Hepatic and Renal Safety of Remdesivir in COVID-19 Patients Observational prospective study

Background: SARS-CoV-2 has been demonstrated to be inhibited by Remdesivir, a broad-spectrum antiviral medication. Remdesivir has been tried for a compassionate use in severe COVID-19 in the absence of any viable treatment for SARS-CoV-2 infection (COVID-19). Methods: In 50 patients with SARSCoV-2 infection who were given Remdesivir as part of their institutional treatment plan, we conducted an observational prospective analysis. Remdesivir 100 mg was given daily for7 days during the therapy period. The results of liver and kidney function tests were compared before and after Remdesivir administration. Results: With the administration of Re%) exhibited an improvement in their oxygen needs. Patients reported only a few minor side effects. Serious side effects, on the other hand, were rare. Conclusion: Remdesivir seems to have an excellent safety profile, while its efficacy in the treatment of COVID-19 is currently inconclusive. Remdesivir use in patients was shown to be safe, with no serious side effects or significant changes in normal test results for liver and kidney functions. Keywords: Adverse events, Covid-19, liver function, remdesivir, renal function

DIFFERENCE OF POWER TEST AND TYPE II ERROR (β) ON MARDIA MVN TEST, HENZE ZIKLER'S MVN TEST, AND ROYSTON'S MVN TEST USING MULTIVARIATE DATA ANALYSIS

The Mardia MVN test, Henze Zikler's MVN test, and Royston's MVN test are the most widely used tests to analyze multivariate normal (MVN) data, but there have not been many studies explaining the advantages and disadvantages of these tests. The research objective was to analyze the difference in test strength and type II (β) error in the Mardia MVN test, Henze Zikler's MVN test, and Royston's MVN test. The research data were analyzed using three MVN tests, namely the Mardia MVN test, Henze Zikler's MVN test, and Royston's MVN test. The results of the analysis in the form of test strength and type II error (β) would be compared at alpha (α) 1%, 5%, 10%, 15%, 20%, and 25%. The comparison results explained that the Mardia test had the greatest test strength and the smallest type II (β) error. The study concluded that the Mardia MVN test was a multivariate normal test better than Henze Zikler's MVN test and Royston's MVN test.

Redundant laboratory testing on referral from general practice to the outpatient clinic

BackgroundInappropriately repeated laboratory testing is a commonly occurring problem. However, this has not been studied extensively in the outpatient clinic after referral by general practitioners.AimThe aim of this study was to investigate how often laboratory tests ordered by the general practitioner were repeated on referral to the outpatient clinic, and how many of the normal test results remained normal on repetition.Design & settingThis is a post hoc analysis of a study on laboratory testing strategies in patients newly referred to the outpatient clinic.MethodAll patients who had a referral letter including laboratory test results ordered by the general practitioner were included. These results were compared to the laboratory test results ordered in the outpatient clinic.ResultsData were available for 295 patients, 191 of which had post-visit testing done. In this group, 56% of tests ordered by the general practitioner were repeated. Tests with abnormal results were repeated more frequently than tests with normal results (65% vs 53%; P<0.001). A longer test interval was associated with slightly smaller odds of tests being repeated (OR 0.97 [0.95–0.99]; P=0.003). Of the tests with normal test results that were repeated, 90% remained normal. This was independent of testing interval or testing strategy.ConclusionLaboratory tests ordered by the general practitioner are commonly repeated on referral to the outpatient clinic. The number of test results remaining normal on repetition suggests a high level of redundancy in laboratory test repetition.

Prevalence and Predictors of Impaired Glucose Tolerance and Diabetes Mellitus Type 2 in Patients with Polycystic Ovary Syndrome

Aim: To estimate the prevalence of impaired glucose tolerance (IGT) and diabetes mellitus type 2 (DMT2), as well as the predictors for glucose abnormalities in women with polycystic ovary syndrome (PCOS). Material and methods: A cross-sectional study with 80 consecutive patients with newly diagnosed PCOS who underwent the standard 75g oral glucose tolerance test (OGTT) and the measurement of sex steroid hormone and lipid profile. Results: According to the results from the OGTT, 63% had a normal test (NT), 23% had IGT, and 9% had DMT2. The NT group was younger with lower BMI than IGT and DMT2 groups (25.1 ± 7.3, 31.5 ± 6.5, 37.4 ± 4.0 years, and 29.1 ± 8.3 kg/m2, 31.7 ± 4.6 kg/m2, and 34.5 ± 5.6 kg/m2, respectively). The testosterone levels were highest in the group with a normal test (2.7 ± 0.8 nmol/l) and lowest in the DMT2 group (1.9 ± 0.8 nmol/L), with statistical significance. The sex hormone bounding globulin (SHBG) levels were low in all three groups, with statistically significant differences between NG and IGT, and the NT and DMT2 groups. The multivariate linear regression model identified age, BMI, SHBG and testosterone as major independent predictors for abnormal glucose metabolism. Conclusion: It seems that the prevalence of IGT and DMT2 among PCOS women in our country is not as high as in Western countries. Age, BMI, and SHBG increase the risk for the development of IGT and DMT2. Thus, close monitoring of older, obese women with low SHBG is needed because of the higher risk for the development of IGT and DMT2 in such patients.

“Go Wild for a While!”: A New Test for Forecast Evaluation in Nested Models

In this paper, we present a new asymptotically normal test for out-of-sample evaluation in nested models. Our approach is a simple modification of a traditional encompassing test that is commonly known as Clark and West test (CW). The key point of our strategy is to introduce an independent random variable that prevents the traditional CW test from becoming degenerate under the null hypothesis of equal predictive ability. Using the approach developed by West (1996), we show that in our test, the impact of parameter estimation uncertainty vanishes asymptotically. Using a variety of Monte Carlo simulations in iterated multi-step-ahead forecasts, we evaluated our test and CW in terms of size and power. These simulations reveal that our approach is reasonably well-sized, even at long horizons when CW may present severe size distortions. In terms of power, results were mixed but CW has an edge over our approach. Finally, we illustrate the use of our test with an empirical application in the context of the commodity currencies literature.

Pengaruh Penggunaan Aplikasi Quizizz terhadap Hasil Belajar IPA Siswa di Sekolah Dasar

Tujuan dilaksanakannya studi ini untuk dalam mengetahui terdapat pengaruh atau tidak hasil belajar IPA akan murid kelas IV melalui menggunakan Aplikasi Quizizz. Metode studi ini berupa Quasi Eksperimen dan bentuk studi Nonquivalent Control Group Design. Pada studi ini dilakukan pretest dan posttest. Sampel penelitan berjumlah 55 siswa yang terdiri dari IV A 26 siswa menjadi kelas kontrol dan IV B 29 siswa menjadi kelas eksperimen.Hasil perhitungan pengujian persyaratan analisis pengujian normalitas kelas eksperimen serta kontrol berdistribusi normal. Test homogenitas kelas eksperimen antara pretest serta posttest d F_(hitung ) < F_(tabel ) = 1,033 < 1,87 dinyatakan data homogen. Perhitungan kelas kontrol antara pretest dan posttest F_(hitung ) < F_(tabel ) = 1,73 < 2,96 dinyatakan data homogen. Hasil pengujian hipotesis t_hitung > t_(tabel ) = 3,289 > 2,000, maka H1 diterima dimana mempunyai arti terdapat pengaruh dalam menggunakan aplikasi Quizizz terhadap hasil belajar IPA siswa IV pada SDN Sumur Batu 08 Jakarta Pusat.Hasil penelitian ini menyatakan terdapat Pengaruh Penggunaan Aplikasi Quiziz Terhadap Hasil Belajar IPA Siswa Kelas IV di SDN Sumur Batu 08 Jakarta Pusat.

Confirmation of Feasibility of Selective Glucocorticoid Replacement Following Unilateral Adrenalectomy for Hypercortisolism and Primary Aldosteronism

Background: Secondary adrenal insufficiency (AI) can develop following unilateral adrenalectomy (UA) foradrenal-dependent hypercortisolism (HC) and has been reported after UA for primaryaldosteronism (PA). An institutional study previously demonstrated that cosyntropin stimulationtesting on postoperative day 1 (POD1-CST) successfully identified patients who requiredglucocorticoid replacement (GR) following UA; 50% of HC patients required GR and no PApatients required GR. The aim of this study was to reevaluate the need for GR following UA forpatients with HC and PA in a larger cohort of patients. Methods We reviewed 108 patients from a prospectively maintained adrenal database who underwent UAfor HC (n=74), PA (n=22), and concurrent HC/PA (n=12) from 9/2014-10/2020. PA patientswithout preoperative evaluation for HC were excluded. Patients with 1mg dexamethasonesuppression test (DST) cortisol &gt;1.8 (µg/dL) were defined as having mild HC, with ³5 defined asovert Cushing’s Syndrome (CS). All patients underwent our institutional POD1-CST protocoland GR was initiated for patients with basal cortisol £5 or stimulated cortisol £14 (&lt;18 prior to4/2017). Results: Overall, 51 (47%) patients had an abnormal POD1-CST and were discharged on GR (44 HC, 1PA, and 6 HC/PA). Two (2%) patients with CS had a normal POD1-CST but developed AIrequiring GR at 8 and 12 weeks post UA. Of the 74 patients with HC, 44 (59%) had an abnormalPOD1-CST and were discharged on GR, including 19/28 (68%) with CS and 25/46 (54%) withmild HC. Preoperative DST cortisol was higher in HC patients who required GR compared topatients with a normal POD1-CST (4.1 vs 3.6; p=0.007). Median cortisol levels for HC patientswith an abnormal POD1-CST vs those with a normal test were: basal: 3.8 vs 15.6 (p=0.027); 30-minute: 10.1 vs 20.1 (p=0.403); and 60-minute 11.4 vs 22.2 (p=0.260). Of the 22 PA patients, 19(86%) had a normal POD1-CST. Median cortisol levels for PA patients with an abnormal POD1-CST vs those with a normal test were: basal: 0.4 vs 12.1; 30-minute: 8.8 vs 24.6; and 60-minute:12.2 vs 28.9. Of the 3 (14%) PA patients with an abnormal POD1-CST, 1 was dischargedwith GR and began tapering after 2 weeks; the other 2 did not require GR and did not developAI. Of the 12 patients with combined PA/HC, 6 (50%) were discharged on GR based on POD1-CST. GR was required by 30 (59%) patients for &lt;3 months and 82% for &lt;12 months; 7/9 whorequired GR &gt;12 months had CS. Conclusions: Using a standard protocol for POD1-CST in patients who underwent unilateral adrenalectomyfor HC, PA, or combined PA/HC, this study demonstrated that routine GR is not required in 32%of patients with CS and 46% of patients with mild HC. POD1-CST safely identifies patients whowill require GR with no immediate concern for adrenal insufficiency. These data also suggestthat routine evaluation for AI in postoperative PA patients is not needed if cortisol excess hasbeen excluded preoperatively.

Confidence intervals for policy evaluation in adaptive experiments

Adaptive experimental designs can dramatically improve efficiency in randomized trials. But with adaptively collected data, common estimators based on sample means and inverse propensity-weighted means can be biased or heavy-tailed. This poses statistical challenges, in particular when the experimenter would like to test hypotheses about parameters that were not targeted by the data-collection mechanism. In this paper, we present a class of test statistics that can handle these challenges. Our approach is to adaptively reweight the terms of an augmented inverse propensity-weighting estimator to control the contribution of each term to the estimator’s variance. This scheme reduces overall variance and yields an asymptotically normal test statistic. We validate the accuracy of the resulting estimates and their CIs in numerical experiments and show that our methods compare favorably to existing alternatives in terms of mean squared error, coverage, and CI size.

Association between faecal occult bleeding and medicines prescribed for chronic disease: a data linkage study

AimsThe presence of detectable faecal haemoglobin (f-Hb) has been shown to be associated with all-cause mortality and with death from a number of chronic diseases not known to cause gastrointestinal blood loss. This effect is independent of taking medicines that increase the risk of bleeding. To further investigate the association of f-Hb with chronic disease, the relationship between f-Hb and prescription of medicines for a variety of conditions was studied.MethodsAll subjects (134 192) who participated in guaiac faecal occult blood test (gFOBT) screening in Tayside, Scotland, between March 2000 and March 2016, were studied in a cross-sectional manner by linking their gFOBT result (abnormal or normal) with prescribing data at the time of the test.ResultsThe screening participants with an abnormal gFOBT result were more likely to have been being prescribed medicines for heart disease, hypertension, diabetes and depression than those with a normal test result. This association persisted after adjustment for sex, age and deprivation (OR 1.35 (95%CI 1.23 to 1.48), 1.39 (1.27 to 1.52), 1.35 (1.15 to 1.58), 1.36 (1.16 to 1.59), all p<0.0001, for the four medicine categories, respectively).ConclusionsThe results of this study confer further substantial weight to the concept that detectable f-Hb is associated with a range of common chronic conditions that have a systemic inflammatory component; we speculate that f-Hb might have potential in identifying individuals who are high risk of developing chronic conditions or are at an early stage of disease.