Chest CT Scan or RT-PCR: Which One is Appropriate for Screening of COVID-19 among the Surgical Patients in the Preoperative Period? A Case Report

Coronavirus disease 2019 (COVID-19) is associated with high morbidity and mortality. It has been a significant impact on the surgical care of the patients. There is still no consensus on elective surgeries under time epochs with national partial control of the disease. The objective is to report the clinical course of the surgical patient who was eventually diagnosed with COVID-19 despite preoperative screening. A 69 years old woman was referred to the surgical ward for elective low anterior resection (LAR). The complete preoperative workup was performed with acceptable results. Reverse transcriptase-polymerase chain reaction (RT-PCR) of SARS-COV-2 was not performed because the patient was asymptomatic and the surgical procedure was scheduled during the time of country's partial pandemic control; the nadir of the curve in daily reported COVID-19 patients. Following the surgery, the patient’s clinical status was stable for about 8 hours; however, the patient became anuric and hypotensive, receiving a variety of treatments for a list of differential diagnosis, including fresh lung CT scan and RT-PCR test; both of the latter were positive for COVID-19. Despite COVID-19 management and respiratory support, the patient died on day 15 of hospitalization. It seems that postponing elective surgeries if possible and general screening with RT-PCR in situations where delay in surgeries is not possible, are rationale strategies for surgical management of the patients during the COVID-19 pandemic, even when daily situation of the pandemic seems stable

UTJECAJ PROGRAMA KRUŽNOG TRENINGA NA MIŠIĆNU SNAGU, SLIKU O SAMOM SEBI TE ANKSIOZNOST STUDENATA NISKOG STUPNJA UHRANJENOSTI

The purpose of this study was to compare the effects of 8-week circuit-strength training on muscle strength, body image and anxiety of anxious underweight male college students. Hence, forty underweight male college students anxious were divided into 2 groups: a strength training group (N=20) and a control group (N=20). Subjects in strength training group trained an 8-week, 3 days per week full body progressive circuit-strength training, whereas control subjects did not participate in any training activity. The anthropometrical, body composition, body image (Multidimensional Body Self- Relations Questionnaire), anxiety (Spielberger state-trait Anxiety Inventory), muscle endurance and one repetition maximum in six exercises were measured before and after an eight-week training period. The results showed that 8- week strength training elicited significant (P<0.05) increase in upper- and lower body strength as measured by 1RM as well as legs\u27 and arms\u27 muscle hypertrophy. In addition, strength training group had a significantly greater improved increase in body image (BI) and reduced social physique anxiety (SPA) then control group. This study provides support for the use of weight training to improve body image and anxiety, these may be derive from considerable physical changes results from resistance training such as significant increase in muscle endurance, strength and muscle mass.Svrha ovog istraživanja bila je usporediti učinke osmotjednog kružnog trening jakosti na snagu mišića, sliku o samom sebi te na tjeskobu studenata niskog stupnja uhranjenosti muškog spola. Četrdeset studenata niskog stupnja uhranjenosti koji su bili anksiozni oko toga su podijeljeni u 2 skupine: skupina treninga jakosti (N = 20) i kontrolna skupine (N = 20). Eksperimentalna skupina je trenirala 8 tjedana, 3 dana tjedno , kružnim treningom snage koji je uključivao sve mišićne skupine. dok kontrolni ispitanici nisu sudjelovali u nikakvom tjelesnom vježbanju. Izmjerene su antropometrijske karakteristike, sastav tijela, slika o svome tijelu (Multidimensional Body Self-Relations Questionnaire), anksioznost (Spielberger state-trait Anxiety Inventory), mišića izdržljivosti i jedno maksimalno ponavljanje (u šest vježbi mjereni) su prije i nakon osam tjedana. Rezultati su pokazali da je trening snage od 8 tjedana izazvao značajno povećanje (P <0,05) u snazi gornjeg i donjeg dijela tijela mjereno s 1RM. Osim toga, skupina u treningu jakosti je imala značajno poboljšanje u doživljaju slike tijela (BI-body image) i smanjenje socijalnog stupnja anksioznosti (SPA) od kontrolne skupine. Ova studija pruža dokaze u korist korištenja treninga s utezima za poboljšanje slike tijela i smanjenje tjeskobe što vjerojatno proizlazi iz osjećaja bolje tjelesne pripremljenosti i tjelesnog izgleda zbog značajnog porasta mišićne izdržljivosti, snage i mišićne mase

The Influence of Fasting and Energy Restricting Diets on IGF-1 Levels in Humans: A Systematic Review and Meta-Analysis

Background: Fasting and energy restricting diets have a potential means of delaying or preventing the onset of a range of age-related metabolic and neoplastic diseases. Consistently at the centre of this effect appears to be a significant reduction in circulating IGF-1 levels. The aim of the current systematic review and meta-analysis was to determine the influence of fasting and energy restriction on IGF-1 levels in human subjects. Methods: A comprehensive systematic search was conducted from onset of the database to February 2019 in Embase, MEDLINE/PubMed, and SCOPUS to identify randomized clinical trials that investigating the impact of fasting or energy restriction circulating IGF-1 levels. Effect size was reported as weighted mean difference (WMD) and 95 confidence intervals (CI) using a random-effects models. Subgroup analysis was performed to identify the probable source of heterogeneity among trials. Results: Total pooling of fasting and energy restriction randomised controlled trials in WMD analysis revealed no significant effect on circulating IGF-1 levels (WMD: �16.41 ng/ml, 95 CI: �35.88, 3.07). Sub grouped analysis fasting regimens appeared to substantially reduce IGF-1 (WMD: -28.87 ng/ml, 95 CI: �43.69, �14.05, I 2 = 00), energy restricting regimens failed to do the same (WMD: -10.98 ng/ml, 95 CI: �33.08, 11.11, I 2 = 90). Within this final subgrouping, it was observed that only energy restriction regimens of 50 or greater of normal daily energy intake were capable of significantly reducing IGF-1 levels (WMD: -36.57 ng/ml, 95 CI: �59.19, �13.95, I 2 = 00). Finally, a meta regression were noted in which the percentage restriction of daily energy intake inversely correlated with plasma IGF-1 levels (p = 0.04). Conclusion: This study uncovered that fasting significantly reduced levels of IGF-1, while energy restriction diets were successful only when intake was reduced by 50 or more. © 2019 Elsevier B.V

Prognostic investigations of B7-H1 and B7-H4 expression levels as independent predictor markers of renal cell carcinoma.

In order to evaluate the correlation of B7-H4 and B7-H1 with renal cell carcinoma (RCC), we analyzed B7-H1 and B7-H4 expressions and their clinical significance by immunohistochemical method. Our result indicated that B7-H4-positive staining was detected in 58.13 % of RCC tissues (25 tissues tumors), and there were 18 tissues of patients without detectable B7-H4. Furthermore, 21 cases (48.83 %) were B7-H1-positive. Positive tumor expressions of B7-H4 and B7-H1 were markedly related to advanced TNM stage (P = 0.001; P = 0.014), high grade (P = 0.001; P = 002), and larger tumor size (P = 0.002; P = 024) in RCC tissues than patients with B7-H4-negative and B7-H1-negative in RCC tissues. The patients with B7-H1 and B7-H4-positive expressions were found to be markedly correlated with the overall survival of the patients (P < 0.05) and tended to have an increased risk of death when compared with negative expression groups. Univariate analysis showed that B7-H4 and B7-H1 expressions, TNM stage, high grade, and tumor size were significantly related to the prognosis of RCC. Furthermore, multivariate analysis showed that B7-H4 and B7-H1 expressions decreased overall survival. The adjusted HR for B7-H1 was 2.83 (95 % CI 1.210-2.971; P = 0.031) and also was 2.918 (95 % CI 1.243-3.102; P = 0.006) for B7-H4 that showed these markers were independent prognostic factors in RCC patients. The expressions of B7-H1 and B7-H4 in RCC patients indicate that these markers may be as a predictor of tumor development and death risk. Further investigations can be helpful to confirm B7-H1 and B7-H4 roles as an independent predictor of clinical RCC outcome