COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Miracles in medicine: A narrative inquiry exploring extraordinary events in pediatrics

Abstract Background and Aims Whether miracles are seen as a source of conflict between healthcare teams and families, a foolish or even harmful belief, or a hindrance to system‐wide improvements and scientific inquiry, miracles within medicine have long been questioned. We were interested in the perspectives of pediatricians on miracles and how that has informed their care of patients. We also sought to explore the intersection and relationship between the medical sciences, faith, and how we view miracles. Methods Using narrative inquiry as a research methodology, we had conversations and explored the experiences of physicians who work directly within pediatric clinical care. We used purposeful sampling by emailing several pediatricians whom we felt might have been interested in the project and may have had experiences with perceived medical miracles. All conversations were conducted over Zoom and recorded. Results We conducted one to three conversations with each participant. During our analysis, we identified two threads. First, participants described miracles mostly as favorable and fortuitous events that invoked a sense of wonder due to contextual factors such as geography, access to resources, time in history but also previous experiences and the expectations of the clinician. Second, there is a complex dynamic within and between the medical sciences and the faith commitments of clinicians and families, especially when facing life‐limiting or end‐of‐life illness. Conclusions The stories that our participants told not only informed their past experiences and how they remembered them but also their present and future experiences. Exploring the topic of medical miracles allowed us to better understand the social discourses that shape our perceptions of miracles, death, and the role of the physician. These stories offer us hope and possibility in a time when we as a medical community may have lost our sense of wonder and the ability to notice miracles

Prevalence of low muscle mass and associated factors in community-dwelling older adults in Singapore

10.1038/s41598-021-02274-3Scientific Reports1112307

Prevalence and associated factors of sarcopenia in community-dwelling older adults at risk of malnutrition

10.1186/s12877-022-03704-1BMC GERIATRICS22

Associations between socio-demographics, nutrition knowledge, nutrition competencies and attitudes in community-dwelling healthy older adults in Singapore: findings from the SHIELD study

10.1186/s41043-021-00277-4JOURNAL OF HEALTH POPULATION AND NUTRITION401completedcomplete

Impact of specialized oral nutritional supplement on clinical, nutritional, and functional outcomes: A randomized, placebo-controlled trial in community-dwelling older adults at risk of malnutrition

10.1016/j.clnu.2020.10.015CLINICAL NUTRITION4041879-189

Factors associated with muscle mass in community-dwelling older people in Singapore: Findings from the SHIELD study

10.1371/journal.pone.0223222PLOS ONE141

A versatile synthetic approach toward diversity libraries using monosaccharide scaffolds

The pyranose scaffold is unique in its ability to position pharmacophore substituents in various ways in 3D space, and unique pharmacophore scanning libraries could be envisaged that focus on scanning topography rather than diversity in the type Of substituents. Approaches have been described that make use of amine and acid functionalities on the pyranose scaffolds to append substituents, and this has enabled the generation of libraries of significant structural diversity. Our general aim was to generate libraries of pyranose-based drug-like mimetics, where the substituents are held close to the scaffold, in order to obtain molecules with better defined positions for the pharmacophore substituents. Here we describe the development of a versatile synthetic route toward peptide mimetics build oil 2-amino pyranose scaffolds. The method allows introduction of a wide range of substituent types, it is regio- and stereospecific, and the later diversity steps are performed on solid phase. Further, the same process was applied oil glucose mid allose scaffolds, in the exemplified cases, and is likely adaptable to other pyranose building blocks. The methods developed in this work give access to molecules that position the three selected binding elements in various 3D orientations oil a pyranose scaffold and have been applied for the production of a systematically diverse library of several hundred monosaccharide-based mimetics

Evidence for High-Efficiency Exciton Dissociation at Polymer/Single-Walled Carbon Nanotube Interfaces in Planar Nano-heterojunction Photovoltaics

There is significant interest in combining carbon nanotubes with semiconducting polymers for photovoltaic applications because of potential advantages from smaller exciton transport lengths and enhanced charge separation. However, to date, bulk heterojunction (BM) devices have demonstrated relatively poor efficiencies, and little is understood about the polymer/nanotube junction. To investigate this interface, we fabricate a planar nano-heterojunction comprising well-isolated millimeter-long single-walled carbon nanotubes underneath a poly(3-hexylthiophene) (P3HT) layer. The resulting junctions display photovoltaic efficiencies per nanotube ranging from 3% to 3.82%, which exceed those of polymer/nanotube BM by a factor of 50-100. The increase is attributed to the absence of aggregate formation in this planar device geometry. It is shown that the polymer/nanotube interface itself is responsible for exciton dissociation. Typical open-circuit voltages are near 0.5 V with All factors of 0.25-0.3, which are largely invariant with the number of nanotubes per device and P3HT thickness. A maximum efficiency is obtained for a 60 nm-thick P3HT layer, which is predicted by a Monte Carlo simulation that takes into account exciton generation, transport, recombination, and dissociation. This platform is promising for further understanding the potential role of polymer/nanotube interfaces for photovoltaic applicationsclose545

Surgical treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial

International audienceOBJECTIVE The Treatment of Brain Arteriovenous Malformations Study (TOBAS) is a pragmatic study that includes 2 randomized trials and registries of treated or conservatively managed patients. The authors report the results of the surgical registry. METHODS TOBAS patients are managed according to an algorithm that combines clinical judgment and randomized allocation. For patients considered for curative treatment, clinicians selected from surgery, endovascular therapy, or radiation therapy as the primary curative method, and whether observation was a reasonable alternative. When surgery was selected and observation was deemed unreasonable, the patient was not included in the randomized controlled trial but placed in the surgical registry. The primary outcome of the trial was mRS score > 2 at 10 years (at last follow-up for the current report). Secondary outcomes include angiographic results, perioperative serious adverse events, and permanent treatment-related complications leading to mRS score > 2. RESULTS From June 2014 to May 2021, 1010 patients were recruited at 30 TOBAS centers. Surgery was selected for 229/512 patients (44%) considered for curative treatment; 77 (34%) were included in the surgery versus observation randomized trial and 152 (66%) were placed in the surgical registry. Surgical registry patients had 124/152 (82%) ruptured and 28/152 (18%) unruptured arteriovenous malformations (AVMs), with the majority categorized as low-grade Spetzler-Martin grade I–II AVM (118/152 [78%]). Thirteen patients were excluded, leaving 139 patients for analysis. Embolization was performed prior to surgery in 78/139 (56%) patients. Surgical angiographic cure was obtained in 123/139 all-grade (89%, 95% CI 82%–93%) and 105/110 low-grade (95%, 95% CI 90%–98%) AVM patients. At the mean follow-up of 18.1 months, 16 patients (12%, 95% CI 7%–18%) had reached the primary safety outcome of mRS score > 2, including 11/16 who had a baseline mRS score ≥ 3 due to previous AVM rupture. Serious adverse events occurred in 29 patients (21%, 95% CI 15%–28%). Permanent treatment-related complications leading to mRS score > 2 occurred in 6/139 patients (4%, 95% CI 2%–9%), 5 (83%) of whom had complications due to preoperative embolization. CONCLUSIONS The surgical treatment of brain AVMs in the TOBAS registry was curative in 88% of patients. The participation of more patients, surgeons, and centers in randomized trials is needed to definitively establish the role of surgery in the treatment of unruptured brain AVMs. Clinical trial registration no.: NCT02098252 ( ClinicalTrials.gov