Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Breast cancer is a heterogeneous disease with varied morphological appearances, molecular features, behavior, and response to therapy. Current routine clinical management of breast cancer relies on the availability of robust clinical and pathological prognostic and predictive factors to support clinical and patient decision making in which potentially suitable treatment options are increasingly available. One of the best-established prognostic factors in breast cancer is histological grade, which represents the morphological assessment of tumor biological characteristics and has been shown to be able to generate important information related to the clinical behavior of breast cancers. Genome-wide microarray-based expression profiling studies have unraveled several characteristics of breast cancer biology and have provided further evidence that the biological features captured by histological grade are important in determining tumor behavior. Also, expression profiling studies have generated clinically useful data that have significantly improved our understanding of the biology of breast cancer, and these studies are undergoing evaluation as improved prognostic and predictive tools in clinical practice. Clinical acceptance of these molecular assays will require them to be more than expensive surrogates of established traditional factors such as histological grade. It is essential that they provide additional prognostic or predictive information above and beyond that offered by current parameters. Here, we present an analysis of the validity of histological grade as a prognostic factor and a consensus view on the significance of histological grade and its role in breast cancer classification and staging systems in this era of emerging clinical use of molecular classifiers.

Breast cancer prognostic classification in the molecular era: the role of histological grade

Arthur Chickering is Distinguished Professor of Higher Education at Memphis State University. On leave from the Directorship of the Center for the Study of Higher Education at Memphis State, he is Visiting Professor at George Mason University. Zelda Gamson is a sociologist who holds appointments at the John W. McCormack Institute of Public Affairs at the University of Massachusetts-Boston and in the Center for the Study of Higher and Postsecondary Education at the University of Michigan.

Seven Principles for Good Practice in Undergraduate Education: Faculty Inventory. Institutional Inventory.

Summary Dengue is the second most common mosquito-borne disease affecting human beings. In 2009, WHO endorsed new guidelines that, for the first time, consider neurological manifestations in the clinical case classification for severe dengue. Dengue can manifest with a wide range of neurological features, which have been noted—depending on the clinical setting—in 0·5–21% of patients with dengue admitted to hospital. Furthermore, dengue was identified in 4–47% of admissions with encephalitis-like illness in endemic areas. Neurological complications can be categorised into dengue encephalopathy (eg, caused by hepatic failure or metabolic disorders), encephalitis (caused by direct virus invasion), neuromuscular complications (eg, Guillain-Barre syndrome or transient muscle dysfunctions), and neuro-ophthalmic involvement. However, overlap of these categories is possible. In endemic countries and after travel to these regions, dengue should be considered in patients presenting with fever and acute neurological manifestations.

https://www.thelancet.com/pdfs/journals/laneur/PIIS1474-4422(13)70150-9.pdf

Neurological complications of dengue virus infection.

Dengue virus belongs to family Flaviviridae, having four serotypes that spread by the bite of infected Aedes mosquitoes. It causes a wide spectrum of illness from mild asymptomatic illness to severe fatal dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS). Approximately 2.5 billion people live in dengue-risk regions with about 100 million new cases each year worldwide. The cumulative dengue diseases burden has attained an unprecedented proportion in recent times with sharp increase in the size of human population at risk. Dengue disease presents highly complex pathophysiological, economic and ecologic problems. In India, the first epidemic of clinical dengue-like illness was recorded in Madras (now Chennai) in 1780 and the first virologically proved epidemic of dengue fever (DF) occurred in Calcutta (now Kolkata) and Eastern Coast of India in 1963-1964. During the last 50 years a large number of physicians have treated and described dengue disease in India, but the scientific studies addressing various problems of dengue disease have been carried out at limited number of centres. Achievements of Indian scientists are considerable; however, a lot remain to be achieved for creating an impact. This paper briefly reviews the extent of work done by various groups of scientists in this country.

Dengue in India

Correlation between nephropathy and ophthalmic complications in cases of sickle cell anemia: An entangled association

Background Obesity, specifically abdominal obesity, is a major risk factor for diabetes. A strong association has been marked between diabetes and obesity. Many abdominal obesity indices have been established, including waist circumference (WC), BMI, and a new tool, the visceral adiposity index (VAI). However, very limited research highlights the association of these anthropometric parameters and VAI to the various microvascular complications of diabetes mellitus (DM). The objective of this study is to investigate the association of VAI with microvascular complications such as retinopathy, nephropathy, and neuropathy in type 2 DM (T2DM) patients. Methodology Data from Acharya Vinoba Bhave Rural Hospital (AVBRH) was analyzed in this case-control study with a sample size of 250 patients consisting of 125 cases and 125 controls. The cases and controls were age- and gender-matched. BMI and WC were measured in these patients, and the VAI was calculated. These anthropometric parameters were then analyzed to estimate their correlation with the microvascular complications of T2DM. Results The mean age of cases in this study was 58.37 ± 12.08 years and that of controls was 57.61 ± 14.51 years. Anthropometric parameters, namely, BMI, WC, and VAI were raised in cases as compared with controls, and they showed significant statistical relation with diabetes (for BMI, P = 0.003; for WC, P = 0.001 for males and P = 0.002 for females; and for VAI, P = 0.005). A significant correlation was noted in the high-density lipoprotein (HDL) cholesterol (P = 0.017 for males and P = 0.0004 for females) and triglyceride (TG) levels (P < 0.0001) between cases and controls. On distributing the male and female cases in quartiles, it was observed that with increasing quartiles, VAI increased significantly and was associated with an increased risk of microvascular complications such as retinopathy, nephropathy, and neuropathy. When the anthropometric parameters and VAI were compared with the total microvascular complications and the receiver operating characteristic curve studied, VAI had the maximum AUC (AUC for VAI was 0.826, WC was 0.813, and BMI was 0.806). Univariate analysis of the various microvascular complications showed that WC, BMI, HDL, TGs, and glycated hemoglobin (HbA1c) were all significantly correlated to the microvascular complications in T2DM patients. Conclusions As the VAI was significantly raised in T2DM patients and also seen to be significantly associated with microvascular complications, it could be used as a screening tool for T2DM patients.

/pdf/visceral-adiposity-index-in-type-2-diabetes-mellitus-dm-and-2ja29glq.pdf

Visceral Adiposity Index in Type 2 Diabetes Mellitus (DM) and Its Correlation With Microvascular Complications

Gospels of a pandemic- A metaphysical commentary on the current COVID-19 crisis

One of the most common oral malignancies is oral squamous cell carcinoma (OSCC). Although the prevalence of oral cancer varies worldwide, it is generally agreed that the oral cavity is a common anatomical site for cancer, depending primarily on the country (and even particular region in some countries) and gender of the patients. Finding diagnostic markers for OSCC is critical for early diagnosis and personalised treatment of patients. Because they are overexpressed in OSCC relative to normal mucosa, cytokeratins (CKs), intermediate filaments of the cytoskeletons, are possibilities for diagnostic markers of OSCC. CK17 should be targeted as a diagnostic marker for OSCC among the CKs, as multiple other CKs have been linked to the disease. This study aims to assess the immuno-histochemistry expression of CK17 and to investigate whether there is a link between CK17 and OSCC differentiation.

/pdf/diagnostic-utility-of-cytokeratin-17-expression-in-oral-31iwrowe.pdf

Diagnostic Utility of Cytokeratin 17 Expression in Oral Squamous Cell Carcinoma: A Review

Cavitary lung lesions have a specific array of differential diagnosis. Among rare causes is mucormycosis that should not be overlooked. A high index of suspicion is necessary for a correct diagnosis and aggressive management. It usually occurs in immunosupressed patients. It is a life-threatening, rapidly progressive, and angioinvasive fungal infection. We present a case of pulmonary mucormycosis presenting as a cavity in an immunocompetent middle aged male.

Isolated pulmonary mucormycosis presenting as cavitary lesion in an immunocompetent adult: A rare case report

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