Tuberculosis: through the artist’s eye

The history of medicine and art have intersected at several instances over time. Centuries ago, even when many diseases were obscure, art has shed some light over early clinical features and signs of many diseases. This article describes Leonardo Da Vinci’s famous sketch, “The Five Grotesque Heads” and highlights the hints of reference to the age-old infection of tuberculosis. Da vinci’s eye for detail has been known to capture several startling anatomical and pathological features of diseases, which were largely unknown at his time. However, these subtle references give us insight into the clinical presentation of the timeless disease of tuberculosis through the ages

Prevalence and pattern of dyslipidemia in newly detected type 2 diabetes mellitus and its correlation with anthropometric parameters

Background: Globally 425 million people have diabetes mellitus (DM) of which 90% are type 2 DM. India carries nearly 70 million cases of DM. India is called the diabetes capital of the world. The escalating epidemic of type 2 diabetes has been attributed to increasing obesity and longevity. Due to the additive cardiovascular risk of hyperglycemia and hyperlipidemia, lipid abnormalities should be aggressively detected and treated as a part of comprehensive diabetic care. The study aimed at detecting the occurrence and pattern of dyslipidemia in newly-detected type 2 diabetic patients in a tertiary care hospital in South India.Methods: This cross-sectional study was conducted over a period of eighteen months. It comprised of 50 newly detected diabetics above the age of 18 years who satisfied the inclusion and exclusion criteria.Results: Fifty patients were included in the study which included 18 males and 32 females. The body mass index (BMI) was abnormal in 62% (as per the Asian criteria) and in 42% (as per the WHO criteria). The waist circumference (WC) was found to be high in 82% and 70% as per the Asian and the WHO criteria, respectively. Forty six percent of the population was found to have elevated total cholesterol levels. LDL was increased in 70% of the study population while triglycerides were elevated in 40%, total cholesterol in 46% and low HDL in 76% of the patients.Conclusions: A significant correlation was found between the fasting blood sugars (FBSs) and serum triglycerides. There was a positive correlation noted between the dyslipidemia and the anthropometric parameters recorded

The Influence of Life History Milestones and Association Networks on Crop-Raiding Behavior in Male African Elephants

Factors that influence learning and the spread of behavior in wild animal populations are important for understanding species responses to changing environments and for species conservation. In populations of wildlife species that come into conflict with humans by raiding cultivated crops, simple models of exposure of individual animals to crops do not entirely explain the prevalence of crop raiding behavior. We investigated the influence of life history milestones using age and association patterns on the probability of being a crop raider among wild free ranging male African elephants; we focused on males because female elephants are not known to raid crops in our study population. We examined several features of an elephant association network; network density, community structure and association based on age similarity since they are known to influence the spread of behaviors in a population. We found that older males were more likely to be raiders than younger males, that males were more likely to be raiders when their closest associates were also raiders, and that males were more likely to be raiders when their second closest associates were raiders older than them. The male association network had sparse associations, a tendency for individuals similar in age and raiding status to associate, and a strong community structure. However, raiders were randomly distributed between communities. These features of the elephant association network may limit the spread of raiding behavior and likely determine the prevalence of raiding behavior in elephant populations. Our results suggest that social learning has a major influence on the acquisition of raiding behavior in younger males whereas life history factors are important drivers of raiding behavior in older males. Further, both life-history and network patterns may influence the acquisition and spread of complex behaviors in animal populations and provide insight on managing human-wildlife conflict

No risk, no gain: effects of crop raiding and genetic diversity on body size in male elephants

Body size is an important influence on the life history of males of polygynous mammals because it is usually highly correlated with fitness and is under intense selection. In this paper, we investigated the effect of high-risk foraging behavior (crop raiding) and genetic heterozygosity on male body size in a well-studied population of African elephants. Crop raiding, the foraging on cultivated food crops by wildlife is one of the main causes of wildlife human conflict and is a major conservation issue for many polygynous mammals that live in proximity to agriculture or human habitation. Body size was estimated using hind foot size, a measure strongly correlated with stature and mass. Crop raiding predicted male size in adulthood, with raiders being larger than nonraiders. However, elephants that became raiders were neither larger nor smaller for age when young. Enhanced growth rates and size among raiders suggest that taking risks pays off for males. Lastly, genetic heterozygosity had no effect on size for age in male elephants, most likely because low-heterozygosity males were rare. Risky foraging behavior can evolve as a result of strong sexual selection for large size and condition-dependent mating success in males. We discuss the implications of these results for managing human--wildlife conflict. Copyright 2011, Oxford University Press.

The value of open-source clinical science in pandemic response: lessons from ISARIC

International audienc

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings