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Objectives To determine whether altered mental status (AMS) as a presenting symptom in older adults with COVID-19 is independently associated with adverse outcomes. Methods A retrospective single center observational study of admitted patients (n = 421) age greater than 60 and a positive COVID-19 test. Outcomes included mortality, intubation, acute respiratory distress syndrome, acute kidney injury, and acute cardiac injury. Multivariate regression analysis was used to determine if presenting with AMS was associated with adverse outcomes. Results There was an increased risk of mortality (RR 1.29, 95% CI 1.05–1.57), intubation (RR 1.52, 95% CI 1.09–2.12) and AKI (RR 1.42, 95% CI 1.13–1.78) in patients that presented with AMS. Conclusions During a global pandemic, prognostic indicators are vital to help guide the clinical course of patients, reduce healthcare cost, and preserve life. Our study suggests that AMS can play a major role in diagnostic algorithms in older adults with COVID-19.

Background Obesity is an epidemic in New York City, the global epicenter of the coronavirus pandemic. Previous studies suggest that obesity is a possible risk factor for adverse outcomes in COVID-19. Objective To elucidate the association between obesity and COVID-19 outcomes. Design Retrospective cohort study of COVID-19 hospitalized patients tested between March 10 and April 13, 2020. Setting SUNY Downstate Health Sciences University, a COVID-only hospital in New York. Participants In total, 684 patients were tested for COVID-19 and 504 were analyzed. Patients were categorized into three groups by BMI: normal (BMI 18.50–24.99), overweight (BMI 25.00–29.99), and obese (BMI ≥ 30.00). Measurements Primary outcome was 30-day in-hospital mortality, and secondary outcomes were intubation, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), and acute cardiac injury (ACI). Results There were 139 patients (27%) with normal BMI, 150 patients who were overweight (30%), and 215 patients with obesity (43%). After controlling for age, gender, diabetes, hypertension, and qSOFA score, there was a significantly increased risk of mortality in the overweight (RR 1.4, 95% CI 1.1–1.9) and obese groups (RR 1.3, 95% CI 1.0–1.7) compared with those with normal BMI. Similarly, there was a significantly increased relative risk for intubation in the overweight (RR 2.0, 95% CI 1.2–3.3) and obese groups (RR 2.4, 95% CI 1.5–4.0) compared with those with normal BMI. Obesity did not affect rates of AKI, ACI, or ARDS. Furthermore, obesity appears to significantly increase the risk of mortality in males (RR 1.4, 95% CI 1.0-2.0, P = 0.03), but not in females (RR 1.2, 95% CI 0.77–1.9, P = 0.40). Conclusion This study reveals that patients with overweight and obesity who have COVID-19 are at increased risk for mortality and intubation compared to those with normal BMI. These findings support the hypothesis that obesity is a risk factor for COVID-19 complications and should be a consideration in management of COVID-19.

Granulocytic sarcoma (GS) is an extramedullary manifestation of acute myeloid leukemia (AML), myelodysplastic syndrome (MDS) or myeloproliferative neoplasms. The diagnosis depends on morphology, immunohistochemistry and flow cytometry. An unusual location of this tumor may mask its primary source, therefore, a strategy involving immediate symptom control, and investigation is crucial in preventing clinical deterioration. We present a case of a 53-year-old man who initially presented with tumor lysis syndrome and transaminitis, with a subsequent CT Scan that revealed multiple liver lesions. This case describes a rare clinical entity of granulocytic sarcoma as multiple hypoattenuating liver lesions mimicking metastatic disease in its radiographic appearance. Since the imaging features of hepatic masses are nonspecific, and considering the aggressive nature of AML with concomitant tumor lysis syndrome, a confirmatory prompt biopsy should routinely be considered.

Depression, cardiovascular diseases and diabetes are among the major non-communicable diseases, leading to significant disability and mortality worldwide. These diseases may share environmental and genetic determinants associated with multimorbid patterns. Stressful early-life events are among the primary factors associated with the development of mental and physical diseases. However, possible causative mechanisms linking early life stress (ELS) with psycho-cardio-metabolic (PCM) multi-morbidity are not well understood. This prevents a full understanding of causal pathways towards the shared risk of these diseases and the development of coordinated preventive and therapeutic interventions., This work is supported by the European Union’s Horizon 2020 research and innovation programme (grant n ̊ 848158).

Importance Initial guidelines recommended prompt endotracheal intubation rather than non-invasive ventilation (NIV) for COVID-19 patients requiring ventilator support. There is insufficient data comparing the impact of intubation versus NIV on patient-centered outcomes of these patients. Objective To compare all-cause 30-day mortality for hospitalized COVID-19 patients with respiratory failure who underwent intubation first, intubation after NIV, or NIV only. Design Retrospective study of patients admitted in March and April of 2020. Setting A teaching hospital in Brooklyn, New York City. Participants Adult COVID-19 confirmed patients who required ventilator support (non-invasive ventilation and/or endotracheal intubation) at discretion of treating physician, were included. Exposures Patients were categorized into three exposure groups: intubation-first, intubation after NIV, or NIV-only. Primary outcome 30-day all-cause mortality, a predetermined outcome measured by multivariable logistic regression. Data are presented with medians and interquartile ranges, or percentages with 95% confidence intervals, for continuous and categorical variables, respectively. Covariates for the model were age, sex, qSOFA score ≥ 2, presenting oxygen saturation, vasopressor use, and greater than three comorbidities. A secondary multivariable model compared mortality of all patients that received NIV (intubation after NIV and NIV-only) with the intubation-first group. Results A total of 222 were enrolled. Overall mortality was 77.5% (95%CI, 72–83%). Mortality for intubation-first group was 82% (95%CI, 73–89%; 75/91), for Intubation after NIV was 84% (95%CI, 70–92%; 37/44), and for NIV-only was 69% (95%CI, 59–78%; 60/87). In multivariable analysis, NIV-only was associated with decreased all-cause mortality (odds ratio [OR]: 0.30, 95%CI, 0.13–0.69). No difference in mortality was observed between intubation-first and intubation after NIV. Secondary analysis found all patients who received NIV to have lower mortality than patients who were intubated only (OR: 0.44, 95%CI, 0.21–0.95). Conclusions & Relevance Utilization of NIV as the initial intervention in COVID-19 patients requiring ventilatory support is associated with significant survival benefit. For patients intubated after NIV, the mortality rate is not worse than those who undergo intubation as their initial intervention.

DNA methylation profiles of aggressive behavior may capture lifetime cumulative effects of genetic, stochastic, and environmental influences associated with aggression. Here, we report the first large meta-analysis of epigenome-wide association studies (EWAS) of aggressive behavior (N=15,324 participants). In peripheral blood samples of 14,434 participants from 18 cohorts with mean ages ranging from 7 to 68 years, 13 methylation sites were significantly associated with aggression (alpha=1.2×10−7; Bonferroni correction). In cord blood samples of 2,425 children from five cohorts with aggression assessed at mean ages ranging from 4 to 7 years, 83% of these sites showed the same direction of association with childhood aggression (r=0.74, p=0.006) but no epigenome-wide significant sites were found. Top-sites (48 at a false discovery rate of 5% in the peripherl blood meta-analysis or in a combined meta-analysis of peripheral blood and cord blood) have been associated with chemical exposures, smoking, cognition, metabolic traits, and genetic variation (mQTLs). Three genes whose expression levels were associated with top-sites were previously linked to schizophrenia and general risk tolerance. At six CpGs, DNA methylation variation in blood mirrors variation in the brain. On average 44% (range=3-82%) of the aggression–methylation association was explained by current and former smoking and BMI. These findings point at loci that are sensitive to chemical exposures with potential implications for neuronal functions. We hope these results to be a starting point for studies leading to applications as peripheral biomarkers and to reveal causal relationships with aggression and related traits.

Background: The larynx is the organ for production of voice & a sphincteric device used in respiration. Larynx from inside outward has a framework of mucosa surrounded by fibroelastic membrane which inturn surrounded by cartilages & muscles. Thyroid cartilage is largest among all the laryngeal cartilage. Aims: To find out dimension of various parameters of thyroid cartilage, variation, differences among all the data & to compare data between males & females. Material & Methods: Fourty five samples of adult thyroid cartilage (24 males & 21 females) of known sex were taken from embalmed cadavers. Morphometric measurement was taken using a digital vernier caliper & goniometer to see normal variation, sex differences and bilateral asymmetry. Observation were analysed after calculating mean &SD. Results: Parameters measured in thyroid cartilage were show significant difference in males & females. All the parameters of thyroid cartilage except thyroid angle were higher in males than females. Bilateral asymmetry in the size of thyroid lamina was seen in majority of specimens. However, in 3 cases (6.67 %) thyroid prominence was not in median plane, deviated towards left side. In one case asymmetry was also associated with asymmetry in direction of superior cornu. Conclusion: The detailed study of thyroid cartilage in the form of morphometric parameters of thyroid cartilage is useful for Anatomist, Plastic surgeons, ENT surgeons and Radiologist to perform advanced surgical & endoscopic procedure & surgeries, planning of laryngeal framework & facial feminization surgery & to analysis of CT-MRI scans of larynx.

Introduction: A study examining the impact of social determinants of health on COVID-19 outcomes is necessary to identify which aspects of a vulnerable population make it more susceptible. We describe the epidemiological and clinical characteristics of a patient population disproportionately impacted by COVID-19 and situate the findings within the broader context of health determinants. Materials and Methods: A descriptive study of 527 laboratory-confirmed COVID-19 patients hospitalized from March 12 to April 13, 2020, evaluated patient demographics, comorbidities, presentation, and outcomes. The study took place at an academic medical center serving a low-income, Black community (predominantly Caribbean-born) in Brooklyn, New York. Results: Compared to previous studies, we report a higher median age of 70 (interquartile range 59–80), a higher percentage of Blacks (91%), a higher prevalence of comorbidities (hypertension [83%], diabetes [53%], and obesity [42%]), a higher prevalence of abnormal findings on presentation (altered mental status [30%], Quick sequential organ failure assessment score ≥2 [27%], elevated random-glucose [77%], elevated creatinine [57%]), and a higher incidence of negative in-hospital outcomes (intensive care unit admission [21%], mechanical ventilation [21%], acute kidney injury [31%], acute respiratory distress syndrome [17%] and acute cardiac injury [18%], and age-adjusted fatality rate [40%.]). Conclusions: This study shows the characteristics of a patient population disproportionately impacted by COVID-19. The intersectionality of the Black race, older age, a high prevalence of comorbidities, and residency in a locale severely affected by COVID-19, deserves further consideration to better address health outcomes in vulnerable patient groups. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and Procedural skills, Systems-based practice.

BackgroundThere are various maternal prenatal biopsychosocial (BPS) predictors of birth weight, making it difficult to quantify their cumulative relationship.MethodsWe studied two birth cohorts: Northern Finland Birth Cohort 1986 (NFBC1986) born in 1985–1986 and the Generation R Study (from the Netherlands) born in 2002–2006. In NFBC1986, we selected variables depicting BPS exposure in association with birth weight and performed factor analysis to derive latent constructs representing the relationship between these variables. In Generation R, the same factors were generated weighted by loadings of NFBC1986. Factor scores from each factor were then allocated into tertiles and added together to calculate a cumulative BPS score. In all cases, we used regression analyses to explore the relationship with birth weight corrected for sex and gestational age and additionally adjusted for other factors.ResultsFactor analysis supported a four-factor structure, labelled closely to represent their characteristics as ‘Factor1-BMI’ (body mass index), ‘Factor2-DBP’ (diastolic blood pressure), ‘Factor3-Socioeconomic-Obstetric-Profile’ and ‘Factor4-Parental-Lifestyle’. In both cohorts, ‘Factor1-BMI’ was positively associated with birth weight, whereas other factors showed negative association. ‘Factor3-Socioeconomic-Obstetric-Profile’ and ‘Factor4-Parental-Lifestyle’ had the greatest effect size, explaining 30% of the variation in birth weight. Associations of the factors with birth weight were largely driven by ‘Factor1-BMI’. Graded decrease in birth weight was observed with increasing cumulative BPS score, jointly evaluating four factors in both cohorts.ConclusionOur study is a proof of concept for maternal prenatal BPS hypothesis, highlighting the components snowball effect on birth weight in two different European birth cohorts.

Background Maternal smoking during pregnancy is associated with adverse offspring health outcomes across their life course. We hypothesize that DNA methylation is a potential mediator of this relationship. Methods We examined the association of prenatal maternal smoking with offspring blood DNA methylation in 2821 individuals (age 16 to 48 years) from five prospective birth cohort studies and perform Mendelian randomization and mediation analyses to assess whether methylation markers have causal effects on disease outcomes in the offspring. Results We identify 69 differentially methylated CpGs in 36 genomic regions (P value < 1 × 10−7) associated with exposure to maternal smoking in adolescents and adults. Mendelian randomization analyses provided evidence for a causal role of four maternal smoking-related CpG sites on an increased risk of inflammatory bowel disease or schizophrenia. Further mediation analyses showed some evidence of cg25189904 in GNG12 gene mediating the effect of exposure to maternal smoking on schizophrenia-related outcomes. Conclusions DNA methylation may represent a biological mechanism through which maternal smoking is associated with increased risk of psychiatric morbidity in the exposed offspring. Electronic supplementary material The online version of this article (10.1186/s13148-019-0683-4) contains supplementary material, which is available to authorized users.

Background: DNA methylation at GFI1-locus has been repeatedly associated with exposure to smoking from foetal period onwards. We explored whether DNA methylation maybe a mechanism that links exposure to maternal prenatal smoking with offspring's adult cardio-metabolic health. Methods: We meta-analysed the association between methylation at GFI1-locus with maternal prenatal smoking, adult own smoking, and cardio-metabolic phenotypes in 22 population-based studies from Europe, Australia, and USA (n=18212). DNA methylation at GFI1-locus was measured in whole-blood. Multivariable regression analyses were fitted to examine its association with exposure to prenatal and own adult smoking. DNA methylation levels were analysed in relation to body mass index (BMI), waist circumference (WC), fasting glucose (FG), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), diastolic, and systolic blood pressure (BP). Findings: Hypomethylation at four out of eight GFI1-CpGs was associated with exposure to maternal prenatal smoking, whereas, all eight CpGs were associated with adult own smoking. Cg14179389 hypomethylation, the strongest maternal prenatal smoking locus, was associated with increased WC and BP when adjusted for sex, age, and adult smoking with Bonferroni-corrected P < 0·012. In contrast, hypomethylation at cg09935388, the strongest adult own smoking locus, was associated with decreased BMI, WC, and BP (adjusted 1 x 10 - 7 < P < 0·01). Similarly, hypo-methylation at cg12876356, cg18316974, cg09662411, and cg18146737 was associated with decreased BMI and WC (5 x 10 - 8 < P < 0·001). Hypomethylation at all the CpGs was consistently associated with higher TG levels. Interpretation: Epigenetic changes at GFI1 were linked to smoking exposure in-utero/in-adulthood and robustly associated with cardio-metabolic risk factors. This introduces a molecular mechanism and biomarker of smoking exposure. Funding: Not applicable Declaration of interests: The authors declare no competing interests. Ethical Approval Statement: Ethical approval for the study was obtained from the ALSPAC Ethics and Law Committee and the Local Research Ethics Committees.

Upper limb arterial variations are commonly encountered and have been reported in many articles. The present study showed a high division of brachial artery in the middle third of arm into its terminal branches, the radial artery laterally and the ulnar artery medially. This study is an attempt to discuss the anatomy, embryological basis and clinical implications of such variations. Knowledge of such anomalous vessels is significant from clinical point of view.

There is lack of standardized and reliable questionnaires to capture various behavioural aspects of subjective health of the population in India and this study was aimed to identify and validate methods and scales measuring determinants of socio-economic inequalities in health in context to Indian adolescents residing in diverse urban areas. In this study scales and questions from internationally validated questionnaires were adopted, and then reliability and validity tests were conducted through a cross sectional study on 1386 Indian adolescents residing in diverse areas of residence (slums, middle class and resettlement colonies) and standardized them to be used on Indian adolescent.

The knowledge of variations of blood vessels of kidney is important during operative and diagnostic procedures. The present study contributes in making the clinicians aware of possible variations in renal vascular pedicle. 48 kidney specimens were studied for renal vessels in the Department of Anatomy, Pt. B. D. Sharma PGIMS, Rohtak. Out of 48 specimens, two kidneys were found to have anomalous vasculature. One kidney (Right Side) was observed to have triple renal veins along with an accessory renal artery. One other kidney (Left Side) exhibited triple renal artery. The study is being carried out till date and is planned for an extensive research for another few years to review and to collect more data in this perspective.

Objectives To assess the socioeconomic inequalities in oral hygiene and to explore the role of various socioeconomic and psychosocial factors as determinants of these inequalities among adolescents residing in Delhi National Capital Territory. Methods A cross-sectional study was conducted among 1386 adolescents aged 12–15 years from three different socioeconomic groups according to their area of residence (middle-class areas, resettlement colonies and urban slum colonies). Level of oral hygiene was examined clinically using the Simplified Oral Hygiene Index (OHI-S), and an interviewer-administered questionnaire was used to measure key socio-demographic variables and psychosocial and health-related behaviours. Logistic regression analysis tested the association between area of residence and poor oral hygiene. Results Poor oral hygiene was observed in 50.2% of the adolescents. There was a socioeconomic gradient in poor oral hygiene, with higher prevalence observed at each level of deprivation. These differences were only partly explained, and the differences between adolescent groups remained statistically significant after adjusting for various demographic variables, standard of living, social capital, social support and health-affecting behaviours (OR: 1.96, 95% CI: 1.30–2.76; and OR: 2.50, 95% CI: 1.60–3.92 for adolescents from resettlement colonies and urban slums, respectively, than middle-class adolescents). Conclusion Area of residence emerged as a strong socioeconomic predictor of prevalence of poor oral hygiene among Indian adolescents. Various material, psychosocial and behavioural factors did not fully explain the observed inequalities in poor oral hygiene among different adolescent groups.

Sex education is an important preventive and continuing approach to the care of preadolescent and adolescents. According to WHO young people aged 15–24 years acquire half of all new sexually transmitted disease and that 1 in 4 sexually active adolescent females have an STD, such as Chlamydia or human Papillomavirus (HPV). OBJECTIVES: To assess the pre-test and post-test knowledge level regarding sex education among adolescent girls. To evaluate the effectiveness of structured teaching program on sex education by comparing pre-test and post-test knowledge score. To associate the pre-test knowledge level on sex education among adolescent girls with selected demographic variables. METHODOLOGY: The research design is pre-experimental. The research approach is a Quantitative. The study was conducted in Shree Ambe Vidyalaya, Waghodia road, Vadodara. The sample consisted of 100 adolescent girls. Structure knowledge questionnaire was used to assess the knowledge. Structured teaching program on sex education was the intervention of the study. In the present study 100 adolescent girls selected using Probability Simple random sampling technique. FINDINGS OF THE STUDY: The overall Pretest mean knowledge score was found to be 45.9% with SD as 3.1. The overall Post test mean knowledge score was found to be 77.7% with SD as 2.9. The ‘t’ Test value was 31.49* (Significant at 5% level) which indicates the effectiveness of structure teaching on knowledge regarding sex education among adolescent girls There is a significant association between pre-test knowledge of mother with selected demographic variables such as age, educational status, religion, family type, monthly family income, education of father, source of information. However, the other selected demographic variables in the Pre test such as number of female siblings, ordinal position, education of mother, occupation of father and mother were found to be non-significant in the Pre test knowledge. CONCLUSION: The findings of the study makes the researcher hopeful that such initiatives has increased the adolescent girls’ knowledge regarding sex education.

The study investigates the need of surveillance during mass gathering events in Wales, UK. An evidenced based risk assessment tool is designed to identify the risk level of an event by grading risk variables present during the occurrence of event. This tool was observed consistent when compared with the international events. The need for a continuous surveillance is associated to the risk level of the mass gathering event. Enhancing the current surveillance system to establish a collaborated department would require less resources to monitor events and for training in emergency conditions.

OBJECTIVES: To assess socioeconomic inequalities in traumatic dental injuries (TDIs) in adolescents in New Delhi and examine the role of material, psychosocial and behavioural factors in explaining these inequalities. METHODS: We conducted a cross sectional study of 1386 adolescents aged between 12-15 years residing in three diverse areas of New Delhi. A non-invasive clinical examination was used to estimate the prevalence of TDIs, and an interviewer-administered questionnaire was used to gather relevant behavioural and socio-demographic data. Multiple logistic regression models were used to assess the association between area based socioeconomic position and TDIs. RESULTS: The overall prevalence of TDIs was 10.9%. Social inequalities in the prevalence of TDIs were observed across the adolescent population according to their area of residence. Socio-economic group differences in the prevalence of TDIs remained statistically significant after adjusting for demographic factors, material resources, social capital, social support and health affecting behaviours (OR 3.36, 95% CI 1.75-6.46 and OR 3.99, 95% CI 1.86-8.56 for adolescents from resettlement areas and urban slums respectively in comparison to middle class adolescents). Different psychosocial, material and socio-demographic variables did not attenuate the estimates for the relationship between area socioeconomic position and TDIs. CONCLUSION: Area of residence was a strong predictor of TDIs in adolescents with a higher prevalence in more deprived areas. Social inequalities in TDIs were not explained by psychosocial and behavioural variables. Health promoting policies aimed at improving the physical environment in which adolescents reside might be instrumental in reducing the prevalence of TDIs and associated inequalities. Language: en

Background: Biliary ductal region being frequently abnormal has been the subject of research since long time for anatomists, surgeons and radiologists as well.Methods: The present study was carried out in the department of Anatomy at PGIMS, Rohtak on 50 specimens of liver taken unblock with associated structures.Results: Accessory hepatic and accessory cystic ducts were observed in 4% cases each. 2% cases exhibited abnormal low fusion of cystic duct with common hepatic duct.Conclusions: These anomalies may add to postoperative complications if ignored. Present study is a step in the direction of creating awareness about these variations among the clinicians.

Background: A thorough knowledge of the anatomy of coronary arteries, the crown of the heart does a self-evident prerequisite for more intelligent planning of surgery or a complete understand of the coronary artery disease. Abnormal origin of coronary arteries may cause potentially dangerous symptoms and even sudden death during strenuous activity. A cadaveric study in an unsuspected population provides a basis for acknowledgment of normal variants, which may facilitate determination of prevalence and evaluation of the value of screening for such anomalies. Objectives: This study was conducted with an aim to describe the anatomical variation in the origin of right and left coronary arteries (RCA and LCA). Materials and Methods: This study based on the examination of 100 cadaveric hearts from the anatomy dissection room and obtained at an autopsy department. By using conventional dissecting techniques, heart specimens were dissected and studied for number of ostia, and their position within respective sinuses. The heights of the ostia from the bottom of sinuses were measured with the help of Vernier caliper. Results: There was no opening found in pulmonary artery and non-coronary sinus coronary arteries. Single, double and triple ostia were present in 78%, 20%, 2% of cases, respectively. The height of coronary ostia from the bottom of the respective aortic cusp which was measured by digital Vernier caliper depicts that RCA ostium was higher than that of the LCA ostium. Conclusion: The findings in this study may provide a basis for understanding the normal variants, for determining the incidence of anomalies, and for evaluating the value of screening for such anomalies.