Clinical Implications of Thrombotic Microvascular Angiopathy (TMA) in Severe and Critical COVID-19 Patients

Severe acute respiratory syndrome coronavirus has a great role in causing respiratory illness in humans and has the most important relationship of its spike proteins with host ACE-2 receptors. After entry into the human body, the viral S protein receptor-binding domain binds to human ACE-2 receptor. Spike protein is split from the cleavage site along its two subunits S1 and S2 then during this process. S2 subunit release RBD (Receptor- Binding Domain) of S1 mediated to the ACE-2. The RBD of S1 consists of 200 amino acid domains. The sample size was of 350 patients between age 48 years ± 2 years. Out of these patients that were screened, 141 were classified as severe and critical stage of the disease and hence serve as subject to this focused study. The effects of this virus on platelets are rather erratic and unusual with slight decrease in the number of platelets. The raised number of d-dimers in blood of patients has been observed resulting in an elevated level of LDH.

Payment Accuracy in Value-Based Care Contracts

Reimbursement for health care services is transferring more risk away from payers and toward health care providers in the form of Alternative Payment Models (APMs), also known as Value-Based Care (VBC) models. VBC models cover a wide variety of forms but all include guarantees by providers of services to improve quality of care and/or reduce cost. Types of risk include performance risk, contract design risk or stochastic risk (because of the random variation in health care services and costs). A form of contract risk that can be a significant driver of cost is model risk, defined as the probability that the savings calculated at contract reconciliation will deviate from the actual savings generated. To estimate the degree of risk we quantify the potential variance in outcomes in a naïve population prior to intervention and the components that could affect outcomes, using examples of maternity and type 2 diabetes. This analysis has implications for both participants in, and designers of value-based contracts.

A Radiological Study for Assessment of Cartilage Abnormalities in Patients with Osteoarthritis of Knee

Present study evaluates spectrum of abnormalities and severity of cartilage injury in patients with Osteoarthritis (OA) of knee by comparing plain radiograph and MRI. This retrospective study with 50 patients as sample that underwent MRI (on 3T scanner) and weight bearing radiograph (on 800mA & 1000mA machine) of the knee at our institution. The included patient population was clinically suspected osteoarthritis of the knee. Kellgren-Lawrence grades and proposed MR grade scale was applied. The standard was based mainly on cartilage injury and additional findings. Results: Present study obtained significant result correlation while assessing the disease severity of patients on Kellgren-Lawrence score (on radiograph) and cartilage abnormality (On MRI). Distributions of associated degenerative changes were also documented. Conclusions: Plain radiographs are still important in evaluating osteoarthritis of knee. MRI plays a vital role in imaging the bony and soft tissues of knee as a whole organ. There is significant correlation between plain radiograph and MRI findings.

MDCT Angiography Evaluation of Arterial Involvement in Carcinoma Gall Bladder: An Institutional Experience

Purpose: Evaluation of pattern of arterial involvement in advance case of gallbladder carcinoma with MDCT Angiography. Method: All CT examinations were performed on a 64- MDCT scanner (Philips Medical System Version 6.4, Extended Brilliance Workspace). Technical features of MSCT were as following 64mm � 1mm collimation, minimum slice thickness of 0.625, gantry rotation time of 320ms, kV of 120, and mAs of 320. CT Angiography was performed with IV administration of nonionic contrast material i.e. omnipaque. The contrast medium and saline solution were injected with a medrad power injector at 4mL/sec through an 18-gauge plastic intravenous catheter placed in an antecubital vein in most of the cases. Contrast medium volumes varied between 100 and 150 mL at 1.5ml/Kg. Images were obtained in triphasic pattern at arterial (20-30 seconds), portal (60-70 seconds), and equilibrium (at 3 minutes) phases. Results: Nearly half of the cases (43.5%) of carcinoma gall bladder showed arterial involvement at the time of diagnosis; most commonly involved artery was found to be cholecystic artery (24.7%) followed by right hepatic artery (14.1%) and replaced right hepatic artery (3.5%). Conclusion: We conclude that nearly half of the patients with carcinoma gall bladder have arterial involvement at the time of diagnosis. The most commonly artery involved was Cholecystic artery followed by right hepatic artery and replaced right hepatic artery. Keywords: MDCT (Multidetector computed tomography); Carcinoma gall bladder; Cholecystic artery; Hepatic artery; Right hepatic artery

A Scoping Review of Animated Video’s Effect on Individual Health Knowledge

Objectives: Animated video has the potential to both educate and persuade patient audiences. This scoping review considers use of animated educational video’s effect on individual-level knowledge in order to inform its application to kidney transplant education and interest among patients and their social network. Methods: A scoping review of standalone animated video studies published before December 1, 2020, was conducted in six research databases. Results: Fifteen of 2,066 studies were included. Eight studies were RCTs. The others were pre-post and between-group designs. Studies focused on multiple health topics. Video duration spanned 2 to 16 minutes and video delivery was generally clinic-based. The majority of the publications did not report the use of a learning theory or patient input to inform video development. Significant gains in participant knowledge, including among at-risk groups, were reported in 80% of studies. Improvements in concerns, attitudes, and anxiety were also reported. Conclusion: While few studies applied standalone animated video to adult patient health education, existing research suggests that standalone animation is a powerful and efficient instructional format for a wide range of learners, with added benefit for reducing anxiety. Practice Implications: These characteristics of animation potentially could be useful to improve transplant education delivery.

Advantages of Application of Whole-Body Low-Dose Computed Tomography in Multiple Myeloma

Aim: This study was designed to investigate the application of whole-body low-dose computed tomography in the examination of multiple myeloma. Method: 40 patients with multiple myeloma admitted to our hospital were prospectively selected as the study subjects. All patients were pathologically confirmed and/or clinically diagnosed with multiple myeloma. Patients were randomly divided into two groups: Group A (n=20) received whole-body lowdose CT scan with SAFIR iterative reconstruction algorithm; Group B (n=20) underwent whole body conventional dose CT scan combined with conventional reconstruction algorithm. The image quality was scored subjectively, and the objective evaluation indexes (including CT value and noise of neck, chest, abdomen, pelvic cavity and lower extremities, signal-to-noise ratio and image quality index) were measured and recorded, and the radiation dose was recorded. Mann-Whitney U test (to evaluate the subjective score) and t test (to evaluate the objective evaluation index and radiation dose) were used to compare the differences of the above indexes between group A and group B. Result: All the images met the diagnostic requirements. There was no statistical significance in the scores between group A and group B (P>0.05). Significant differences in CT value, noise and SNR of neck, chest, abdomen, pelvis and lower extremities between group A and group B (P<0.05) were identified. For the image quality index (figure of merit, FOM), the FOM of chest, abdomen and pelvis was not statistically significantly changed (P<0.05). The radiation dose of group A decreased by 56.77% (3.06/5.39) compared to group B with a statistically significant difference (P<0.05). The Kappa values of subjective scores of the two groups showed no statistically significant difference (respectively, 0.68 and o.69, P>0.05). Conclusion: Compared to conventional CT examination, whole-body lowdose CT scan combined with SAFIR iterative reconstruction algorithm can effectively reduce noise, reduce X-ray radiation dose, and obtain ideal image quality in multiple myeloma examination, which has a certain application value.

Differences in Stress Level between Nurses Working Two-Shift and Three-Shift Rotations

Background: Shift work has been widely documented to affect stress among nurses; however, it is not clear how different shift work schedules are associated with nurses’ levels of stress. Objective: This study aimed to compare levels of stress among Chinese nurses working on different shift work schedules by examining their salivary amylase and cortisol. Design: A cross-sectional survey design. Saliva samples were collected from nurses who had been working in two-shift modes (shift at 5pm or 8pm) or three-shift modes (shift at 11pm, 12am, or 1am) for at least one year. Data collection was conducted from March 1, 2017 to May 31, 2017. Setting: Participants were recruited from a public tertiary teaching medical center in eastern China. Participants: A total of 216 nurses were included in the final analysis, including 55 working in two-shift modes and 161 working in three-shift modes. Method: Stress level was assessed using the amylase and cortisol profiles. Logistic regression analyses for amylase and cortisol profiles were adjusted for marriage, age, working years, education background, professional title. Conclusion: Our findings suggested that nurses’ stress was contingent on night-shift schedules. Three-shift rotations may be superior than two-shift rotations in keeping nurses’ stress levels low. Nurse managers may take nurses’ potential stress levels into consideration when design work schedules.

Cytokines and miRNAs in the Pathogenesis of Rheumatoid Arthritis: A Review

Rheumatoid Arthritis (RA) is a chronic autoimmune disease characterized by inflammatory synovial hyperplasia. The pathogenesis of RA may be related to heredity, infection and sex hormones. The initial stage of RA involves the activation of T cells. Immature CD4+ T cells differentiate into T helper (Th) cells and T regulatory (Treg) cells under antigen stimulation and cytokine signal transduction. Cytokines secreted by Th cells and Treg cells play crucial roles in the pathophysiology of RA. The cytokines can be roughly divided into proinflammatory cytokines, anti-inflammatory cytokines, and both pro- and antiinflammatory cytokines. The imbalance between pro-inflammatory cytokines and anti-inflammatory cytokines would lead to a variety of autoimmune diseases. The disease severity was significantly indicated by serum or plasma cytokine levels with RA patients. Many clinical trials have shown that anticytokine drugs are effective in treating RA. This article reviews the differentiation process of different Th cells and Treg cells, the roles of cytokines secreted by them in the pathogenesis of RA and how miRNAs mediate immune regulation in RA. By understanding the roles of cytokines and miRNAs in the pathogenesis of autoimmunity, it is necessary to develop potential anti-cytokine drugs and biomarkers/therapeutic targeted drugs through various ways in the treatment of RA.

Defense and Immune Response to Severe Acute Respiratory Syndrome Coronavirus 2 in COVID-19 Patients: A Narrative Review

In the present review, we aim to determine the defense methods, assessment the profile of acute antibodies response in COVID-19 patients, and to provide accurate date for the usage of antibody test in clinical practice. After exposure to COVID-19, the immune system is responded in different ways and particles in different concentrations according on period of infection graduation. While the main response of immune system includes IgM, IgG and IgA antibodies, and, the most serological diagnosis tests and researches were found that “≥4- fold increase in the IgG titer” is suitable for a majority of COVID-19 patients and after three months is disappeared. IgM and IgG antibodies are the best defense methods. Serologic test method is helpful for the diagnosis of SARSCoV- 2 infection in suspects and close contacts. Antibodies determination in SARS Cov-2 is essential for COVID-19 assessment, treatment and vaccine development. In conclusion, we noticed in most of cases the production of IgM is started after 72 hrs. Of symptoms appears and peak up the production curve in 20-22 days then is disappeared in day 56 of infection. While, the production of IgG is started after 8 days of infection and peak up the production curve in 17-19 day then disappeared in day 80 of infection, but IgA production is started in 5th day of infection.