The effect of patient ethnicity on the accuracy of peripheral pulse oximetry in patients with COVID-19 pneumonitis: a single-centre,retrospective analysis

Pulse oximetry is used widely to titrate oxygen therapy and for triage in patients who are critically ill. However, there are concerns regarding the accuracy of pulse oximetry in patients with COVID-19 pneumonitis and in patients who have a greater degree of skin pigmentation. We aimed to determine the impact of patient ethnicity on the accuracy of peripheral pulse oximetry in patients who were critically ill with COVID-19 pneumonitis by conducting a retrospective observational study comparing paired measurements of arterial oxygen saturation measured by co-oximetry on arterial blood gas analysis (SaO₂) and the corresponding peripheral oxygenation saturation measured by pulse oximetry (S_pO₂). Bias was calculated as the mean difference between SaO₂ and S_pO₂ measurements and limits of agreement were calculated as bias ±1.96 SD. Data from 194 patients (135 White ethnic origin, 34 Asian ethnic origin, 19 Black ethnic origin and 6 other ethnic origin) were analysed consisting of 6216 paired SaO₂ and S_pO₂ measurements. Bias (limits of agreement) between SaO₂ and S_pO₂ measurements was 0.05% (−2.21–2.30). Patient ethnicity did not alter this to a clinically significant degree: 0.28% (1.79–2.35), −0.33% (−2.47–2.35) and −0.75% (−3.47–1.97) for patients of White, Asian and Black ethnic origin, respectively. In patients with COVID-19 pneumonitis, S_pO₂ measurements showed a level of agreement with SaO₂ values that was in line with previous work, and this was not affected by patient ethnicity.     

To what extent does IQ 'explain' socio-economic variations in function?

Background  

The aims of this study were to examine the extent to which higher intellectual abilities protect higher socio-economic groups from functional decline and to examine whether the contribution of intellectual abilities is independent of childhood deprivation and low birth weight and other socio-economic and developmental factors in early life.     

Discordant repeat size and phenotype in Kennedy syndrome

Previous reports in the literature have described correlation of increasing repeat length with severity of the phenotype, in Kennedy syndrome. We describe male siblings with different repeat lengths, with lack of expression of the phenotype in the sibling with the longer repeat length. The phenotype was identical to motor neurone disease. There is variability of expression in Kennedy syndrome and repeat length even in siblings cannot be taken as a conclusive indicator of severity. CAG repeat length cannot be used to predict the natural history of Kennedy disease. The diagnosis of Kennedy syndrome should be considered in male patients presenting with atypical motor neurone disease.     

INTERFERONS IN ONCOLOGY

SUMMARY The interferons are natural glycoproteins secreted in response to various stimuli, including viral infection. They have antiviral, antiproliferative and immunomodulatory effects on different target cell populations. Since recombinant human interferons have become available, they have been tested in a wide range of malignancies. They are well established in the treatment of hairy cell leukaemia, chronic myelogenous leukaemia and multiple myeloma. Although they have documented activity against lymphoma, melanoma, renal cell cancer and carcinoid tumours, their role in the treatment of these tumours is less clear. In the common solid tumours, such as lung cancer and colorectal cancer, the use of interferons remains experimental. Here we will summarise their practice applications in oncology, using randomised studies where available to establish their place in multi-modality treatment. We will not discuss their use as antiviral or immunomodulating agents in viral and autoimmune diseases, multiple sclerosis or after organ transplantation.     

The Fates of Cells in the Developing Cerebral Cortex of Normal and Methylazoxymethanol Acetate-lesioned Mice

We are interested in the mechanisms that generate the mature cerebral cortex. We used bromodeoxyuridine (BrdU) to label cortical cells as they were being born. We followed the fates of specific sets of cortical precursors in normal mice and in mice in which other groups of cortical progenitors had been destroyed with the antimitotic agent methylazoxymethanol acetate (MAM Ac). In normal mice, most cells destined for the cerebral cortex were produced from embryonic day 12 (E12) to E16 in the expected inside-to-outside sequence (deep layers first, superficial layers last). Injection of MAM Ac at E13 killed cells that would normally have contributed to the deep cortical layers. As a consequence, the cortex was thinned by ∼25% at postnatal day 21 (P21). However, all laminae were present and had normal connections with subcortical structures, although all were proportionately thinner. BrdU injected on E16 labelled a normally sized complement of cells that spanned a larger proportion of the depth of the thinned cortex. Thus, the deep cortical layers comprised many cells that were born several days later than normal. At embryonic ages prior to E12, a transient set of cells is produced in the early telencephalon. After injection with MAM Ac at E10, the cortex appeared histologically and histochemically normal at P21. However, many cells that would normally have contributed to superficial cortex (born on E15) were significantly deeper than normal. These results suggest that, during the early stages of cortical development, the nervous system is sufficiently plastic to compensate to some extent for the destruction of specific precursor cells by altering the fates of neurons born later. They indicate that the embryonic date on which a cortical cell is born does not necessarily determine its eventual phenotype.