Laboratory manifestations of COVID-19 associated with hemostatic abnormalities

Hemostatic abnormalities had been reported in COVID-19 patients, which may include disseminated intravascular coagulation (DIC), hypercoagulability, and alterations in platelets parameters. Articles that investigate the alterations of hemostatic abnormalities during the COVID-19 disease (2020-2021) and their predictive value of disease outcome have been thoroughly reviewed. Among the reviewed articles, thrombocytopenia is observed in 5.0-41.7% of COVID-19 patients, which is related to disease severity. Moreover, other platelets parameters, including Platelets/lymphocytes ratio (PLR), Mean platelets volume (MPV), and aggregation, may also be affected. On the other hand, findings of coagulation tests such as D dimer; fibrinogen, Antithrombin (AT), and Fibrin degradation products (FDP) are significantly elevated in COVID-19 patients, while in a single study, most of the patients had positive Lupus anticoagulants (LA) and normal protein C (PC). In the same perspective, these alterations showed significant correlations with disease severity. Overall, hemostatic laboratory markers are significant predictors of COVID-19 disease outcome as indicated by the increased risk of venous and arterial thrombotic events, especially in ICU patients. &nbsp

IN VITRO ANTIMCROBIAL ACTIVITY OF MANGIFERA INDICA L

The chloroform, methanol and aqueous extracts    of Mangifera indica seeds  were     subjected to preliminary    antimicrobial  activity against   two Gram- positive bacteria   (Bacillus subtilis, Staphylococcus aureus ) three Gram-negative bacteria Escherichia coli, Proteus vulgaris,  Pseudomonas aeruginosa  and two fungi, Aspergillus niger and Candida albicans.The seeds chloroform and methanol extracts showed high activity   against   all organisms tested. The aqueous   extract showed high activity against both Gram-positive    organisms   and    one   Gram-negative bacteria namely Proteus vulgaris, low     activity     against Escherichia coli,  and was   inactive against Pseudomonas aeruginosa.   Therefore the active chloroform and  methanol extracts were further tested against sixty clinical ; Staphyllococcus aureus (n=15 ), Escherichia coli (n=15 ), Proteus vulgaris  (n=15 ) and  Pseudomonas aeruginosa (n=15 ) and the aqueous extract was tested against thirty clinical isolates of Staphyllococcus aureus (n=15 ) and Proteus vulgaris  (n=15 ) collected randomly from  specimens from Sudanese patients.  The clinical isolates exhibited low susceptibility compared to the standard organisms. The standard organisms were tested against reference antibiotics (Ampicillin and Gentamicin). It was found that the chloroform extract of Mangifera indica seeds at 200 mg/ml was more effective than 20mg/ml Ampicillin and15ug/ml Gentamicin against the majority of the organisms tested.The methanol extract   at 200mg/ml was more effective than 40mg/ml Gentamicin against the organisms tested.The aqueous extract was more effective than 40mg/ml Ampicillin against the majority of the organisms tested. All  extracts were inactive against Aspergillus niger.Both chloroform and methanol extracts were active  against Candida albicans while the aqueous extract was inactive. Therefore C.albicans is more susceptible than A.niger.The chloroform extract inhibited C.albicans with inhibitory action between 25-50mg/ml  Nystatin and the methanol extract inhibited C.albicans with inhibitory action almost similar to 10mg /ml Clotrimazole.Therefore the high activity of the plant might justify its uses in traditional medicine

Layout of CCS monitoring infrastructure with highest probability of detecting a footprint of a CO2 leak in a varying marine environment

Monitoring of the marine environment for indications of a leak, or precursors of a leak, will be an intrinsic part of any subsea CO2 storage projects. A real challenge will be quantification of the probability of a given monitoring program to detect a leak and to design the program accordingly. The task complicates by the number of pathways to the surface, difficulties to estimate probabilities of leaks and fluxes, and predicting the fluctuating footprint of a leak. The objective is to present a procedure for optimizing the layout of a fixed array of chemical sensors on the seafloor, using the probability of detecting a leak as metric. A synthetic map from the North Sea is used as a basis for probable leakage points, while the spatial footprint is based on results from a General Circulation Model. Compared to an equally spaced array the probability of detecting a leak can be nearly doubled by an optimal placement of the available sensors. It is not necessarily best to place the first in the location of the highest probable leakage point, one sensor can monitor several potential leakage points. The need for a thorough baseline in order to reduce the detection threshold is shown.publishedVersio

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

On the Formulation of Mass, Momentum and Energy Conservation in the KdV Equation

The Korteweg-de Vries (KdV) equation is widely recognized as a simple model for unidirectional weakly nonlinear dispersive waves on the surface of a shallow body of fluid. While solutions of the KdV equation describe the shape of the free surface, information about the underlying fluid flow is encoded into the derivation of the equation, and the present article focuses on the formulation of mass, momentum and energy balance laws in the context of the KdV approximation. The densities and the associated fluxes appearing in these balance laws are given in terms of the principal unknown variable η representing the deflection of the free surface from rest position. The formulae are validated by comparison with previous work on the steady KdV equation. In particular, the mass flux, total head and momentum flux in the current context are compared to the quantities Q, R and S used in the work of Benjamin and Lighthill (Proc. R. Soc. Lond. A 224:448–460, 1954) on cnoidal waves and undular bores

Numerical modelling of organic waste dispersion from fjord located fish farms

In this study, a three-dimensional particle tracking model coupled to a terrain following ocean model is used to investigate the dispersion and the deposition of fish farm particulate matter (uneaten food and fish faeces) on the seabed due to tidal currents. The particle tracking model uses the computed local flow field for advection of the particles and random movement to simulate the turbulent diffusion. Each particle is given a settling velocity which may be drawn from a probability distribution according to settling velocity measurements of faecal and feed pellets. The results show that the maximum concentration of organic waste for fast sinking particles is found under the fish cage and continue monotonically decreasing away from the cage area. The maximum can split into two maximum peaks located at both sides of the centre of the fish cage area in the current direction. This process depends on the sinking time (time needed for a particle to settle at the bottom), the tidal velocity and the fish cage size. If the sinking time is close to a multiple of the tidal period, the maximum concentration point will be under the fish cage irrespective of the tide strength. This is due to the nature of the tidal current first propagating the particles away and then bringing them back when the tide reverses. Increasing the cage size increases the likelihood for a maximum waste accumulation beneath the fish farm, and larger farms usually means larger biomasses which can make the local pollution even more severe. The model is validated by using an analytical model which uses an exact harmonic representation of the tidal current, and the results show an excellent agreement. This study shows that the coupled ocean and particle model can be used in more realistic applications to help estimating the local environmental impact due to fish farms

Thyrotoxic periodic paralysis as the first presentation of Graves' disease: A case report

Abstract Thyrotoxic periodic paralysis (TPP) is a rare disease seen predominantly in men of Asian origin. It should be considered in the differential diagnosis of patients with acute onset of weakness, and it is reversible after the correction of serum potassium. TPP can rarely be the initial presentation of Graves' disease