Cutaneous manifestations, viral load, and prognosis among hospitalised patients with COVID-19: a cohort study.

INTRODUCTION: Various cutaneous manifestations have been reported as symptoms of coronavirus disease 2019 (COVID-19), which may facilitate early clinical diagnosis and management. This study explored the incidence of cutaneous manifestations among hospitalised patients with COVID-19 and investigated its relationships with viral load, co-morbidities, and outcomes. METHODS: This retrospective study included adult patients admitted to a tertiary hospital for COVID-19 from July to September 2020. Clinical information, co-morbidities, viral load (cycle threshold [Ct] value), and outcomes were analysed. RESULTS: In total, 219 patients with confirmed COVID-19 were included. Twenty patients presented with new onset of rash. The incidence of new rash was 9.1% (95% confidence interval=6.25%-14.4%). The most common manifestations were maculopapular exanthem (n=6, 42.9%, median Ct value: 24.8), followed by livedo reticularis (n=4, 28.6%, median Ct value: 21.3), varicella-like lesions (n=2, 14.3%, median Ct value: 19.3), urticaria (n=1, 7.1%, median Ct value: 14.4), and acral chilblain and petechiae (n=1, 7.1%, median Ct value: 33.1). The median Ct values for patients with and without rash were 22.9 and 24.1, respectively (P=0.58). There were no significant differences in mortality or hospital stay between patients with and without rash. Patients with rash were more likely to display fever on admission (P<0.01). Regardless of cutaneous manifestations, patients with older age, hypertension, and chronic kidney disease stage ≥3 had significantly higher viral load and mortality (P<0.05). CONCLUSION: This study revealed no associations between cutaneous manifestation and viral load or clinical outcomes. Older patients with multiple co-morbidities have risks of high viral load and mortality; they should be closely monitored.

Prospective study to validate HpOne in the diagnosis of Helicobacter pylori infection.

INTRODUCTION: The HpOne test is a new five-minute rapid urease test developed for the rapid detection of Helicobacter pylori infection during gastroscopy. However, evidence in the literature supporting its use clinically is scarce. The most commonly used rapid urease test remains the Campylobacter-like organism (CLO) test, which generates accurate readings only after 24 hours. The aim of this study was to evaluate the efficacy of the HpOne test in our local population. METHODS: From August 2007 to May 2008, consecutive patients undergoing gastroscopy for various indications were recruited into this prospective study. Patients who were pregnant, lactating, on proton pump inhibitors, antibiotics, immunosuppressants or had previous gastric surgery were excluded. During gastroscopy, six gastric mucosal biopsies were taken; three from the body and three from the antrum. One body and one antral biopsy were used for each of the HpOne test, CLO test and histology. Results of the HpOne and CLO tests were then compared against the gold standard of histology. RESULTS: Of the 149 patients recruited, 82 (55 percent) were men and 67 (45 percent) were women. The prevalence of Helicobacter pylori infection was 38.9 percent (n is 58). The sensitivity and specificity of the HpOne test were 65.5 percent and 85.7 percent, respectively, while those for the CLO test were 63.8 percent and 84.6 percent, respectively. CONCLUSION: The HpOne test is as efficacious as the CLO test, with the added advantage of yielding results faster. It is thus a superior alternative and should be considered for clinical use.

Early improvement in type 2 diabetes mellitus post Roux-en-Y gastric bypass in Asian patients.

INTRODUCTION: Obesity is a growing problem worldwide that is closely related to type 2 diabetes mellitus (T2DM). The Roux-en-Y gastric bypass (RYGBP), a restrictive and malabsorptive bariatric procedure, shows mounting evidence of inducing improvement of T2DM. Few studies, especially those examining the early changes in diabetic parameters, have been done in the Asian population. METHODS: All morbidly obese patients with T2DM undergoing RYGBP at our institution from August 2008 to January 2010 were prospectively studied. Six patients had RYGBP, and one had a laparoscopic sleeve gastrectomy with a duodenojejunal bypass. Data collected included pre- and postoperative 75 g oral glucose tolerance test, daily postoperative fasting plasma glucose, and haemoglobin A1c (HbA1c) pre-operation and at two, four and 12 weeks post operation. RESULTS: After 12 weeks, the mean drop in HbA1c was 2.29 +/- 1.39 percent. The change in HbA1c at four (p is 0.039) and 12 (p is 0.005) weeks showed significant improvements. A significant decrease in diabetic medication usage was observed, with four (57 percent) patients not requiring medications within four weeks. Remission of DM was achieved in two (28.6 percent) patients within 12 weeks. Weight loss by various parameters was significant from two weeks onwards. CONCLUSION: The cure rate of 28.6 percent and an improvement rate of 100 percent of T2DM in morbidly obese Asian patients within 12 weeks post operation are promising. Many patients discontinued their diabetic medications in the immediate postoperative period, even before significant weight loss had occurred, indicating that RYGBP has an effect on hormonal mechanisms that influence glucose homeostasis in the body.

Quantitative assessment of lens opacities with anterior segment optical coherence tomography.

AIM: To evaluate the reliability of lens density measurement with anterior segment optical coherence tomography (OCT) and its association with the Lens Opacity Classification System Version III (LOCS III) grading. METHODS: Fifty-five eyes from 55 age-related cataract patients were included. One eye from each subject was selected at random for lens evaluation. After dilation, lens photographs were taken with a slit lamp and graded against the LOCS III standardised condition. Anterior segment OCT imaging was performed on the same eyes with a high-resolution scan. The association between the anterior segment OCT nucleus density measurement and LOCS III nuclear opalescence (NO) and nuclear colour (NC) scores was evaluated with the Spearman correlation coefficient. Anterior segment OCT measurement precision, coefficient of variation (CVw), and intraclass correlation coefficient (ICC) were calculated. RESULTS: The mean NO and NC scores were 3.39 (SD 1.10) and 3.37 (SD 1.27), respectively. Significant correlations were found between anterior segment OCT nuclear density measurements and the LOCS III NO and NC scores (r = 0.77 and 0.60, respectively, both with p<0.001). The precision, CVw and ICC of anterior segment OCT measurement were 2.05 units, 4.55% and 0.98, respectively. CONCLUSION: Anterior segment OCT nucleus density measurement is reliable and correlates with the LOCS III NO and NC scores.

Cost-utility analysis of the cochlear implant in children.

CONTEXT: Barriers to the use of cochlear implants in children with profound deafness include device costs, difficulty assessing benefit, and lack of data to compare the implant with other medical interventions. OBJECTIVE: To determine the quality of life and cost consequences for deaf children who receive a cochlear implant. DESIGN: Cost-utility analysis using preintervention, postintervention, and cross-sectional surveys conducted from July 1998 to May 2000. SETTING: Hearing clinic at a US academic medical center. PARTICIPANTS: Parents of 78 profoundly deaf children (average age, 7.5 years) who received cochlear implants. MAIN OUTCOME MEASURES: Direct and total cost to society per quality-adjusted life-year (QALY) using the time-trade-off (TTO), visual analog scale (VAS), and Health Utilities Index-Mark III (HUI), discounting costs and benefits 3% annually. Parents rated their child's health state at the time of the survey and immediately before and 1 year before implantation. RESULTS: Recipients had an average of 1.9 years of implant use. Mean VAS scores increased by 0. 27, from 0.59 before implantation to 0.86 at survey. In a subset of participants, TTO scores increased by 0.22, from 0.75 to 0.97 (n = 40) and HUI scores increased by 0.39, from 0.25 to 0.64 (n = 22). Quality-of-life scores were no different 1 year before and immediately before implantation. Discounted direct costs were $60,228, yielding $9,029 per QALY using the TTO, $7,500 per QALY using the VAS, and $5,197 per QALY using the HUI. Including indirect costs such as reduced educational expenses, the cochlear implant provided a savings of $53,198 per child. CONCLUSIONS: Cochlear implants in profoundly deaf children have a positive effect on quality of life at reasonable direct costs and appear to result in a net savings to society. JAMA. 2000;284:850-856

Cost-utility of the cochlear implant in adults: a meta-analysis.

OBJECTIVE: To conduct a meta-analysis of the cost-utility of the cochlear implant in adults. DATA SOURCES: MEDLINE literature search, review of article bibliographies, and consultation with experts. STUDY SELECTION: Studies that reported (1) data on adults (age > or = 18 years) with bilateral, postlingual, profound deafness; (2) a health-utility gain from cochlear implantation on a scale from 0.00 (death) to 1.00 (perfect health); (3) a cost-utility ratio in terms of dollars per quality-adjusted life-year (QALY); and (4) at least 1 conventional statistical parameter (ie, SD, 95% confidence interval [CI], or P value). DATA EXTRACTION: From each study, we extracted the number of subjects, study design, health-utility instrument used, health-utility associated with profound deafness, health-utility gain from cochlear implantation, cost-utility of cochlear implantation, and reported statistical parameters. DATA SYNTHESIS: Weighted averages were calculated using a statistical weight of 1 per variance. Pooling 9 reports (n = 619), the health-utility of profoundly deaf adults without cochlear implants was 0.54 (95% CI, 0.52-0.56). Pooling 7 studies (n = 511), the health-utility of profoundly deaf adults after cochlear implantation was 0.80 (95% CI, 0.78-0.82). This improvement of 0.26 in health-utility resulted in a cost-utility ratio of $12,787 per QALY. CONCLUSIONS: Profound deafness in adults results in a substantial health-utility loss. Over half of that loss is restored after cochlear implantation, yielding a cost-utility ratio of $12,787 per QALY. This figure compares favorably with medical and surgical interventions that are commonly covered by third-party payers in the United States today.

Meta-analysis of pediatric cochlear implant literature.

We analyzed published reports of the effect of age at implantation and the cause of and age at onset of deafness on speech perception benefit in children with cochlear implants, and compared these results with those of unreported trials of multichannel cochlear implants. Combining data from published and unpublished patient series was constrained by differences in test protocols between studies, but was made feasible by employing a meta-analysis in which data were converted into an ordinal classification scale that represented levels of communicative benefit. Results showed that more rapid gains in speech perception are associated with earlier age at implantation, and that speech perception results are independent of cause of or age at onset of deafness after 1 year of implant use. Moreover, with minor exceptions, there was no statistical difference between published and unpublished data, thereby indicating no publication bias in the literature. A meta-analytic approach is useful because it can clarify the quality of reported data and the direction of future research and, hopefully, foster collaboration in conducting and reporting future research. A standardized approach to reporting results in children is advised in order to produce a balanced interpretation of implant benefit and to facilitate wider understanding and dissemination of study conclusions.

The murine LIM-kinase gene (limk) encodes a novel serine threonine kinase expressed predominantly in trophoblast giant cells and the developing nervous system.

Throughout vertebrate embryogenesis, membrane bound and intracellular protein kinases govern the fundamental decisions necessary for coordinated cell growth and differentiation. Here we have characterized limk, a novel protein kinase with serine threonine substrate specificity which also contains two LIM domains. We used Northern blot and in situ hybridization techniques to determine its pattern of expression in early mouse development. Between 7.5 and 8.5 d.p.c., limk is expressed in three broad domains within the embryo, the neuroectodermal of the prospective forebrain and mid-brain regions, the cardiac mesoderm, and the newly formed definitive endodermal derivatives the foregut and hindgut. By 10.0 d.p.c. limk remains prominently expressed in the ventromedial regions of the developing forebrain and midbrain, with continued expression in the hindgut. In adults limk is expressed most prominently in the brain. Additionally we have shown that limk is most abundantly expressed in the trophoblast giant cells, from 4.5 d.p.c. onwards. Moreover, high levels of limk expression is associated with the overt formation of giant cells from diploid progenitors, suggesting an involvement for limk in the differentiation of this highly specialized extra-embryonic cell type.

A possible prognostic role of immunoglobulin-G antibody against recombinant Epstein-Barr virus BZLF-1 transactivator protein ZEBRA in patients with nasopharyngeal carcinoma.

BACKGROUND: Epstein-Barr virus BZLF-1 replication activator (ZEBRA) is involved in the switch from viral latency to a productive cycle. Previous immunofluorescent study has shown that patients with nasopharyngeal carcinoma (NPC) have elevated immunoglobulin-G (IgG) antibody titres against recombinant ZEBRA protein (ZEBRA/IgG). METHODS: The prognostic role of ZEBRA/IgG was further investigated by enzyme-linked immunosorbent assay (ELISA) in 110 NPC patients under long period of clinical follow-up. RESULTS: Ninety-seven percent (85 of 88) of the patients with NPC had significantly higher ZEBRA/IgG titres (geometrical mean titre, i.e., GMT = 8397) than normal Chinese individuals (GMT = 233 and P < 0.0001). Based on Kaplan-Meier analysis, the actuarial survival in patients with high ZEBRA/IgG titres (25%) after radiotherapy was significantly lower than that of those with low (76%; P = 0.0008) or intermediate titres (62%; P = 0.0036), although the titres taken before treatment did not bear such a relationship. Subdividing the patients into either individual UICC or Ho's stages, those with late-stage disease (UICC Stage 4 and Ho's Stages 3 and 4) and with high ZEBRA/IgG titres also had poorer prognosis than those with disease of the same stages but who had low titres. Poor prognosis in those with high titres could be associated with a high risk of distant metastasis because consistent titre increase was found in the majority of patients who later developed distant metastasis either in the lung or liver. Only a minimal increase was found in patients with recurrence in the cervical lymph nodes. No consistent increase was observed, however, in patients whose disease was in remission or the majority of those with bone metastasis or local recurrence in the nasopharynx. CONCLUSION: The postradiotherapy ZEBRA/IgG titre could be a potentially useful marker for differentiating NPC patients with poor prognosis from those at high risk for the development of distant metastasis to the lung or liver.