Prediction of mortality in hospitalized Egyptian patients with Coronavirus disease-2019: A multicenter retrospective study

We aimed to assess the epidemiological, clinical, and laboratory characteristics associated with mortality among hospitalized Egyptian patients with COVID-19. A multicenter, retrospective study was conducted on all polymerase chain reaction (PCR)-confirmed COVID-19 cases admitted through the period from April to July 2020. A generalized linear model was reconstructed with covariates based on predictor’s statistical significance and clinically relevance. The odds ratio (OR) was calculated by using stepwise logistic regression modeling. A total of 3712 hospitalized patients were included; of them, 900 deaths were recorded (24.2%). Compared to survived patients, non-survived patients were more likely to be older than 60 years (65.7%), males (53.6%) diabetic (37.6%), hypertensive (37.2%), and had chronic renal insufficiency (9%). Non-survived patients were less likely to receive azithromycin (p <0.001), anticoagulants (p <0.001), and steroids (p <0.001). We found that age ≥ 60 years old (OR = 2.82, 95% CI 2.05–3.86; p <0.0001), diabetes mellitus (OR = 1.58, 95% CI 1.14–2.19; p = 0.006), hypertension (OR = 1.69, 95% CI 1.22–2.36; p = 0.002), chronic renal insufficiency (OR = 3.15, 95% CI 1.84–5.38; p <0.0001), tachycardia (OR = 1.65, 95% CI 1.22–2.23; p <0.001), hypoxemia (OR = 5.69, 95% CI 4.05–7.98; p <0.0001), GCS <13 (OR 515.2, 95% CI 148.5–1786.9; p <0.0001), the use of therapeutic dose of anticoagulation (OR = 0.4, 95% CI 0.22–0.74, p = 0.003) and azithromycin (OR = 0.16, 95% CI 0.09–0.26; p <0.0001) were independent negative predictors of mortality. In conclusion, age >60 years, comorbidities, tachycardia, hypoxemia, and altered consciousness level are independent predictors of mortality among Egyptian hospitalized patients with COVID-19. On the other hand, the use of anticoagulants and azithromycin is associated with reduced mortality.

Time-Specific Associations of Wearable, Sensor-Based Cardiovascular and Behavioral Readouts with Disease Phenotypes in the Outpatient Setting of the Chronic Renal Insufficiency Cohort (CRIC)

Patients with chronic kidney disease (CKD) are at risk of developing cardiovascular disease. To facilitate out-of-clinic evaluation, we piloted wearable device-based analysis of heart rate variability and behavioral readouts in patients with CKD participating in the Chronic Renal Insufficiency Cohort and (n=49) controls. Time-specific partitioning of HRV readouts indicate higher parasympathetic nervous activity during the night (mean RR at night 14.4+/-1.9 ms versus 12.8+/-2.1 ms during active hours; n=47, ANOVA q=0.001). The alpha2 long-term fluctuations in the detrended fluctuation analysis, a parameter predictive of cardiovascular mortality, significantly differentiated between diabetic and non-diabetic patients (prominent at night with 0.58+/-0.2 versus 0.45+/-0.12, respectively, adj. p=0.004). Both diabetic and nondiabetic CKD patients showed loss of rhythmic organization compared to controls, with diabetic CKD patients exhibiting deconsolidation of peak phases between their activity and SDNN (standard deviation of interbeat intervals) rhythms (mean phase difference CKD 8.3h, CKD/T2DM 4h, controls 6.8h). This work provides a roadmap toward deriving actionable clinical insights from the data collected by wearable devices outside of highly controlled clinical environments.

Development and Validation of a Predictive Scoring System for In-hospital Death in Patients With Intra-Abdominal Infection: A Single-Center 10-Year Retrospective Study

Objective: To develop and validate a scoring system to predict the risk of in-hospital death in patients with intra-abdominal infection (IAI).Materials and Methods: Patients with IAI (n = 417) treated at our hospital between June 2010 and May 2020 were retrospectively reviewed. Risk factors for in-hospital death were identified by logistic regression analysis. The regression coefficients of each risk factor were re-assigned using the mathematical transformation principle to establish a convenient predictive scoring system. The scoring system was internally validated by bootstrapping sample method.Results: Fifty-three (53/417, 12.7%) patients died during hospitalization. On logistic regression analysis, high APACHE II score (P = 0.012), pneumonia (P = 0.002), abdominal surgery (P = 0.001), hypoproteinemia (P = 0.025), and chronic renal insufficiency (P = 0.001) were independent risk factors for in-hospital death. On receiver operating characteristic curve analysis, the composite index combining these five risk factors showed a 62.3% sensitivity and 80.2% specificity for predicting in-hospital death (area under the curve: 0.778; 95% confidence interval: 0.711–0.845, P &lt; 0.001). The predictive ability of the composite index was better than that of each independent risk factor. A scoring system (0–14 points) was established by re-assigning each risk factor based on the logistic regression coefficient: APACHE II score (10–15 score, 1 point; &gt;15 score, 4 points); pneumonia (2 points), abdominal surgery (2 points), hypoproteinemia (2 points), and chronic renal insufficiency (4 points). Internal validation by 1,000 bootstrapping sample showed relatively high discriminative ability of the scoring system (C-index = 0.756, 95% confidence interval: 0.753–0.758).Conclusions: The predictive scoring system based on APACHE II score, pneumonia, abdominal surgery, hypoproteinemia, and chronic renal insufficiency can help predict the risk of in-hospital death in patients with IAI.

Loss of Autophagy In Tibial Growth Plate Chondrocytes Causes Increased Chondrocyte Apoptosis In Young Rats With Chronic Renal Insufficiency

Background: To observed the effect of autophagy in tibial growth plate chondrocytes on apoptosis in chronic renal insufficiency(CRI) rats.Method: Male 4-week-old Sprague Dawley(SD) rats were randomly divided into two groups (n=20/per group): (1) the normal group was intragastrically administered distilled water; and (2) the CRI group was given a 150 mg/(kg·d) adenine suspension. All rats were sacrificed after continuous gavage for 6 weeks. The tibial length and the width of the tibial growth plate were measured using micro-CT. The width of the tibial growth plate was also measured in histological sections at both 4 w and 10 w. The level of the autophagy marker Beclin-1 in chondrocytes was measured by immunofluorescence. The level of glycogenin-1, a marker of intracellular glycogen accumulation, was measured by immunohistochemistry in chondrocytes in vivo and in vitro. The apoptosis rate of chondrocytes was measured by the TUNEL method in vivo and in vitro.Results: The results showed that the length of tibia was shorter and the width of tibia growth plate was narrower in CRF young rats. Autophagy level of chondrocytes in tibial growth plate decreased, and accumulation of glycogen granules in chondrocytes increased significantly. Meanwhile, the apoptosis rate of chondrocytes in tibial growth plate increased.Conclusion: When CRF occurred in young rats, the autophagy level of chondrocytes in tibial growth plate decreased significantly.As a result, there are not enough autophagic vesicles to swallow glycogen granules in chondrocytes and degrade them into glucose for energy supply, which leads to chondrocyte apoptosis.Autophagy of chondrocytes is at least partly involved in energy metabolism of cells.

Calciphylaxis of the temporal artery simulating temporal arteritis

Calciphylaxis is characterized by intense deposition of calcium in small blood vessels, skin, and other organs, described mainly in patients with chronic renal insufficiency, renal transplant of parathyroid dysfunction. To date, there are only seven cases described in literature of calciphylaxis mimicking giant cell arteritis (GCA). In this review, we present the eighth case pathologically documented.