The rate of acute kidney injury (AKI) associated with patients hospitalized with Covid-19, and associated outcomes are not well understood. This study describes the presentation, risk factors and ...outcomes of AKI in patients hospitalized with Covid-19. We reviewed the health records for all patients hospitalized with Covid-19 between March 1, and April 5, 2020, at 13 academic and community hospitals in metropolitan New York. Patients younger than 18 years of age, with end stage kidney disease or with a kidney transplant were excluded. AKI was defined according to KDIGO criteria. Of 5,449 patients admitted with Covid-19, AKI developed in 1,993 (36.6%). The peak stages of AKI were stage 1 in 46.5%, stage 2 in 22.4% and stage 3 in 31.1%. Of these, 14.3% required renal replacement therapy (RRT). AKI was primarily seen in Covid-19 patients with respiratory failure, with 89.7% of patients on mechanical ventilation developing AKI compared to 21.7% of non-ventilated patients. 276/285 (96.8%) of patients requiring RRT were on ventilators. Of patients who required ventilation and developed AKI, 52.2% had the onset of AKI within 24 hours of intubation. Risk factors for AKI included older age, diabetes mellitus, cardiovascular disease, black race, hypertension and need for ventilation and vasopressor medications. Among patients with AKI, 694 died (35%), 519 (26%) were discharged and 780 (39%) were still hospitalized. AKI occurs frequently among patients with Covid-19 disease. It occurs early and in temporal association with respiratory failure and is associated with a poor prognosis.
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Private versus public old-age security Barnett, Richard C.; Bhattacharya, Joydeep; Puhakka, Mikko
Journal of population economics,
07/2018, Volume:
31, Issue:
3
Journal Article
Peer reviewed
Open access
We directly compare two institutions, a family compact—a parent makes a transfer to her parent in anticipation of a possible future gift from her children—with a pay-as-you-go, public pension system, ...in a life cycle model with endogenous fertility wherein children are valued both as consumption and investment goods. Absent intragenerational heterogeneity, we show that a benevolent government has no welfare justification for introducing public pensions alongside thriving family compacts since the former is associated with inefficiently low fertility. This result hinges critically on a fiscal externality—the inability of middle age agents to internalize the impact of their fertility decisions on old-age transfers under a public pension system. With homogeneous agents, a strong-enough negative aggregate shock to middle-age incomes destroys all family compacts, and in such a setting, an optimal public pension system cannot enter. This suggests the raison d’être for social security must lie outside of its function as a pension system—specifically its redistributive function which emerges with heterogeneous agents. In a simple modification of our benchmark model—one that allows for idiosyncratic frictions to compact formation such as differences in infertility/mating status—a welfare-enhancing role for a public pension system emerges; such systems may flourish even when family compacts cannot.
Liver cirrhosis Barnett, Richard
The Lancet (British edition),
07/2018, Volume:
392, Issue:
10144
Journal Article
Peer reviewed
Two major themes in the history of medicine have shaped our understanding of cirrhosis (from a Greek conjunction meaning yellowish disease): a long story of cultural, political, and clinical ...attitudes towards alcohol consumption, and an almost equally fractious set of debates over the function of the liver. In a short paper published in 1911, Frank Burr Mallory, Professor of Pathology at Harvard Medical School, drew on new clinical and pathological work to redefine cirrhosis as a syndrome: “a chronic, progressive, destructive lesion of the liver combined with reparative activity and contraction on the part of the connective tissue”. Many governments have sought to reduce the demand for transplant through legislation and social programmes that seek to tackle alcohol consumption and addiction—strategies with their own seemingly intractable difficulties.
This paper studies the fight-or-flight ambivalence people show towards the success of the proverbial Joneses. If an agent cares about leisure and his consumption relative to a benchmark set by the ...Joneses, his preferences display the keeping-up-with-the-Joneses (KUJ) property if an increase in the benchmark urges him to substitute away from leisure into work, allowing him to finance more consumption; the opposite is labeled running-away-from-the-Joneses (RAJ). The long literature, thus far, finds a) if any agent’s behavior displays KUJ (or RAJ), everyone’s will, or b) if an agent displays KUJ (or RAJ) in one portion of the consumption space, so will he everywhere. In an otherwise-standard environment with endowment heterogeneity, we provide conditions under which different agents sharing the same underlying preferences may endogenously respond very differently to the Joneses: while some may choose to keep up, others, possibly their close neighbors, may choose to run away. These choices themselves shape the income distribution, which in turn, determine the identity and fate of the Joneses. The analysis is novel because (a) such fight-or-flight conflict does not arise in existing models of consumption externalities, and (b) it identifies an endogenous mechanism that may dampen or amplify market income inequality arising from innate heterogeneity.
To determine the influence of severity and direction (craniocaudal length vs cross-sectional area) of intramuscular tendon tears in the lower limb on return-to-play times, compared to muscle injuries ...without intramuscular tendon involvement.
Systematic review with meta-analysis.
AMED, CINAHL, SPORTDiscus, ScienceDirect, PubMed (MEDLINE) and Web-of-Science were searched from inception to 31st July 2023, retrieving 666 records, of which nine were deemed eligible. A random-effects meta-analysis was performed on time to return-to-play for British Athletics Muscle Injury Classification ‘b’ vs ‘c’.
On the Quality in Prognosis Studies tool, one study had low risk of bias and eight had high risk. Using a best-evidence synthesis, no strong evidence emerged for a difference in time to return-to-play between injuries with or without intramuscular tendon involvement. Moderate evidence was found for an association between increased return-to-play time and the presence of “waviness” on magnetic resonance imaging and loss of tendon tension, but no association with longitudinal extent of tendon involvement. Pooled analysis revealed a medium effect-size difference between British Athletics Muscle Injury Classification ‘b’ and ‘c’ injuries, favouring classification ‘b’ (Hedges g = 0.67; 95% confidence interval 0.20 to 1.15; P = 0.002).
It remains difficult to provide an accurate prognosis for muscle injuries involving the intramuscular tendon due to high risk of bias and moderate heterogeneity across studies. Moderate evidence favoured the prognosis for injuries at the musculotendinous junction (British Athletics Muscle Injury Classification ‘b’) over intratendinous injuries (British Athletics Muscle Injury Classification ‘c’).
Using an expanded genetic code, antibodies with site-specifically incorporated nonnative amino acids were produced in stable cell lines derived from a CHO cell line with titers over 1 g/L. Using ...anti-5T4 and anti-Her2 antibodies as model systems, site-specific antibody drug conjugates (NDCs) were produced, via oxime bond formation between ketones on the side chain of the incorporated nonnative amino acid and hydroxylamine functionalized monomethyl auristatin D with either protease-cleavable or noncleavable linkers. When noncleavable linkers were used, these conjugates were highly stable and displayed improved in vitro efficacy as well as in vivo efficacy and pharmacokinetic stability in rodent models relative to conventional antibody drug conjugates conjugated through either engineered surface-exposed or reduced interchain disulfide bond cysteine residues. The advantages of the oxime-bonded, site-specific NDCs were even more apparent when low–antigen-expressing (2+) target cell lines were used in the comparative studies. NDCs generated with protease-cleavable linkers demonstrated that the site of conjugation had a significant impact on the stability of these rationally designed prodrug linkers. In a single-dose rat toxicology study, a site-specific anti-Her2 NDC was well tolerated at dose levels up to 90 mg/kg. These experiments support the notion that chemically defined antibody conjugates can be synthesized in commercially relevant yields and can lead to antibody drug conjugates with improved properties relative to the heterogeneous conjugates formed by nonspecific chemical modification.
Osteoarthritis Barnett, Richard
The Lancet (British edition),
05/2018, Volume:
391, Issue:
10134
Journal Article
Peer reviewed
Stiffness and pain in the joints was for centuries seen as a mark of mortality, one of the natural shocks of old age: just look at Leonardo da Vinci or Thomas Rowlandson's caricatures of old people, ...with their crooked digits and knobbly joints. Since the 16th century, anatomists have been familiar with the basic structure of joints—bones capped with cartilage, connected by ligaments, and lubricated by synovial fluid—and the name they gave to the principal disorder of these joints is a classic example of plain English put into learned Greek: arthritis, literally joint inflammation. ...physicians increasingly acknowledged a distinction between rheumatoid arthritis as a form of chronic inflammation and osteoarthritis as the consequence of physical wear. A broad demographic shift forced industrial states and their health-care systems to confront the burden of chronic disease affecting older populations, while medicine itself took on a new role in monitoring and maintaining health from cradle to grave.
Abstract
Introduction
A pediatric sleep study scored by adult criteria may miss the diagnosis of obstructive sleep apnea (OSA) and delay proper care. In our patient, use of alternative definition of ...hypopneas by a lab inexperienced in the care of children resulted in an insignificant AHI despite many snore events. Diagnosis of OSA should be considered particularly in adolescents with symptoms of unexplained daytime sleepiness, and a “normal” PSG.
Report of Case
We present a case of a 12-year-old girl with history of who underwent tonsillectomy and adenoidectomy for snoring but developed velopharyngeal insufficiency after surgery due to previously unrecognized submucous cleft palate. She initially presented to ENT clinic for corrective pharyngeal flap surgery. After surgery was done patient manifested symptoms of snoring and hypersomnia. Polysomnography at an outside hospital revealed an AHI of only 0.2/hour and the patient was referred for evaluation of unexplained hypersomnia. On exam she had BMI of 19, neck circumference of 12 inches and abnormal pharynx with evidence of a pharyngeal flap repair. Review of outside polysomnography (PSG) showed that adult criteria were utilized and while the AHI was normal the snoring index was 500 per hour. Rescoring of PSG using 3% desaturation criteria for hypopnea resulted in AHI of 18/hr increased in REM to 34/hr. Positive airway pressure titration showed significant improvement in snoring and excessive daytime sleepiness.
Conclusion
All labs should use appropriate monitoring (including measurement of CO2), scoring and interpretation to detect OSA in the pediatric population.
Obstructive sleep apnea is common in patients with pharyngeal flap surgery compared to the general population. Great care should be taken to evaluate patients for sleep abnormalities. Detailed sleep history should be a routine part of the evaluation. PSG should be considered in patients with history suspicious for OSA and follow-up PSG should be done after intervention.
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