Prospective Case-control Study Research Articles

Role of CD64 and myeloperoxidase as biomarkers for early diagnosis of sepsis in pediatric intensive care unit

Globally, sepsis is the primary cause of death for children. While research conducted on adults has a significant impact on the diagnosis and treatment of sepsis in newborns and young children, there are significant factors that are pertinent to pediatrics as well. This prospective case-control study was conducted during the period from August 2020 to October 2022 after approval by the institutional ethical committee. The study included 48 critically ill children admitted at the Pediatric intensive care unit and 30 apparently healthy children as a control group. Laboratory investigations including complete blood picture, C-reactive protein (CRP), blood culture and sensitivity and plasma level of cluster of differentiation 64 (CD64) and myeloperoxidase (MPO) were investigated for all participants. A daily follow up for the signs of systemic inflammatory response syndrome (SIRS) or sepsis was done, and the patients were divided into SIRS and non-SIRS subgroups then patients were divided into two groups according to the presence of severe sepsis. A follow up CD64 and MPO sample were withdrawn from them to assess their prognostic value. SIRS was reported in 39.58 % of patients while severe sepsis was reported in 20.8%. CD64 and MPO were significantly higher in cases than controls (p= 0.003, p<0.001, respectively) and, in patients with SIRs and severe sepsis CD64 was 1559.00± 367.09 pg/ml and 1547.9 4± 436.14 pg/ml, respectively. Also, MPO was significantly higher in patients with SIRS (113.58± 25.19 mU/ml) and severe sepsis (111.70± 26.50 mU/ml). CD64 and MPO significantly increased after development of sepsis in admitted patients. ROC was significantly higher for CD64 and MPO at admission than that for CRP at admission (p=0.123, p=0.014, respectively). In conclusion, plasma level of CD64 and MPO in peripheral blood can be considered an early sensitive marker for the detection and follow up of pediatric sepsis.

White matter spinal tracts impairment in patients with degenerative cervical myelopathy evaluated with the magnetization transfer saturation MRI technique.

Prospective case-control study. We investigated the use of the magnetization transfer saturation (MTsat) technique to assess the structural integrity of the spinal cord tracts in individuals with clinically significant degenerative cervical myelopathy (DCM) and associated disability. Novosibirsk Neurosurgery Centre, Russia. A total of 53 individuals diagnosed with DCM and 41 patients with cervical radiculopathy underwent high-resolution MRI of the cervical spinal cord via the magnetization transfer technique. The MRI data were processed using the Spinal Cord Toolbox (v5.5), with MTsat values determined for each spinal tract and compared between the two groups. Furthermore, associations between MTsat values and the clinical disability rates of patients were investigated. A significant decrease in the MTsat of the ventral spinocerebellar tract was observed in the DCM group compared to the control group (adjusted p < 0.001). There was a trend towards lower MTsat values in the rubrospinal tract in the DCM group (adjusted p = 0.08). Additionally, a decrease in MTsat values in the lateral funiculi of the spinal cord was found in patients with DCM (adjusted p < 0.01). Furthermore, a trend toward a positive correlation was observed between the JOA score and the MTsat values within the ventral spinocerebellar tract (R = 0.33, adjusted p = 0.051). The findings of our study indicate that demyelination in patients with DCM affects mainly the ventral spinocerebellar and rubrospinal tracts, and the extent of changes in the ventral spinocerebellar tract is related to the severity of the condition.

Evaluation of the Effect of Phacoemulsification Surgery on Retinal and Choroidal Microvasculature in Diabetic Patients Using Optical Coherence Tomography Angiography

Abstract Aim To evaluate the effect of phacoemulsification surgery on retinal and choroidal microvasculature in diabetic patients using optical coherence tomography angiography. Settings and Design A prospective comparative case control study performed at the Ophthalmology department of Ain Shams University hospital, between November 2020 and November 2022. Methods and Material 50 eyes of 35 cataractous patients were included in this prospective study divided into two groups: the control group (25 eyes of 19 patients) and the diabetic group (25 eyes of 16 patients with mild non proliferative diabetic retinopathy). All patients underwent routine ophthalmic examination, OCT and OCTA scans of the macula before phacoemulsification surgery and 1week 1month, 3months and 6months after the surgery. Results The BCVA significantly improved in both group by ∼ 0.26 logMAR units in control and diabetic groups (p &amp;lt; 0.001 for both). the mean change in CST was 23.44±43.7 vs 13.6±22 um (p = 0.3) in the control group and the diabetic group, respectively but statistically insignificant. There was insignificant change in each group in all vascular parameters during the follow up period. In addition, there was insignificant difference between 2 groups at each visit in most vascular parameters of SVD, DVD, and choriocapillaris VD. On the other hand, the diabetic groups has significantly lower SVD of whole image and perifovea at 1 week than controls (42.92 ± 4.54 % vs 46.16 ± 3.98 %, p = 0.01 in whole image respectively) (44.29 ± 4.87 % vs 47.32 ± 3.85 %,p=0.018 in perifovea respectively). The diabetic group also showed significantly higher parafoveal DVD than the control group at 1 month postoperatively : 52.67 ± 4.00 vs 47.24 ± 9.85 % (p = 0.014) that levelled up on month 3 and 6 (p = 0.397, 0.538 respectively). the diabetic group showed lower CC VD of whole image than the control group at 1 week postoperatively: 70.60 ± 2.87 vs 72.22 ± 1.98 % respectively (p = 0.025), and also significantly lower CC VD of perifovea than the control group at 1 week: 71.19 ± 2.82 vs 72.72 ± 2.20 % (p = 0.038), 1 month: 71.08 ± 2.87 vs 72.78 ± 2.61 % (p = 0.033) and 3 months: 71.35 ± 2.63 vs 72.83 ± 2.52 %(p = 0.048). Those values levelled up at the last postoperative visit at month 6 (p = 0.152). Conclusion Phacoemulsification surgery may lead to the transient and mild reduction of choroidal blood flow in diabetic eyes rather than retinal blood flow. Most of choroidal and retinal vascular change happened in the perifoveal area within 1 week to 1 month postoperatively and rarely extended to 3months. Further research is needed to detect its influence on diabetic retinopathy progression.

Corneal topographic changes in thyroid eye disease

Background Thyroid eye disease (TED) causes lid retraction, extraocular muscle enlargement, and tear film changes, which can affect corneal topography. Aim To assess the corneal topographic changes associated with TED and relate these changes to disease activity and severity. Patients and methods This prospective cross-sectional case-control study was carried out on 50 eyes of 25 patients aged less than or equal to 50 years old, both sexes, diagnosed with TED and present or past serological evidence for thyroid disease (TED group). Patients were divided into two groups: the TED group: 30 eyes of 15 patients with TED and the control group: 20 eyes of 10 patients with age-matched and sex-matched without TED. Results In the TED group, axial proptosis was negatively correlated with minimal corneal thickness. Both upper and lower lid infrared meibography showed a positive correlation with axial proptosis. Active patients had considerably greater Baiocchi-Calossi-Versaci front and upper lid meibomian glands loss than inactive cases. In moderate to severe instances, upper and lower lid meibomian gland loss was much greater than in mild cases. Baiocchi-Calossi-Versaci front, Baiocchi-Calossi-Versaci back, Baiocchi-Calossi-Versaci total, and meibomian glands loss were considerably greater in TED than the control group. The TED group had significantly lower flat, steep, and average keratometry than the control group. Conclusion Corneal anterior surface flattening is the most characteristic topographic change in TED not related to disease activity or severity. TED increases meibomian gland loss, which is a major factor of ocular surface alteration in TED.

Difference in risk factor profile for abdominal aortic aneurysm and thoracic aortic aneurysm

ObjectivePrevious studies suggest partly different risk factor profiles of thoracic aortic aneurysms (TAAs) and abdominal aortic aneurysms (AAAs), but prospective data are scarce. The purpose of this prospective population-based case-control study was to investigate differences in risk factor profile between TAAs and AAAs. MethodsParticipants in two prospective population-based studies, the Västerbotten Intervention Project (VIP) and the Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, between 1986 and 2010, underwent cardiovascular risk assessments, including blood samples, oral glucose tolerance test, blood pressure readings, and a self-reported health questionnaire. All individuals who were later diagnosed with TAAs or AAAs were identified. Age, sex, and time-matched controls were selected from the same cohorts, aiming at four controls/case. Adjusted odds ratios (aORs) for potential risk factors for later diagnosis of TAAs and AAAs, respectively, were estimated by multivariate conditional logistic regression analyses. ResultsFrom a total of 96,196 individuals with prospectively collected data in the VIP/MONICA cohort, a total of 236 individuals with AAAs (181 men and 55 women) and 935 matched controls, and 168 individuals with TAAs (115 men and 53 women) and 662 controls were included. The average age at baseline examination was 57.0 ± 5.7 years for AAA cases and controls, and 52.1 ± 8.8 years for TAA cases and controls. Mean time between baseline examination and diagnosis of AAAs/TAAs was 12.1 and 11.7 years, respectively. There was a clear difference in risk factor profile between AAAs and TAAs. Smoking, hypertension, and coronary artery disease were significantly associated with later diagnosis of AAAs, with highest aORs for a history of smoking (aOR, 10.3; 95% confidence interval [CI], 6.3-16.8). For TAAs, hypertension was the only positive risk factor (aOR, 1.7; 95% CI, 1.1-2.7), whereas smoking was not associated. Diabetes was not associated with either AAAs or TAAs; neither was self-reported physical activity. ConclusionsIn this prospective, population-based, case-control study, risk factor profile differed between AAAs and TAAs. This suggests a partially different etiology for TAAs and AAAs.

Pancreatic Ultrasound in High-risk Neonates

Pancreatic ultrasound is employed to assess the structure of the organ and diagnose various conditions. However, analyses of pancreatic images of high-risk newborn infants are scarce.Aim of the study: to investigate pancreatic echogenicity in high-risk neonates and evaluate the association between pancreatic echogenicity and clinical diagnosis.Materials and methods. This prospective observational case-control ultrasound study included 105 neonates admitted to the neonatal intensive care unit or outpatient. The patients were divided into two groups: group 1 (high-risk), which included 55 high-risk neonates, and group 2 (control), which included 50 neonates of comparable age with no history of high-risk pregnancy or delivery who were presented for medical consultation. Abdominal ultrasound examinations were performed, with a focus on the pancreas. Pancreatic echogenicity was classified as hyperechoic, isoechoic, or hypoechoic, relative to the liver.Results. No significant difference in pancreatic size was observed between the high-risk and control groups. A significant predominance of hyperechogenicity over hypoechogenicity or isoechogenicity was found in the high-risk group. A significant difference in echogenicity was found between the high-risk and control groups (P=0.0001). Neonates in the control group were more likely to have pancreatic isoechogenicity (60%) compared to hyperechogenicity (34%) or hypoechogenicity (6%). In the high-risk group, neonates had a higher frequency of pancreatic hyperechogenicity (72.72%) compared to hypoechogenicity (10.9%) or isoechogenicity (16.36%). Notably, 83.3% of infants born to diabetic mothers had a hypoechogenic pattern. Certain high-risk infants, such as preterm infants and those with perinatal asphyxia, had a higher frequency of hyperechogenicity (83.3%). The percentage of hypoechoic pattern was comparable in male and female newborns (50%); isoechoic pattern was more prevalent in females (77.3%) than in males (22.2%), while males had a more frequent hyperechoic pattern (57.5%).Conclusion. Evaluation of the pancreas in high-risk neonates and monitoring of long-term outcomes are of critical importance, especially in the infants of diabetic mothers.

Assessment of Corneal Epithelial Thickness in Dry Eye Patients by OCT

Abstract Background Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film and accompanied by ocular symptoms. Tear film instability and hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities play important role in the etiology of dry eye. Objective To correlate the corneal epithelial thickness and grades of dryness using optical coherence tomography (OCT) in dry eye patients versus normal eye patients. Patients and Methods A prospective case control study was conducted on patients of the outpatient clinic at Ophthalmology department, Faculty of Medicine, Ain Shams University. The study was conducted on patients in middle age group (from 20 to 50 years old of both sexes). The sample size was 30 dry eyes and 30 normal eyes. Results Regarding the AS/OCT-C 5 mm results among the studied patients, we found that Avg. of superior quadrants in Dry eyes group ranged from 47 to 59.6 with mean ± SD = 53.63 ± 3.7 while in Normal eyes group the Avg. of superior quadrants ranged from 49 to 56 with mean ± SD = 52.7 ± 1.93 with no statistical significant difference (p = 0.227) between the two groups. Avg. of inferior quadrants in Dry eyes group ranged from 49 to 65.6 with mean ± SD = 55.62 ± 4.35 while in Normal eyes group the Avg. of inferior quadrants ranged from 49 to 56 with mean ± SD = 52.7 ± 1.93 with statistical significant difference (p = 0.002) between the two groups. Regarding Comparison, there was a highly significant difference between the two studied groups (p = &amp;lt;.001). Conclusion There was significant difference Fundus examination, AS/OCT-C 5 mm, highest thickness, AS/OCT-C 2mm and AS/OCT-P 9mm results between dry eye patients and normal subjects.

Role of Soluble Transferrin Receptor and Transferrin Receptor-Ferritin Index to Detect Iron Deficiency Anemia in Regular Hemodialysis Patients

Abstract Introduction Several iron indicators can be used to detect iron deficiency anaemia (IDA) where confounding comorbidities occurred such as patients with regular hemodialysis. Aim of the Study to determine the diagnostic value of sTfR and TfR-F and to combine these two markers in detecting IDA in HD anemic patients. Patients and Methods This is observational prospective case–control study carried on 30 cases &amp;30 controls. IDA was diagnosed based on TS &amp;lt; 20% and ferritin level &amp;lt; 200 ng/L and functional iron deficiency when TS &amp;lt; 20% and ferritin &amp;gt; 200 ng/L. TfR-F index calculated as sTfR/log ferritin. All participants were subjected to full clinical examination&amp; routine laboratory investigations (CBC, RBCs indices, iron profile, serum electrolytes blood urea and creatinine) specific investigations (Serum sTfR was measured with ELISA technique) Results There is statistically significant difference between the two groups as regard sTfR. There were strong significant correlations between TfR-F index and T.SAT, CRP, TIBC and sTfR. In Univariate correlation regression, there were strong significant positive correlations between TfR-F index and T.SAT, CRP, TIBC and sTfR. In Multivariate correlation regression, there were strong significant positive correlations between TfR-F index and T.SAT, CRP, TIBC and sTfR. Sensitivity of sTfR and TfR-F index was 83.5% and 85% respectively. Specificity of sTfR and TfR-F index was 70.1% and 75% respectively. Conclusion When sTfR and the TfR-F index used in combination to detect IDA, we found that sensitivity of sTfR and TfR-F index was 83.5% and 85% respectively. Specificity of sTfR and TfR- F index was 70.1% and 75% respectively.

Assessment of salivary and serum leptin in tobacco smokers and oral squamous cell carcinoma-A case-control study

ObjectivesOral squamous cell carcinoma (OSCC) is the most common head and neck malignancy and tobacco-related cancers account for a significant portion of all oral cancers. Cancer patients often suffer from cachexia, which contributes significantly to mortality. Leptin is a protein released by adipocytes identified to play an important role in obesity and inflammation. The present study aimed to quantify and compare salivary and serum leptin in tobacco smokers and OSCC. Materials and MethodsThe present prospective case-control study enrolled 42 subjects divided equally among OSCC and tobacco smokers without oral lesions (TS). Both saliva and blood were collected from each subject and leptin levels were determined using enzyme-linked immunosorbent assay. The data obtained were analysed using Mann Whitney U, Kruskal Wallis, Friedman, and Spearman correlation tests (p < 0.05). ResultsA significant reduction in both salivary and serum leptin levels in OSCC was observed (p < 0.001, 0.002 respectively). In addition, significant reductions in weight and body mass index were also observed during follow-ups at 3, 6, and 9 months (p < 0.001 for both). ConclusionsReduced salivary and serum leptin levels in OSCC proved that it is an important diagnostic marker, with non-invasive saliva measurement being more patient-friendly. Future multicentric studies with higher samples in OSCC subgroups are warranted. Clinical RelevanceLeptin reduction in oral squamous cell carcinoma proved to be an important diagnostic marker. Non-invasive salivary techniques could be employed in mass screening programmes. The significant correlation between leptin and BMI also shed insight into the overall well-being of the patient.

Metabolomics of basal tears in amyotrophic lateral sclerosis: a cross-sectional study

PurposeAmyotrophic lateral sclerosis (ALS) clinical variability, along with the lack of conclusive diagnostic instruments, result in average diagnosis delays of 9 months. This study aimed to assess whether metabolomic profiling of basal tears in ALS patients could act as a biological marker for diagnosing ALS, predicting prognosis, and discriminating between endophenotypes. MethodsA single-center prospective case-control study was conducted in France from September 2021 to March 2023 including patients with ALS according to the revised EI Escorial criteria. Two microliters of basal tears were collected using microcapillary glass tubes and analyzed with ultra-high performance liquid chromatography coupled with mass spectrometry. Both univariate and multivariate analyses were performed. ResultsTwenty-five patients with ALS and 30 controls were included. No significant differences in metabolite levels were found between ALS and control groups (p>0.05). The basal tear metabolome significantly discriminated bulbar and spinal forms of ALS based on 6 metabolites, among which 5 were decreased (aniline, trigonelline, caffeine, theophylline and methyl beta-D-galactoside) in the bulbar form and 1 was decreased in the spinal form (dodecanedioic acid). ConclusionThis study represents the first prospective analysis of basal tear metabolomics in individuals with ALS. Despite the inability to distinguish between ALS patients and controls based on metabolic signatures, these findings could contribute to understanding the phenotypic diversity of ALS. Notably, distinct metabolic profiles were identified that differentiate between the bulbar and spinal forms of the disease.

Circulating MicroRNA as a Potential Biomarker for Skeletal Disease in Primary Hyperparathyroidism: A Case-control Study.

The goal of this study was to characterize the microRNA (miRNA) expression signatures in patients with Primary hyperparathyroidism (PHPT) and identify miRNA biomarkers of bone homeostasis. PHPT is associated with increased bone turnover and decreased bone mass. miRNA are markers of bone remodeling. We performed a prospective case-control study of postmenopausal females with PHPT and control subjects matched for race, age, and bone mineral density (BMD). We collected clinical and biochemical data, assessed BMD by dual-energy x-ray absorptiometry, and measured 27 serum miRNAs related to bone remodeling. We used linear regression to assess the correlation between miRNA levels, conventional biochemical markers, and BMD. A total of 135 subjects were evaluated, including 49 with PHPT (discovery group), 47 control patients without PHPT, and an independent validation cohort of 39 PHPT patients. Of 27 miRNAs evaluated, 9 (miR-335-5p, miR-130b-3p, miR-125b-5p, miR-23a-3p, miR-152-3p, miR-582-5p, miR-144-5p, miR-320a, and miR-19b-3p) were differentially expressed in PHPT compared with matched control subjects. All 9 differentially expressed miRNAs significantly correlated with levels of serum parathyroid hormone (PTH), and 8 of the 9 correlated with calcium levels. No differentially expressed miRNAs were consistently correlated with markers of BMD. Subjects with PHPT segregate from controls based on the signature of these 9 miRNAs on principle component analysis. These data suggest that PHPT is characterized by a unique miRNA signature that is distinct from postmenopausal and idiopathic osteoporosis. Levels of specific miRNAs significantly correlate with PTH, suggesting that bone remodeling in PHPT may be mediated in part by PTH-induced changes in miRNA.

Evaluation of cardiac remodeling in pediatric chronic kidney disease by cardiovascular magnetic resonance

BackgroundChildren with chronic kidney disease (CKD) are at high risk of cardiovascular disease. Cardiovascular magnetic resonance (CMR) is the reference method for assessing cardiac remodeling. To our knowledge, no study has reported a comprehensive analysis of left ventricular(LV) cardiac remodeling using CMR in different stages of pediatric CKD. This prospective case-control study aimed to investigate cardiac remodeling in pediatric CKD, using CMR, and determine its relationship with risk factors.MethodCMR was performed in 124 children with CKD and 50 controls. The cardiac remodeling parameters included left ventricular mass index (LVMI), LV remodeling index (LVRI), and LV wall thickness. Univariable and multivariable analyses were performed to assess the cardiac remodeling risk factors.ResultsCardiac remodeling was observed in 35.5% (44/124) of children with CKD. The LVMI, LVRI, and LV wall thickness were higher in advanced stages of CKD (P < 0.05). In the CKD stage 1–2 group, a lower in the estimated glomerular filtration rate was an independent determinant of impaired LVMI (β = −0.425, P = 0.019) and LVRI (β = −0.319, P = 0.044). A higher protein to creatinine ratio(PCR) was independently associated with impaired LVRI (β = 0.429, P = 0.022). In the CKD stage 3–5 group, higher in systolic blood pressure (SBP) (β = 0.464, P = 0.005) and PCR (β = 0.852, P = 0.031) were independent determinants of impaired LVMI. Additionally, higher SBP was positively correlated with impaired LVRI(r = 0.599, P < 0.001). There was a trend toward more abnormal cardiac remodeling in the CKD stage 3–5 group with hypertension than those without.ConclusionCardiac remodeling is prevalent in children with CKD, from an early stage. kidney markers are independently associated with cardiac remodeling. Hypertension increases the risk of cardiac remodeling in CKD stages 3–5. Strict BP control may help reverse or prevent remodeling.

Diagnostic Value of Plasma Methylated Septin 9 in Detection of Hepatocellular Carcinoma in Egyptian Patient with post Hepatitis C Liver Cirrhosis in Comparison to Serum Level of Alphafeto Protein

Abstract Background Egypt has the highest hepatitis C virus (HCV) prevalence worldwide. Cirrhosis secondary to HCV is associated with the highest annual risk for developing hepatocellular carcinoma. The burden of HCC has been increasing in Egypt with a doubling in the incidence rate in the past 10 years. HCC contributes to 14.8% of all cancer mortality in Egypt. Most HCCs (80%) arise in a cirrhotic liver, a situation where there has been longstanding hepatocyte damage and chronic inflammation leading to fibrosis. Aim of the Work This study aims to evaluate the diagnostic value of plasma mSEPT9 assay in detection of HCC in Egyptian patients with post hepatitis C liver cirrhosis in comparison to serum level of α-fetoprotein (AFP). Patients and Methods This is a prospective case-control study conducted at the Gastroenterology department in Ain Shams University Hospital. The study population consisted of 80 subjects, divided into three groups: 40 patients with hepatocellular carcinoma, 20 patients with liver cirrhosis, and 20 healthy subjects as controls with matched age and gender. Results The study found that hepatocellular carcinoma (HCC) was more frequent in male patients and that the age of HCC patients was statistically significantly higher than patients with cirrhosis and healthy controls. Patients with HCC and cirrhosis had a higher Child Pugh score than healthy controls. Portal hypertension and portal vein thrombosis were more frequent in HCC and cirrhosis patients than in the control group. Liver enzymes were higher in patients with HCC and cirrhosis compared to healthy controls, while hemoglobin and platelet levels were lower in patients with HCC. Hepatitis C antibody and PCR were positive in HCC and cirrhosis patient groups. AFP and Methylated Septin 9 levels were higher in patients with HCC and cirrhosis than in healthy controls, and AFP had better diagnostic accuracy than Methylated Septin 9. Both AFP and Methylated Septin 9 levels were positively correlated with age, Child Score, liver enzymes, and coagulation profile and negatively correlated with platelet count and hemoglobin level. AFP level was positively correlated with the number of focal lesions and liver size. Conclusion This study demonstrated that plasma Methylated Septin 9 can be a promising noninvasive and circulating epigenetic biomarker for HCC diagnosis at the individual level. However, our results showed that AFP was superior than Methylated Septin 9 in the detection of HCC, Methylated Septin 9 has higher Sensitivity. It was suggested that the combination of plasma mSEPT9 and AFP could enhance the sensitivity of Methylated Septin 9 or AFP alone in the diagnosis of HCC. Further comparative studies with larger sample size and longer follow-up are needed to confirm our results and to identify risk factors of adverse events.

Level of CD11a among Newly Diagnosed ITP Patients and after 6 Months Follow Up

Abstract Background and Objectives Immune thrombocytopenia (ITP) is a relatively frequent acquired bleeding disorders. Etiology is not yet well understood. Lymphocytic function associated antigen-1(LFA-1) might play an important role in signal coordination and lymphocyte activation. The aim of this study was to assess CD11a expression on lymphocytes in newly diagnosed ITP patients and to correlate it with bleeding severity in ITP and to evaluate the effect of immunomodulation medications on CD11a expression in children with ITP. Patients and Methods This is a prospective case-control study enrolling children with ITP attending pediatric Hematology clinic, Ain Shams University Hospitals through November 2021-November 2022 and near equal number of age and sex matched control subjects were randomly selected. All necessary laboratory tests for diagnosis of ITP were performed and the expression of CD11a on lymphocytes was analyzed by flow cytometry at the start of the study and after 6 months of follow up and assessment of bleeding manifestations according to ITP- specific bleeding assessment tool (ITP-BAT). Results Thirty-five patients aged (2-15) years with median age 6.5 years. 21 males and 14 females were enrolled as newly diagnosed primary ITP. The mean platelet count in these patients was 13(103/ul) initially and 239(103/ul) at follow up with response rate of 94.1%. The treatment received in ITP patients was corticosteroid (97.1%),IVIG (11.6%),thrombopoietin receptor agonist (17.4%) and anti CD20 monoclonal antibody (5.8%). The mean fluorescence intensity (MFI) of CD11a was 95.7% initially and 94.7 % at follow up and it was 94.3% in the control group. The mean fluorescence intensity (MFI) of CD11a on lymphocytes showed significant difference in ITP patients initially compared to healthy controls (p value= 0.001) and (MFI) of CD11a on lymphocytes show significant difference between patients before and after treatment (p value=0.001). Conclusion CD11a had a possible role in the pathogenesis of ITP. Immune-modulatory therapy for ITP affects the level of CD11a expression on lymphocytes. CD11a expressions on lymphocytes were not correlated with the platelet counts nor the bleeding score in ITP.

Stress Assessment in Parents of Children With Autism Spectrum Disorder: A Prospective Case-Control Study.

Autism spectrum disorder (ASD) is a disorder that is manageable but has no cure. Therefore, it is associated with parental stress, which is often not given importance. Early identification and holistic management of children with ASD are needed. This prospective case-control study, conducted over 18 months, included 111 newly diagnosed autism cases (ages 2-9) from the Child Development Clinic at Shri Mahant Indiresh Hospital, Dehradun, India, diagnosed as per the International Clinical Epidemiology Network (INCLEN) criteria (DSM-V). Controls were 99 typically developing children from a well-baby clinic. Data collection involved administering the Autism Parenting Stress Scale and a predesigned questionnaire to both cases and controls. Parents with psychiatric or mental health issues were excluded. Parents of children with autism exhibited significantly higher stress scores compared to parents of typically developing children. In our study, out of a total of 210 subjects, 52.9% were diagnosed with autism, while 47.1% were controls.Cases were analyzed based on household and socioeconomic background. It was found that 94.6% of the cases showed significant stress levels. ASDsignificantly impacts parental stress, particularly among families from higher socioeconomic backgrounds and metropolitan areas. This study emphasizes the need for targeted support and interventions to address elevated stress levels and improve family dynamics, especially for parents of higher-functioning children.

Decreased ventricular repolarization variability in one-year-olds of gestational diabetes mothers

BackgroundGestational diabetes mellitus (GDM) is currently the most common medical complication in pregnancy, affecting approximately 13 % of all pregnant women. Although long-term effects on the offspring are still unclear, previous studies indicate ventricular myocardial changes. ObjectivesThe aim of our study was to investigate whether early biomarkers such as QT interval variability (QTV) are sensitive enough to predict these structural changes in children of GDM mothers. MethodsWe focused on children of GDM mothers. Healthy children of mothers without GDM served as controls. All of them were examined at the German Heart Center, Munich, Germany. Heart rate variability (HRV) and QTV measures were extracted from 10 to 15 min Einthoven II electrocardiograms, split into 5 min windows, to characterize the effects of possible autonomic nervous system alterations and cellular ventricular mutations. Results75 children were included in this prospective observational case-control study; 42 of them were children of GDM mothers. The median age at the examination was 12 months (11–13 months). We found decreased QTV as a measure of ventricular repolarization variability in one-year-olds of GDM mothers compared to healthy controls (p < 0.05). ConclusionWe have found increased very low frequency HRV in females and decreased QTV in male children of GDM mothers, which suggests diverse responses and could reflect increased sympathetic tone and altered ventricular myocardium at a cellular level, respectively. Further work is required to understand the long-term significance of these findings in terms of providing an easy-to-use and cost-effective technology for early diagnosis of myocardial damage.

Investigating soluble CD40 ligand as a prognostic factor among acute coronary syndromes patients: A multi-center prospective case-control study.

Soluble CD40 ligand (sCD40L) is a protein that plays a crucial role in the inflammatory response associated with the development and progression of acute coronary syndrome (ACS). Recent studies have suggested that sCD40L may be a useful prognostic factor for ACS, but the data are conflicting. This study aimed to investigate the potential of sCD40L as a prognostic marker among ACS patients and provide valuable insights for clinical practice. To our knowledge, this is the first study of its type in the Arabic World. A multi-center prospective case-control study was conducted in Damascus, Syria, involving 158 participants with different ACS subtypes (STEMI, NSTEMI, UA) and a control group of healthy individuals. Sociodemographic data, medical history, and sCD40L levels were collected. The predictive ability of sCD40L for ACS, STEMI, NSTEMI, and UA was assessed using receiver operating characteristic (ROC) curves. Statistical analysis was performed using IBM SPSS version 25. The study included 58 STEMI, 33 NSTEMI, 36 UA patients, and 30 healthy individuals. The mean age of participants was 55 years (SD 10.7 years). Analysis of sCD40L levels revealed significantly higher concentrations in ACS patients compared to the control group (P < .001). ROC curve analysis demonstrated that sCD40L had a significant predictive ability for ACS, STEMI, and NSTEMI (P < .05), while its predictive value for UA was not statistically significant. This study provides evidence supporting the potential of sCD40L as a prognostic factor in ACS. The elevated levels of sCD40L observed in these subtypes indicate its potential usefulness in risk stratification and predicting adverse cardiovascular events. Further investigations are warranted to establish standardized sCD40L cutoff values and evaluate its clinical implications in the management of ACS patients.

Bikini line one-anastomosis gastric bypass (BLOGB): initial report

BackgroundThis study introduces a new access method for one-anastomosis gastric bypass (OAGB) by placing ports at the bikini line.ObjectiveTo describe our initial experience and assess the feasibility, safety, and effectiveness of this novel access.SettingUniversity Hospital.MethodsThis prospective case–control study included 72 patients: 42 were allocated to the bikini line one-anastomosis gastric bypass (BLOGB) group, and 30 were assigned to the control group. Exclusion criteria included a history of major abdominal surgery, hiatal hernia, extensive lower abdominal adhesions, or a body mass index (BMI) exceeding 55 kg/m2.ResultsThe mean preoperative BMI of the study sample was 40.01 ± 2.84. Weight loss was satisfactory, with the highest percent excess weight loss (%EWL) observed at 12 months: 90.88 ± 7.90 and 91 ± 7.11 (p = 0.474) in both groups, respectively. Both groups showed no significant differences in operative complications, hospital stay, weight loss, or resolution of obesity-associated diseases. However, the BLOGB patients had a longer mean operative time of 110.71 ± 17.72 min compared to 98 ± 18.27 min in the control group (p = 0.002). Moreover, they experienced less postoperative pain and reported greater satisfaction with the appearance of their scars.ConclusionBLOGB was found to be potentially feasible, safe, and effective, offering improved aesthetic outcomes and reduced postoperative pain. This approach may be suitable for a select group of patients concerned with scar appearance. However, large-scale studies are necessary to ensure that safety is not compromised in pursuit of aesthetic benefits.

T cell responses and clinical symptoms among infants with congenital cytomegalovirus infection.

BACKGROUNDCongenital cytomegalovirus (cCMV) infection can cause developmental impairment and sensorineural hearing loss (SNHL). To determine the relationship between immune responses to cCMV infection and neurologic sequelae, T cell responses were compared for their connection to clinical symptoms at birth and neurodevelopmental outcomes.METHODSThirty cCMV-infected and 15 uninfected infants were enrolled in a single-center prospective observational case-control study. T cell pp65-specific cytokine responses; CD57, CD28, and PD-1 expression; and memory subsets were compared.RESULTSInfected neonates (73% symptomatic at birth) lacked pp65-specific cytokine-secreting T cells, with elevated frequencies of CD57+, CD28-, and PD-1+CD8+ T cells and effector memory subsets. Though frequencies overlapped between cCMV symptom groups, asymptomatic infants had higher frequencies of CD57+PD-1+CD8+ T cells. Neonates with subsequent developmental delay lacked detectable CMV-specific T cell responses, with patterns resembling those of uninfected infants. Two children with progressive SNHL had high frequencies of PD-1+CD8+ T cells over the first year compared with children without progressive SNHL.CONCLUSIONSimilar to published reports, neonatal viral antigen-specific cytokine-secreting T cell responses were not detected, but overall patterns indicate that globally differentiated memory CD8+ T cell populations were induced by cCMV infection, with higher frequencies of terminally differentiated PD-1+CD8+ T cells potentially associated with asymptomatic infection. In this cohort, a lack of in utero T cell differentiation was associated with developmental delay, and high frequencies of PD-1+CD8+ T cells persisted only in children with progressive SNHL. Further work is needed to define the specificity of these T cells and their mechanistic connection to these outcomes.FUNDINGThis study was funded through an intramural research award at Nationwide Children's Hospital, the Pediatric Infectious Disease Society Fellowship Award funded by Stanley and Susan Plotkin and Sanofi Pasteur, the Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Pichichero Family Foundation Vaccines for Children Initiative Research Award from the Pediatric Infectious Diseases Society Foundation.

Diagnosis of newly developed multiple myeloma without bone disease detectable on conventional computed tomography (CT) scan by using dual-energy CT

ObjectiveTo evaluate the diagnostic utility of fat (hydroxyapatite) density [DFat (HAP)] on dual-energy computed tomography (DECT) for identifying clinical diagnosed multiple myeloma without bone disease (MNBD) that is not visible on conventional CT scans. Material and MethodsIn this age-gender-examination sites matched case control prospective study, Chest and/or abdominal images on Revolution CT of MNBDs and control subjects were consecutive enrolled in a 1:2 ratio from October 2022 to November 2023. Multiple myeloma was clinical diagnosed according to criteria of the International Myeloma Working Group. Regions of interest (ROIs) were drawn separately for all thoracolumbar vertebrae in the scanning range by two radiologists. Additionally, a radiologist specializing in musculoskeletal imaging supervised the process. DFat (HAP) was extracted from each ROI. The spine was divided into upper thoracic (UPT), middle and lower thoracic (MLT), thoracolumbar (TL), and middle and lower lumbar (MLL) vertebrae. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the diagnostic performance of DFat (HAP) in diagnosing multiple myeloma, and the sensitivity, specificity, and accuracy under the optimal cut-off were determined by Youden index (sensitivity + specificity −1). ResultsA total of 32 and MNBD patients and 64 control patients were included. The total number of ROIs outlined included MNBD group (n = 493) and control group (n = 986). For all vertebrae, DFat(HAP) got average performance in the diagnosis of MNBD (AUC = 0.733, p < 0.001) with a cut-off value of 958 (mg/cm3); the sensitivity, specificity, and accuracy were 58.8 %, 77.8 %, and 71.7 %, respectively. Regarding segment analysis, the diagnostic performance was good for all (AUC, 0.803–0.837; p < 0.001) but the UPT segment (AUC = 0.692, p = 0.002). The optimal diagnostic cut-off values for the MLT, TL, and MLL vertebrae were 955 mg/cm3, 947 mg/cm3, and 947 mg/cm3, respectively; the sensitivity, specificity, and accuracy were 80.0 %-87.5 %, 71.9 %-82.6 %, and 77.1 %-81.6 %, respectively. ConclusionDECT was effective for detecting MNBD, and better diagnostic results can be obtained by grouping different spine segments.