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BackgroundCancer patients are at increased risk of severe COVID-19. As COVID-19 presentation and outcomes are heterogeneous in cancer patients, decision-making tools for hospital admission, severity prediction and increased monitoring for early intervention are critical.ObjectiveTo identify features of COVID-19 in cancer patients predicting severe disease and build a decision-support online tool; COVID-19 Risk in Oncology Evaluation Tool (CORONET)MethodData was obtained for consecutive patients with active cancer with laboratory confirmed COVID-19 presenting in 12 hospitals throughout the United Kingdom (UK). Univariable logistic regression was performed on pre-specified features to assess their association with admission (≥24 hours inpatient), oxygen requirement and death. Multivariable logistic regression and random forest models (RFM) were compared with patients randomly split into training and validation sets. Cost function determined cut-offs were defined for admission/death using RFM. Performance was assessed by sensitivity, specificity and Brier scores (BS). The CORONET model was then assessed in the entire cohort to build the online CORONET tool.ResultsTraining and validation sets comprised 234 and 66 patients respectively with median age 69 (range 19-93), 54% males, 46% females, 71% vs 29% had solid and haematological cancers. The RFM, selected for further development, demonstrated superior performance over logistic regression with AUROC predicting admission (0.85 vs. 0.78) and death (0.76 vs. 0.72). C-reactive protein was the most important feature predicting COVID-19 severity. CORONET cut-offs for admission and mortality of 1.05 and 1.8 were established. In the training set, admission prediction sensitivity and specificity were 94.5% and 44.3% with BS 0.118; mortality sensitivity and specificity were 78.5% and 57.2% with BS 0.364. In the validation set, admission sensitivity and specificity were 90.7% and 42.9% with BS 0.148; mortality sensitivity and specificity were 92.3% and 45.8% with BS 0.442. In the entire cohort, the CORONET decision support tool recommended admission of 99% of patients requiring oxygen and of 99% of patients who died.Conclusions and RelevanceCORONET, a decision support tool validated in hospitals throughout the UK showed promise in aiding decisions regarding admission and predicting COVID-19 severity in patients with cancer presenting to hospital. Future work will validate and refine the tool in further datasets.

Objective: To determine the knowledge regarding needle stick injury (NSI) among nursing staff and technicians at Isra university Hospital. Study setting: Isra university hospital, Hyderabad Sindh Pakistan Study design: Cross-sectional survey Study duration: 10 months from February 2015 to December 2015 Materials and Method: All the health care providers including nursing staff, dispensers and laboratory technicians of Isra University Hospital, Hyderabad either of gender were included. A structured questionnaire in English language was designed to assess the knowledge regarding needle stick injury. All the data was entered in the proforma. Results: Total 60 health care providers were studied and most common age groups were 31-40 years and 41-50 years. According to health care providers, nurses were most common 46.70%, followed by dispensers 25.0%, laboratory technicians were 18.30% and doctors were only 10.0%. 37.0% had history of needle-stick injuries. Most of the cases 90.0% were aware regarding needle-stick injuries, assisted in disposal of needles was among 67.0%, 58.0% knew about first aid after NSI, 48.0% knew about universal precautions, 63.0% Get investigated after NSI, 48.0% Use gloves and 78.0% had sufficient number of safety tools. Conclusion: It was concluded that the almost all individuals knew regarding needle-stick injuries, but ignorance was very common and use of preventive protocols were inadequate. Key words: Needle-stick injuries, knowledge, healthcare providers

Using the notion of professional uncertainty a population-based proxy need measure for hospital services was developed. Its relationship with socioeconomic variables and Standardized Mortality Ratios (SMR) was investigated in an attempt to develop an adjustment factor for socioeconomic risk factors beyond age-sex adjustment to be used for a population-based healthcare funding formula for Alberta. The data used are 1990, 1991, 1992 vital statistics and hospital separation abstracts, 1991 census data and Refined Diagnosis Related Group (RDRG) case weights. Geographic units studied were the 26 federal electoral districts in Alberta using postal codes as a linkage geo-code between census and hospital utilization and death data. SMRs, age-sex standardized per capita hospital utilization and proxy need rates were derived and correlated with socioeconomic variables derived from the census files. It appears that the poor, the less educated and aboriginals need more hospital services than the affluent, employed and educated, confirming previous findings. The unemployed tend to need more but use fewer services while immigrants and non-white ethnics tend to need and use fewer services. The unemployed, less educated and non-white ethnics are associated with positive correlation with premature mortality (SMR based on deaths under age 75 years), while the employed, highly educated tend to live longer. In general SMRs have positive but very low correlations with utilization and need rates suggesting that SMRs should not be used for resource allocation. Stepwise multiple regression analyses showed that the percentages of unemployed, immigrants, non-whites, aboriginals and those with education less than grade 9 explain about 90% of the variation in age-sex standardized hospital utilization rates. Percentages of unemployed, non-white ethnics, residents with education less than grade 9 and aboriginals explained 71% of variations in age-sex standardized per capita proxy hospital service need measures. Based on the results of regression analyses, a SEAM (Socio-Economic Adjustment Multiplier) scale was developed for utilization (SEAM-U) and proxy needs (SEAM-N). In essence a SEAM is a set of relative value (RV) multipliers applicable to a provincial common per age-sex adjusted capita allocation value to account for the impact of socioeconomic risk factors on hospital service needs or utilization. Finally, the resulting regression equations derived from the 26 Federal electoral district data were applied to Alberta's health regions, regional SEAMs were derived, and the impact of such adjustment was assessed.

Raised levels of serum muscle enzyme activity are frequently seen following unaccustomed or prolonged strenuous exercise. Following particularly severe exercise, muscle enzyme levels can be extremely high and are occasionally associated with rhabdomyolysis. A case of rhabdomyolysis following a moderate degree of accustomed exercise in a fit young soldier is reported and discussed.

Obstruction of the urinary tract is a common and potentially reversible cause of acute and chronic renal failure. Although the clinical features of obstructive nephropathy have been generally recognized for many years, recently our understanding of the pathophysiology of the disturbed renal function has been enhanced by the detailed study of experimental models of this disorder. The effects of urinary tract obstruction on renal function must be considered both during and after relief of obstruction and are greatly influenced by whether the obstruction is unilateral or bilateral, acute or chronic, partial or complete. Striking changes in renal function occur during the first 24 hours of complete unilateral (UUO) or bilateral ureteral obstruction (BUO) in experimental animals. After relief of BUO, there is marked increase in sodium and water excretion despite the severe reduction in glomerular filtration rate (GFR), a natriuretic state referred to as postobstructive diuresis (POD). After relief of UUO, in contrast, there is no absolute increase in sodium and water excretion, although fractional excretion is greater from the post-obstructive kidney. Acute partial ureteral obstruction causes a decrease, not an increase, in sodium and water excretion, but the characteristic functional change in chronic hydronephrosis is an inability to conserve sodium and water. The purpose of this review is to examine the experimental data that clarifies selected aspects of the pathophysiology of obstructive nephropathy.

The effect of unilateral papillectomy on renal function in the rat was compared with the effect of partial nephrectomy which produced a similar decrease in glomerular filtration rate (G.F.R.) in the presence of an intact papilla. Under hydropenic conditions the kidney with papillectomy had a higher urine flow rate, sodium excretion rate, fractional sodium excretion, and osmolar clearance, while urine osmolality was lower. After an acute saline load the differences in sodium and water excretion disappeared, and fractional excretion of sodium and water were significantly higher in both types of kidney damage than in the contralateral control kidney. Free water reabsorption was lower in the papillectomized kidney after saline loading. Thus removal of the papilla resulted in abnormalities in the renal handling of salt and water which varied with the state of hydration of the animal and which were distinct from the effects of a reduction in G.F.R. by partial nephrectomy. It was concluded that the site of nephron loss, whether mainly in the renal medulla or in the cortex, may be another factor, in addition to G.F.R. and tubular reabsorption, which influences sodium and water excretion by the moderately damaged kidney.