Role of hyperglycemia in the pathogenesis of Na+/K+ disturbance

Background: Electrolytes play an important role in maintaining acid-base balance, blood-clotting, control body fluid, muscle contraction, nerve conduction. The diabetic patients develop frequently a constellation of electrolyte imbalance. Imbalance in electrolyte concentration may affect the course of diabetes and its management. It has been reported that there is an inverse relationship between serum sodium (Na+) and potassium (K+) levels in diabetic patients. The aim of present study was to determine whether such relation is seen in context of Nepal and whether this inverse relation depends upon serum glucose levels in diabetic patients for their glycemic control.Methods: This is a retrospective study performed on records of 135 diabetic patients who were treated at out-patient clinic of Kist Medical College and Teaching Hospital from 15 June 2015-15 July 2015. Fasting blood glucose (FPG) level was analyzed with semiautomatic analyzer- humalyzer 3000 by GOD-POD method and Na+ and K+ levels were analyzed with ion selective electrode- nova electrolyte. The relationship among serum Na+ level, serum K+ levels and Fasting plasma glucose levels were determined by SPSS version 20.Results: Serum Na+ level was insignificantly negatively correlated (r=-0.091, p=0.296) with FPG level while a positive correlation of serum K+ level (r=0.235, p=0.006) was seen with FPG level and an inverse relation between serum Na+ and K+ was found. Age showed insignificant negative correlation with serum Na+ (r= -0.203, p=0.018), insignificant positive correlation with K+ (r=0.067, p=0.443) and insignificant negative correlation with FPG (r= -0.045, p=0.608).Conclusions: Hyperglycemia disrupts the balance of serum Na+ and K+ in uncontrolled diabetes mellitus

2016 Graduate Medical Education Exit Survey Report

In order to plan effective healthcare workforce development initiatives, it is important to understand the reasons why the Indiana University School of Medicine (IUSM) residency and fellowship graduates’ choose to practice in specific locations. This study documented the proportion of residency and fellowship graduates that were planning to practice in areas of need in Indiana. The 2016 IUSM Graduate Medical Education Exit Survey© identified factors affecting graduates’ choice of practice location and gathered feedback on their self-rated level of competency training to serve the rural and underserved populations; assessment of their training program and the six Accreditation Council for Graduate Medical Education (ACGME) competency areas.IUSM Office of Graduate Medical Educatio

Guelb el Ahmar (Bathonian, Anoual Syncline, eastern Morocco): First continental flora and fauna including mammals from the Middle Jurassic of Africa

We report the discovery in Mesozoic continental “red beds” of Anoual Syncline, Morocco, of the new Guelb el Ahmar (GEA) fossiliferous sites in the Bathonian Anoual Formation. They produced one of the richest continental biotic assemblages from the Jurassic of Gondwana, including plants, invertebrates and vertebrates. Both the sedimentological facies and the biotic assemblage indicate a lacustrine depositional environment. The flora is represented by tree trunks (three families), pollen (13 species, five major clades) and charophytes. It suggests local forests and humid (non-arid) conditions. The vertebrate fauna is dominated by microvertebrates recovered by screening–washing. It is rich and diverse, with at least 29 species of all major groups (osteichthyans, lissamphibians, chelonians, diapsids, mammals), except chondrichthyans. It includes the first mammals discovered in the Middle Jurassic of Arabo-Africa. The GEA sites yielded some of the earliest known representatives of osteoglossiform fishes, albanerpetontid and caudate amphibians, squamates (scincomorphans, anguimorphan), cladotherian mammals, and likely choristoderes. The choristoderes, if confirmed, are the first found in Gondwana, the albanerpetontid and caudatan amphibians are among the very few known in Gondwana, and the anguimorph lizard is the first known from the Mesozoic of Gondwana. Mammals (Amphitheriida, cf. Dryolestida) remain poorly known, but are the earliest cladotherians known in Gondwana. The GEA biotic assemblage is characterized by the presence of Pangean and Laurasian (especially European) taxa, and quasi absence of Gondwanan taxa. The paleobiogeographical analysis suggests either a major fossil bias in Gondwana during the Middle Jurassic, and an overall vicariant Pangean context for the GEA assemblage, or alternatively, noticeable Laurasian (European) affinities and North-South dispersals. The close resemblance between the Bathonian faunas of GEA and Britain is remarkable, even in a Pangean context. The similarity between the local Anoual Syncline Guelb el Ahmar and Ksar Metlili faunas raises questions on the ?Berriasian age of the latter

An exploratory randomized control study of combination cytokine and adult autologous bone marrow progenitor cell administration in patients with ischaemic cardiomyopathy: the REGENERATE-IHD clinical trial

This work forms part of the research themes contributing to the translational research portfolio of Barts and the London Cardiovascular Biomedical Research Unit, which is supported and funded by the National Institute of Health Research. This work was funded by unrestricted grants from the Heart Cells Foundation, Barts, and the London Charity and Chugai Pharmaceuticals

Evaluating the Effects of SARS-CoV-2 Spike Mutation D614G on Transmissibility and Pathogenicity.

Global dispersal and increasing frequency of the SARS-CoV-2 spike protein variant D614G are suggestive of a selective advantage but may also be due to a random founder effect. We investigate the hypothesis for positive selection of spike D614G in the United Kingdom using more than 25,000 whole genome SARS-CoV-2 sequences. Despite the availability of a large dataset, well represented by both spike 614 variants, not all approaches showed a conclusive signal of positive selection. Population genetic analysis indicates that 614G increases in frequency relative to 614D in a manner consistent with a selective advantage. We do not find any indication that patients infected with the spike 614G variant have higher COVID-19 mortality or clinical severity, but 614G is associated with higher viral load and younger age of patients. Significant differences in growth and size of 614G phylogenetic clusters indicate a need for continued study of this variant

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2–4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease