Hypothyroidism does not lead to worse prognosis in COVID-19: findings from the Brazilian COVID-19 registry

Background: It is not clear whether previous thyroid diseases influence the course and outcomes of COVID-19. The study aims to compare clinical characteristics and outcomes of COVID-19 patients with and without hypothyroidism. Methods: The study is a part of a multicentric cohort of patients with confirmed COVID-19 diagnosis, including data collected from 37 hospitals. Matching for age, sex, number of comorbidities and hospital was performed to select the patients without hypothyroidism for the paired analysis. Results: From 7,762 COVID-19 patients, 526 had previously diagnosed hypothyroidism (50%) and 526 were selected as matched controls. The median age was 70 (interquartile range 59.0-80.0) years-old and 68.3% were females. The prevalence of underlying comorbidities were similar between groups, except for coronary and chronic kidney diseases, that had a higher prevalence in the hypothyroidism group (9.7% vs. 5.7%, p=0.015 and 9.9% vs. 4.8%, p=0.001, respectively). At hospital presentation, patients with hypothyroidism had a lower frequency of respiratory rate > 24 breaths per minute (36.1% vs 42.0%; p=0.050) and need of mechanical ventilation (4.0% vs 7.4%; p=0.016). D-dimer levels were slightly lower in hypothyroid patients (2.3 times higher than the reference value vs 2.9 times higher; p=0.037). In-hospital management was similar between groups, but hospital length-of-stay (8 vs 9 days; p=0.029) and mechanical ventilation requirement (25.4% vs. 33.1%; p=0.006) were lower for patients with hypothyroidism. There was a trend of lower in-hospital mortality in patients with hypothyroidism (22.1% vs. 27.0%; p=0.062). Conclusion: In this large Brazilian COVID-19 Registry, patients with hypothyroidism had a lower requirement of mechanical ventilation, and showed a trend of lower in-hospital mortality. Therefore, hypothyroidism does not seem to be associated with a worse prognosis, and should not be considered among the comorbidities that indicate a risk factor for COVID-19 severity.

Is Workload Associated with Ulnar Collateral Ligament Tears in Professional Baseball Players? An Analysis of Days of Rest, Innings Pitched and Batters Faced (126)

Objectives: To determine if workload; as measured by number of days rest between outings, innings pitched, batters faced, and being a starting pitcher; associates with risk for sustaining a subsequent UCL tear in professional baseball players. Methods: All professional baseball pitchers who sustained a UCL tear between 2011-2017 were identified using the major league baseball (MLB) Health and Injury Tracking System (HITS). A separate player usage was used to determine workload . We then compared these variables between player-games 2, 6, 12, and >12 weeks prior to a documented UCL tear and player games from a non-UCL tear control group. In a paired analysis, we compared the acute workload (2, 6, 12 weeks) prior to injury and the injured player’s workload >12 weeks prior to injury. Results: There were 2,204 elbow injuries within MLB, 369 of which were unique UCL tears in pitchers. In all time periods, player-games with more days rest, more innings pitched, and more batters faced associated with a subsequent UCL tear. Players who pitched 4 of more innings per outing had a 1.78-fold increase in percent of players with a subsequent UCL tear as compared to players with one inning pitched. Being a starting pitcher carried a relative risk of 1.51 (p<0.001) of subsequent UCL injury. In a paired analysis there were significantly more innings pitched and batters faced in the player-games 2 weeks prior to UCL injury than in the player-games >12 weeks prior to UCL injury (p=0.028 and p=0.017). Conclusions: Being a starting pitcher, pitching more innings per game, and facing more batters per game increased the risk of a UCL tear. An increase in workload in the 2 weeks prior to injury over that player’s baseline also significantly increased the risk for injury.

Low-Cost Algorithms for Metabolic Pathway Pairwise Comparison

Metabolic pathways provide key information to achieve a better understanding of life and all its processes; this is useful information for the improvement of medicine, agronomy, pharmacy, and other similar areas. The main analysis tool used to study these pathways is based on the idea of pathway comparison, using graph data structures. Metabolic pathway comparison has been defined as a computationally complex task \cite{ay2011submap,abaka2013campways}. In previous work from 2017, two different approaches that simplify the problem of comparing pathways represented as graphs were introduced. The first algorithm consists of the transformation of a two-dimensional graph structure, representing a metabolic pathway, to a one-dimensional structure and thus aligning the corresponding data using a reduced 1 dimension string. The second algorithm consists of performing a paired analysis between reactions in pathways and thus eliminating all similarities, finally, showing these differences to the user. The suggestion is to use the information provided by these algorithms as a previous analysis to a deeper, more expensive, comparison tool use. Here we provide an extension of this work with more data and deeper analysis. These methods have shown to be an effective way to treat the problem of metabolic pathway comparison as listed in the discussion and results section. Our results show evidence of a quick, simple and effective way to resolve the described problem.

Swab pooling: A new method for large-scale RT-qPCR screening of SARS-CoV-2 avoiding sample dilution

To minimize sample dilution effect on SARS-CoV-2 pool testing, we assessed analytical and diagnostic performance of a new methodology, namely swab pooling. In this method, swabs are pooled at the time of collection, as opposed to pooling of equal volumes from individually collected samples. Paired analysis of pooled and individual samples from 613 patients revealed 94 positive individuals. Having individual testing as reference, no false-positives or false-negatives were observed for swab pooling. In additional 18,922 patients screened with swab pooling (1,344 pools), mean Cq differences between individual and pool samples ranged from 0.1 (Cr.I. -0.98 to 1.17) to 2.09 (Cr.I. 1.24 to 2.94). Overall, 19,535 asymptomatic patients were screened using 4,400 RT-qPCR assays. This corresponds to an increase of 4.4 times in laboratory capacity and a reduction of 77% in required tests. Therefore, swab pooling represents a major alternative for reliable and large-scale screening of SARS-CoV-2 in low prevalence populations.

High blood pressure and overweight in children with Legg-Calvé-Perthes disease: a nationwide population-based cohort study

Purpose Legg-Calvé-Perthes disease (LCPD) and its association with cardiovascular diseases, obesity and hypertension has been consistently observed but remains cloudy. This study aimed to investigate the presence of hypertension and overweight/obesity at diagnosis of LCPD and at a 2-year follow-up and its association with age, sex and lateral pillar classification. Method We compared blood pressure (BP) (n = 93) and body mass index (BMI) (n = 125) in patients registered in the Perthes’ register - a part of the Swedish pediatric orthopedic quality register (SPOQ) - with normative data for children with the same age and sex. Results In children with LCPD 19% had high BP. At the 2-year follow-up, 13% had high BP. For children with LCPD, 30% were either overweight or obese. At the 2-year follow-up, 32% were either overweight or obese. Paired analysis showed stable BMI z-score between these 2 measurements. The sample size of this study was too small to analyze possible associations of high BP or BMI with age, sex and lateral pillar classification. Conclusions The prevalence of hypertension was higher in children with LCPD compared to general pediatric normative data. The same pattern was seen for overweight/obesity. Further studies are needed to investigate whether BP and obesity are catalyzing factors in the etiology of LCPD.

Splenectomy with Portoazygous Disconnection for Correction of Systemic Hemodynamic Disorders in Hepatic Cirrhosis Patients with Portal Hypertension: A Prospective Single-Center Cohort Study

Objective. To investigate the effect of splenectomy for correction of systemic hemodynamic disorders in hepatic cirrhosis patients with portal hypertension. Methods. Hepatic cirrhosis patients with portal hypertension were enrolled from April 2015 to July 2018. Systemic hemodynamic parameters (heart rate, mean arterial pressure (MAP), cardiac output, and total peripheral vascular resistance (TPR)) were prospectively measured at baseline and 1 week, 1, 3, and 6 months, and 1, 2, and 3 years postoperatively. Paired analysis was conducted. Results. Sixty-nine patients were eligible, and 55 (79.7%) cases had a history of upper gastrointestinal bleeding. Child–Pugh classification was grade A in 41 (59.4%) cases, grade B in 26 (37.7%) cases, and grade C in 2 (2.9%) cases. The heart rate was significantly higher at 1 week postoperatively versus the baseline ( P < 0.001 ). Meanwhile, the heart rate was significantly lower from 3 months to 2 years postoperatively versus the baseline ( P < 0.05 ). The MAP was significantly higher at 6 months to 2 years postoperatively versus the baseline ( P < 0.05 ). At 1 month postoperatively and 6 months to 2 years, the cardiac output was significantly lower versus the baseline ( P < 0.05 ). At 1 month postoperatively and 6 months to 2 years, the TPR was significantly higher versus the baseline ( P < 0.05 ). Conclusion. Splenectomy corrects systemic hemodynamic disorder in hepatic cirrhosis patients with portal hypertension, and the effect is rapid and durable.

Increasing importance of climate change and other threats to at-risk species in Canada

In a previous analysis, six major threats to at-risk species in Canada were quantified: habitat loss, introduced species, over-exploitation, pollution, native species interactions, and natural causes (O. Venter et al. 2006. Bioscience, 56(11): 903–910). Because of rapid environmental change in Canada and an enhanced understanding of the drivers of species endangerment, we updated the 2005 analysis and tested for changes in threats up until the end of 2018. We also expanded the scope to acknowledge climate change as a seventh major threat to species, given its increasing importance for reshaping biological communities. Using information on the COSEWIC (Committee on the Status of Endangered Wildlife in Canada) website, we scored the threats for each of 814 species. Habitat loss remained the most important anthropogenic threat to Canada’s at-risk species, affecting 82% of species, followed by over-exploitation (47%), introduced species (46%), and pollution (35%). Climate change was the least important threat, affecting only 13% of species. However, report writers used less certain language when talking about climate change compared with other threats, so when we included cases where climate change was listed as a probable or future cause, climate change was the fourth most important anthropogenic threat, affecting some 38% of species. The prevalence of threat categories was broadly similar to those for the United States and IUCN listed species. The taxa most affected by climate change included lichens (77%), birds (63%), marine mammals (60%), and Arctic species of all taxa (79%), whereas vascular plants (23%), marine fishes (24%), arthropods (27%), and non-Arctic species (35%) were least affected. A paired analysis of the 188 species with two or more reports indicated that any mention of climate change as a threat increased from 12% to 50% in 10 years. Other anthropogenic threats that have increased significantly over time in the paired analysis included introduced species, over-exploitation, and pollution. Our analysis suggests that threats are changing rapidly over time, emphasizing the need to monitor future trends of all threats, including climate change.