RESUMEN
OBJECTIVE: Accumulating evidence suggests the role of immune-inflammatory markers in early risk stratification and prognostication of COVID-19 patients. We aimed to evaluate their association with severity and the development of diagnostic scores with optimal thresholds in critical patients. SETTING AND PARTICIPANTS: This retrospective case study includes hospitalized COVID-19 patients from March 2019 to March, 2022, in the developing area teaching hospital in Pakistan. Polymerase chain reaction (PCR) positive patients, n = 467 were investigated for clinical outcomes, comorbidities and disease prognosis. The plasma levels of Interleukin-6 (IL-6), Lactate dehydrogenase (LDH), C-reactive protein (CRP), Procalcitonin (PCT), ferritin and Complete blood count markers were measured. RESULTS: Majority were males (58.8%) and patients with comorbidities had more severe disease. Hypertension and diabetes mellitus were the commonest comorbidities. Shortness of breath, myalgia and cough were the main symptoms. The hematological markers NLR, as well as the plasma levels of immune-inflammatory variables, IL-6, LDH, Procalcitonin, Erythrocyte sedimentation rate, Ferritin were markedly raised in severe and critical patients (p < 0.0001 for these markers). ROC analysis supports IL-6 as the most accurate marker with high prognostic relevance with proposed cut-off threshold (43 pg/ml), determining >90% of patients in terms of COVID-19 severity (AUC = 0.93, 91.7%, se; 90.3%sp). Furthermore, positive correlation with all other markers including NLR with cut-off = 2.99 (AUC = 0.87, se = 89.8%, sp = 88.4%), CRP with cut-offs at 42.9â mg/l, (AUC = 0.883, se = 89.3% and sp = 78.6%), LDH cut-off at 267µg/L, evidenced in >80% patients (AUC = 0.834 se = 84% and sp = 80%). Additionally, ESR and ferritin have the corresponding AUC 0.81 and 0.813 with cut-off at 55â mm/hr and 370, respectively. CONCLUSION: Investigating the immune-inflammatory markers can assist physicians in providing prompt treatment and ICU admission in terms of COVID-19 severity. As a result, which may reduce the overall mortality of COVID-19 patients.
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COVID-19 , SARS-CoV-2 , Masculino , Humanos , Femenino , Estudios Retrospectivos , Polipéptido alfa Relacionado con Calcitonina , Interleucina-6 , Pakistán/epidemiología , Biomarcadores , Proteína C-Reactiva/análisis , FerritinasRESUMEN
BACKGROUND: Breast cancer is the most common female malignancy worldwide. Pakistan has the highest incidence rate of breast cancer than any other Asian population. The purpose of the study was to evaluate the worth of sono-mammography in diagnosis of symptomatic breast diseases by comparing it with mammogram. METHODS: In this cross-sectional validation study, 45 subjects with mean age of 45 +/- 12.07 were included. Majority of the patients presented with complaint of breast lump. After complete history and clinical examination, all the patients had high resolution ultrasound of bilateral breasts and axilla followed by bilateral mammography. Histopathology was taken as gold standard in this study. The exclusion criteria were pregnancy and patients having direct clinical signs of breast malignancy. RESULTS: Based on histopathology, out of 45 patients with breast symptoms, 12 patients had benign lesions, whereas 32 patients were diagnosed as the cases of breast cancers. Finally one patient did not have biopsy proven final diagnosis. Sensitivity and specificity of ultrasound were calculated to be 100% and 67% as compared to sensitivity and specificity of 90.6% and 91.7% for that of mammography. CONCLUSIONS: Ultrasound is a useful complementary tool to mammography in assessment of symptomatic breast diseases since it helps in characterization and localization of breast lesions seen on mammogram and it is not limited by dense breasts. Also it should be the considered as initial imaging technique for assessment of palpable breast lumps.
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Enfermedades de la Mama/diagnóstico por imagen , Medición de Riesgo/métodos , Ultrasonografía Mamaria/métodos , Enfermedades de la Mama/epidemiología , Estudios Transversales , Femenino , Humanos , Incidencia , Persona de Mediana Edad , Pakistán/epidemiología , Curva ROC , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Stress fractures are quite common both in athletes and military recruits. The purpose of the study was to evaluate the efficacy of tuning fork in stress fractures by comparing it with three phase bone scan. METHODS: The current study examined 55 subjects whose age ranged 18-28 years. X-rays of all the subjects were unremarkable. After history and clinical examination tuning fork test (TFT) was performed on each case by placing 128 Hertz vibrating tuning fork on the site of pain (underlying bony surface) of tibia or fibula. Each case was scanned using triple phase bone scintigraphy. RESULTS: Fifty-five patients had a total of 67 stress fractures, out of which 53 were picked up by TFT. Sensitivity of TFT was found to be 79% and specificity of 63%. Positive and negative predictive values were 88% and 46% respectively. CONCLUSION: Tuning fork test is a simple and easy approach of diagnosing stress fractures which can be performed even by athletics and military trainers. Management should be initiated in patients who have history of stress related below-knee pain and positive tuning fork test without waiting for bone scintigraphy. For complicated cases the bone scan is the gold standard for diagnosis.