Effects of Different Anticoagulation Doses on Moderate-to-Severe COVID-19 Pneumonia With Hypoxemia.

Background COVID-19 is a prothrombotic disease that can cause thromboembolism and microthrombi, which could lead to multiorgan failure and death. Since COVID-19 is a relatively new disease, there are guidelines for anticoagulation dosing for COVID-19 patients without consensus on the dosing. We studied the effects of different doses of anticoagulation in hospitalized patients with COVID-19 pneumonia and hypoxemia on any differences in need for high-flow oxygen, mechanical ventilation, and mortality. We also analyzed the patient population who benefited most from anticoagulation. Methodology We performed a retrospective chart review of all patients who were admitted with the diagnosis of COVID-19 infection with positive polymerase chain reaction, pneumonia (confirmed either by chest X-ray or CT chest), and hypoxemia (oxygen saturation of <94%, while on room air). These patients were studied for outcomes (the need for high-flow oxygen, the requirement for mechanical ventilation, and overall mortality) for different doses of anticoagulation (prophylactic, escalated, and therapeutic). Results The sample consists of 132 subjects, predominantly males (116, 87%), with a mean age of 59 years and a standard deviation of 15. About one-third of the participants had diabetes, and more than 50% had hypertension. Additionally, 27 (20.3%) had a history of heart disease, and 70 (53%) of the subjects were admitted to the intensive care unit (ICU) at some point during the study. Among those admitted to the ICU, about 11 (8%) subjects required mechanical ventilation and 16 (12%) passed away during the study. Those who died had higher use of high-flow oxygen, noninvasive mechanical ventilation, and invasive mechanical ventilation and had a longer stay on mechanical ventilation. There was no significant difference in mortality or need for mechanical ventilation for any strategy of anticoagulation. Conclusions Different doses of anticoagulation did not show any statistically significant relationship between the need for mechanical ventilation and mortality. More patients on high-flow oxygen had received escalated doses of anticoagulation as compared to those who were not on high-flow oxygen. Anticoagulation levels did not have any statistically significant effect on overall survival of patients.

Molecular communication network and its applications in crop sciences.

MAIN CONCLUSION: Plant molecular biology and bacterial behaviour research in the future could focus on using genetically engineered bacteria as a sensor, hormonal/disease detector, and target gene expression, as well as establishing a bioluminescence feedback communication system. Over the last two decades, understanding plant signal transduction pathways of plant hormones has become an active research field to understand plant behavior better. To accomplish signal transduction, plants use a variety of hormones for inter- and intra-communication, and biotic or abiotic stressors activate those. Signal transduction pathways refer to the use of various communication methods by effectors to elicit a response at the molecular level. Research methodologies such as inter-kingdom signaling have been introduced to study signal transduction and communication pathways, or what we can term plant molecular communication. However, stochastic qualities are inherent in most technologies used to monitor these biological processes. Molecular communication (MC) is a new research topic that uses the natural features of biological organisms to communicate and aims to manipulate their stochastic nature to achieve the desired results. MC is a multidisciplinary research field inspired by the use of molecules to store, spread, and receive information between biological organisms known as "Biological Nanomachines." It has been used to demonstrate how biological entities may be characterised, modelled, and engineered as communication devices in the same manner as traditional communication technologies are. We attempted to link MC and PLANT'S MC in this study and we believe that reasonable combined efforts may be made to use the functional applications of MC for detecting and understanding molecular-level activities such as signaling transduction pathways in crops.

Expert Recommendations on the Usage of Non-vitamin K Antagonist Oral Anticoagulants (NOACs) from India: Current Perspective and Future Direction.

Non-vitamin K antagonist oral anticoagulants (NOACs) are a new class of anticoagulant drugs used in the prevention and treatment of venous thromboembolism (VTE) and atrial fibrillation (AF). Anticoagulation requires the integration of the correct type and dose of oral anticoagulants based on patient characteristic, and therefore therapy needs to be individualized for each patient. Growing scientific evidence from studies on NOACs has led to a better understanding of their benefits and safety. A large amount of available data creates a necessity for an adaptable practical document for the usage of NOACs in India. The current consensus, developed by experts from India, aims to give recommendations on various frequently raised clinical questions with regards to NOACs and its usage. This practical document provides a platform upon which future guidelines, policies, training, and education for the use of NOACs can be tailored.

Aggressiveness of care at end of life in patients with high-grade glioma.

BACKGROUND: Patients with high-grade glioma (HGG) face unique challenges toward the end of life (EoL), given their aggressive trajectory and neurologic deterioration. Aggressiveness of medical care at EoL has been identified as an important quality metric for oncology patients. At this time, limited data exist around the nature of EoL care of patients with HGG. METHODS: Patients with HGG and palliative care (PC) referral seen between 2010 and 2015 were identified (N = 80). Of these, N = 52 met inclusion criteria. Random selections of patients with (1) HGG not referred to PC (n = 80), and (2) non-CNS cancers with PC referral (n = 80) were identified for comparison. A composite score of aggressiveness of medical care at EoL was calculated for each patient from predetermined variables. A time of eligibility for PC was defined for each patient when predetermined criteria based on symptom burden, functional status, and prognosis were met. RESULTS: Among the patients analyzed with HGG referred to PC, 59.6% (N = 31) were referred as inpatients, and 53.8% (N = 28) were referred within the last 12 weeks of life. Patients with HGG had similar aggressiveness of care at EoL regardless of PC referral, and HGG patients had less aggressive care at EoL than patients with non-CNS cancers (p = 0.007). Care was more aggressive at EoL in HGG patients who received late versus early PC referrals (p = 0.012). Motor weakness at time of eligibility (OR = 2.55, p = 0.002) and more disease progressions (OR = 1.25, p = 0.043) were associated with less aggressive care at EoL. CONCLUSIONS: Early clinical- and disease-related features predict the aggressiveness of medical care at EoL in patients with HGG. Formal PC consultation is used infrequently and suboptimally in patients with HGG. Our data suggest that the role of PC in improving EoL outcomes in HGG warrants further evaluation.

Frequency of Burnout Among Palliative Care Physicians Participating in a Continuing Medical Education Course.

CONTEXT: Palliative care (PC) physicians are vulnerable for burnout given the nature of practice. The burnout frequency may be variable and reported between 24% and 38% across different countries. OBJECTIVE: The main objective of our study was to determine the frequency of burnout among PC physicians participating in PC continuing medical education course. METHODS: A survey including the Maslach Burnout Inventory-General along with 41 custom questions were administered to determine the frequency of burnout among physicians attending the 2018 Hospice and Palliative Medicine Board review course. RESULTS: Of 110 physicians, 91 (83%) completed the survey. The median age was 48 years with 65% being females, 81% married, 46% in community practice, 38% in practice for 6-15 years. PC was practiced ≥50% of the time by 62%, and 76% were doing clinical work. About 73 (80%) reported that PC is appreciated at their work, 58 (64%) reported insurance to be a burden, and 58 (64%) reported that the electronic medical record was a burden. About 82 (90%) felt optimistic about continuing PC in future. Maslach Burnout Inventory results suggest that 35 (38%) participants reported at least one symptom of burnout. Only being single/separated showed trend toward significance with burnout (P = 0.056). CONCLUSION: Burnout among PC physicians who attended a board review course was 38%. Being single/separated showed trend toward association with burnout. Physicians who choose to attend continuing medical education may have unique motivating characteristics allowing them to better cope with stress and avoid burnout.

Modulation of seminal plasma content in extended semen improves the quality attributes of ram spermatozoa following liquid preservation at 3-5°C.

Seminal plasma (SP) is known to induce motility and capacitation in spermatozoa curtailing their lifespan when preserved. Hence, this study was conducted to examine the effects of removal of SP from sperm surface prior to liquid preservation either by high dilution (1/15) or by washing and the poststorage treatment with SP (15% and 25%, v/v) on the quality attributes of liquid-preserved ram semen. Over the period of storage, the rapid motility (66.0% and 71.1% vs. 58.3%), straightness (87.1% and 82.1% vs. 79.4%), average path velocity (152.3 and 152.0 µm/s vs. 133.3 µm/s) and the straight-line velocity (131.3 and 127.8 µm/s vs. 108.5 µm/s) were significantly (p < 0.05) higher in both the high-dilution and wash groups as compared to the control (1/3 dilution). The functional membrane integrity (82.3% vs. 77.2%) and noncapacitated sperm count (65.0% vs. 58.7%) were also significantly (p < 0.05) higher in the high-dilution and wash groups, respectively, as compared to the control. The poststorage treatment of sperm with SP significantly (p < 0.05) increased the functional membrane integrity (70.1% vs. 53.8%) and most of the motility attributes as compared to the control (without SP). In conclusion, both the removal of SP prior to liquid preservation and poststorage treatment with SP significantly improved the quality attributes of ram spermatozoa.

Personalized Pain Goal as an Outcome Measure in Routine Cancer Pain Assessment.

BACKGROUND: There is currently no universally accepted outcome measure in cancer pain management. The personalized pain goal (PPG) has been shown to be a relevant outcome measure. We examined its use in routine outpatient practice and compared it with the clinically important difference (CID, ≥2 points or 30%), a pain outcome measure frequently used in several clinical studies. MEASURES: Initial and follow-up clinical information of outpatients with advanced cancer pain were retrospectively reviewed. PPG response was defined as pain ≤ PPG and CID response as ≥30% or ≥2-point decrease in pain intensity at follow-up. OUTCOMES: PPG was successfully completed in 375 of 387 eligible patients (97%) with cancer pain. The median baseline PPG was three for all patients and remained unchanged at follow-up. One hundred thirty-two of 375 (35%) had a PPG response and 243 of 375 (65%) were non-responders. The odds ratio for PPG non-response was 1.01 for each milligram increase in morphine equivalent daily dose (P = 0.001), 1.46 for each point increase in the number of adjuvant analgesics (P = 0.006), 2.63 for severe pain (P = 0.002), and 2.55 for moderate depression (P = 0.006). Using PPG response as the gold standard for pain relief, the overall sensitivity and specificity of CID response were 83% and 77%, respectively. CONCLUSION: PPG was successfully completed in the vast majority of patients, suggesting its feasibility as a pain outcome measure in routine clinical practice. Higher baseline pain intensity, depression, opioid dose, and number of adjuvant analgesics were independent predictors of poor pain relief. Further research is needed to further evaluate its clinical importance in cancer pain management.

Effect of walking stress on growth, physiological adaptability and endocrine responses in Malpura ewes in a semi-arid tropical environment.

Sheep in hot semi-arid environments are mostly reared using extensive systems. In addition to thermal stress and feed scarcity, the animals need to walk long distances for grazing in this ecological zone. A study was conducted to assess the effect of long-distance walking on adaptive capability in terms of physiological, biochemical and endocrine responses in Malpura ewes. Fourteen adult Malpura non-pregnant ewes weighing between 33 and 35 kg were used in the study. The ewes were randomly allocated into two groups of seven animals each: GI (n = 7; Control), and GII (n = 7; walking stress). The animals were stall-fed with a diet consisting of 70% roughage and 30% concentrate. Both GI and GII ewes had uniform access to feed and water. The walking stress group (GII) ewes were made to walk 14 km in two spans between 0900 and 1500 hours with 1 h 30 min for each span (7 km) of walking. The ewes subjected to walking stress (GII) were prevented from grazing by applying a face mask made of cotton thread. The study was conducted for a period of two estrous cycles (35 days) during the autumn season (October-November). Physiological responses were recorded twice daily at 0800 and 1400 hours at weekly intervals. Blood samples were collected from the jugular vein at weekly intervals to study the effects of walking stress on blood biochemical and endocrine parameters. The results indicate that walking stress had significant (P < 0.05) influence on body weight, average daily gain, respiration rate (RR), rectal temperature (RT), haemoglobin (Hb), packed cell volume (PCV), plasma glucose, calcium, phosphorus, aspartate amino transferase (AST), alanine amino transferase (ALT), tri-iodo-thyronine (T(3)), thyroxin (T(4)), and cortisol. However, walking stress did not influence the reproductive hormone levels. The significant changes in RR, RT, plasma cortisol, T(3) and T(4) show that Malpura ewes have the capability to adapt to long-distance walking, and that adrenal and thyroid gland hormones play a significant role in such adaptation.