Assessment Of Disease Severity Research Articles

Pituitary adenomas: biology, nomenclature and clinical classification.

An 'adenoma' is a benign neoplasm composed of epithelial tissue, and has been standard nomenclature for primary pituitary neoplasms. In 2022, the fifth edition of the WHO Classification of Endocrine Tumours and of Central Nervous System Tumours, renamed pituitary adenomas as neuroendocrine tumours (NETs), assigning an oncology label to pituitary invariably benign neoplasms. Multidisciplinary workshops convened by the Pituitary Society have questioned the process, validity, and merit of this arbitrary change, while addressing the adverse clinical implications of the proposed new nomenclature. Unlike NETs, pituitary adenomas are highly prevalent, indolent and very rarely become malignant, and in general do not affect life expectancy when appropriately managed. A nomenclature change to NET does not advance mechanistic insight, treatment or prognosis but confers a misleading oncology connotation, potentially leading to overtreatment as well as engendering unnecessary patient anxiety. As the majority of pituitary adenomas do not require surgery, exclusion of these disorders is a major shortcoming of the pathology-based WHO classification system which is limited to patients undergoing surgery. Many factors influence prognosis other than histopathology. A new clinical classical classification has been developed for guiding prognosis and therapy of pituitary adenomas by integrating clinical, genetic, biochemical, radiological, pathological, and molecular information for all adenomas arising from anterior pituitary cell lineages. The system uses an evidence-based scoring of risk factors to yield a cumulative grade score that reflects disease severity. It can be used at the bedside to guide pituitary adenoma management. Once validated in prospective studies, this simple classification system could provide a standardised platform for assessing disease severity, prognosis, and effects of therapy on pituitary adenoma outcomes.

Systemic Inflammatory Immune Index (SII) Predicts Disease Activity in Systemic Lupus Erythematosus (SLE) Patients: A Cross-Sectional Study

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by widespread inflammation and diverse clinical manifestations. The systemic inflammatory immune index (SII), calculated as platelet count * neutrophil count/lymphocyte count, has emerged as a potential marker of systemic inflammation in various conditions. This study aimed to investigate the relationship between SII and disease activity in SLE patients. Methods: We conducted a cross-sectional study involving 60 SLE patients diagnosed according to the 2019 EULAR/ACR classification criteria. Demographic and clinical data were collected, and disease activity was assessed using the Mexican Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI). Blood samples were analyzed to determine SII values. Statistical analysis included Spearman's correlation to assess the relationship between SII and MEX-SLEDAI scores. Results: The study population predominantly consisted of women (98.3%), with a median age of 29 years. A strong positive correlation was observed between SII and MEX-SLEDAI scores (r = 0.931, p < 0.001). Patients with higher SII values exhibited significantly greater disease activity. Conclusion: Our findings suggest that SII is a promising predictor of disease activity in SLE patients. This readily available index may aid clinicians in assessing disease severity and tailoring treatment strategies. Further research is warranted to validate these findings and explore the utility of SII in monitoring disease progression and treatment response.

International Expert-Based Consensus Definition, Classification Criteria, and Minimum Data Elements for Osteoradionecrosis of the Jaw: An Inter-Disciplinary Modified Delphi Study.

Osteoradionecrosis of the jaw (ORNJ) is a severe iatrogenic disease characterized by bone death after radiation therapy (RT) to the head and neck. With over 9 published definitions and at least 16 classification systems, the true incidence and severity of ORNJ are obscured by lack of a standard for disease definition and severity assessment, leading to inaccurate estimation of incidence, reporting ambiguity, and likely under-diagnosis worldwide. This study aimed to achieve consensus on an explicit definition and phenotype of ORNJ and related precursor states through data standardization to facilitate effective diagnosis, monitoring, and multidisciplinary management of ORNJ. The ORAL Consortium comprised 69 international experts, including representatives from medical, surgical, radiation oncology, and oral/dental disciplines. Using a web-based modified Delphi technique, panelists classified descriptive cases using existing classification systems, reviewed systems for feature extraction and specification, and iteratively classified cases based on clinical/imaging feature combinations. The Consortium ORNJ definition was developed in alignment with SNOMED-CT terminology and recent ISOO-MASCC-ASCO guideline recommendations. Case review using existing ORNJ classification systems showed high rates of inability to classify (up to 76%). Ten consensus statements and nine minimum data elements (MDEs) were outlined for prospective collection and classification of precursor/ORNJ disease states. This study provides an international, consensus-based definition and MDE foundation for standardized ORNJ reporting in cancer survivors treated with RT. Head and neck surgeons, radiation, surgical, medical oncologists, and dental specialists should adopt MDEs to enable scalable health information exchange and analytics. Work is underway to develop both a human- and machine-readable knowledge representation for ORNJ (i.e., ontology) and multidisciplinary resources for dissemination to improve ORNJ reporting in academic and community practice settings.

The Significance of Fractional Exhaled Nitric Oxide, Fractional Nasal Exhaled Nitric Oxide and Lung Function Tests in Children with Moderate-to-Severe Allergic Rhinitis.

Fractional nasal exhaled NO (FnNO), fractional exhaled NO (FeNO) and lung function tests were performed in children with moderate-to-severe persistent allergic rhinitis (AR) to investigate the significance of the above indices in the assessment and diagnosis of children with AR. A total of 135 children with persistent AR were selected and divided into moderate-to-severe and mild groups; serum total immunoglobulin E (IgE), peripheral blood eosinophil counts (EOS), FnNO, FeNO, and lung function tests were performed. Children in the moderate-to-severe group had increased levels of FnNO and FeNO and decreased levels of forced expiratory flow at 75% of forced vital capacity as a percentage of the predicted value (FEF75%) and maximum mid-term expiratory flow as a percentage of the predicted value (MMEF%) . IgE in children with AR was positively correlated with FeNO and FnNO and negatively correlated with FEF75% . EOS was positively correlated with FnNO. FeNO was negatively correlated with FEF75% and forced expiratory flow at 50% of forced vital capacity as a percentage of the predicted value (FEF50%). FnNO was negatively correlated with FEF75%, FEF50%, and MMEF%. FnNO, FeNO, and pulmonary function tests may help assess disease severity and level of disease control in children with persistent AR.

Disease features at diagnosis and changes in disease course severity among commercially insured patients with childhood-onset compared with adult-onset systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) causes widespread inflammation and damage in affected organs. Severity is determined by the type of organ systems affected and the extent of involvement. SLE occurs in childhood or adulthood and disease severity varies according to age of onset. We compared disease features and changes in disease severity over time between childhood-onset (cSLE) and adult-onset SLE (aSLE). Patients 0-64years old, newly diagnosed with SLE during 2014-2020 were identified using the MarketScan® database. A validated algorithm was used to assess disease severity. Improving severity versus baseline was defined as a transition from a higher (severe) to a lower (mild/moderate) disease state during each evaluation period. Group comparisons were made using the Pearson chi-square test for categorical and t test for continuous measures. A total of 10,912 patients were included. Most (89.9%) were female with a mean age of 14.2 versus 44.6years for cSLE and aSLE groups, respectively. Patients with cSLE were more likely to have severe disease at diagnosis (38.3% vs 10.7%; p < .0001) versus aSLE. The largest reduction in SLE severity occurred during 6 to <12months post-index with cSLE experiencing the greatest improvement (36.7% vs 19.9%; p < .0001) compared with aSLE. However, despite improvements observed over time in cSLE, this group was still more likely to have severe disease at 0 to <6months (26.4% vs 10.5%) and 6 to <12 months (14.4% vs 8.6%) post-index compared with aSLE patients (p < .01, all). For aSLE, the proportions of patients experiencing either an improvement or deterioration in symptoms was similar during 0 to <6months and 6 to <12months. However, during 12 to <24months, nearly twice as many patients in this group experienced a deterioration in symptoms (30.1%) compared to improvement (15.6%). Children with SLE present with greater symptom severity compared with adults. Although children were more likely to experience improvements following treatment, they had more active disease over time than aSLE patients. Disease severity remained stable for aSLE patients until the second year of follow-up, when more patients experienced a deterioration rather than improvement in symptoms.

Intranasal Calcitriol Accelerates Improvement of Sinonasal Inflammation and Olfactory Impairment in Mice After Cessation of Chronic Cigarette-Smoke Exposure.

Smoking has been shown to be associated with circulating deficiencies in 25(OH)D3 and reduced sinonasal tissue levels of the active form of vitamin D, 1,25(OH)2D3. Given vitamin D's ability to reduce inflammation, we sought to examine if intranasal (IN) delivery of calcitriol [clinical analog of 1,25(OH)2D3] could reduce inflammation and improve disease severity in a murine model of chronic cigarette smoke-induced sinonasal inflammation (CS-SI). Mice were exposed to CS 5 h/day, 5 days/week for 9 months, and then began IN calcitriol three times per week for 4 weeks. Micro-CT was used to assess disease severity. Sinonasal tissues were collected for RNA-seq analysis. Olfactory function was assessed using a T-maze odorant avoidance sniff behavior test. Nasal lavage fluid (NALF) was used for cytology and cytokines analysis. Quantification of disease severity by micro-CT showed IN calcitriol reduced opacification by 18%, as compared to smoke cessation alone, in which only a 5% reduction was noted. H&E analysis of NAFL demonstrated heightened neutrophil infiltration and neutrophil-associated chemokines in CS-SI mice, which was reduced with IN calcitriol treatment. RNA-seq pathway analysis demonstrated that smoking was associated with odorant binding changes and that calcitriol treatment reduced neutrophil migration and inflammation. Lastly, IN calcitriol reversed olfactory loss caused in CS-SI. IN delivery of calcitriol accelerates inflammatory resolution in the nose and olfactory mucosa after prolonged CS exposure. Furthermore, treatment was associated with improved olfactory function in mice CS-SI, as such local delivery of calcitriol may serve as a novel treatment for modulating sinonasal inflammation.

Rare constituents of the nasal microbiome contribute to the acute exacerbation of chronic rhinosinusitis.

Dysbiosis of the nasal microbiome is considered to be related to the acute exacerbation of chronic rhinosinusitis (AECRS). The microbiota in the nasal cavity of AECRS patients and its association with disease severity has rarely been studied. This study aimed to characterize nasal dysbiosis in a prospective cohort of patients with AECRS. We performed a cross-sectional study of 28 patients with AECRS, 20 patients with chronic rhinosinusitis (CRS) without acute exacerbation (AE), and 29 healthy controls using 16S rRNA gene sequencing. Subjective and objective assessments of CRS disease severity during AE were also collected. Compared to healthy controls and patients with CRS without AE, AECRS presented with a substantial decrease of the Corynebacterium_1 and a significant increase of Ralstonia and Acinetobacter at the genus level (LDA score > 2.0 [P < 0.05]). Furthermore, genera with a mean relative abundance (MRA) of less than 1% were defined as rare components based on published studies, then 29 genera with a substantial alteration in AECRS were rare constituents of the microbiome, of which 18 rare genera were highly associated with subjective and objective disease severity. Moreover, a combination of 15 genera could differentiate patients with AECRS with an area under the curve of 0.870 (95% CI = 0.784-0.955). Prediction of microbial functional pathways involved significantly enhanced lipopolysaccharide biosynthesis pathways and significantly decreased folate biosynthesis, sulfur relay system, and cysteine and methionine metabolism pathways in patients with AECRS. The rare nasal microbiota (MRA < 1%) correlated with disease status and disease severity in patients with AECRS. The knowledge about the pattern of the nasal microbiome and its metabolomic pathway may contribute to the fundamental understanding of AECRS pathophysiology.

Treatment of severe flares in Crohn's disease and ulcerative colitis

In chronic inflammatory bowel diseases (IBD), severe flares are characterized by intense inflammatory activity and ahigh disease burden for patients. Treatment addresses both short-term goals (e.g., symptom reduction, prevention of complications) and long-term goals (sustained clinical steroid-free remission and healing of inflammatory lesions, known as "mucosal healing"). To present evidence-based, targeted diagnostics and stepwise treatment of severe flares in Crohn's disease (CD) and ulcerative colitis (UC), in order to prevent complications, including mortality, and to achieve rapid remission. Selective literature review, including German and European guidelines for the treatment of severe flares. After ruling out complications (e.g., infections, strictures, abscesses, toxic megacolon), based on astructured assessment of disease severity, intravenous steroid therapy is indicated in severe acute flares for both CD and UC, which should lead to improvement within the first 72 h. If no improvement occurs, medical therapy must be intensified. Various therapeutics, including biologics targeting tumor necrosis factor (TNF)-α, α4ß7 integrins, interleukin (IL)-12/23 or IL-23, as well as Janus kinase (JAK) inhibitors, sphingosine 1‑phosphate receptor (S1PR) modulators, and calcineurin inhibitors, are available today, but there is no clear algorithm preferring one drug for CD or UC. Instead, treatment should be selected based on approvals, the patient's medical history, prior treatment, risk profile, and potential complications. Surgical options must always be considered as part of close interdisciplinary care.

New Intestinal Ultrasound Score for Assessing Inflammatory Bowel Disease Activity and Identifying Severity.

The purpose of this study is to propose new ultrasound scores to assess inflammatory bowel disease (IBD) activity and to analyze their accuracy in assessing disease severity. In addition to this, to validate that intestinal ultrasound can be used as a follow-up tool for the assessment of IBD. One hundred and thirty-six adult IBD patients who underwent intestinal ultrasound. Patients were divided into two groups based on colonoscopic findings: 93 patients with UC, 43 patients with CD. UC patients and CD patients were divided into active and inactive groups based on colonoscopic findings, respectively. After forming scores, cut-off values, sensitivity, and specificity were calculated using receiver operating characteristic (ROC) analysis, respectively. Both in UC patients and in CD patients, bowel wall thickness (BWT) and vascular index (VI) were much higher in the active group compared with the inactive group, CEUS mode III, IV, CDFI grades 3-4, fat wrapping, and lost stratification were more likely to imply active disease. In UC patients only, Young's modulus value was much higher in the active group compared with the inactive group. The new intestinal ultrasound scores can be used to assess UC and CD activity and may be useful in identifying severe endoscopic activity in IBD.

Redefining the severity of orofacial tissue damage caused by noma: a novel classification approach.

Noma is a severe orofacial disease with high mortality and morbidity. Although severity scales exist, they fail to fully capture the extent of damage caused by the disease. This study analysed 404 photos of 260 noma cases from Facing Africa (n=228) and Project Harar (n=32) to create a new severity classification system. Photos were displayed on a large screen for better visualization. Tissue damage was assessed in terms of width, depth and surface area using the American Burn Association's grading system. A mathematical formula was also developed to quantify the extent of noma-induced orofacial damage. Fifteen orofacial anatomical units vulnerable to noma were identified, leading to the development of a new severity classification system that enhances the assessment of noma. This system evaluates tissue damage qualitatively as minor, moderate or major and quantitatively using a purpose-built mathematical formula. Current classification systems inadequately capture noma severity due to vague definitions and limited consideration of the affected anatomical units. The new approach addresses these gaps by considering all tissue damage, including dentition, and allows for precise qualitative and quantitative assessment of disease severity. Continued research and validation are essential to refine this method, improving its clinical and research applications and enhancing outcomes for noma patients worldwide.

Coronary health index based on immunoglobulin light chains to assess coronary heart disease risk with machine learning: a diagnostic trial.

Recent studies suggest a connection between immunoglobulin light chains (IgLCs) and coronary heart disease (CHD). However, current diagnostic methods using peripheral blood IgLCs levels or subtype ratios show limited accuracy for CHD, lacking comprehensive assessment and posing challenges in early detection and precise disease severity evaluation. We aim to develop and validate a Coronary Health Index (CHI) incorporating total IgLCs levels and their distribution. Additionally, we aim to evaluate its effectiveness by integrating patient data and using machine learning models through diagnostic trial. The CHI was developed and combined with other clinical data. Nine machine learning models were screened to identify optimal diagnostic performance, with the XGBoost model emerging as the top performer. Performance was assessed based on accuracy, sensitivity, and its ability to identify severe CHD cases characterized by complex lesions (SYNTAX score > 33). The XGBoost model demonstrated high accuracy and sensitivity in diagnosing CHD, with an area under the curve (AUC) of 0.927. It also accurately identified patients with severe CHD, achieving an AUC of 0.991. An online web tool was introduced for broader external validation, confirming the model's effectiveness. Combining the CHI with the XGBoost model offers significant advantages in diagnosing CHD and assessing disease severity. This approach can guide clinical interventions and improve large-scale CHD screening.

The Diagnosis and Treatment of Branch Retinal Vein Occlusions: An Update.

Branch retinal vein occlusion (BRVO) is a common retinal vascular condition and a significant contributor to vision loss worldwide, particularly in middle-aged and elderly populations. This review synthesizes current knowledge on the epidemiology, pathogenesis, and clinical features of BRVO, alongside recent advancements in diagnostic and therapeutic strategies. BRVO is approximately four times more prevalent than central retinal vein occlusion (CRVO) and often leads to significant vision impairment. By focusing on BRVO, this review aims to address the specific challenges and advancements in its diagnosis and management. The pathophysiology of BRVO is complex, involving factors such as venous compression, inflammation, and increased levels of vascular endothelial growth factor (VEGF). Diagnostic approaches such as optical coherence tomography (OCT) and fluorescein angiography are highlighted for their roles in assessing disease severity and guiding treatment decisions. Therapeutic interventions, including laser photocoagulation, anti-VEGF therapy, and intravitreal corticosteroids, are critically evaluated, emphasizing emerging treatments such as gene therapy, peptide-based agents, and small-molecule inhibitors. Despite advancements in management strategies, the recurrence of macular edema and treatment resistance remain significant challenges. Continued research is essential to refine therapeutic protocols and improve long-term visual outcomes for patients with BRVO.

Epidemiological Characteristics and Prognostic Scoring in Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome: Insights from a 17-Year Burn Center Experience.

Background and Objectives: Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare yet life-threatening dermatologic conditions characterized by severe skin and mucous membrane involvement. Accurate prognostic systems are crucial for clinical management to assess disease severity and predict outcomes. The primary objective of this study was to assess the epidemiological characteristics and clinical outcomes of patients with Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap over a 17-year period at a specialized burn center. The secondary objectives were to evaluate the performance of existing prognostic scoring systems (SCORTEN, Re-SCORTEN, and ABCD-10) in predicting mortality and to propose a novel classification tree model to improve mortality prediction. Materials and Methods: A 17-year retrospective study at a burn center included 68 patients with SJS, SJS/TEN overlap, or TEN. Demographic, clinical, laboratory data, and prognostic scores (SCORTEN, Re-SCORTEN, ABCD-10) were collected and analyzed for associations with mortality. A classification tree was created to detect unknown determinants of SJS/TEN mortality. Results: The drug most frequently associated with the occurrence of SJS/TEN was metamizole. The mortality rate was 51%. Affected body surface area, platelet count, and serum blood urea nitrogen differed significantly between survivors and non-survivors. Regarding the scoring systems, only the Re-SCORTEN showed reliable differentiation for these groups. A classification tree model achieved an accuracy of 89% in predicting the mortality risk. In the ROC curve analysis, the AUC values were 0.88 for the classification tree, 0.66 for Re-SCORTEN, 0.61 for SCORTEN, and 0.56 for ABCD-10. Conclusions: This study explores mortality predictors in SJS/TEN via a classification tree model, highlighting potential factors for further investigation. While cautioning against immediate clinical application due to data constraints, the findings underscore the need for larger studies to validate and refine prediction models in this context.

Field-scale detection of Bacterial Leaf Blight in rice based on UAV multispectral imaging and deep learning frameworks.

Bacterial Leaf Blight (BLB) usually attacks rice in the flowering stage and can cause yield losses of up to 50% in severely infected fields. The resulting yield losses severely impact farmers, necessitating compensation from the regulatory authorities. This study introduces a new pipeline specifically designed for detecting BLB in rice fields using unmanned aerial vehicle (UAV) imagery. Employing the U-Net architecture with a ResNet-101 backbone, we explore three band combinations-multispectral, multispectral+NDVI, and multispectral+NDRE-to achieve superior segmentation accuracy. Due to the lack of suitable UAV-based datasets for rice disease, we generate our own dataset through disease inoculation techniques in experimental paddy fields. The dataset is increased using data augmentation and patch extraction methods to improve training robustness. Our findings demonstrate that the U-Net model incorporating ResNet-101 backbone trained with multispectral+NDVI data significantly outperforms other band combinations, achieving high accuracy metrics, including mean Intersection over Union (mIoU) of up to 97.20%, mean accuracy of up to 99.42%, mean F1-score of up to 98.56%, mean Precision of 97.97%, and mean Recall of 99.16%. Additionally, this approach efficiently segments healthy rice from other classes, minimizing misclassification and improving disease severity assessment. Therefore, the experiment concludes that the accurate mapping of the disease extent and severity level in the field is reliable to accurately allocating the compensation. The developed methodology has the potential for broader application in diagnosing other rice diseases, such as Blast, Bacterial Panicle Blight, and Sheath Blight, and could significantly enhance agricultural management through accurate damage mapping and yield loss estimation.

Predictive Value of Lung Ultrasound Scores Combined with Serum ANGPTL4 Levels on Severity and Prognosis of Neonatal Respiratory Distress Syndrome.

Respiratory distress syndrome threatens neonates' life. This study probed the predictive value of lung ultrasound scores combined with serum angiopoietin-like protein 4 (ANGPTL4) levels on neonatal respiratory distress syndrome (NRDS) severity and prognosis. The NRDS group (n = 115) and control group (n = 30) were established. In both groups, lung ultrasound scores and serum ANGPTL4 levels, lung ultrasound scores and serum ANGPTL4 levels of newborns with NRDS of different severity, the risk factors affecting the poor prognosis of NRDS neonates, and the value of serum ANGPTL4 levels combined with lung ultrasound scores in determining the severity and prognosis of newborns with NRDS were analyzed. The NRDS groups had higher lung ultrasound scores and serum ANGPTL4 levels, and lower Apgar scores than the control group; lung ultrasound scores and serum ANGPTL4 levels were higher in the moderate and severe groups than in the mild group, and those were higher in the severe group than in the moderate group (all p < 0.05). The logistic regression analysis showed that high lung ultrasound scores, and high serum ANGPTL4 levels were risk factors for NRDS poor prognosis (OR > 1, p < 0.05), and high Apgar scores are the protective factor for poor prognosis in NRDS neonates (OR < 1, p < 0.05). The area under the curve of lung ultrasound scores combined with serum ANGPTL4 levels to assess the severity and prognosis of NRDS neonates exhibited a higher assessed value than the single test. Lung ultrasound scores and serum ANGPTL4 levels are closely related to the severity and prognosis of NRDS neonates, and the combination of the two improves the assessed value of the severity and prognosis of NRDS neonates. The study provided a reference for the disease severity assessment of NRDS and the prediction of its prognosis.

Genomic profiling of interferon signaling pathway gene mutations in type 2 diabetic individuals with COVID-19

Abstract Objectives Comorbidities, especially diabetes, significantly contribute to the mortality and morbidity of COVID-19. Studies indicate higher rates of mortality and morbidity among diabetic COVID-19 patients compared to the general population. However, the precise mechanisms underlying this immune response remain incompletely understood. Our study aimed to explore potential disparities in COVID-19 prognosis among type 2 diabetic patients and investigate the genomic-level relationship between key proteins of the interferon signaling pathway: IFNAR1, IFNAR2, IRF3, and IRF7. Methods Mutation/polymorphism analysis was conducted to identify potential mutations and polymorphisms in the study group. Predictive assessments of mutation pathogenicity were performed using the PolyPhen-2 bioinformatics tool, while STRING network analysis enhanced our understanding of functional protein relationships in cellular processes. Results We detected 10 mutations (3 missense, 2 intronic, 2 indel, 1 nonsense, 1 regulatory, and 1 frameshift mutation), all documented in the Human Gene Mutation Database. PolyPhen2 analysis flagged three missense and 1 nonsense mutations as potential pathogens. The study found no consistent trend in mutation rates across all genes. However, mutation rates in the IFNAR2 and IRF7 genes decreased as disease severity lessened in both patient and control groups. Diabetic and Covid-19 patients exhibited higher mutation rates in the IFNAR2, IRF3, and IRF7 genes compared to non-diabetic controls, suggesting that Type 2 diabetic patients might be more susceptible to genetic mutations when infected with COVID-19. Conclusions Understanding these genetic profiles could improve disease severity assessments, enhance preventive measures, and aid in developing effective treatment strategies for coronaviral syndromes and severe acute respiratory infections.

The Role of Rotational Thromboelastometry in Early Detection of the Hemostatic Derangements in Neonates with Systemic Candida Infection.

Systemic Candida infection (SCI) is the third most common cause of late-onset sepsis in Neonatal Intensive Care Units (NICU). While platelet involvement in fungal infections has been extensively studied, evaluation of the hemostatic mechanism in Candida infections, especially in neonates, has not been widely investigated. The aim of the current study was to evaluate the hemostatic profile of neonates with SCI through rotational thromboelastometry (ROTEM), a laboratory method that assesses the viscoelastic properties of blood. This is a single-centered prospective cohort study including a group of neonates with SCI (n = 21); the control group consisted of healthy neonates (n = 24). Demographics, clinical parameters, and laboratory data were recorded at the disease onset. Neonatal scores for the assessment of disease severity (Modified NEOMOD, nSOFA, and NeoBAT) were also calculated. ROTEM parameters of neonates with SCI were compared to those of healthy neonates. ROTEM parameters differed between neonates with SCI and healthy neonates, indicating a hypocoagulable profile of infected neonates. Specifically, neonates with SCI had significantly prolonged clotting time (CT) and clot formation time (CFT), as well as lower clot amplitude at 10 min (A10) and maximum clot firmness (MCF) when compared to healthy neonates (p values < 0.05), findings that remained consistent after adjusting for confounding factors such as gestational age, birth weight, and sex. In addition, a strong correlation was noted between ROTEM parameters and disease severity based on the modified NEOMOD, nSOFA, and NeoBAT scores. ROTEM parameters revealed a hypocoagulable profile in neonates during the early stages of SCI, which is also associated with disease severity. The results of this study highlight the need for monitoring of hemostatic status of this vulnerable group of patients and indicate that ROTEM analysis may have a role in the early detection of the hemostatic derangements associated with SCI in neonates, in order to ensure timely diagnosis and targeted therapeutic intervention.

Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) : A narrative review.

Vestibular migraine (VM) has a wide range of clinical presentations that can have a significant negative impact on quality of life. Currently, there is no objective test available to confirm the diagnosis or measure the severity of VM. The only available tools for assessing disease severity are patient-reported outcome measures (PROMs), such as the Dizziness Handicap Inventory (DHI). This manuscript aims to summarize the current knowledge about a newly developed PROM called the Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI). A comprehensive search was conducted across the Web of Science, Scopus, PubMed, and Google Scholar databases up to February 2024, using the keywords "Vestibular migraine," "VM-PATHI," and "Patient-Reported Outcome Measure." Only studies involving human participants were included, and no additional restrictions were applied. The reference lists of included studies were also reviewed to identify other eligible studies. The main outcome of interest was the evaluation of VM-PATHI in patients with VM. The VM-PATHI is a 25-item questionnaire divided into six sections: headache equivalents, motion sensitivity, anxiety, cognition, disequilibrium/central audiovestibular disturbance, and emotion/sense of being overwhelmed. This tool has demonstrated good face and content validity, discriminant validity, responsiveness, test-retest reliability, and internal reliability (Cronbach's α: 0.92). Patients with VM are likely to show clinical improvement in symptoms if their VM-PATHI scores decrease by ≥6 points. Additionally, VM-PATHI has shown a good correlation with clinical improvement across various treatment modalities. The VM-PATHI may provide advantages over other PROMs by measuring a wider spectrum of disease-specific effects of VM. Scores are correlated with the DHI, dizzy days per month, and other quality of life metrics.

Outcomes Associated With Blastomycosis in Solid Organ and Hematopoietic Cell Transplant Recipients.

With reports of expanding epidemiology of blastomycosis across the United States, the purpose of this study was to evaluate the incidence and outcomes associated with blastomycosis in solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients. We conducted a retrospective case series of adult SOT and HCT recipients at a tertiary care medical center between January 1, 2005 and September 30, 2023. Cases were defined as culture-proven blastomycosis. We performed descriptive statistical analysis to evaluate diagnosis, management, and outcomes (mortality) of blastomycosis in SOT. The cumulative incidence of blastomycosis was 0.11% with a median time to infection following transplant of 743 days. Of the 19 cases, the majority of patients were SOT recipients (90%). Supratherapeutic immunosuppression within 30 days of diagnosis was observed in 42% of cases with documented drug monitoring. Urine antigen testing was highly sensitive (100%). Fourteen (73.7%) patients received induction therapy with liposomal amphotericin B followed by azole therapy for a minimum of 12 months. Despite appropriate treatment, 1-year mortality was high at 26.3%, with attributable mortality of 21.1%. While rates of blastomycosis remain low among SOT and HCT recipients, infection is associated with poor posttransplant outcomes. Antigen testing can aid in timely assessment of disease severity and initiation of appropriate therapy. Among survivors, no relapses were observed while on lifelong secondary suppression. Future studies should aim to better define risk factors associated with developing blastomycosis and establish effective strategies for prevention.

Could Residents Adequately Assess the Severity of Skin Lesions in Mycosis Fungoides/Sézary Syndrome? Evaluation of Interrater Agreement and Interrater Reliability of mSWAT.

Background/Objectives: Cutaneous T-cell lymphoma (CTCL), including Mycosis fungoides (MF) and Sézary syndrome (SS), is a challenging-to-diagnose lymphoproliferative malignancy characterized by T-cell dysfunction and progressive cutaneous and extra cutaneous involvement. Disease severity assessment in CTCL is crucial for guiding treatment. This study aims to evaluate the interrater agreement and interrater reliability of mSWAT among dermatology residents and identify lesion types most prone to scoring variability. Methods: Sixteen dermatology residents with varied experience levels assessed 14 patients with confirmed MF/SS diagnoses. Using mSWAT, residents independently scored lesions severity on a standardized set of patient's photos. The results were compared with reference mSWAT scores provided by an experienced clinician. Descriptive statistics and the Shapiro-Wilk test were applied to evaluate data distributions, while Student's t-test assessed score deviations from reference values. Furthemore, we conducted a pilot the high frequency ultrasound (HFUS) study on a single patient, whose mSWAT score and photographs are also presented in the manuscript. Results: Significant discrepancies were observed in 64.29% of cases (9/14), with tumors and infiltrative lesions in erythrodermic SS patients posing particular scoring challenges. Misclassification of tumors as patches or plaques was a frequent issue, leading to underestimations in mSWAT scores. Residents' assessments of infiltrative lesions were also notably inconsistent. Conclusions: This study highlights significant interobserver variability in mSWAT scoring among less experienced dermatology residents, particularly with tumor and erythrodermic lesions. Findings underscore the need for enhanced training and standardized scoring protocols to improve mSWAT reliability. Similar to other comparable indices, such as PASI, the mSWAT should be employed consistently by the same physician during each assessment to systematically monitor and evaluate the skin condition of a patient under observation. However, broader application requires the acquisition of sufficient experience. The study suggests the use of the HFUS as an objective method of assessment of the skin lesion infiltration in MF/SS patients.