Comparison of outcomes of the 50-year follow-up of a randomized trial assessed by study questionnaire and by data linkage: The CONCUR study.

BACKGROUND/AIMS: Self-reported questionnaires on health status after randomized trials can be time-consuming, costly, and potentially unreliable. Administrative data sets may provide cost-effective, less biased information, but it is uncertain how administrative and self-reported data compare to identify chronic conditions in a New Zealand cohort. This study aimed to determine whether record linkage could replace self-reported questionnaires to identify chronic conditions that were the outcomes of interest for trial follow-up. METHODS: Participants in 50-year follow-up of a randomized trial were asked to complete a questionnaire and to consent to accessing administrative data. The proportion of participants with diabetes, pre-diabetes, hyperlipidaemia, hypertension, mental health disorders, and asthma was calculated using each data source and agreement between data sources assessed. RESULTS: Participants were aged 49 years (SD = 1, n = 424, 50% male). Agreement between questionnaire and administrative data was slight for pre-diabetes (kappa = 0.10), fair for hyperlipidaemia (kappa = 0.27), substantial for diabetes (kappa = 0.65), and moderate for other conditions (all kappa >0.42). Administrative data alone identified two to three times more cases than the questionnaire for all outcomes except hypertension and mental health disorders, where the questionnaire alone identified one to two times more cases than administrative data. Combining all sources increased case detection for all outcomes. CONCLUSIONS: A combination of questionnaire, pharmaceutical, and laboratory data with expert panel review were required to identify participants with chronic conditions of interest in this follow-up of a clinical trial.

Long-term outcomes of transcutaneous retrobulbar amphotericin B in COVID-19-associated mucormycosis.

Purpose: To describe the long-term outcomes of transcutaneous retrobulbar amphotericin B (TRAMB) in COVID-19-associated mucormycosis. Methods: In total, 18 cases of COVID-19-associated mucormycosis were reviewed. In addition to the recommended treatment protocol, all patients were to be given 3.5 mg/ml/day of TRAMB for five days. Results: Of the 18 patients, 2 presented with stage 3a disease, 13 had stage 3c disease, and 3 patients had central nervous system (CNS) involvement (stage 4a and 4c). In addition to planned retrobulbar doses, five patients were given more while two patients received fewer injections (i.e., <5). At the last mean follow-up of 34.67 (±8.88) weeks, 11 patients were in radiological regression and 4 had stable disease while 2 patients had to undergo exenteration; one mortality was observed because of disease progression. Clinical regression in terms of visual and ptosis improvement was seen in seven and nine patients, respectively. Conclusion: Rhino-orbito-cerebral mucormycosis is a serious condition which warrants an aggressive treatment strategy. In unprecedented situations witnessed recently, TRAMB turned out to be an effective and economical alternative. Though large randomized studies are needed to establish its efficacy, TRAMB still manages to halt progression and salvage the globe in significant number of patients, and hence its use should be encouraged on a case-to-case basis especially in developing countries with limited resources.

Analysis of the primary presenting symptoms and hematological findings of COVID-19 patients in Bangladesh.

INTRODUCTION: SARS-Cov-2 infection or COVID-19 is a global pandemic. In this manuscript, we investigated the primary symptoms and basic hematological presentations of SARS-CoV-2 infection among the Bangladeshi patients. METHODOLOGY: This was a multicentre cross-sectional study done on COVID-19 patients tested positive by RT PCR in Bangladesh. Clinical features of mild to moderate degree of COVID-19 patients; hematological and biochemical admission day laboratory findings of moderate to severe degree hospitalized COVID-19 patients were analyzed. RESULTS: COVID-19 patients in Bangladesh commonly presented with fever, cough, fatigue, shortness of breath, and sore throat. But symptoms like myalgia, diarrhea, skin rash, headache, Abdominal pain/cramp, nausea, vomiting, restlessness, and a higher temperature of >100°F have a greater presentation rate and more frequent than other published studies. CRP and Prothrombin time was found to increase in all the patients. Serum ferritin, ESR, SGPT, and D-Dimer were increased among 53.85%, 80.43, 44%, and 25% patients. 17.39% of the patients had leucocytosis and neutrophilia, 28.26% presented with lymphocytopenia, and 62.52% had mild erythrocytopenia. The difference between the decrease hemoglobin count (higher in the male) and increased SGPT (higher in female) against gender was significant. CONCLUSIONS: Our study had evaluated a different expression in presenting symptoms of COVID-19 patients in Bangladesh. CRP, Prothrombin time, serum ferritin, ESR, SGPT, D-Dimer, erythrocytopenia, and lymphocytopenia can be assessments for diagnosis and prognosis of COVID-19 disease. Decrease hemoglobin count (higher in the male) and increased SGPT (higher in female) establish these two markers as a good candidate for diagnostic value against gender.

Uncompensated tooth loss in cardiac patients of Punjab Institute of Cardiology, Lahore.

OBJECTIVE: To observe replacement of missing teeth with artificial teeth in subjects with and with out cardiac diseases and find its possible association with coronary heart diseases (CHD). METHODOLOGY: Consecutive patients aged 20 and above with coronary heart disease and accompanied healthy subjects with tooth loss were examined for oral prosthesis after having a verbal consent, over a one month period in a cross-sectional study at Punjab Institute of Cardiology, Lahore. Chi-square and T- test were applied to analyze variables in subjects with and without coronary heart disease. RESULTS: Among 1694 subjects found with tooth loss, 1473 (86.95) subjects had no oral prosthesis; 817 (87.37%) were among the 935 cardiac patients and 656 (86.42%) among 759 healthy subjects. Oral prosthesis was found in 86 (8.05%) males and 32 (5.11%) females with coronary heart diseases. Of the healthy population, 46 (4.30%) males and 57 (9.10%) females had oral prosthesis. Statistical association for prosthesis was insignificant among cardiac patients and healthy subjects. CONCLUSION: No association of uncompensated tooth loss with cardiac diseases was observed in this study. Although a large majority of cardiac patients and healthy subjects were observed with uncompensated tooth loss which was statistically insignificant.

Human development index, maternal mortality rate and under 5 years mortality rate in West and South Asian countries, 1980-2010: an ecological study.

BACKGROUND: Human Development Index (HDI), maternal mortality rate (MMR) and children aged under 5 years mortality rate (U5MR) are fundamental issues, especially in low- and middle-income countries. AIMS: The aim of this study was to evaluate the changes in HDI, MMR and U5MR from 1980 to 2010 in certain West Asian countries as well as the relationship between these indexes. METHODS: In this ecological study, HDI, MMR and U5MR information from studied countries during 1980 to 2010 was extracted from the gap minder site and then analysed using descriptive and analytical methods, including Spearman correlation. RESULTS: The lowest and highest rates of HDI and MMR in 2010 were seen in the United Arab Emirates and Pakistan (HDI: 0.49, 0.81; MMR: 7.14, 335.45 respectively). HDI is rising in all countries studied, with the highest increase in the Islamic Republic of Iran (0.21). MMR and U5MR saw a decline over the years, with the greatest decrease seen in India, and the lowest and highest child mortality rate in 2010 found in Bahrain and Pakistan (8.3, 91.8 respectively). However, there was a negative relationship between HDI and MMR (r = -0.7, P < 0.001). CONCLUSIONS: HDI increased during 1980-2010. The highest rate of HDI decrease was observed in the Islamic Republic of Iran, and the greatest reduction of MMR was seen in India. Also, the highest decrease in U5MR was related to India as well, while MMR and U5MR rate decreased. Hence, improving HDI might have a definite impact on decreasing MMR and U5MR, especially in low- and middle-income countries.