Visual classification of three computed tomography lung patterns to predict prognosis of COVID-19: a retrospective study

Background Quantitative evaluation of radiographic images has been developed and suggested for the diagnosis of coronavirus disease 2019 (COVID-19). However, there are limited opportunities to use these image-based diagnostic indices in clinical practice. Our aim in this study was to evaluate the utility of a novel visually-based classification of pulmonary findings from computed tomography (CT) images of COVID-19 patients with the following three patterns defined: peripheral, multifocal, and diffuse findings of pneumonia. We also evaluated the prognostic value of this classification to predict the severity of COVID-19. Methods This was a single-center retrospective cohort study of patients hospitalized with COVID-19 between January 1st and September 30th, 2020, who presented with suspicious findings on CT lung images at admission (n = 69). We compared the association between the three predefined patterns (peripheral, multifocal, and diffuse), admission to the intensive care unit, tracheal intubation, and death. We tested quantitative CT analysis as an outcome predictor for COVID-19. Quantitative CT analysis was performed using a semi-automated method (Thoracic Volume Computer-Assisted Reading software, GE Health care, United States). Lungs were divided by Hounsfield unit intervals. Compromised lung (%CL) volume was the sum of poorly and non-aerated volumes (− 500, 100 HU). We collected patient clinical data, including demographic and clinical variables at the time of admission. Results Patients with a diffuse pattern were intubated more frequently and for a longer duration than patients with a peripheral or multifocal pattern. The following clinical variables were significantly different between the diffuse pattern and peripheral and multifocal groups: body temperature (p = 0.04), lymphocyte count (p = 0.01), neutrophil count (p = 0.02), c-reactive protein (p < 0.01), lactate dehydrogenase (p < 0.01), Krebs von den Lungen-6 antigen (p < 0.01), D-dimer (p < 0.01), and steroid (p = 0.01) and favipiravir (p = 0.03) administration. Conclusions Our simple visual assessment of CT images can predict the severity of illness, a resulting decrease in respiratory function, and the need for supplemental respiratory ventilation among patients with COVID-19.

Gender roles and women’s mental health: their influence on the demand for psychological care

The prevalence of certain diagnoses, such as eating disorders, depression, anxiety, and borderline personality disorder, is higher among women than among men. When it comes to women’s mental health, focusing on social aspects influencing the way women fall ill becomes crucial. Using a sample of 368 women, we studied the classification ability of a number of clinical variables and sociocultural factors (conformity to gender norms) in order to ascertain whether or not women were receiving psychological care and determine the importance of each of the variables when predicting which women were receiving therapy. Our results showed that women were more likely to be receiving psychological treatment when scoring high on certain clinical variables (such as Suicidal Ideation and Borderline Features) and on a number of variables related to conforming to gender norms (Care for Children, Nice in Relationships, and Sexual Fidelity). Therefore, we believe that integrating the gender perspective into educational, health-related, and psychological care programmes is essential so that gender roles can become more diverse and less constricting of people’s potential, resulting in improved health. La prevalencia de determinados diagnósticos –trastorno de la conducta alimentaria, depresión, ansiedad y trastorno límite– es superior en mujeres que en hombres. Considerando la salud mental en mujeres, resulta imprescindible poner el foco en los aspectos sociales que influyen en la forma de enfermar. Se estudia en una muestra de 368 mujeres la capacidad de clasificación de algunas variables clínicas y factores socioculturales (conformidad con las normas de género) para determinar si una mujer está recibiendo asistencia psicológica o no, así como la importancia de cada una de esas variables a la hora de pronosticar qué mujeres estarían recibiendo terapia. Los resultados mostraron que cuando las mujeres puntúan alto en algunas variables clínicas (como Ideaciones Suicidas y Rasgos Límites) y en algunas relacionadas con conformidad con las normas de género (Cuidadora de Niños/as, Agradable en las relaciones y la Fidelidad Sexual) era más probable que estén recibiendo tratamiento psicológico. Por lo tanto, se considera que la inclusión de la perspectiva de género en programas de educativos, de salud y atención psicológica es fundamental para que los roles de género puedan ser más diversos y constriñan menos las potencialidades de las personas, lo que influirá en que tengan una mejor salud.

Opinion and perception of attitudes related to smoking and its prohibition in mental health services

Introduction: The opinions and perceptions about smoking in the psychiatric population contribute to the fact that its prevalence in this population remains two or three times higher than that found in other groups.Aims: 1) To compare the opinions of the psychiatric population and general population regarding the smoking ban in mental health services, as well as their perception of mental health professionals’ attitudes in relation to smoking; 2) To identify the association between personal and clinical variables with opinions and perception of attitudes.Methods: This Brazilian cross-sectional epidemiological study took place in: Mental Health Outpatient Unit (n=126), Psychiatric Hospital (n=126) and Primary Health Unit (n=126). Individual interviews were performed using a questionnaire.Results: Most participants believe that smoking ban may aggravate psychiatric symptoms. When comparing the responses of the psychiatric population with those of the general population, it is observed that the two groups have similar opinions regarding the effects of tobacco on psychiatric symptoms and behaviors. The population hospitalized in the psychiatric hospital was the one that most agreed with the perception of the attitudes of professionals working in mental health services towards smoking, possibly due to situations experienced in the psychiatric hospital. Among the personal and clinical variables, the illiterate or those who studied up to primary/junior high school were the ones who most agreed that the smoking ban aggravates psychiatric symptoms.Conclusions: This study contribute to the practice of psychiatric nursing by disclosing the opinions and perceptions of attitudes associated with smoking in mental health services. Introducción: Las opiniones y percepciones acerca del tabaquismo de la población psiquiátrica contribuyen a que su prevalencia, en esa población, sea de dos a tres veces superior a la encontrada en otros grupos.Objetivos: 1) Comparar las opiniones de la población psiquiátrica y de la población general en relación a la prohibición de fumar, en los servicios de salud mental, así como comparar la percepción que tienen de las actitudes de profesionales de salud mental, en relación al tabaquismo; 2) Identificar la asociación entre variables personales y clínicas con las opiniones y percepciones de las actitudes.Método: Este estudio epidemiológico brasileño de corte transversal fue realizado en Ambulatorio de Salud Mental (n=126), en Hospital psiquiátrico (n=126) y en Unidad Básica de Salud (n=126). Fueron realizadas entrevistas individuales usando un cuestionario.Resultados: La mayoría de los participantes cree que los síntomas psiquiátricos pueden agravarse con la prohibición de fumar. Al comparar las respuestas de la población psiquiátrica con la población general, se observó que los dos grupos tienen opiniones similares acerca de los efectos del tabaco en los síntomas psiquiátricos y en el comportamiento. La población internada en el hospital psiquiátrico fue la que más concordó con las afirmaciones relacionadas a las actitudes de los profesionales que trabajan en los servicios de salud mental, en relación al tabaquismo, posiblemente debido a las situaciones que experimentan en el hospital psiquiátrico. Entre las variables personales y clínicas, los analfabetos y los que estudiaron hasta la enseñanza fundamental fueron los que más concordaron que la prohibición de fumar puede agravar los síntomas psiquiátricos.Conclusión: Este estudio contribuye para la práctica de la enfermería psiquiátrica, al revelar las opiniones y percepciones de actitudes relacionadas al tabaquismo, en los servicios de salud mental. Introdução: As opiniões e percepções acerca do tabagismo da população psiquiátrica contribuem para sua prevalência, nessa população, ser duas a três vezes superior à encontrada em outros grupos.Objetivo: 1) Comparar as opiniões da população psiquiátrica e da população geral em relação à proibição do fumo nos serviços de saúde mental, bem como a percepção que elas têm das atitudes dos profissionais de saúde mental em relação ao tabagismo; 2) Identificar a associação entre variáveis pessoais e clínicas com as opiniões e percepção das atitudes.Método: Este estudo epidemiológico brasileiro de corte transversal foi realizado em: Ambulatório de Saúde Mental (n=126), Hospital psiquiátrico (n=126) e Unidade Básica de Saúde (n=126). Foram conduzidas entrevistas individuais usando questionário.Resultados: A maioria dos participantes acredita que os sintomas psiquiátricos podem ser agravados com a proibição do fumo. Ao comparar as respostas da população psiquiátrica com as da população geral, é observado que os dois grupos têm opiniões similares acerca dos efeitos do tabaco nos sintomas psiquiátricos e no comportamento. A população internada no hospital psiquiátrico foi a que mais concordou com as afirmativas relacionadas às atitudes dos profissionais que trabalham nos serviços de saúde mental em relação ao tabagismo, possivelmente devido às situações que experienciam no hospital psiquiátrico. Dentre as variáveis pessoais e clínicas, os analfabetos e os que estudaram até o ensino fundamental foram os que mais concordaram que a proibição do fumo pode agravar os sintomas psiquiátricos.Conclusão: Este estudo contribui para a prática da enfermagem psiquiátrica ao revelar as opiniões e percepções das atitudes relacionadas ao tabagismo nos serviços de saúde mental.

Identification of acute respiratory distress syndrome subphenotypes de novo using routine clinical data: a retrospective analysis of ARDS clinical trials

ObjectivesThe acute respiratory distress syndrome (ARDS) is a heterogeneous condition, and identification of subphenotypes may help in better risk stratification. Our study objective is to identify ARDS subphenotypes using new simpler methodology and readily available clinical variables.SettingThis is a retrospective Cohort Study of ARDS trials. Data from the US ARDSNet trials and from the international ART trial.Participants3763 patients from ARDSNet data sets and 1010 patients from the ART data set.Primary and secondary outcome measuresThe primary outcome was 60-day or 28-day mortality, depending on what was reported in the original trial. K-means cluster analysis was performed to identify subgroups. Sets of candidate variables were tested to assess their ability to produce different probabilities for mortality in each cluster. Clusters were compared with biomarker data, allowing identification of subphenotypes.ResultsData from 4773 patients were analysed. Two subphenotypes (A and B) resulted in optimal separation in the final model, which included nine routinely collected clinical variables, namely heart rate, mean arterial pressure, respiratory rate, bilirubin, bicarbonate, creatinine, PaO2, arterial pH and FiO2. Participants in subphenotype B showed increased levels of proinflammatory markers, had consistently higher mortality, lower number of ventilator-free days at day 28 and longer duration of ventilation compared with patients in the subphenotype A.ConclusionsRoutinely available clinical data can successfully identify two distinct subphenotypes in adult ARDS patients. This work may facilitate implementation of precision therapy in ARDS clinical trials.

LIM Homeobox Transcription Factors as Novel Prognosis Biomarkers in Head and Neck Squamous Cell Carcinoma

Background: LIM class homeobox (LHX) genes, an important subfamily of the homeobox genes, encode transcription factors that have a fundamental role during embryonic development. However, knowledge regarding the function and mechanism of LHXs in head and neck squamous cell carcinoma (HNSCC) is still lacking. Methods: We conduct a bioinformatic analysis to systematically explore the mRNA expression, clinical correlation, prognostic values, and underlying mechanisms of distinct LHXs in HNSCC. The differentially expressed mRNAs in the LIM homeobox gene family and their correlation with clinical variables were determined and verified with packages in software R. The prognosis values of LHXs expression levels were evaluated by Kaplan-Meier (KM) method and Cox proportional hazard model. Gene set enrichment analysis (GSEA) was conducted to understand the potential biological function of LHXs. The immune cell infiltration patterns were estimated through CIBERSORT and TIMER, and the methylation levels of LHXs in HNSCC were explored in UALCAN and MEXPRESS.Results: We found that among 12 LHXs, 8 genes (ISL1, LHX1-3, 5, 9, LMX1A, and LMX1B) showed altered expression in HNSCC tissues and detected significant correlations between their expression and clinical variables. Survival analysis revealed that LHX1, LHX5, LMX1A, LMX1B can serve as unfavorable prognosis predictors, and ISL1, LHX2, LHX9 can serve as favorable predictors in all HNSCC patients. Gene sets enrichment analysis and immune infiltration analyses showed that the aberrant expression of LHXs was closely related to cancer-associated processes and immune cell infiltration patterns. Finally, we observed hyper-methylation in the promoters of ISL1, LHX2, 5, 9, LMX1A, LMX1B and hypo-methylation in LHX3 promoter, suggesting the regulatory mechanism of LHXs abnormal expression may be related to aberrant DNA methylation. Conclusions: Our study found the oncogenic roles of LHX1,5 and LMX1B and the tumor-suppressor roles of ISL1 and LHX2 in patients with HNSCC, suggesting these LHXs as novel diagnostic and prognostic biomarkers for HNSCC.

The Effects of Hopelessness and Some Variables on Metabolic Syndrome in Schizophrenia Patients

This is a descriptive study conducted to determine the prevalence of Metabolic Syndrome (MetS) in Schizophrenia patients and identify the effects of hopelessness and some variables on MetS. The study was conducted at the Psychiatry Clinic of a university hospital in Turkey between May and August 2020 with 105 schizophrenia patients receiving treatment as inpatients. The data of the study were collected by a Personal Information Form, a Physiological Measurements Form and (BHS). The data were analyzed by using SPSS 25. The mean age of the patients was 35.31 ± 9.07, their mean duration of disease was 11.35 ± 9.07 years, and 60.0% of the patients were using atypical antipsychotics as their latest drug treatment. 42.9% of the patients had MetS, while the mean hopelessness level of those with MetS was 10.84 ± 3.81. It was determined that hopelessness levels and some sociodemographic (age) and clinical variables significantly predicted the MetS status in the schizophrenia patients.

Effectiveness of Intradialytic Stretching Exercises on Muscle Cramps among Patients Undergoing Haemodialysis in a Selected Tertiary Care Hospital Kancheepuram District, Tamil Nadu, India

Background: Chronic kidney disease is the vital and non-communicable disease epidemic that affects the world population including India. Muscle cramps are a common complication of haemodialysis treatments and they often result in the early termination of the session, it is an important priority to provide timely intervention to improve their muscle cramps of haemodialysis patients. Materials and Methods: The aim of the study is to evaluate the effectiveness of intradialytic stretching exercises on muscle cramps among patients on haemodialysis. Time series quasi experimental design was conducted in dialysis unit of Chettinad Super Specialty Hospital, Kelambakkam at Chengalpet District, Tamil Nadu, India.Total sample of 138 belong to 30 to 60 years were selected with the use of purposive sampling technique as per the statistical calculation and equally allocated to control 69 samples and to Study group 69. The structured questionnaire are demographic, Clinical variables & Modified cramps questionnaire chart was used to assess the effectiveness of intradialytic stretching exercises on level of muscle cramps. Results: The study findings concluded that in pre test 41(59.4 %) of the patients in study group and 38(55.1 %) of the patients in control group had mild muscle cramps whereas in post test 4(5.8 %) of the patients in study group had severe muscle cramps and 16 (23.2 %) of the patients in control group had severe muscle cramps. While comparing the post test mean value of control group 2.652±0.854 the study group mean value was 2.101±0.769 was significantly reduced with‘t’ value of 10.185 at p ≤ 0.000. Therefore the Research hypothesis H1 was retained. Hence there was no significant association between the test scores on intensity of muscle cramps among patients undergoing haemodialysis with selected demographic and clinical variables of group 2 (study) at P ≤ 0.000 level. Therefore the Research hypothesis H2 was rejected.The majority finding of the study results that in pre test 32 (46.4 %) of the patients were in mild muscle cramps in post test 1.More than half of the patients 30 (43.5 %) of moderate muscle cramps in post test 2. And majority 40 (58 %) of the patients in moderate muscle cramps in post test 3.The effect of intradialytic stretching exercises in reducing the level of muscle cramps during haemodialysis. Conclusion: Intradialytic stretching exercises is an effective method which can be used as a preventive therapy in the treatment of muscle cramps.

Predictors of Patient-Reported Dysphagia and Reflux Symptoms in Obstructive Sleep Apnea

Purpose: Despite the reported high prevalence of dysphagia and reflux, patients with obstructive sleep apnea (OSA) are not routinely screened for dysphagia or reflux during conventional OSA management. The purpose of this exploratory study was to (a) identify prevalences of dysphagia and reflux self-reported symptoms in patients with OSA and (b) determine associations between dysphagia and reflux symptoms and demographic and clinical variables. Method: A chart review was completed on 75 patients with treated OSA during routine medical management at a university-affiliated sleep center. All participants completed the 10-Item Eating Assessment Tool (EAT-10) and Reflux Symptom Index (RSI) questionnaires, which are patient-reported outcome measures (PROMs) of swallowing and reflux symptoms, respectively. Relevant demographic and clinical variables were extracted. A binary logistic regression was computed to examine the relationships between dysphagia and reflux PROMs and demographic and clinical variables. Result: Sixty-three participants met eligibility criteria ( M age = 64 years). In addition, 14% ( n = 9) and 11% ( n = 7) of patients with OSA syndrome reported swallowing and reflux symptoms, respectively. Among the demographic and clinical variables investigated, there were no significant predictive factors for EAT-10 scores. Age and apnea–hypopnea index were significant predictive factors for RSI scores. Conclusions: To our knowledge, this is the first preliminary study to investigate swallowing and reflux symptoms concurrently in OSA, as well as potential mitigating factors. Although our findings suggest a relatively low percentage of patients with OSA report dysphagia and reflux symptoms, the true prevalences of swallowing and reflux disorders may be higher based on previous evidence suggesting that pharyngeal afferent (sensory) dysfunction may cause patients to underestimate their symptoms.