Prognostic Value of Elevated Lipase in Pancreatitis versus Non Pancreatitis Hyperlipasemia (NPHL) due to Non-Malignant Causes

Introduction: While elevated lipase is typically used to diagnose acute pancreatitis, it has also been associated with other critical disease states including sepsis, COVID-19, bowel obstruction, and trauma. In this study we compared outcomes of patients with elevated lipase who had pancreatitis and NPHL. Method(s): Retrospective analysis was performed on all patients who presented to the Emergency Department between February 2016 and August 2020 with lipase >= 3x the upper limit of normal. Patient demographics and past medical history, including active cancer, were noted. Patient outcomes were followed through November 2021. If applicable, dates of death were also documented. Result(s): 414 total patients were included in this study. Upon initial evaluation, 305/414 (74%) were diagnosed with acute pancreatitis (AP) and 109/414 had NPHL. The age (54 617 vs. 58 618, p=0.0220), Sex (male 164/305 vs. 49/109, p=0.1194), and BMI (28.9 67.4 vs. 25.8 64.6, p=0.0066) were compared between the AP and NPHL groups. The serum lipase in the AP and NPHL group were respectively 1471 61070 vs. 605 6555 (p< 0.0001). The most common causes of NPHL were sepsis (10/109;9%) renal failure (7/109;6%), GI bleed (5/109;4%), and bowel obstruction (5/109;4%). The NPHL group had higher rate of malignancy (29/105;28%) compared to those with AP (35/305;11%, p< 0.0001). NPHL patients without malignancy had a higher mortality rate (63/80;80%) compared to those without malignancy in the AP group (17/270;6.3%, p< 0.0001). The most common malignancy in patients with AP was breast (6/35;17%, vs. 3/29;10%, p=0.4943). In NPHL, the most common malignancies were pancreatic (4/29;14%, vs. 3/35;9%, p=0.6920) and bowel malignancies (4/29;14%, vs. 4/35, 11% p51.0000). Conclusion(s): Patients with NPHL without malignancy have higher mortality than those with pancreatitis despite lower serum lipase levels. A limitation of our study is the difference between age and BMI of AP versus NPHL patients. Whether this impacts the prognostic relevance of NPHL on survival need to be explored in future studies.

Sustainability in the aviation industry in the post-COVID-19 era

The purpose of this study is to understand and identify sustainability measures applicable in the aviation industry. Further, the study also explores the enablers of sustainability in the aviation sector. The study uses a systematic literature review, published in Scopus-indexed journals. The study addresses the complexity of sustainability in the sector and identifies key indicators based on comprehensive and valid datafrom different stakeholders. The study focuses separately on the three pillars of sustainability-social economic, and environmental sustainability-and identifies sustainability indicators for each pillar from the views of the triple bottom line. The study finds that there is a lack of sustainability knowledge and awareness in the aviation sector despite its resistant growth and expansion. The results show that the aviation industry highlights the importance of sustainability indicators that value equitable development in the pursuit of business goals and environmental and economic efficiency. © 2023, IGI Global. All rights reserved.

Intention to Use Social Media in Online and Blended Learning: Potential Predictors and Mediation of Collectivism

The COVID-19 pandemic has drastically impacted traditional classroom education and all the associated multi-stakeholders (Universities, teachers, and students). With education embracing online media, there is a need to develop sustainable models of education. Social media is a tool that can be effectively used to create sustainable development in higher education. In this context, this study emphasizes on the development of an empirical model for intention to use social media in online/blended learning in a multi-stakeholder (Universities, teachers, and students) context. A total of 330 samples were collected through an online survey from students/faculties of various public and private higher educational institutions in India. The data from the survey was analyzed employing Explorative Factor Analysis (EFA) using R-Studio and, Confirmatory Factor Analysis (CFA) and Path Analysis (AP) using Structure Equation Modelling (SEM) on the AMOS 20.0 software platform. Results demonstrate a significant impact of perceived privacy, perceived security, ICT facility, and trust, on the intention to use social media in educational institutions following online/blended learning methods. The mediation of collectivism is also confirmed in this study. Hence, our findings will add value to the existing literature on online/blended learning and the sustainable development of education. By implementing more stringent security and privacy policies, good Internet connectivity, better technology infrastructure, and excellent and smart features in mobile, tablets, and laptops social media and collective effort of students, instructors, and external student communities may generate trust in the stakeholders, motivating them to use social media as a tool in higher education. IEEE

Into the Unknown: Uncertainty, Foreboding and Financial Markets

While the link between financial market movement and economic policy uncertainty indices is well-established in literature, uncertainty in the form of ‘foreboding' emanating from catastrophic events has not been explored in literature. This paper explores "foreboding”, which reflects uncertainty at its extreme, following the Covid-19 pandemic. Using Natural Language Processing on minute-by-minute news data, I construct two Foreboding Indices, representing ‘foreboding' or ‘fearful apprehension', for 28,622 Covid-related news for the period July 2020–August 2021. The impact of foreboding on financial market volatility is explored using a logistic regression model. Both the indices show a marked increase in June–July, 2020, in January 2021, April, 2021, and July–August, 2021 and have a positive impact on volatility for hourly S&P 500 Index. Understanding of foreboding sentiment is crucial for central banks looking to monitor financial market volatility. Appropriate signaling in accordance to sentiment can help central banks handle detrimental impacts of market volatility. Moreover, FI can be used for market practitioners to gauge the sentiment and take effective trading decisions. © 2023, The Author(s), under exclusive licence to Springer Japan KK, part of Springer Nature.

COVID-19 Patient Recovery Prediction Using Efficient Logistic Regression Model

This research develops a COVID-19 patient recovery prediction model using machine learning. A publicly available data of infected patients is taken and pre-processed to prepare 450 patients' data for building a prediction model with 20.27% recovered cases and 79.73% not recovered/dead cases. An efficient logistic regression (ELR) model is built using the stacking of random forest (RF) and logistic regression (LR) classifiers. Further, the proposed model is compared with state-of-art models such as logistic regression (LR), support vector machine (SVM), decision tree (C5.0), and random forest (RF). All the models are evaluated with different metrics and statistical tests. The results show that the proposed ELR model is good in predicting not recovered/dead cases and handling imbalanced data. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Performance of prognostic scores in prediction of 30-day postoperative mortality in COVID-19 patients after emergency surgery: A retrospective cohort study.

Background: : Risk assessment with prognostic scoring, though important, is scarcely studied in emergency surgical patients with COVID-19 infection. Methods and Material: We conducted a retrospective cohort study on adult emergency surgical patients with COVID-19 infection in our institute from 1 May 2020 to 31 October 2021 to find the 30-day postoperative mortality and predictive accuracy of prognostic scores. We assessed the demographic data, prognostic risk scores (American Society of Anesthesiologists-Physical Classification (ASA-PS), Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scores), surgical and anesthetic factors. We assessed the postoperative morbidity using the Clavien-Dindo scale and recorded the 30-day mortality. Correlation of prognostic scores and mortality was evaluated using Univariate Cox proportional hazards regression, receiver operating characteristic curve (ROC), Youden's index and Hosmer- Lemeshow goodness of fit model. Results: Emergency surgery was performed in 67 COVID-19 patients with postoperative complication and 30-day mortality rate of 33% and 19%, respectively. A positive qSOFA and ASAPS IIIE/IVE had a 9.03- and 12.7-times higher risk of mortality compared to a negative qSOFA and ASA-PS IE/IIE (P < 0.001), respectively. Every unit increase of SOFA, POSSUM and P-POSSUM scores was associated with a 50%, 18% and 17% higher risk of mortality, respectively. SOFA, POSSUM and P-POSSUM AUCROC curves showed good discrimination between survivors and non-survivors (AUC 0.8829, 0.85 and 0.86, respectively). Conclusions: SOFA score has a higher sensitivity to predict 30-day postoperative mortality as compared to POSSUM and P-POSSUM. However, in absence of a control group of non-COVID-19 patients, actual risk attributable to COVID-19 infection could not be determined.

Exploring the backyard of ncovid: Determinants of death toll in pandemics

Heterogeneity in number of deaths in different countries during the ongoing nCOVID crisis challenged us to look for determinants of pandemic death toll across the world. Using the past two decades data of pandemic deaths in the world, this study considered if engagement in international trade, health care expenditure and population density have any impact on the pandemic death toll. Using linear regression model controlled for types of disease, we not only found trade significantly impacting death toll, but also surprisingly found positive correlation between share of healthcare expenditure in GDP and fatalities in pandemics. Our findings suggest that policy intervention is required for mitigating health impacts of trade and ‘tweaking’ the health expenditure towards pandemic prevention. © 2020 Australasian College of Health Service Management. All rights reserved.

Guillain-barré syndrome associated with COVID-19

INTRODUCTION: Reports of neurological complications related to COVID-19 are limited but cases of COVID-19 associated Guillain-Barré syndrome (GBS) are emerging in the literature. Herein, we aim to describe a case of an immunocompromised male who presented with bulbar symptoms after the initiation of pregabalin in the setting of positive IgG serology for COVID-19 and imaging, CSF analysis and EMG consistent with Miller-Fisher variant of GBS. METHODS: A 55-year-old male presented with bulbar symptoms after the initiation of pregabalin, which progressed to progressive descending paralysis and nasal myiasis. His past medical history was significant for status-post orthotopic liver transplant 7 months prior, end-stage renal disease on intermittent hemodialysis, type II diabetes mellitus, methicillin-sensitive Staphylococcus aureus empyema and recent pseudomonal bacteremia. While the patient had no reported symptoms of COVID-19 viral infection and had several negative rapid COVID-19 tests, the COVID-19 IgG returned positive. His initial physical exam was notable for rapid, progressive descending paralysis progressing to acute respiratory failure necessitating intubation. Cerebrospinal fluid analysis revealed an albumin-cytologic dissociation, MRI was unrevealing, and EMG supported a diagnosis of GBS, therefore plasma exchange therapy was started. The patient had notable improvement after a single session, and continued improvement in strength and respiratory effort with subsequent sessions. Based on the imaging studies, CSF analysis and rapid improvement with plasma exchange therapy, the patient was diagnosed with Miller-Fisher variant of GBS associated with positive COVID-19 IgG serology. RESULTS: Our case describes a rare neurological complication associated with a presumed asymptomatic COVID-19 infection in the setting of positive COVID-19 IgG serology.

Acute Pancreatitis Patients with Elevated Unbound Fatty Acids at Admission Have Worse Outcomes

Background: Elevated serum unsaturated non-esterified fatty acids (NEFA) are associated with severe pancreatitis. However, most NEFA are carried bound to albumin, which along with calcium can reduce their toxicity. We have recently shown unbound fatty acids (uFA) mediate cell injury and are associated with worse lung injury during COVID-19 infection. We therefore investigated the prognostic value of serum uFA in patients admitted with acute pancreatitis. Methods: Patients presenting to theMayo Clinic Arizona's emergency department with acute pancreatitis were included. Admission serum was analyzed and patients were followed during their hospitalization for severity, and length of stay (LOS). Parameters studied included age, sex, bodymass index, LOS, serum calcium, albumin and uFA. Normal values of uFA were determined based on outpatient controls. Results: The study consisted of 86AP patients, and 56 controls (uFA = 0.4-4.8 μM). 9 AP patients developed persistent organ failure (POF). Patients with mild AP had lower uFA (3.5 ± 2.4 μM) vs. those with severe AP (12.9 ± 18.5 μM, P < 0.005) and a shorter LOS 3.2 ± 2.8 days (vs 15.7 ± 10.9 days, P < 0.005). A cut off uFA ≥4.9 μMwas associated with a longer LOS (8.8 ± 9.6 days vs 3.3 ± 2.8 days, P < 0.04), and increased risk of POF (odds ratio, 11.47;95% CI, 2.19-60.2;P < 0.004). Mild AP patients had higher calcium (9.6 ± 0.5 mg/dl vs 8.6 ± 1.3 mg/dl, P < 0.005) and albumin (4.4 ± 0.5 g/dl vs 3.6 ± 1.1 g/dl, P < 0.005) levels. Other factors including lipase, amylase, BMI, and age were not significantly different between mild and severe AP patients. There was no association between Serum uFAvs serum Calcium or albumin. Conclusions: Patients with high unbound fatty acids on admission have a higher risk of POF, and longer length of hospital stay. The prognostic value of these in relation to other risk factors for severe AP remains to be determined.