIALS AND METHODS: In this prospective physiological study 40 patients with COVID-19-associated hypoxemic respiratory failure on HFNO with O2 concentration <92% were included. The effect of placing different masks over HFNO on oxygenation, respiratory rate, heart rate, blood pressure, patient comfort, and partial pressure of carbon dioxide level (pCO2) was recorded after a prespecified time interval. RESULTS: We observed a significantly higher mean SPO2 and lower mean respiratory rate on using various study masks over HFNO compared to HFNO alone. On comparing various mask types, the use of N95 masks and nonrebreather (NRB) masks with O2 showed a significant increase in O2 concentration and reduction in respiratory rate compared to surgical mask (SM) and NRB without O2. The proportion of patients who achieved SPO2 of >92% was higher with the use of N95 masks (47.5%) or NRB with O2 (45%) over HFNO compared to SM (35%) and NRB without O2 (35%). No significant change was observed in heart rate, blood pressure, and CO2 level with the use of any mask over HFNO. CONCLUSION: This study demonstrates improvement in oxygenation and reduction in respiratory rate with the use of various masks over HFNO in patients of COVID-19-related hypoxemic-respiratory-failure. Significantly greater benefit was achieved with the use of N95 or NRB with O2 compared to SM or NRB without O2.

Effect of Staining Beverages on Color Stability of Composite: A Spectrophotometric Study.

Objective: This study used spectrophotometry to examine how staining beverages affect the color stability of three commercial composite materials (nanohybrid composite (A), bulk fill composite (B), and flowable composite (C)) over time. Materials and Methods: Composite discs were randomly divided into groups. The specimens were kept in coffee, tea, red wine, and cola for 14 days at 37°C in the dark. At baseline, 7 days, and 14 days, spectrophotometers measured color. Calculated and analyzed color differences (E). Results: Staining beverages changed the color of all composites. Composite material A had the best color stability, whereas material C stained beverages the most. Red wine and coffee discolored composites most. Discoloration increased over the 14-day immersion period. Conclusion: Composite materials with better color stability were material A. Red wine and coffee discolored composites most. When choosing restorative materials, dentists should consider composite materials' color stability for long-lasting, visually acceptable results.

An analysis of long-term survival after pneumonectomy for lung cancer: A retrospective study of 20 years.

INTRODUCTION: The incidence of pneumonectomy for lung cancer in the UK is continuing to decline in the era of minimally invasive thoracic surgery totalling approximately 3.5% of lung cancer resections annually. Literature is lacking for long-term survival of pneumonectomies. This study updates our previous results. Between 1998 and 2008, 206 patients underwent pneumonectomy compared to 98 patients between 2009 and 2018. METHODS: From January 1998 until December 2018, 304 patients underwent pneumonectomy. This was a retrospective study; data was analysed for age, gender, laterality, histology and time period. RESULTS: Operative mortality was 4.3% overall which was lower than the national average of 5.8%. In the last five years, there were no in-hospital, operative or 30-day mortality. During this period, 90-day mortality was 9.2%. Left-sided pneumonectomies had significantly better overall survival (3.00 vs. 2.03 years; p = 0.0015), squamous cell carcinoma (3.23 vs. 1.54 years; p = 0.00012) as well as those aged less than 70 (2.79 vs. 2.13 years; p = 0.011). There was no significant difference in survival between gender (p = 0.48). Intervention from 1998 to 2008 had significantly greater survival compared to the latter 10 years (2.68 vs. 2.46 years; p = 0.031). The Cox model shows that laterality, age, histology and time period remain significant with multivariate testing. No patient survived after 16 years. DISCUSSION: Our updated retrospective study has built on our previous results by reinforcing the success of pneumonectomies. The incidence of pneumonectomies is likely to decrease with the deployment of nation-wide lung cancer screening in the UK due to earlier detection.

Impact of lung cancer screening on surgical stage distribution and surgical practice: a regional analysis of patients operated in and out of a screening program.

OBJECTIVES: The aim of this study was to assess variations in surgical stage distribution in 2 centres within the same UK region. One centre was covered by an active screening program started in November 2018 and the other was not covered by screening. METHODS: Retrospective analysis of 1895 patients undergoing lung resections (2018-2022) in 2 centres. Temporal distribution was tested using Chi-squared for trends. A lowess curve was used to plot the proportion of stage 1A patients amongst those operated over the years. RESULTS: The surgical populations in the 2 centres were similar. In the screening unit (SU), we observed a 18% increase in the proportion of patients with clinical stage IA in the recent phase compared to the early phase (59% vs 50%, P = 0.004), whilst this increase was not seen in the unit without screening. This difference was attributable to an increase of cT1aN0 patients in the SU (16% vs 11%, P = 0.035) which was not observed in the other unit (10% vs 8.2%, P = 0.41). In the SU, there was also a three-fold increase in the proportion of sublobar resections performed in the recent phase compared to the early one (35% vs 12%, P < 0.001). This finding was not evident in the unit without screening. CONCLUSIONS: Lung cancer screening is associated with a higher proportion of lung cancers being detected at an earlier stage with a consequent increased practice of sublobar resections.

Eryptosis: a driver of anemia in chronic kidney disease.

PURPOSE OF REVIEW: Anemia, characterized by a reduction in red blood cell (RBC) count or hemoglobin concentration, commonly accompanies chronic kidney disease (CKD), significantly impacting patients' quality of life. This review delves into the multifaceted nature of anemia in CKD, with a focus on novel mechanisms, particularly the dysregulation of eryptosis or programmed cell death of RBCs, leading to shortened RBC lifespan. RECENT FINDINGS: Recent studies in CKD patients and mouse models revealed that eryptosis, driven by factors such as uremic toxins, inflammation, and imbalances in calcium homeostasis, plays a pivotal role in the development of renal anemia. Dysregulated eryptosis results in premature RBC destruction, exacerbating the hypoproliferative character of anemia in CKD. SUMMARY: Recognizing the intricate relationship between eryptosis and anemia in CKD opens promising prospects for improving patient outcomes and enhancing our understanding of this complex condition. Future research and therapeutic development in this area hold the potential to improve anemia treatment of CKD patients.

How ESG reporting is effected by sustainable finance and green innovation: moderating role of sales growth.

In light of the conflicting findings within the existing empirical literature regarding the factors influencing environmental, social, and governance (ESG) disclosures in the context of sustainable investment and firms' green innovation performance (GIP), our current study stands out as a distinctive research endeavor that examines how the relationship is influenced by the moderating effects of sales growth. Non-financial trade manufacturing companies listed on the Shanghai and Shenzhen stock exchanges between 2015 and 2020 were selected for this study. For data estimation, panel regression estimations using OLS and fixed effects models have been used. The results demonstrate a significant moderation of manufacturing industry's sales growth in China on the relationship between ESG disclosures and sustainable finance (operationalized by green credit, and green investment), and green innovation (operationalized by R&D intensity and green patents). Several practical takeaways are offered to boost green innovation performance among ESG reporting enterprises and increase the effectiveness of R&D intensity. These findings, including policy recommendations, will benefit all stakeholders.

Combination therapy of nitazoxanide with oseltamivir compared with oseltamivir in hospitalized patients with seasonal influenza.

Antiviral combinations have been proposed as treatment for influenza in order to increase the antiviral activity by action at different sites of action as well as obviate the emergence of drug resistance to the commonly used antiviral agents like oseltamivir. Nitazoxanide has been found to exhibit anti-influenza viral activity with clinical benefit in a previous study. We recruited 242 cases of SARI, among whon 67 were confirmed to have influenza viral infection. In a randomized blinded fashion, 34 patients received a combination of nitazoxanide and oseltamivir whereas 33 cases received oseltamivir alone. Clinical parameters were followed in both groups and the nasal swabs were re-tested on day 6 for influenza positivity and the cycle threshold (CT) values. No significant differences were observed in terms of time for resolution of fever, other symptoms, and SOFA scores. Nine patients succumbed during the course of the illness that included three in the oseltamivir group and six in the combination group. All but one of those who expired had an underlying co-morbid illness. Our preliminary data suggest that the addition of nitazoxanide does not improve outcomes in hospitalized patients with influenza. Larger studies are recommended for statistically robust conclusions.

The diagnosis and surgical management of pulmonary sequestration in adults: a case series from a single centre in the UK.

Pulmonary sequestration (PS) is a rare congenital malformation where extrapulmonary lung tissue receives systemic blood supply from an anomalous branch directly from the thoracic or abdominal aorta. Whilst non-malignant, it can often present with similar symptoms as lung cancer. We present a retrospective review of 8 consecutive adult patients undergoing surgical management for PS within a single centre in the UK. Of our cohort, 62.5% had never smoked. PS in the right lung was seen in 62.5% of cases. Anomalous branches of the pulmonary artery, pulmonary vein or coeliac axis supplied 37.5% of the PS seen in our cohort, and 12.5% did not have a radiologically identifiable blood supply. Techniques varied from thoracotomy (n = 4), video-assisted thoracoscopic surgery (VATS) (n = 3) to robotic resection (n = 1) with no intra-operative or post-operative complications reported within hospital. The mean length of stay was 2 days. The post-operative mortality rate was 12.5%; one patient had died following the robotic resection of the mass of pneumonia in the local district hospital 26 days post-operatively after being discharged. No other complications nor recurrence was recorded over the follow-up period. Where pulmonary masses receive blood supply from anomalous branches of the pulmonary vein and coeliac axis, diagnoses of PS should be considered. The clinical feasibility of discharge in 2 days with no symptom recurrence should undergo further investigation with a larger sample size.

Exploring the China-Pakistan economic corridor project performance during Covid-19 pandemic.

The outburst of the coronavirus into the global arena, first as a respiratory disease and later as a worldwide pandemic and health emergency, pushed the world economic order into complete turmoil and aftermath, posing severe challenges to the financial stability of developing countries like Pakistan. The temporary suspension of economic activities worldwide has resulted in significant disruptions to international supply chains, leading to substantial delays in implementing infrastructure projects associated with the China-Pakistan Economic Corridor (CPEC). The pandemic has further hindered CPEC progress. Building mega-projects, such as the CPEC, is crucial in determining the economic stability of a nation such as Pakistan. Nevertheless, it is essential to consider that the implementation of infrastructure projects can be subject to delays due to the COVID-19 lockdown and travel restrictions. However, it is worth noting that there needs to be more scholarly research available examining the ongoing progress and performance of CPEC projects from a particular perspective. This study aims to assess the impact of the COVID-19 lockdown policy and travel restrictions on CPEC project performances by highlighting the role of socioeconomic and infrastructure development factors. The study will shed light on numerous causes of concerns in project development phases and provide policy recommendations to help CPEC officials reduce project losses and better survival in the event of extreme uncertainty. The data were collected through an online survey from all over Pakistan using self-administered questionnaires with 570 responses from CPEC employees, officials, and professors from management and economic departments. The structural equation modeling (SEM) technique analyzes the problem mentioned above. As per the results of this study, it is evident that the COVID-19 lockdown policy and travel restrictions have a detrimental effect on the construction of the CPEC project. Moreover, it has been observed that the socioeconomic and infrastructure development associated with the CPEC has a notable impact on the performance of the CPEC projects. This paper aims to provide valuable insights to policymakers by examining the management of the COVID-19 pandemic from the perspective of the CPEC.

Robust genetic machine learning ensemble model for intrusion detection in network traffic.

Network security has developed as a critical research subject as a result of the Rapid advancements in the development of Internet and communication technologies over the previous decades. The expansion of networks and data has caused cyber-attacks on the systems, making it difficult for network security to detect breaches effectively. Current Intrusion Detection Systems (IDS) have several flaws, including their inability to prevent attacks on their own, the requirement for a professional engineer to administer them, and the occurrence of false alerts. As a result, a plethora of new attacks are being created, making it harder for network security to properly detect breaches. Despite the best efforts, IDS continues to struggle with increasing detection accuracy while lowering false alarm rates and detecting new intrusions. Therefore, network intrusion detection enhancement by preprocessing and generation of highly reliable algorithms is the main focus nowadays. Machine learning (ML) based IDS systems have recently been implemented as viable solutions for quickly detecting intrusions across the network. In this study, we use a combined data analysis technique with four Robust Machine learning ensemble algorithms, including the Voting Classifier, Bagging Classifier, Gradient Boosting Classifier, and Random Forest-based Bagging algorithm along with the proposed Robust genetic ensemble classifier. For each algorithm, a model is created and tested using a Network Dataset. To assess the performance of both algorithms in terms of their ability to anticipate the anomaly occurrence, graphs of performance rates have been evaluated. The suggested algorithm outperformed other methods as it shows the lowest values of mean square error (MSE) and mean absolute error (MAE). The experiments were conducted on the Network traffic dataset available on Kaggle, on the Python platform, which has limited samples. The proposed method can be applied in the future with more machine learning ensemble classifiers and deep learning techniques.

Assessment of Outcome of Oral Supplementation of Vitamin D3 as an Adjunct to Scaling and Root Planing in Chronic Periodontitis Patients with Type II Diabetes Mellitus - A Randomized Controlled Clinical Trial.

Background: Both diabetes and periodontitis affect millions of people worldwide and Vitamin D insufficiency may create a conducive environment for the progression of diabetes and periodontal disease. The aim of the study was to assess the outcome of oral supplementation of Vitamin D3 in patients with Type 2Diabetes Mellitus with generalized chronic periodontitis, as an adjuvant toscaling and root planing. Methodology: A total of 92 patients, including 46 each in non-diabetic and diabetec group. Clinical parameters including Plaque Index (PI), Gingival Bleeding Index (GBI), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), levels of Vitamin D in serum, and Fasting Blood sugar were assessed at the baseline. SRP was finished for each participant in the trial. Following SRP, the first 25people in each group got 60,000 IU of oral vitamin D3 granules once a week for eight weeks, while the remaining 21 subjects from each group did not. At the conclusion of the 8th week following interventions, all the indicators were reviewed. Results: Following SRP and Vitamin D supplementation there was a measurably critical reduction in every one of the periodontal clinical indicators in both groups. In both groups, there was a statistically significant rise in serum vitamin D levels. Conclusion: In addition to SRP, vitamin D supplementation shows promise as a host immunomodulatory drug in the management of periodontitis, particularly in patients with diabetes mellitus.

Investigation of the impact of nonsynonymous mutations on thyroid peroxidase dimer.

Congenital hypothyroidism is one of the most common preventable endocrine disorders associated with thyroid dysgenesis or dyshormonogenesis. Thyroid peroxidase (TPO) gene defect is mainly responsible for dyshormonogenesis; a defect in the thyroid hormone biosynthesis pathway. In Bangladesh, there is limited data regarding the genetic etiology of Congenital Hypothyroidism (CH). The present study investigates the impact of the detected mutations (p.Ala373Ser, and p.Thr725Pro) on the TPO dimer protein. We have performed sequential molecular docking of H2O2 and I- ligands with both monomers of TPO dimer to understand the iodination process in thyroid hormone biosynthesis. Understanding homodimer interactions at the atomic level is a critical challenge to elucidate their biological mechanisms of action. The docking results reveal that mutations in the dimer severely disrupt its catalytic interaction with essential ligands. Molecular dynamics simulation has been performed to validate the docking results, thus realizing the consequence of the mutation in the biological system's mimic. The dynamics results expose that mutations destabilize the TPO dimer protein. Finally, principal component analysis exhibits structural and energy profile discrepancies in wild-type and mutant dimers. The findings of this study highlight that the mutations in TPO protein can critically affect the dimer structure and loss of enzymatic activity is persistent. Other factors also might influence the hormone synthesis pathway, which is under investigation.

Pathophysiology of Red Blood Cell Dysfunction in Diabetes and Its Complications.

Diabetes Mellitus (DM) is a complex metabolic disorder associated with multiple microvascular complications leading to nephropathy, retinopathy, and neuropathy. Mounting evidence suggests that red blood cell (RBC) alterations are both a cause and consequence of disturbances related to DM-associated complications. Importantly, a significant proportion of DM patients develop varying degrees of anemia of confounding etiology, leading to increased morbidity. In chronic hyperglycemia, RBCs display morphological, enzymatic, and biophysical changes, which in turn prime them for swift phagocytic clearance from circulation. A multitude of endogenous factors, such as oxidative and dicarbonyl stress, uremic toxins, extracellular hypertonicity, sorbitol accumulation, and deranged nitric oxide metabolism, have been implicated in pathological RBC changes in DM. This review collates clinical laboratory findings of changes in hematology indices in DM patients and discusses recent reports on the putative mechanisms underpinning shortened RBC survival and disturbed cell membrane architecture within the diabetic milieu. Specifically, RBC cell death signaling, RBC metabolism, procoagulant RBC phenotype, RBC-triggered endothelial cell dysfunction, and changes in RBC deformability and aggregation in the context of DM are discussed. Understanding the mechanisms of RBC alterations in DM provides valuable insights into the clinical significance of the crosstalk between RBCs and microangiopathy in DM.

Facial expression recognition using lightweight deep learning modeling.

Facial expression is a type of communication and is useful in many areas of computer vision, including intelligent visual surveillance, human-robot interaction and human behavior analysis. A deep learning approach is presented to classify happy, sad, angry, fearful, contemptuous, surprised and disgusted expressions. Accurate detection and classification of human facial expression is a critical task in image processing due to the inconsistencies amid the complexity, including change in illumination, occlusion, noise and the over-fitting problem. A stacked sparse auto-encoder for facial expression recognition (SSAE-FER) is used for unsupervised pre-training and supervised fine-tuning. SSAE-FER automatically extracts features from input images, and the softmax classifier is used to classify the expressions. Our method achieved an accuracy of 92.50% on the JAFFE dataset and 99.30% on the CK+ dataset. SSAE-FER performs well compared to the other comparative methods in the same domain.

Multilevel diffractive lens in the MWIR with extended depth-of-focus and wide field-of-view.

Optics in the mid-wave-infra-red (MWIR) band are generally heavy, thick and expensive. Here, we demonstrate multi-level diffractive lenses; one designed using inverse design and another using the conventional propagation phase (the Fresnel zone plate or FZP) with diameter = 25 mm and focal length = 25 mm operating at λ=4µm. We fabricated the lenses by optical lithography and compared their performance. We show that the inverse-designed MDL achieves larger depth-of-focus and better off-axis performance when compared to the FZP at the expense of larger spot size and reduced focusing efficiency. Both lenses are flat with thickness ≤0.5 mm and weigh ≤3.63 g, which are far smaller than their conventional refractive counterparts.

Gestational low dietary protein induces intrauterine inflammation and alters the programming of adiposity and insulin sensitivity in the adult offspring.

Malnutrition associated with low dietary protein can induce gestational inflammation and sets a long-lasting metabolic impact on the offspring even after replenishment. The work investigated whether a low-protein diet (LPD) during pregnancy and lactation induces intrauterine inflammation and predisposes offspring to adiposity and insulin resistance in their adult life. Female Golden Syrian hamsters were fed LPD (10.0% energy from protein) or a control diet (CD, 20.0 % energy from protein) from preconception until lactation. All pups were switched to CD after lactation and continued until the end. Maternal LPD increased intrauterine inflammation by enhancing neutrophil infiltration, amniotic hsCRP, oxidative stress, and mRNA expression of NFκß, IL8, COX2, and TGFß in the chorioamniotic membrane (P<.05). The prepregnancy body weight, placental, and fetal weights, serum AST and ALT were decreased, while blood platelets, lymphocytes, insulin, and HDL were significantly increased in LPD-fed dams (P<.05). A postnatal switch to an adequate protein could not prevent hyperlipidemia in the 6-months LPD/CD offspring. The lipid profile and liver functions were restored over 10 months of protein feeding but failed to normalize fasting glucose and body fat accumulation compared to CD/CD. LPD/CD showed elevated GLUT4 expression & activated pIRS1 in the skeletal muscle and increased expression of IL6, IL1ß, and p65-NFκB proteins in the liver (P<.05). In conclusion, present data suggest that maternal protein restriction may induce intrauterine inflammation and affect liver inflammation in the adult offspring by an influx of fats from adipose that may alter lipid metabolism and reduce insulin sensitivity in skeletal muscle.

Risperidone-Induced Sexual Dysfunction Case Report.

Treatment-emergent sexual dysfunctions are a common and distressing adverse effect of antipsychotic medication, particularly risperidone, which can result in medication noncompliance among patients with psychiatric disorders. In this case report, we present a 55-year-old male patient with a history of bipolar disorder type 1 who was admitted to an inpatient psychiatric facility due to a severe manic episode with psychotic features. The patient reported having previously taken risperidone for his bipolar symptoms but stopped taking it two months prior to hospitalization due to sexual side effects, including reduced libido and anejaculation. Comprehensive medical and psychiatric evaluations were performed during the patient's hospitalization, and his symptoms were treated with lurasidone instead of resuming risperidone. The patient's symptoms improved, and he was discharged with close outpatient follow-up for six months without symptoms of sexual dysfunction, depressive or manic symptoms, or adverse medication effects. This case adds to the growing body of literature on the adverse effects of risperidone, which is known to stimulate prolactin and contribute to sexual dysfunction in as many as 50-70% of patients, and highlights the potential benefits of switching to lurasidone, which has limited literature but as of this publication has not been associated with sexual dysfunction in clinical trials. However, more research is needed to fully understand the impact of antipsychotic switching on sexual side effects and the reluctance of patients to switch medications due to discomfort discussing these sensitive issues.