Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Chemotherapy in psychiatry : , Chemotherapy in psychiatry : , کتابخانه دیجیتال جندی شاپور اهواز

Chemotherapy in psychiatry

Importance In a recent meta-analysis of randomized clinical trials, femoropopliteal artery revascularization with paclitaxel drug-coated devices was associated with increased long-term all-cause mortality compared with non-drug-coated devices. However, to our knowledge, these findings have not been replicated in other data sources and may be subject to confounding from missing data associated with patient withdrawal and loss to follow-up. Objective To evaluate differences in all-cause mortality between patients who were treated with drug-coated devices vs non-drug-coated devices for femoropopliteal artery revascularization. Design, setting, and participants This nationwide, multicenter retrospective cohort study included 16 560 Centers for Medicare and Medicaid Services beneficiaries who were admitted for femoropopliteal artery revascularization from January 1, 2016, to December 31, 2016. All-cause mortality was analyzed through September 30, 2017. Exposures Drug-coated devices (drug-eluting stent [DES] or drug-coated balloon [DCB]) compared with non-drug-coated devices (bare metal stent or uncoated percutaneous transluminal angioplasty balloon). Main outcomes and measures The primary outcome was all-cause mortality analyzed through the end of follow-up. Results Among 16 560 patients treated at 1883 hospitals, the mean (SD) age was 72.9 (11) years, 7734 (46.7%) were men, 12 232 (73.9%) were white, 8222 (49.7%) currently or had previously used tobacco, 9817 (59.3%) had diabetes, and 8450 (51.0%) had critical limb ischemia (CLI). Drug-coated devices were used in 5989 participants (36.2%). The median follow-up was 389 days (interquartile range, 277-508 days). Among all patients, treatment with drug-coated devices was associated with a lower cumulative incidence of all-cause mortality compared with treatment with non-drug-coated devices through 600 days postprocedure (32.5% vs 34.3%, respectively; log-rank P = .007). Similar survival trends were observed when treatment was stratified by using a DCB alone or DES with or without DCB. After multivariable adjustment, drug-coated devices were not associated with a difference in all-cause mortality compared with non-drug-coated devices (hazard ratio [HR], 0.97; 95% CI, 0.91-1.04; P = .43). These findings were consistent among those with CLI (HR, 0.93; 95% CI, 0.85-1.01; P = .09) or without CLI (HR, 0.94; 95% CI, 0.85-1.03; P = .20), and for those treated with DCB alone (HR, 0.94; 95% CI, 0.86-1.03; P = .17) or DES with or without DCB (HR, 0.97; 95% CI, 0.89-1.06; P = .48). Conclusions and relevance In this large nationwide analysis of Centers for Medicare and Medicaid Services beneficiaries, there was no evidence of increased all-cause mortality following femoropopliteal artery revascularization with drug-coated devices compared with non-drug-coated devices.

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Association of Survival With Femoropopliteal Artery Revascularization With Drug-Coated Devices.

Radiation oncology has always been deeply rooted in modeling, from the early days of isoeffect curves to the contemporary Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) initiative. In recent years, medical modeling for both prognostic and therapeutic purposes has exploded thanks to increasing availability of electronic data and genomics. One promising direction that medical modeling is moving toward is adopting the same machine learning methods used by companies such as Google and Facebook to combat disease. Broadly defined, machine learning is a branch of computer science that deals with making predictions from complex data through statistical models. These methods serve to uncover patterns in data and are actively used in areas such as speech recognition, handwriting recognition, face recognition, "spam" filtering (junk email), and targeted advertising. Although multiple radiation oncology research groups have shown the value of applied machine learning (ML), clinical adoption has been slow due to the high barrier to understanding these complex models by clinicians. Here, we present a review of the use of ML to predict radiation therapy outcomes from the clinician's point of view with the hope that it lowers the "barrier to entry" for those without formal training in ML. We begin by describing 7 principles that one should consider when evaluating (or creating) an ML model in radiation oncology. We next introduce 3 popular ML methods--logistic regression (LR), support vector machine (SVM), and artificial neural network (ANN)--and critique 3 seminal papers in the context of these principles. Although current studies are in exploratory stages, the overall methodology has progressively matured, and the field is ready for larger-scale further investigation.

Machine Learning Approaches for Predicting Radiation Therapy Outcomes: A Clinician's Perspective

Plague, a zoonosis caused by Yersinia pestis, is found in Asia, the Americas but mainly in Africa, with the island of Madagascar reporting almost one third of human cases worldwide. In the highlands of Madagascar, plague is transmitted predominantly by two flea species which coexist on the island, but differ in their distribution. The endemic flea, Synopsyllus fonquerniei, dominates flea communities on rats caught outdoors, while the cosmopolitan flea, Xenopsylla cheopis, is found mostly on rats caught in houses. Additionally S. fonquerniei seems restricted to areas above 800 m. Climatic constraints on the development of the two main vectors of plague could explain the differences in their distribution and the seasonal changes in their abundance. Here we present the first study on effects of temperature and relative humidity on the immature stages of both vector species. We examined the two species’ temperature and humidity requirements under experimental conditions at five different temperatures and two relative humidities. By employing multivariate and survival analysis we established the impact of temperature and relative humidity on development times and survival for both species. Using degree-day analysis we then predicted the average developmental threshold for larvae to reach pupation and for pupae to complete development under each treatment. This analysis was undertaken separately for the two relative humidities and for the two species. Development times and time to death differed significantly, with the endemic S. fonquerniei taking on average 1.79 times longer to complete development and having a shorter time to death than X. cheopis under adverse conditions with high temperature and low humidity. Temperature had a significant effect on the development times of flea larvae and pupae. While humidity did not affect the development times of either species, it did influence the time of death of S. fonquerniei. Using degree-day analysis we estimated an average developmental threshold of 9 °C for S. fonquerniei, and 12.5 °C for X. cheopis. While many vector-borne diseases are limited to warm, low-lying regions, plague in Madagascar is unusual in being most prevalent in the cool, highland regions of the country. Our results point towards the possibility that this is because the endemic flea vector, S. fonquerniei, is better adapted to cool temperatures than the exotic flea vector, X. cheopis. Future warming caused by climate change might reduce the area suitable for S. fonquerniei and may thus reduce the incidence of plague in Madagascar.

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Effect of temperature and relative humidity on the development times and survival of Synopsyllus fonquerniei and Xenopsylla cheopis, the flea vectors of plague in Madagascar.

Many clinical trials involve following patients for a long time. The primary event of interest in those studies is death, relapse, adverse drug reaction or development of a new disease. The follow-up time for the study may range from few weeks to many years. A different set of statistical procedures are employed to analyze the data, which involves time to event an analysis. It is a very useful tool in clinical research and provides invaluable information about an intervention. This article introduces the researcher to the different tools of survival analysis.

Survival analysis in clinical trials: Basics and must know areas

Majority of Indian still think that Medicine is the noblest profession in our country. The respect a ‘doctor’ gets in the society puts pressure on parents to pressurize their children to pursue Medicine once their school is over. It is a dream of short of many parents that their child would study medicine after her/ his class twelve and become a ‘doctor’ later in life. Many a times the child has to sacrifice her/ his career choice to fulfill the wishes of her/his parents. This may result in adverse outcome later in the life of the ward. Though some report has shown that medicine is not among the top career choice of today’s youth, many traditional families still believe that medicine is a good career option for their children [i] . The number of students appearing for medical entrance examination is fluctuating [ii] . The present study was conducted in a teaching hospital located in a sub-divisional town in a district bordering Bangladesh in West Bengal. The primary objective of the study was to know the factors behind opting medicine as their career choice. A questionnaire was prepared which had questions related to their age, marks in school final examination, occupation of father and motivator behind pursuing medicine. Students of first and third semester MBBS curriculum of the medical college were told in detail about the study before their consent was taken to be part of the study. A total of 144 students participated in the study. 98 (68.1%) of them were males. The mean (SD) age of the students were 20.6 (1.6) years. The mean (SD) percentage of marks scored in class 12 examination was 82.4 (7.8).  The medium of instruction of 78 (54.2%) students were vernacular (Bengali) in class twelve. 41.7% students studied in English medium schools. Majority (63.9%) of the students gave the West Bengal Board of Higher Secondary Education Examination. Another 13.9% gave the Indian Certificate of Secondary Education (CBSE). 32 (22.2%) students gave Central Board of Secondary Examination. Majority of CBSE students passed class 12 from outside the state. More than three-fourth (69.4%) students lived in urban area. Out of 44 students who belonged to rural areas, only three (6.8%) were females. This was statistically significant (chi square value: 18.400, p value .000).  81 (56.3%) of the study participants were enrolled in coaching class before appearing for the competitive entrance examination for medical admission. 37% of females students and 65.3% of male students took the help of coaching centers for passing the medical entrance examination. It was significantly more in male students (chi square value: 10.224, p value .001). When asked about the motivating force behind opting medicine as a career choice 85 (59%) students said that their parent forced them to take it and 53 (36.8%) took medicine because of their own preference. The study shows that for majority of students who took medicine as their career choice the decision was influenced by their parents and more male students took help of coaching classes to pass the medical entrance examination compared to female students. Less number of girls from rural background gets to study medicine. Parental influence is more in this study when compared with a study done in Delhi [iii] , 59% and 41% respectively. In a study in Tanzania advice from important persons were perceived as least important factor in choosing a career [iv] .

Why choose medicine as a career: a cross-sectional survey among undergraduate medical students

Common geriatrics cases seen by a general practitioner in an urban area of jharkhand state, India.

Background: Hypertension is a very important risk factor for cardiovascular and cerebrovascular diseases. The number of patients with hypertension is estimated to rise from 118 million in 2000 to 214 million in 2025. The prevalence study of hypertension and prehypertension among the doctors in India is lacking.

Objective: To find out the prevalence of prehypertension and hypertension among doctors of different disciplines in a tertiary-care teaching hospital of West Bengal, India, and show any possible correlation between the mean blood pressures (BPs).

Materials and Methods: After getting consent from the doctors, the following data were recorded: height, body weight, systolic and diastolic BPs, smoking history, drug history, and family history. Three recordings of BP were measured, and the average was taken. Definitions of prehypertension and hypertension were standardized from Joint National Committee 8 criteria.

Result: One-fourth of the participant doctors were found to be normotensive, 14.82% of the doctors showed hypertension, and 60.49% of doctors showed prehypertension. This study also showed a significant positive correlation between body mass index and mean BP of the subject. This study also showed the impact of smoking and family history on the mean BP of the subject.

Conclusion: This study indicates that the prevalence of prehypertension and hypertension is not at all less than the rest of the Indian population. Rather, the risk factors such as raised body mass index and smoking are very common among the doctors.

Prevalence of hypertension and prehypertension among doctors of different specialties in a tertiary-care teaching hospital in Eastern India and its correlation with body mass index -

| | | | Pharmacology cannot be learnt exclusively in the confine of a classroom. Students need to work extensively on analysing the basic principles of pharmacology in terms of their application in management of real life patients during their second year of medical curriculum. A novel teaching learning model in undergraduate pharmacology was tried and the impact on second year medical students in a medical college of West Bengal was analysed. Students were taught basic principles of pharmacology for two months in the scheduled lecture classes. Then these topics were assigned for project work in groups. They tried to correlate these concepts with the management of individual patients encountered during clinical postings with the help of a teacher acting as a facilitator. After two months of self-reading, hospital learning and interaction in groups, they expressed their knowledge on the assigned topics by means of charts or models in their own innovative manner. The mean score with regard to interest in the subject increased from 4.07 to 7.05 after the project. There were similar increases in the scores related to various other domains of learning. The project made them discuss the subject with friends and search related information 50% more than previously. This novel project based learning helped the students in understanding the concepts of pharmacology better. They were able to remember and liked subject more after the project. Fruitful time spent before the computer and with friends discussing the subject increased following the project. undergraduate pharmacology, project based learning, didactic lecture

Keshab Mukhopadhyay

Papers

Survival analysis in clinical trials: Basics and must know areas

Why choose medicine as a career: a cross-sectional survey among undergraduate medical students

Common geriatrics cases seen by a general practitioner in an urban area of jharkhand state, India.

Prevalence of hypertension and prehypertension among doctors of different specialties in a tertiary-care teaching hospital in Eastern India and its correlation with body mass index -

Students' perception and practice in learning basic pharmacology through a 'Project Based Learning' programme