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BackgroundThroughout 2020, the coronavirus disease 2019 (COVID-19) has become a threat to public health on national and global level. There has been an immediate need for research to understand the clinical signs and symptoms of COVID-19 that can help predict deterioration including mechanical ventilation, organ support, and death. Studies thus far have addressed the epidemiology of the disease, common presentations, and susceptibility to acquisition and transmission of the virus; however, an accurate prognostic model for severe manifestations of COVID-19 is still needed because of the limited healthcare resources available.ObjectiveThis systematic review aims to evaluate published reports of prediction models for severe illnesses caused COVID-19.MethodsSearches were developed by the primary author and a medical librarian using an iterative process of gathering and evaluating terms. Comprehensive strategies, including both index and keyword methods, were devised for PubMed and EMBASE. The data of confirmed COVID-19 patients from randomized control studies, cohort studies, and case-control studies published between January 2020 and July 2020 were retrieved. Studies were independently assessed for risk of bias and applicability using the Prediction Model Risk Of Bias Assessment Tool (PROBAST). We collected study type, setting, sample size, type of validation, and outcome including intubation, ventilation, any other type of organ support, or death. The combination of the prediction model, scoring system, performance of predictive models, and geographic locations were summarized.ResultsA primary review found 292 articles relevant based on title and abstract. After further review, 246 were excluded based on the defined inclusion and exclusion criteria. Forty-six articles were included in the qualitative analysis. Inter observer agreement on inclusion was 0.86 (95% confidence interval: 0.79 - 0.93). When the PROBAST tool was applied, 44 of the 46 articles were identified to have high or unclear risk of bias, or high or unclear concern for applicability. Two studied reported prediction models, 4C Mortality Score from hospital data and QCOVID from general public data from UK, and were rated as low risk of bias and low concerns for applicability.ConclusionSeveral prognostic models are reported in the literature, but many of them had concerning risks of biases and applicability. For most of the studies, caution is needed before use, as many of them will require external validation before dissemination. However, two articles were found to have low risk of bias and low applicability can be useful tools.

Summary Background C-reactive protein (CRP), an inflammation biomarker, indicates cardiovascular risk and is elevated in psoriasis. The effect of etanercept on CRP in psoriasis has not been previously examined. Objectives The primary objective was to examine the effect of etanercept on CRP levels from baseline to week 12 compared with placebo. Secondary objectives included assessment of baseline CRP and relationships between CRP and body mass index (BMI), statin drug use, and Psoriasis Area and Severity Index (PASI) scores. Methods A retrospective analysis was conducted of CRP levels from patients with psoriasis who participated in a randomized, double-blind, placebo-controlled, U.S. registrational study. Data were analysed separately if patients self-reported psoriatic arthritis. Results Baseline CRP levels were elevated in patients with psoriasis with and without psoriatic arthritis. CRP was significantly reduced in both groups after 12 weeks of etanercept treatment. Patients with psoriasis with psoriatic arthritis and patients with higher BMIs had higher median baseline CRP values and greater reduction of CRP values compared with those without psoriatic arthritis and those with lower BMIs. Etanercept lowered CRP levels in statin users and nonusers. Regression analyses revealed an association between baseline PASI score and baseline CRP independent of BMI in patients with psoriasis. Conclusions Patients with moderate to severe plaque psoriasis, with or without psoriatic arthritis, have increased systemic inflammation demonstrated by elevated CRP levels. In psoriasis without psoriatic arthritis, skin disease activity is associated significantly with CRP elevation, independent of BMI, age and sex. Etanercept reduced CRP levels in all but the normal weight psoriasis group without psoriatic arthritis.

SummaryClinical and biochemical evidence of a catecholamine-secreting tumour was documented in a 19-year-old female presenting with malignant hypertension. The tumour was successfully localized to the pelvis by means of plasma noradrenaline assay from multiple sites, after previous attempts at localization had failed. Subsequently, computed tomographic (CT) scan allowed correct pre-operative localization to the urinary bladder.

Summary A prospective screen for hypercalcaemia in 58,053 hospital in-patients was conducted over 12 months. The incidence of hypercalcaemia was 0.6%, being transient in 19.2% of patients and sustained in the remainder. The most common causes in the sustained group were malignancy (45%) and primary hyperparathyroidism (16.5%). The incidence of primary hyperparathyroidism was 78/100,000 hospital in-patients, and its discovery was directly attributable to the survey in over half the cases.

There is evidence suggesting that thyrotoxicosis increases β-adrenoreceptor density on some target tissues. We have studied the in vivo effect of d,l-propranolol (a nonselective β-adrenoreceptor blocking agent) on T3-induced enhancement of in situ proteolysis in fast twitch muscle fibers of the rat. Chronic treatment with T3 as opposed to saline resulted in a 76% enhancement of the rate of in situ muscle proteolysis [0.79 ± 0.04 (n = 8) compared with 0.45 ± 0.01 (n = 8) nmol tyrosine/mg muscle·2 h]. Treatment of rats with both T3 and 2 mg propranolol resulted in a 62% reduction in the T3-induced increment in situ muscle proteolysis [0.58 ± 0.02 (n = 8) vs. 0.79 ± 0.04]. This significant inhibition by propranolol of T3-induced enhanced proteolytic rates in vitro suggests that this may comprise one component of the observed beneficial clinical effects of β-blockade in thyrotoxic myopathy. (Endocrinology 117: 869–871, 1985)

Neurotensin-like immunoreactivity (NTLI) was measured in gastric antral, pancreatic and jejuno-ileal extracts of lean and obese Zucker rats. No significant difference was found in pancreatic or antral NTLI levels, but significantly diminished levels of NTLI were found in jejuno-ileal extracts of the obese rats.

Neuropathic (Charcot) ankle joints developed in a 50-year-old patient with end-stage renal disease from primary, nonfamilial amyloidosis. Sensory neuropathy in the legs had been noted three years before the onset of uremia and had porgressed. Sural nerve, but not synovial biopsy specimen, showed amyloid in and around arteriolar walls by light and electron microscopy. Since Charcot joints are only rarely associated with amyloid neuropathy, it is possible that uremic neuritis, or prolonged survival by dialysis, contributed to progression of the neuropathy, allowing subsequent joint degeneration.

• The Treponema pallidum immobilization test, a specific means of diagnosing the biologic false-positive reactor, will separate syphilitic from nonsyphilitic patients, within minor limitations. However, the diagnosis of biologic false-positive reactor raises significant questions concerning the patient. Of 555 patients having this diagnosis, 21.6% had systemic disease in one form or another, 2% having systemic lupus erythematosus. Alertness to the finding of a biologic false-positive reaction is indicated, especially in young women; such findings require careful follow-up, including a search for vague signs and symptoms of a previously undiscovered systemic illness.

OBJECTIVES: Monoamniotic twin pregnancies are at increased risk of perinatal complications, primarily owing to the risk of cord entanglement. There is no recommendation on whether such pregnancies should be managed in hospital or can be safely managed in an outpatient setting, and the timing of planned delivery is also a subject of debate. The aim of this study was to compare the perinatal outcomes of inpatient vs outpatient fetal surveillance approaches employed among 22 participating study centers, and to calculate the fetal and neonatal death rates according to gestational age, in non-anomalous monoamniotic twins from 26 weeks' gestation. METHODS: The MONOMONO study was a multinational cohort study of consecutive women with monochorionic monoamniotic twin pregnancies, who were referred to 22 university hospitals in Italy, the USA, the UK and Spain, from January 2010 to January 2017. Only non-anomalous uncomplicated monoamniotic twin pregnancies with two live fetuses at 26 + 0 weeks' gestation were included in the study. In 10 of the centers, monoamniotic twins were managed routinely as inpatients, whereas in the other 12 centers they were managed routinely as outpatients. The primary outcome was intrauterine fetal death. We also planned to assess fetal and neonatal death rates according to gestational age per 1-week interval. Outcomes are presented as odds ratio (OR) with 95% CIs. The main outcome was analyzed using both standard logistic regression analysis, in which each fetus was treated as an independent unit, and a generalized mixed-model approach, with each twin pair treated as a cluster unit, considering that the outcome for a twin is not independent of that of its cotwin. RESULTS: 195 consecutive pregnant women with a non-anomalous uncomplicated monoamniotic twin gestation (390 fetuses) were included. Of these, 75 (38.5%) were managed as inpatients and 120 (61.5%) as outpatients. The overall perinatal loss rate was 10.8% (42/390) with a peak fetal death rate of 4.3% (15/348) occurring at 29 weeks' gestation. There was no significant difference in mean gestational age at delivery (31 weeks), birth weight (∼1.6 kg), or emergency delivery rate between the inpatient and outpatient surveillance groups. Based on generalized mixed-model analysis, there was no statistically significant difference in fetal death rates between inpatient management commencing from around 26 weeks compared with outpatient surveillance protocols from 30 weeks (3.3% vs 10.8%; adjusted OR 0.21 (95% CI, 0.04-1.17)). Maternal length of stay in the hospital was 42.1 days in the inpatient group, and 7.4 days in the outpatient group (mean difference 34.70 days (95% CI, 31.36-38.04 days). From 32 + 0 to 36 + 6 weeks, no fetal or neonatal death in either group was recorded. 46 fetuses were delivered after 34 + 0 weeks, and none of them died in utero or within the first 28 days postpartum. CONCLUSION: In uncomplicated monoamniotic twins, inpatient surveillance is associated with similar fetal mortality as outpatient management. After 31 + 6 weeks, and up to 36 + 6 weeks, there were no intrauterine fetal deaths or neonatal deaths. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.