Analysis of altered level of blood-based biomarkers in prognosis of COVID-19 patients.

INTRODUCTION: Immune and inflammatory responses developed by the patients with Coronavirus Disease 2019 (COVID-19) during rapid disease progression result in an altered level of biomarkers. Therefore, this study aimed to analyze levels of blood-based biomarkers that are significantly altered in patients with COVID-19. METHODS: A cross-sectional study was conducted among COVID-19 diagnosed patients admitted to the tertiary care hospital. Several biomarkers-biochemical, hematological, inflammatory, cardiac, and coagulatory-were analyzed and subsequently tested for statistical significance at P<0.01 by using SPSS version 17.0. RESULTS: A total of 1,780 samples were analyzed from 1,232 COVID-19 patients (median age 45 years [IQR 33-57]; 788 [63.96%] male). The COVID-19 patients had significantly (99% Confidence Interval, P<0.01) elevated levels of glucose, urea, alanine transaminase (ALT), aspartate aminotransaminase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), ferritin, D-Dimer, and creatinine phosphokinase-MB (CPK-MB) compared to the control group. However, the levels of total protein, albumin, and platelets were significantly (P<0.01) lowered in COVID-19 patients compared to the control group. The elevated levels of glucose, urea, WBC, CRP, D-Dimer, and LDH were significantly (P<0.01) associated with in-hospital mortality in COVID-19 patients. CONCLUSIONS: Assessing and monitoring the elevated levels of glucose, urea, ALT, AST, ALP, WBC, CRP, PCT, IL-6, ferritin, LDH, D-Dimer, and CPK-MB and the lowered levels of total protein, albumin, and platelet could provide a basis for evaluation of improved prognosis and effective treatment in patients with COVID-19.

A Giant Pheochromocytoma Presenting in Pheochromocytoma Crisis: A Case Report.

Giant pheochromocytomas are rare tumors, with the majority being clinically silent. Clinically manifesting pheochromocytoma can present with symptoms of catecholamine excess, but nonspecific symptoms and variable clinical patterns of hypertension make it difficult to diagnose. Missing the diagnosis can lead to cardiovascular catastrophes like a pheochromocytoma crisis and even death. We report a 45-year-old woman on antihypertensives, repeatedly visiting a hospital for recurrent headaches finally presented in a hypertensive crisis at an emergency department. Management was started along with an injection of labetalol, which led to an unpredicted abrupt blood pressure fall, and was successfully resuscitated. Imaging and plasma metanephrine studies revealed an underlying giant pheochromocytoma, which was cured after successful surgical resection. A high degree of clinical suspicion, elaborate and focused history-taking, and initial ultrasound imaging can guide us toward the early diagnosis of pheochromocytoma. Before the alpha blockade, beta-blockers should not be used in any cases of pheochromocytoma. Keywords: case reports; headache; hypertension; pheochromocytoma.

Spondylolysis among Patients Without Low Back Pain in a Diagnostic Centre: A Descriptive Cross-sectional Study.

Introduction: Spondylolysis can either be asymptomatic or can cause significant low back pain. It is sometimes associated with the translation of one vertebra over another and is termed spondylolisthesis. The aim of the study was to find out the prevalence of spondylolysis among patients without low back pain in a diagnostic centre. Methods: A descriptive cross-sectional study was carried out in a referral diagnostic centre from 15 December 2018 to 14 December 2021 . Ethical approval was obtained from the Nepal Health Research Council (Reference number: 2903). Images of a computed tomography scan of the abdomen performed for other abdominal causes and without low back pain were reconstructed in the sagittal and coronal plane and evaluated for the presence of spondylolysis and spondylolisthesis in the lumbar spine. Demographic data were taken from the hospital records. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 768 patients without low back pain, spondylolysis was found in 59 (7.68%) (5.80-9.56, 95% Confidence Interval). Spondylolisthesis was found in only 16 (27.1%) individuals with spondylolysis. The majority of spondylolysis cases were encountered in L5 level in 54 (91.53%). The mean age of patients with spondylolysis was 41.9±14.46 years. Male to female ratio was 1:1.18. Conclusions: The prevalence of spondylolysis in our study was found to be similar to other studies done in similar settings. Keywords: low back pain; spondylolisthesis; spondylolysis.

Duplication of urethra: A case report from Nepal.

Urethral duplication is uncommon with few cases reported in the literature. We report a case in which a patient presented with discharge from proximal part of penis since childhood and recent history of infection. The diagnosis of pre-pubic sinus was made and complete excision of the sinus tract was done.

Filariasis diagnosed by real-time ultrasound scanning as filarial dance sign - A case report.

Introduction: Lymphatic filariasis (LF) is a vector-borne illness caused due to Wuchereria bancrofti. Genital abnormalities may result from chronic inflammation of the lymphatic vessels and obstruction of the afferent vessels in Bancroftian filariasis. Doxycycline, albendazole, diethylcarbamazine, and ivermectin are among the treatments available. Case: A 16-year male presented to our OPD with a complaint of left inguinal swelling for the past 6 Months. Examination of the swelling revealed a left-sided inguinal swelling of 5 × 4 cm with intact overlying skin. A provisional diagnosis of inguinal lymph varix was made, and real-time ultrasound scanning along with FNAC was performed. Swelling resolved after conservative management. Discussion: Ultrasonography can easily observe adult worms due to their size and fast movements. Using pulsed-wave doppler mode, the characteristic movement profile of adult worms in pulsed-wave doppler mode can be distinguished from other movements (e.g., blood in venous vessels). Conclusion: Ultrasound is the imaging modality of choice to detect filarial worms/microfilaria in the lymphatic system, which produces the classic twirling of microfilaria in the lymphatic system, known as the "filarial dance sign".

High Mobility Two-Dimensional Electron Gas at the BaSnO3/SrNbO3 Interface.

Oxide two-dimensional electron gases (2DEGs) promise high charge carrier concentrations and low-loss electronic transport in semiconductors such as BaSnO3 (BSO). ACBN0 computations for BSO/SrNbO3 (SNO) interfaces show Nb-4d electron injection into extended Sn-5s electronic states. The conduction band minimum consists of Sn-5s states ∼1.2 eV below the Fermi level for intermediate thickness 6-unit cell BSO/6-unit cell SNO superlattices, corresponding to an electron density in BSO of ∼1021 cm-3. Experimental studies of analogous BSO/SNO interfaces grown by molecular beam epitaxy confirm significant charge transfer from SNO to BSO. In situ angle-resolved X-ray photoelectron spectroscopy studies show an electron density of ∼4 × 1021 cm-3. The consistency of theory and experiments show that BSO/SNO interfaces provide a novel materials platform for low loss electron transport in 2DEGs.

High throughput analysis of leaf chlorophyll content in sorghum using RGB, hyperspectral, and fluorescence imaging and sensor fusion.

BACKGROUND: Leaf chlorophyll content plays an important role in indicating plant stresses and nutrient status. Traditional approaches for the quantification of chlorophyll content mainly include acetone ethanol extraction, spectrophotometry and high-performance liquid chromatography. Such destructive methods based on laboratory procedures are time consuming, expensive, and not suitable for high-throughput analysis. High throughput imaging techniques are now widely used for non-destructive analysis of plant phenotypic traits. In this study three imaging modules (RGB, hyperspectral, and fluorescence imaging) were, separately and in combination, used to estimate chlorophyll content of sorghum plants in a greenhouse environment. Color features, spectral indices, and chlorophyll fluorescence intensity were extracted from these three types of images, and multiple linear regression models and PLSR (partial least squares regression) models were built to predict leaf chlorophyll content (measured by a handheld leaf chlorophyll meter) from the image features. RESULTS: The models with a single color feature from RGB images predicted chlorophyll content with R2 ranging from 0.67 to 0.88. The models using the three spectral indices extracted from hyperspectral images (Ration Vegetation Index, Normalized Difference Vegetation Index, and Modified Chlorophyll Absorption Ratio Index) predicted chlorophyll content with R2 ranging from 0.77 to 0.78. The model using the fluorescence intensity extracted from fluorescence images predicted chlorophyll content with R2 of 0.79. The PLSR model that involved all the image features extracted from the three different imaging modules exhibited the best performance for predicting chlorophyll content, with R2 of 0.90. It was also found that inclusion of SLW (Specific Leaf Weight) into the image-based models further improved the chlorophyll prediction accuracy. CONCLUSION: All three imaging modules (RGB, hyperspectral, and fluorescence) tested in our study alone could estimate chlorophyll content of sorghum plants reasonably well. Fusing image features from different imaging modules with PLSR modeling significantly improved the predictive performance. Image-based phenotyping could provide a rapid and non-destructive approach for estimating chlorophyll content in sorghum.

Intravenous Ringers lactate versus normal saline for predominantly mild acute pancreatitis in a Nepalese Tertiary Hospital.

BACKGROUND: Acute pancreatitis (AP) is a common presentation in patients admitted with acute abdomen. Whether Ringers lactate (RL) or Normal Saline (NS) as a resuscitation fluid is better still remains unclear. The aim of this study is to compare the efficacy of RL and NS in terms of control of systemic inflammation by measuring indirect markers specifically Systemic Inflammation Response Syndrome (SIRS) scores and C- Reactive Protein (CRP) level. METHODS: This was an open label randomized trial conducted in a tertiary level hospital of Nepal. Ethical approval was obtained prior to the study. Patients with acute pancreatitis were randomized to either RL or NS group for the fluid resuscitation. The fluid was given as per the study protocol for three days for hydration. Baseline SIRS and CRP were recorded on admission and subsequently as defined. All the data were analyzed using SPSS ver 20.0 software. RESULTS: Total 51 patients were enrolled, 26 in RL and 25 in NS group. The commonest etiology of AP was alcohol (84.31%). SIRS was present in 46.2% and 64.0% of patients in RL and NS group respectively (p = 0.20) on admission. At least one SIRS criteria was still present in 44.0% of patients in the NS group compared to only 15.4% in the RL group after 24 hours (p = 0.025). The baseline CRP were comparable in both the groups. However after 72 hours, the increment of CRP was more in the NS group compared to the RL group; median value of 14.2 mg/dl (12.15, 16.45) and 22.2 mg/dl (18.20, 30.60) in RL and NS group respectively (p<0.001). CONCLUSIONS: Ringers lactate was associated with a reduction in systemic inflammation compared to normal saline in patients with acute pancreatitis. Incidence of SIRS at 72 hours and occurrence of local complications were however similar in both the groups.

Urology during COVID-19 Pandemic Crisis: A Systematic Review.

Background Coronavirus disease 2019 (COVID-19) has evolved as a pandemic of unimaginable magnitude. The health care system is facing a tremendous challenge to provide ethical and quality care. The transformation of the patient-based care to population-based care during the COVID-19 pandemic has raised ethical dilemma among urologists. Our objective is to explore the consensus in modified standard urology care, that can be adopted and applied during COVID-19 and similar pandemic. Methods We adopted an exploratory study design using secondary data. The data were extracted from a web-based medical library using keywords "COVID-19," "severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)," and "urology." We identify and extrapolate (screening, eligibility, and inclusion) the data using PRISMA protocol, and summarize pandemic standard urology care under four main themes: (1) general urology care, (2) choice of surgical modality, (3) triage, and (4) urology training. Result We identified 63 academic papers related to our research question. The majority are expert opinions and perspectives on urology care. The common consensus is triage-based urology care and surgeries. Life or organ threatening conditions need immediate attention. Universal protective measures (personal protective equipment, safe operative environment) and protocol-based patient care are necessary to prevent and control SARS-CoV-2 infection. Conservation of the resources and its rational distribution provide an ethical basis for population-based health care during a pandemic. Informed decision making serves best to patients, families, and society during the public health crisis. Conclusion COVID-19 pandemic tends to transform standard urology practice into crisis standard population-based care. The consensus in crisis is drawn from evolving pieces of medical evidence and public health ethics. The provision of urology care during a pandemic is based on the availability of resources; severity of the disease, consequences of deferment of service, and dynamics of the pandemic.

Prevalence of Malnutrition in Patients with Liver Cirrhosis in A Tertiary Care Hospital.

INTRODUCTION: Cirrhosis of liver is a progressively deteriorating disease. Medical management consist of treatment and prevention of complications. Nutritional intervention to improve nutritional status of the malnourished patient has favorable impact on prognosis. Traditional measures of nutritional assessment like Body Mass Index and waist circumference are inaccurate. This study was conducted to study the prevalence of malnutrition in cirrhotic patients. METHODS: This was a descriptive cross-sectional study conducted at National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal. The study included 60 cirrhotic patients from outpatient department. Subjective Global Assessment was performed for all participants and level of malnutrition recorded. Height, weight, waist circumference, body mass index were measured and recorded. RESULTS: Among the cirrhotic patients, malnutrition was detected in 46 (76.66%) [68.38 to 85.94 at Confidence Interval 95%]. Out of 46 patients who were malnourished, 20 (43.47%) had mild to moderate malnutrition whereas 26 (56.53%) had severe malnutrition. The most common cause of cirrhosis was alcohol. The mean body mass index and mean waist circumference were within normal limits. CONCLUSIONS: Malnutrition is very common among cirrhotic patients and its prevalence increased from Child A to Child C status.

Factors Predicting Mortality of Acute Variceal Bleeding in Liver Cirrhosis.

INTRODUCTION: Acute variceal bleeding in liver cirrhosis is an immediate life-threatening condition and amajor complication of portal hypertension associated with higher morbidity, mortality and hospital costs than any other causes of UGI bleeding. Therefore, early stratification and initiation of therapy based on several factors can reduce mortality associated with it. We aimed to study the predictors of mortality in acute variceal bleeding in LC. METHODS: An observational prospective study was conducted in Gastroenterology and Hepatology units of Bir Hospital, Kathmandu, Nepal from April 1, 2016 to May 30, 2017. Patients were included if they had underlying liver cirrhosis and presented upper GI bleeding which were proven to be secondary to variceal bleeding. RESULTS: Seventy-five patients with mean age of 52.5 years were available or the analysis. The M:F ratio was 2.1:1. There were 66 patients in mortality group and 9 in survivor group. The mean CTP and MELD score were 10.17±1.66 and 20.40±8.29 respectively. Among the predictors of the mortality studied, CTP score, MELD score, mean arterial pressure, Serum bilirubin, serum creatinine, need of FFP as well as PRP transfusion, presence of hepatorenal syndrome and hepatic encephalopathy were high in mortality group with statistical significance. On multivariate analysis, high CTP and high serum creatinine level were only significant predictors of mortality. Receiver operating curve for predicting accuracy of mortality was significant with higher MELD and higher CTP score. CONCLUSIONS: Strong predictors of mortality in patients with cirrhosis presenting with variceal bleeding are CTP score and high serum creatinine level.

A Novel LiDAR-Based Instrument for High-Throughput, 3D Measurement of Morphological Traits in Maize and Sorghum.

Recently, imaged-based approaches have developed rapidly for high-throughput plant phenotyping (HTPP). Imaging reduces a 3D plant into 2D images, which makes the retrieval of plant morphological traits challenging. We developed a novel LiDAR-based phenotyping instrument to generate 3D point clouds of single plants. The instrument combined a LiDAR scanner with a precision rotation stage on which an individual plant was placed. A LabVIEW program was developed to control the scanning and rotation motion, synchronize the measurements from both devices, and capture a 360° view point cloud. A data processing pipeline was developed for noise removal, voxelization, triangulation, and plant leaf surface reconstruction. Once the leaf digital surfaces were reconstructed, plant morphological traits, including individual and total leaf area, leaf inclination angle, and leaf angular distribution, were derived. The system was tested with maize and sorghum plants. The results showed that leaf area measurements by the instrument were highly correlated with the reference methods (R² > 0.91 for individual leaf area; R² > 0.95 for total leaf area of each plant). Leaf angular distributions of the two species were also derived. This instrument could fill a critical technological gap for indoor HTPP of plant morphological traits in 3D.

Butyl-bis-(diphenyl-glyoximato)(pyridine-κN)-cobalt(III).

In the title compound, [Co(C(4)H(9))(C(14)H(11)N(2)O(2))(2)(C(5)H(5)N)], the Co(III) atom is coordinated by a butyl group, a nitro-gen-bonded pyridine and two N,N'-bidentate diphenyl-glyoximate ligands in a distorted octa-hedral geometry. The crystal structure features two short O-H⋯O bridges between the two chelating anions, with O⋯O distances less than 2.5 Å.

Butyl-bis-(dimethyl-glyoximato-κN,N')(pyridine-κN)cobalt(III).

In the title compound, [Co(C(4)H(9))(C(4)H(7)N(2)O(2))(2)(C(5)H(5)N)], which was prepared as a model complex of vitamin B(12), the Co(III) atom is coordinated by a butyl group, a pyridine and two N,N'-bidentate dimethyl-glyoximate ligands in a distorted octa-hedral geometry. The bis-chelating dimethyl-glyoximate ligands, which occupy equatorial sites, are linked by strong intra-molecular O-H⋯O hydrogen bonds.

4-[(4'-Chloro-methyl-[1,1'-biphen-yl]-4-yl)meth-yl]bis-(dimethyl-glyoximato-κN,N')(pyridine-κN)cobalt(III).

The title compound, [Co(C(14)H(14)Cl)(C(4)H(6)N(2)O(2))(2)(C(5)H(5)N)], is a model compound for the more complex cobalamines like vitamins B(12). The Co(III) atom is coordinated by a (4'-chloro-methyl-[1,1'-biphen-yl]-4-yl)methyl group, an N-bonded pyridine and two N,N'-bidentate dimethyl-glyoximate ligands in a distorted octa-hedral geometry. The glyoximate ligands exhibit intra-molecular O-H⋯O hydrogen bonds, which is very common in cobaloxime derivatives.