Alterations in biochemical profiles of patients with severe COVID-19 pneumonia: Analysis of repeated laboratory tests

Objective: This study was initiated to show the changes in the biochemical profile and identify the mortality risk factors of patients with severe coronavirus disease-19 (COVID-19) pneumonia. Materials and Methods: This study was designed as non-interventional and cohort research. Demographic and clinical data were retrospectively obtained from paper-based documents and electronic health records. Complete blood counts, inflammatory markers, liver, and kidney function tests, and coagulation profiles were recorded 3 times. Two-way ANOVA for repeated measures was used to analyze for continuous dependent variables. Binary logistic regression analysis was performed to determine in-hospital mortality risk factors. Results: Two hundred and fifty-two adult patients with severe COVID-19 pneumonia enrolled in our study – 15.8% of patients died during hospitalization. The mortality rate was 57.5% for those over 65 years of age. 61.9% of patients had at least one coexisting disease. We revealed hemoglobin, leukocyte, lymphocyte, platelet, C-reactive protein, procalcitonin, d-dimer, aspartate aminotransferase, and alanine aminotransferase, lactate dehydrogenase, creatinine, and ferritin were significantly changing within the time and also between survivors and non-survivors. Conclusion: The study showed that blood cell counts, coagulation profiles, liver and kidney function tests, and inflammatory markers deteriorated in non-survivor COVID-19 patients. Patients with shortness of breath, history of congestive heart failure, coronary artery disease, dementia, chronic renal disease, higher Charlson comorbidity index score, the need for invasive mechanic ventilation, presence of acute respiratory distress syndrome, and intensive care unit admission are more vulnerable to death

Health status and working condition of migrant workers: Major public health problems

WOS: 000423163400002PubMed ID: 28966757Background: Very little research and survey have been performed on the occupational health, hazards, and working condition of urban and rural of workers in Qatar. The aim of the current study is to identify the health status, lifestyle condition, working-related problems, and accidents experienced by Indian subcontinental migrants (ISCM) in Qatar and their access to health-care facilities. Methods: This is a cross-sectional study based on a representative sample of 1186 workers and study covering sociodemographic characteristics, medical conditions, and health-seeking behaviors and personal experience. Results: There were statistically significant differences between semi-urban and urban migrant workers in terms of educational, occupation, income, working hours, and accommodation type (P < 0.001). Furthermore, there were statistically significant differences between migrant workers in terms of body mass index, delay in receiving salary, the right to medical insurance and sick day entitlement, cigarettes and shisha smoking, amenities, having on-site safety measure, and sleeping hours (P < 0.01). Moreover, there were statistically significant differences between semi-urban and urban migrant workers in terms of pain, cardiopulmonary, gastrointestinal, and pseudoneurologic and medical symptoms (P < 0.01). Multiple logistic regression was used for predictors' health problems in migrant workers such as the absence of drinking water, tap water availability, safety facility tools, occupational status, shisha smoking, toilet facility, working hours, and accommodation type were considered the strong predictors. Conclusions: The current study revealed that there is a lack of insufficient information for the migrants about their lifestyle, medical conditions, health risks, injury, and rights privilege in relation to legal working condition and health services.Hamad Medical Corporation [HMC RC/36012/2012, 12025/12]The author would like to thank the Hamad Medical Corporation for their support and ethical approval research project studies (HMC RC/36012/2012 and RP# 12025/12)

Risk factors of zinc deficiency in children with atopic dermatitis

Summary: Background and objectives. Zinc deficiency increases risk of infections, allergies and autoimmunity. We wished to determine risk factors in severe atopic dermatitis (AD) and identify of hypozincemia rate. Materials and methods. Retrospective study done on AD children (≤ 14 years) with serum zinc test. Data included demographic and laboratory tests (serum zinc level, IgE, food-specific IgE), and skin tests. Results. 168 AD children, aged 38.9 months with concomitant allergies in 47 (28%), family history of allergies in 131 (80%), and parental consanguinity in 134 (79.9%). AD was mild in 12 (7.2%, SCORAD 15.8) children, moderate in 41 (24.5%, SCORAD 30.4), and severe in 115 (68.3%, SCORAD 69.4). Hypozincemia was observed in 42 (25%, zinc 8.6 ± 1.1 µmoI/L) children and associated only with severe AD (p = 0.0418) and elevated IgE (p = 0.001). Conclusions. Hypozincemia is rather prevalent in AD, and severe AD and high IgE increase its risk. An adjunct oral zinc may help reducing severe poorly responsive AD.Research Medical Center of Hamad Medical Corporation (RMC

Predictors risk factors for acute complex appendicitis pain in patients: Are there gender differences?

Objective: The purpose of this study is to determine the predictive risk factors for appendicitis and the cost-effectiveness of using abdominal helical computed tomography (CT) in comparison to abdominal ultrasonography (US) for the diagnosis of acute appendicitis in patients.Subjects and methods: The typical case was a patient with abdominal pain in the right lower quadrant and suspicion of appendicitis. A total of 643 patients who were consequently treated with appendectomy upon diagnosis of acute appendicitis between January 2015 and December 2018 were included in the study. The four diagnostic alternatives chosen were US, CT, biochemistry parameters, and physical examination in the hospital.Results: There were statistically significant differences between male and female patients with regards to age, BMI, cigarette smoking, sheesha smoking, family history of diabetes, hypertension and family history of gastrointestinal discomfort (GI), anxiety (P < 0.001), red eye (P = 0.006), dizziness (P = 0.021), headache (P < 0.001), muscular symptoms, weakness and cramps (P < 0.001), bloating or swollen stomach (P < 0.001), UTI (P < 0.001), chest pain (P < 0.001), guarding (P < 0.001), loss of appetite (P = 0.004), nausea (P < 0.001) vomiting (P = 0.042), anorexia (P = 0.009), and constipation (P = 0.002). Moreover, there were statistically significant differences between male and female patients for pain (P < 0.001), pain right belly (P = 0.027), severe crumps (P = 0.007), high temperature and fever (P < 0.001), irritable bowel syndrome (P < 0.001), right iliac fossa (RIF) pain (P = 0.008), rebound tenderness (P = 0.024), positive bowel sounds (P = 0.029), and pointing tenderness (P < 0.001). Multivariate stepwise logistic regression showed nausea (P < 0.001), C-reactive protein (CRP) (P < 0.001), dizziness (P = 0.016), vomiting (P < 0.001), muscular symptoms (P = 0.007), irritable bowel syndrome (P = 0.034), guarding (P = 0.040), and loss appetite (P = 0.046) were considered at higher risk as predictors for appendicitis patients.Conclusions: CT is more cost-effective than the US and clinical examination for determining appendicitis. The current study suggested that nausea, C-reactive protein, dizziness, vomiting, muscular symptoms, irritable bowel syndrome, guarding, and loss appetite were considered as higher risk predictors for appendicitis patients

Is there a relationship between microvascular complications and the severity of type 2 diabetes mellitus?

Objective: The aim of this study was to determine the relationship between microvascular Type 2 diabetes mellitus (T2DM) complications and the severity and duration of diabetes in the light of sociodemographic and lifestyle variables. Materials and Methods: This is a prospective cohort study based on 899 (527 females, 372 males) patients with T2DM aged 25-70 years. Patient information including socio-demographic variables; body mass index (BMI); lifestyle habits and duration of diabetes; treatment of diabetes; values for hemoglobin A1c (HbA1c); development of diabetes complications; and the presence of neuropathy, nephropathy, and retinopathy were recorded. A univariate and multivariate statistical analysis were performed. Results: Significant differences were found between diabetics with HbA1c 7 in terms of the education level, occupation, household income, duration of diabetes, the number of children, smoking, physical exercise, eating fast food, control regularity, and diabetes education. A total of 17.1% of patients had diabetic retinopathy, 17.0% had neuropathy, and 13.7% had nephropathy. Among diabetics, 2.3% had three microvascular complications, whereas 66.6% had none of them. The prevalence of diabetes complications was lower in patients who had good glycemic control than those who had poor glycemic control. Furthermore, the highest reduction in the level of HbA1c was for sulfonylurea usage. Conclusion: A high prevalence of diabetes complications is a burden for both the patients and the health care system. Screening, early diagnosis, management of the glucose level, and the follow-up may result in delayed diabetes complications

Editorial: Immune-modulatory effects of vitamin D

Vitamin D plays an essential role in bone development. However, recent studies are beginningto uncover its role as a modulator of the immune system (1). Several reports have shownassociations between vitamin D deficiency (2) and the incidence as well as the severity of chronicinflammatory diseases such as cardiovascular disease (3, 4), inflammatory bowel disease (5), asthma(6), and chronic obstructive pulmonary disease (COPD) (7). Consistent with this, vitamin Dsupplementations have been shown to reduce the severity of and inflammation markers in chronicinflammatory diseases (8). At the molecular level, the hormonally active form of vitamin D (α1,25dihydroxyvitamin D3) regulates the expression of vitamin D responsive genes that can lead todifferential regulation of signaling pathways in immune cells. For example, vitamin D positivelyregulates iron homeostasis and erythropoiesis via the iron-hepcidin-ferroportin axis (9). VitaminD deficiency is highly prevalent world-wide including countries with abundance of sunshine (10).Singh et al. reviewed the causes of vitamin D deficiency where they dissected the complex impactof genetic predisposition, gut microbiota, and immune system. In this review, authors examinedGWAS database (11) and listed genes variants with SNPs that associate with risk of vitamin Ddeficiency. These alleles are common in vitamin D receptor (VDR) and vitamin D binding protein(VDPB). Since gut microbiota plays a crucial role in nutrients and vitamins production, absorptionand degradation, authors also highlighted the role of vitamin D metabolism and VDR is regulatinghost-gut microbiota interactions

Camel's milk allergy

WOS: 000442986400010PubMed ID: 30153889Introduction: Camel's milk is a safe and therapeutic nutrient. Camel's milk allergy is almost unknown. Objective: To identify the clinical and laboratory features of camel's milk allergy. Methods: In this retrospective study, the records of patients with camel's milk allergy were reviewed. Data collected included age, sex, clinical presentation, concomitant allergies, family history, laboratory tests (complete blood cell count [CBC], white blood cell [WBC] count, total immunoglobulin E [IgE] food specific IgE), and skin-prick tests (SPT) to camel's milk and other foods. Results: Nine patients (four male patients, five female patients; mean age +/- SD 4.3 +/- 1.4 years) presented with cutaneous urticaria and/or angioedema (five patients [55.6%]) and anaphylaxis (four patients [44.4%]). Allergic reactions occurred within the first 15 minutes of ingesting camel's milk in all the patients (100%). Concurrent allergies were observed in 77.8% of the patients, of whom, five patients (71.4%) had atopic dermatitis (AD) and two patients (22%) had cow's milk allergy that exacerbated AD. All the patients (100%) had a family history of allergies. The family farm was the source of camel's milk in all the patients (100%). The WBC count was 9425 +/- 1452.8 (mean +/- SD) cells/mu L, and eosinophils was 612 +/- 455.4 (mean +/- SD) cells/mu L, and the median IgE was 301.5 kU/mL. A camel's milk SPT resulted in a wheal of 8.7 +/- 4.9 (mean +/- SD) mm. Conclusion: Camel's milk allergy is a distinct, yet very rare, disease entity. Cutaneous and systemic allergic reactions are the main clinical manifestations. Concomitant other allergies, viz., AD, and positive family history are risk factors. Early life exposure to camel's milk is a possible risk factor. High blood eosinophil counts and total IgE levels were observed in patients with camel's milk allergy. In the presence of a consistent and specific clear-cut history of camel's milk-related symptoms, a SPT was a dependable confirmatory test.Research Medical Center of Hamad Medical Corporation [RMC 2034/12]This study was supported, in part, by Research Medical Center of Hamad Medical Corporation (RMC 2034/12

Assessment of the Gail model in estimating the risk of breast cancer: Effect of cancer worry and risk in healthy women

Background: There has been substantial interest in developing methods to predict the risk of breast cancer. The Gail model is one the first model have been widely used to identify women at higher risk of breast cancer. Aim: This study aimed to determine the 5-year and the general life-time risk of breast cancer and also to determine breast cancer predictors in women using the Gail model. Methods: We used the Gail model to estimate the risk of breast cancer in female Turkish outpatients aged above 35 years in this cross-sectional study. Age, life-style habits, breast-feeding duration, family history of breast cancer, and body mass index were compared between high and low-risk subjects. We have performed the Patient Health Questionnaire 9-item (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7) tools on patients regarding depression and anxiety. We also assessed the association of these covariates with the estimated risk of breast cancer in multivariate linear regression analysis. Results: We enrolled 1065 subjects with a mean age of 52.9 ± 8.4 years. The mean of the five-year risk for breast cancer was 1.33%±0.6. Meanwhile, the mean of lifetime risks for breast cancer was 10.15%±3.18, respectively. Nearly one-third of the participants had one child, 55.9% had breast-fed their children more than six months. Meanwhile, 18.5% of the subjects had a high depression score, 15.2% had a high anxiety score. Higher age, age at first birth, and parity; lower age at menarche; presence of menopause and family history of breast cancer were higher in the high-risk group. Higher age, and age at first birth; lower age at menarche; family history of breast cancer, presence of menopause, and parity were independently associated with higher breast cancer risk. Conclusion: We identified certain risk factors for breast cancer in our study population and Gail model is a reliable and useful breast cancer risk prediction model for clinical decision-making. This study contributes to the body of evidence in order to facilitate early detection and better plan for possible malignancies in Turkish population

Correlations Between Relatives with Respect to Dermatoglyphic Patterns on Specific Fingertips. I. Parent-child Correlations

1039 parent-child pairs from a Polish population are analyzed for the occurrence of the major dermatoglyphic patterns on each of the ten digits. Correlations between father and son, father and daughter, mother and son, and mother and daughter, as well as parent and child regardless of sex, were calculated for the occurrence of whorls, ulnar loops, radical loops, either kind of loop, and arches on specific fingertips. Parental influence varied widely in the specification of the different patterns. Father-daughter correlations were generally higher for whorls, ulnar loops and arches, mother-daughter correlations were higher for total loops, and father-son for radial loops. These influences, which could be both genetic and nongenetic, must be further identified and quantified before pattern determination on specific finger­tips can be understood

The effect of high-dose postpartum maternal vitamin d supplementation alone compared with maternal plus infant vitamin d supplementation in breastfeeding infants in a high-risk population. A randomized controlled trial

In view of continuing reports of high prevalence of severe vitamin D deficiency and low rate of infant vitamin D supplementation, an alternative strategy for prevention of vitamin D deficiency in infants warrants further study. The aim of this randomized controlled trial among 95 exclusively breastfeeding mother–infant pairs with high prevalence of vitamin D deficiency was to compare the effect of six-month post-partum vitamin D3 maternal supplementation of 6000 IU/day alone with maternal supplementation of 600 IU/day plus infant supplementation of 400 IU/day on the vitamin D status of breastfeeding infants in Doha, Qatar. Serum calcium, parathyroid hormone, maternal urine calcium/creatinine ratio and breast milk vitamin D content were measured. At baseline, the mean serum 25-hydroxyvitamin D (25(OH)D) of mothers on 6000 IU and 600 IU (35.1 vs. 35.7 nmol/L) and in their infants (31.9 vs. 29.6) respectively were low but similar. At the end of the six month supplementation, mothers on 6000 IU achieved higher serum 25(OH)D mean ± SD of 98 ± 35 nmol/L than 52 ± 20 nmol/L in mothers on 600 IU (p < 0.0001). Of mothers on 6000 IU, 96% achieved adequate serum 25(OH)D (≥50 nmol/L) compared with 52%in mothers on 600 IU (p < 0.0001). Infants of mothers on 600 IU and also supplemented with 400 IU vitamin D3 had slightly higher serum 25(OH)D than infants of mothers on 6000 IU alone (109 vs. 92 nmol/L, p = 0.03); however, similar percentage of infants in both groups achieved adequate serum 25(OH)D ≥50 nmol/L (91% vs. 89%, p = 0.75). Mothers on 6000 IU vitamin D3/day also had higher human milk vitamin D content. Safety measurements, including serum calcium and urine calcium/creatinine ratios in the mother and serum calcium levels in the infants were similar in both groups. Maternal 6000 IU/day vitamin D3 supplementation alone safely optimizes maternal vitamin D status, improves milk vitamin D to maintain adequate infant serum 25(OH)D. It thus provides an alternative option to prevent the burden of vitamin D deficiency in exclusively breastfeeding infants in high-risk populations and warrants further study of the effective dose