Clinical Risk Factors Research Articles

Assessing the Variation in COVID-19 Severity Among the Different Nationalities Living in Qatar.

Background Coronavirus disease (COVID-19) is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and it has resulted in a global pandemic. The COVID-19 pandemic has resulted in numerous reports on clinical outcomes and risk factors associated with morbidity and mortality. However, the extent to which nationality influences the severity of COVID-19 is not fully understood. Therefore, this study aimed to explore disparities in COVID-19 severity among individuals of different nationalities in Qatar. Methods This is a retrospective study. Secondary data were obtained from the Ministry of Public Health in Qatar. Patients of different nationalities were categorized into different groups based on the WHO regional classification, and the severity of COVID-19 across these groups was analyzed. Results Data were obtained for 96,728 patients. This study found a statistically significant difference in disease severity among nationalities. The highest number of patients were from the Eastern Mediterranean group (42.3%), followed by Southeast Asia (39.4%). The severity of COVID-19 was highest among the Eastern Mediterranean groups (40%), followed by those from Southeast Asia (38.5%) and the Western Pacific (12.4%). There was a significant correlation between disease severity and vaccination status. Conclusion The findings of this study provide novel perspectives on the severity of COVID-19 among individuals of various nationalities. Moreover, it emphasizes the importance of healthcare interventions to address disparities in COVID-19 morbidity and mortality within these groups. The results of this study provide a useful foundation for developing approaches to prevent and manage pandemics more effectively and reduce the number of cases and fatalities during future health crises.

Clinical and radiological risk factors for poor outcomes in patients with spontaneous muscle hematomas

PurposeSpontaneous muscle hematomas (SMH) are frequently seen in the Emergency Department (ED), particularly as a complication of anticoagulation treatments. To date, there are no standard guidelines for the management of this condition in the ED.This work aims to identify clinical-radiological parameters of SMH at risk of poor outcomes. MethodThis is a retrospective, observational cohort study conducted in an urban teaching hospital from 2016 to 2019. A multivariate logistic regression analysis was performed to identify parameters independently associated with an adverse outcome defined as the need for treatment (blood products, TAE, surgery) or hospitalization. The parameters analyzed were hematoma size, anticoagulation therapy, age, and the Charlson Comorbidity Index (CCI). ROC analysis was performed to identify the best cut-off hematoma size value to predict poor outcomes. ResultsOur study enrolled 231 patients aged between 18 and 96 years, with a mean age of 67 years. In our population, 125 patients (54.1 % %) were on anticoagulant therapy.Multivariate analysis showed that an SMH diameter > 5.5 cm was independently associated with poor outcome ((odds Ratio [95 % CI] 4,009 [1,786–9,001], p 0.001). Among clinical parameters, only advanced age was proved to be an independent predictor of adverse outcomes (odds Ratio [95 % CI] 1,035 [1,003–1,069], p = 0.033) ConclusionsOur data suggest that an SMH diameter greater than 5.5 cm on a CT scan and advanced age are predictors of poor outcomes. Surprisingly, anticoagulant therapy seems to play a minor role in the outcome of SMHs.

COVID-19 disease in children and adolescents following allogeneic hematopoietic stem cell transplantation: A report from the Turkish pediatric bone marrow transplantation study group.

Data on the risk factors and outcomes for pediatric patients with SARS-CoV-2 infection (COVID-19) following hematopoietic stem cell transplantation (HSCT) are limited. The study aimed to analyze the clinical signs, risk factors, and outcomes for ICU admission and mortality in a large pediatric cohort who underwent allogeneic HSCT prior to COVID-19 infection. In this nationwide study, we retrospectively reviewed the data of 184 pediatric HSCT recipients who had COVID-19 between March 2020 and August 2022. The median time from HSCT to COVID-19 infection was 209.0 days (IQR, 111.7-340.8; range, 0-3845 days). The most common clinical manifestation was fever (58.7%). While most patients (78.8%) had asymptomatic/mild disease, the disease severity was moderate in 9.2% and severe and critical in 4.4% and 7.6%, respectively. The overall mortality was 10.9% (n: 20). Deaths were attributable to COVID-19 in nine (4.9%) patients. Multivariate analysis revealed that lower respiratory tract disease (LRTD) (OR, 23.20, p: .001) and lymphopenia at diagnosis (OR, 5.21, p: .006) were risk factors for ICU admission and that HSCT from a mismatched donor (OR, 54.04, p: .028), multisystem inflammatory syndrome in children (MIS-C) (OR, 31.07, p: .003), and LRTD (OR, 10.11, p: .035) were associated with a higher risk for COVID-19-related mortality. While COVID-19 is mostly asymptomatic or mild in pediatric transplant recipients, it can cause ICU admission in those with LRTD or lymphopenia at diagnosis and may be more fatal in those who are transplanted from a mismatched donor and those who develop MIS-C or LRTD.

Bleeding risk from anticoagulant thromboprophylaxis in patients with multiple myeloma: a MarketScan analysis

BackgroundMultiple myeloma (MM) is associated with high risk of venous thromboembolism (VTE). Anticoagulant prophylaxis is frequently recommended but underutilized partly due to the absence of studies assessing bleeding risk. ObjectivesTo determine the rate of severe (hospitalized) bleeding from thromboprophylaxis in patients treated for MM and identify clinical risk factors for bleeding in this population. MethodsUsing the MarketScan database, we analyzed 6656 patients treated for MM between 2013 and 2021. Concomitant thromboprophylaxis was defined using prescription claims. Hospitalized bleeding was identified through the Cunningham algorithm. Bleeding rates were compared by thromboprophylaxis status, and Cox regression identified risk factors for bleeding. ResultsAnticoagulant thromboprophylaxis was used in 6.6% (436) patients treated for MM. Patients on thromboprophylaxis had a higher rate of immunomodulatory-based therapy (63.8% vs 46.7%; P < .01) and lower rate of antiplatelet use (2.1% vs 4.7%; P < .01). Bleeding occurred in 1.4% of them during median follow-up of 1.3 years. Rate of severe bleeding was not different between those on prophylaxis (7.8 per 1000 person-years) and those not on prophylaxis (10.1 per 1000 person-years). No association was identified between thromboprophylaxis and bleeding. Factors associated with increased bleeding included age (hazard ratio [HR], 1.38 per 10 years increase in age), comorbidity index (HR, 1.18 per SD increase), history of bleeding (HR, 1.54), hypertension (HR, 1.87), and renal disease (HR, 1.56). ConclusionRisk of serious bleeding from thromboprophylaxis in patients treated for MM was low, and concomitant anticoagulant therapy did not result in increased bleeding risk. Clinical risk factors for bleeding included age, comorbidity index, bleeding history, hypertension, and renal disease.

Radiomic nomogram based on lumbar spine magnetic resonance images to diagnose osteoporosis.

We aimed to establish a novel model using a radiomics analysis of magnetic resonance (MR) images for predicting osteoporosis. To investigate the effectiveness of a radiomics approach utilizing magnetic resonance imaging (MRI) of the lumbar spine in identifying osteoporosis. In this retrospective study, a total of 291 patients who underwent MRI were analyzed. Radiomics features were extracted from the MRI scans of all 1455 lumbar vertebrae, and build the radiomics model based on T2-weighted (T2W), T1-weighted (T1W), and T2W + T1W imaging. The performance of the combined model was assessed using metrics such as the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. The AUCs of these models were compared using the DeLong test. Their clinical usefulness was assessed using a decision curve analysis. T2W, T1W, and T1W + T2W imaging retained 27, 27, and 17 non-zero coefficients, respectively. The AUCS about radiomics scores based on T2W, T1W, and T1W + T2W imaging were 0.894, 0.934, and 0.945, respectively, which all performed better than the clinical model significantly. The rad-signatures based on T1W + T2W imaging, which exhibited a stronger predictive power, were included in the creation of the nomogram for osteoporosis diagnosis, and the AUC was 0.965 (95% confidence interval (CI)=0.944-0.986) in the training cohort and 0.917 (95% CI=0.738-1.000) in the test cohort. The calibration curve indicated that the radiomics nomogram had considerable clinical usefulness in prediction, observation, and decision curve analysis. A reliable and powerful tool for identifying osteoporosis can be provided by the nomogram that combines the T1W and T2W imaging radiomics score with clinical risk factors.

Risk factors for surgery in stricturing small bowel Crohn's disease: A retrospective cohort study from the GETAID pédiatrique.

Previous studies have shown rates of surgical resection of up to 41% in stricturing pediatric Crohn's disease (CD). In this retrospective multicenter study, our aims were to identify clinical risk factors and magnetic resonance enterography (MRE) features of small bowel strictures associated with surgery. Pediatric patients with symptomatic stricturing small bowel CD (defined as obstructive symptoms or proximal dilatation on MRE) confirmed by MRE between 2010 and 2020 were recruited from 12 French tertiary hospitals. Patient characteristics were compared by surgical outcome multivariable Cox regression. Fifty-six patients (61% boys) aged 12.2 ± 2.7 years at diagnosis of CD were included. Median duration of CD before diagnosis of stricture was11.7 months (interquartile range [IQR]: 25-75: 1.2-29.9). Nineteen (34%) patients had stricturing phenotype (B2) at baseline. Treatments received before stricture diagnosis includedMODULEN-IBD (n = 31), corticosteroids (n = 35), antibiotics (n = 10), anti-TNF (n = 27), immunosuppressants (n = 28). Thirty-six patients (64%) required surgery, within 4.8 months (IQR: 25-75: 1.8-17.3) after stricture diagnosis. Parameters associated with surgical resection wereantibiotic exposure before stricture diagnosis (adjusted odds ratio [aOR]: 15.62 [3.35-72.73], p = 0.0005), Crohn's disease obstructive symptoms score (CDOS) > 4 (aOR: 3.04 [1.15-8.03], p = 0.02) and dilation proximal to stricture >28 mm (aOR: 3.62 [1.17-11.20], p = 0.03). In this study, antibiotic treatment before stricture diagnosis, intensity of obstructive symptoms, and diameter of dilation proximal to small bowel stricture on MRE were associated with risk for surgical resection.

Suicidal behaviour among patients with congestive cardiac failure in a Nigerian teaching hospital.

Suicidal behaviour is an established psychiatric complication of congestive cardiac failure (CCF), contributing significantly to morbidity and death by suicide. The magnitude and risk factors for suicidal behaviour among patients with CCF are yet to be unpacked, especially in developing nations such as Nigeria. To determine the prevalence of suicidal behaviour and the risk factors associated with suicidal behaviour, among patients with CCF in Nigeria. Cardiology outpatient clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. A cross-sectional study was conducted among 98 randomly selected patients with a diagnosis of CCF. Participants were assessed with a socio-demographic and clinical factors questionnaire and Beck Scale of Suicidal Ideation. Chi-square test, t-test and logistic regression were used to analyse data. The prevalence of suicidal ideation and suicidal attempt among patients with CCF was 52% and 1%, respectively. No socio-demographic factor was significantly associated with suicidal ideation. Clinical factors associated with suicidal ideation were age at diagnosis (p = 0.042), aetiology of CCF (p = 0.001) and severity of CCF (p = 0.032). Only the severity of CCF (odds ratio [OR] = 20.557, p = 0.014) predicted suicidal ideation among patients with CCF. Suicidal behaviour constitutes a huge burden among the outpatient CCF population. The identification of clinical risk factors for suicidal ideation (age at diagnosis, aetiology and severity of CCF) further illuminates a pathway to mortality among patients with CCF. The findings lend a voice to the need for screening for suicidal behaviour, suicide prevention programmes, surveillance systems and government policies that support mental health for patients with CCF.

Arrhythmias and ion channelopathies causing sudden cardiac death in Hispanic/Latino and Indigenous populations.

The limited literature and increasing interest in studies on cardiac electrophysiology, explicitly focusing on cardiac ion channelopathies and sudden cardiac death in diverse populations, has prompted a comprehensive examination of existing research. Our review specifically targets Hispanic/Latino and Indigenous populations, which are often underrepresented in healthcare studies. This review encompasses investigations into genetic variants, epidemiology, etiologies, and clinical risk factors associated with arrhythmias in these demographic groups. The review explores the Hispanic paradox, a phenomenon linking healthcare outcomes to socioeconomic factors within Hispanic communities in the United States. Furthermore, it discusses studies exemplifying this observation in the context of arrhythmias and ion channelopathies in Hispanic populations. Current research also sheds light on disparities in overall healthcare quality in Indigenous populations. The available yet limited literature underscores the pressing need for more extensive and comprehensive research on cardiac ion channelopathies in Hispanic/Latino and Indigenous populations. Specifically, additional studies are essential to fully characterize pathogenic genetic variants, identify population-specific risk factors, and address health disparities to enhance the detection, prevention, and management of arrhythmias and sudden cardiac death in these demographic groups.

Parental Reflective Functioning on the Parent Development Interview: A narrative review of measurement, association, and future directions.

A caregiver's capacity to mentalize is thought to be one of the most important features of secure parent-child relationships. Parental mentalizing can be measured using the Reflective Functioning (RF) coding system applied to the Parent Development Interview (PDI). In this narrative review, we summarize the research using this measure and synthesize what has been learnt about the predictors, correlates and sequelae of parental RF. Studies have consistently shown that PRF on the PDI is associated with both parent and child attachment and is an important factor in the intergenerational transmission of attachment. It is also related to the quality of parental representations, parent-child interactions, and child outcomes. While a number of social and clinical risk factors are associated with lower PRF, it is difficult to disentangle the unique contribution of each of these. We discuss these findings and present the direction of future work that is planned to expand and refine the PRF scale for the PDI.

The association of FRAX with predictors of falls in the assessment of postmenopausal osteoporosis in Turkey: the fracture study of Turkey (FRACT study)

SummaryAlthough FRAX is used for fracture risk evaluation, this tool does not include balance and fall risk. The association between the predictors of falls and high FRAX scores we found in this study suggests that risk indicators for falls may add substantial value to FRAX by improving fracture risk prediction.PurposeThis observational, descriptive, and cross-sectional study aimed to assess the fall risk predictors and explore their association with FRAX in Turkish patients with postmenopausal osteoporosis.MethodsTwo hundred and nine (209) women with postmenopausal osteoporosis referred to the Fracture Liaison Service (FLS) at Istanbul University–Cerrahpaşa were enrolled in the FRACT study (The Fracture Study of Turkey). Clinical risk factors were assessed using the FRAX tool. Tandem stance, Tandem walking, Timed up and go (TUG), and Chair stand tests were performed to assess balance and fall risk.ResultsAmong patients with a mean age of 67.6 (± 9.7) years, 66 patients (31.6%) had osteoporosis without fractures and 143 patients (68.4%) had fragility fractures. The proportion of patients with poor performance of fall prediction tests was significantly higher in patients with a fragility fracture than those with osteoporosis alone. There was an inverse relationship between dynamic balance tests and the reported number of prior falls in the past year. FRAX score was higher in patients with impaired Tandem stance, Tandem walking, and TUG tests (p = 0.008, p = 0.035, p = 0.001, respectively).ConclusionAssessment of fall risk predictors should be one of the major pillars in the physical evaluation of osteoporotic patients in the FLS setting. FRAX is a useful tool to determine the fracture risk of patients with both static and dynamic balance impairments. Combining balance assessment with FRAX may be an important step to optimize osteoporosis risk assessment.

Pediatric Idiopathic Intracranial Hypertension: Clinical Presentations, Risk Factors, and Prognostic Indicator

Pediatric Idiopathic Intracranial Hypertension: Clinical Presentations, Risk Factors, and Prognostic Indicator

Days alive and out of hospital for adult female and male cardiac surgery patients: a population-based cohort study

BackgroundResearch shows women experience higher mortality than men after cardiac surgery but information on sex-differences during postoperative recovery is limited. Days alive and out of hospital (DAH) combines death, readmission and length of stay, and may better quantify sex-differences during recovery. This main objective is to evaluate (i) how DAH at 30-days varies between sex and surgical procedure, (ii) DAH responsiveness to patient and surgical complexity, and (iii) longer-term prognostic value of DAH.MethodsWe evaluated 111,430 patients (26% female) who underwent one of three types of cardiac surgery (isolated coronary artery bypass [CABG], isolated non-CABG, combination procedures) between 2009 – 2019. Primary outcome was DAH at 30 days (DAH30), secondary outcomes were DAH at 90 days (DAH90) and 180 days (DAH180). Data were stratified by sex and surgical group. Unadjusted and risk-adjusted analyses were conducted to determine the association of DAH with patient-, surgery-, and hospital-level characteristics. Patients were divided into two groups (below and above the 10th percentile) based on the number of days at DAH30. Proportion of patients below the 10th percentile at DAH30 that remained in this group at DAH90 and DAH180 were determined.ResultsDAH30 were lower for women compared to men (22 vs. 23 days), and seen across all surgical groups (isolated CABG 23 vs. 24, isolated non-CABG 22 vs. 23, combined surgeries 19 vs. 21 days). Clinical risk factors including multimorbidity, socioeconomic status and surgical complexity were associated with lower DAH30 values, but women showed lower values of DAH30 compared to men for many factors. Among patients in the lowest 10th percentile at DAH30, 80% of both females and males remained in the lowest 10th percentile at 90 days, while 72% of females and 76% males remained in that percentile at 180 days.ConclusionDAH is a responsive outcome to differences in patient and surgical risk factors. Further research is needed to identify new care pathways to reduce disparities in outcomes between male and female patients.

Modification of coronary artery disease clinical risk factors by coronary artery disease polygenic risk score

The extent to which the relationships between clinical risk factors and coronary artery disease (CAD) are altered by CAD polygenic risk score (PRS) is not well understood. Here, we determine whether the interactions between clinical risk factors and CAD PRS further explain risk for incident CAD. Participants were of European ancestry from the UK Biobank without prevalent CAD. An externally trained genome-wide CAD PRS was generated and then applied. Clinical risk factors were ascertained at baseline. Cox proportional hazards models were fitted to examine the incident CAD effects of CAD PRS, risk factors, and their interactions. Next, the PRS and risk factors were stratified to investigate the attributable risk of clinical risk factors. A total of 357,144 individuals of European ancestry without prevalent CAD were included. During a median of 11.1 years of follow-up (interquartile range 10.4-14.1 years), CAD PRS was associated with 1.35-fold (95% confidence interval [CI] 1.332-1.368) risk per SD for incident CAD. The prognostic relevance of the following risk factors was relatively diminished for those with high CAD PRS on a continuous scale: type 2 diabetes (hazard ratio [HR]interaction 0.91, 95% CIinteraction 0.88-0.94), increased body mass index (HRinteraction 0.97, 95% CIinteraction 0.96-0.98), and increased C-reactive protein (HRinteraction 0.98, 95% CIinteraction 0.96-0.99). However, a high CAD PRS yielded joint risk increases with low-density lipoprotein cholesterol (HRinteraction 1.05, 95% CIinteraction 1.04-1.06) and total cholesterol (HRinteraction 1.05, 95% CIinteraction 1.03-1.06). The CAD PRS is associated with incident CAD, and its application improves the prognostic relevance of several clinical risk factors. P.N. (R01HL127564, R01HL151152, and U01HG011719) is supported by the National Institutes of Health.

The association between schizophrenia and increased COVID-19 mortality in a cohort of over 2 million people in Brazil.

To describe the clinical outcomes and risk factors of death related to mental disorders in a cohort of Brazilian hospitalized patients with COVID-19. This retrospective cohort study utilized the Brazilian database SIVEP-Gripe to analyze patients aged ≥18 years who had been hospitalized with COVID-19 between 2020 and 2022. The exposure of interest were mental disorders (anxiety, depression, schizophrenia, and bipolar disorder), identified through self-reported fields. The primary outcome was in-hospital mortality. Covariates included demographic and clinical features. Descriptive statistics, t-tests, chi-square tests, and binary logistic regression were used to analyze the data. A cohort of 2,124,285 patients was included in the analysis, with 23,246 individuals (1.1%) having self-reported mental disorders. Among these mental disorders, depression was the most prevalent (52.3%). The mortality rate of the patients with mental disorders was 30.8%. Analysis of risk factors for mortality revealed that age, gender, region, dyspnea, low oxygen saturation, and comorbidities were associated with an increased risk of death. Patients with schizophrenia had a higher mortality risk (aOR:1.68;95%CI:1.54-1.81). Patients diagnosed with schizophrenia have a greater likelihood of COVID-19- related death than those without mental health conditions. These findings underscore the significant effect of serious mental disorders on COVID-19 mortality.

Polygenic scores for cardiovascular risk factors improve estimation of clinical outcomes in CCB treatment compared to pharmacogenetic variants alone

Pharmacogenetic variants are associated with clinical outcomes during Calcium Channel Blocker (CCB) treatment, yet whether the effects are modified by genetically predicted clinical risk factors is unknown. We analyzed 32,000 UK Biobank participants treated with dihydropiridine CCBs (mean 5.9 years), including 23 pharmacogenetic variants, and calculated polygenic scores for systolic and diastolic blood pressures, body fat mass, and other patient characteristics. Outcomes included treatment discontinuation and heart failure. Pharmacogenetic variant rs10898815-A (NUMA1) increased discontinuation rates, highest in those with high polygenic scores for fat mass. The RYR3 variant rs877087 T-allele alone modestly increased heart failure risks versus non-carriers (HR:1.13, p = 0.02); in patients with high polygenic scores for fat mass, lean mass, and lipoprotein A, risks were substantially elevated (HR:1.55, p = 4 × 10−5). Incorporating polygenic scores for adiposity and lipoprotein A may improve risk estimates of key clinical outcomes in CCB treatment such as treatment discontinuation and heart failure, compared to pharmacogenetic variants alone.

Clinical Epidemiological Characteristics and Risk Factors for Severity of SARS-CoV-2 Pneumonia in Pediatric Patients: A Hospital-Based Study in Vietnam.

Introduction Coronavirus disease (COVID-19) is an infectious disease caused by SARS-CoV-2, which can cause organ failure in several organs, cardiac problems, or acute respiratory distress syndrome (ARDS). Identifying clinical epidemiological characteristics and risk factors for complications of COVID-19 allows clinicians to diagnose and treat promptly. Objectives This study aims to describe the clinical epidemiological characteristics of COVID-19 and assess risk factors for the severity of SARS-CoV-2 pneumonia in children treated at Haiphong Children's Hospital. Methods A descriptive cross-sectional study was conducted in Haiphong Children's Hospital, Haiphong, Vietnam, for one year, from January 1, 2022, to December 31, 2022. Results In our study, 540 children were evaluated; the male-to-female ratio was 1.48/1; the median age was 23 months (IQR=6-74); Children aged under one year accounted for the highest proportion (n=202; 37.4%); 40 (7.4%) children had underlying illnesses. The number of admitted patients diagnosed with COVID-19 peaked in February 2022. Regarding severity, 380 (70.4%) cases were mild, 136 (25.2%) were moderate, only 24 (4.4%) cases were severe, and no children died. Common symptoms were fever in 483 (89.4%), coughing in 399 (73.9%), and tachypnea in 163 (30.2%) children. Laboratory features: white blood cell count, platelet count, serum CRP, and coagulation test showed little change. Around 116(21.5%) had lymphopenia and 148 (27.4%) had pneumonia. Patients under one year were approximately 1.64 times more likely to experience pneumonia complications from COVID-19 than those without such a history (OR=1.64, 95%CI = 1.12 - 2.41, p=0.0112). Patients with underlying conditions were approximately 2.08 times more likely to experience pneumonia complications from COVID-19 compared to those without such conditions (OR=2.08, 95%CI =1.08 - 4.02, p=0.0289). Conclusion In COVID-19 pediatric patients, the severity of the disease was mild to moderate without any mortality. Children aged under one year accounted for the highest proportion of all COVID-19 patients. This study found that age under one year and underlying illnesses are related to pneumonia in COVID-19 pediatric patients.

Cluster analysis of long COVID symptoms for deciphering a syndrome and its long-term consequence

AbstractThe long-term symptoms of COVID-19 are the subject of public and scientific discussions. Understanding how those long COVID symptoms co-occur in clusters of syndromes may indicate the pathogenic mechanisms of long COVID. Our study objective was to cluster the different long COVID symptoms. We included persons who had a COVID-19 and assessed long-term symptoms (at least 4 weeks after first symptoms). Hierarchical clustering was applied to the symptoms as well as to the participants based on the Euclidean distance h of the log-values of the answers on symptom severity. The distribution of clusters within our cohort is shown in a heat map.From September 2021 to November 2023, 2371 persons with persisting long COVID symptoms participated in the study. Self-assessed long COVID symptoms were assigned to three symptom clusters. Cluster A unites rheumatological and neurological symptoms, cluster B includes neuro-psychological symptoms together with cardiorespiratory symptoms, and a third cluster C shows an association of general infection signs, dermatological and otology symptoms. A high proportion of the participants (n = 1424) showed symptoms of all three clusters. Clustering of long COVID symptoms reveals similarities to the symptomatology of already described syndromes such as the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) or rheumatological autoinflammatory diseases. Further research may identify serological parameters or clinical risk factors associated with the shown clusters and might improve our understanding of long COVID as a systemic disease. Furthermore, multimodal treatments can be developed and scaled for symptom clusters and associated impairments.

Early prediction of gestational diabetes mellitus using maternal demographic and clinical risk factors

ObjectiveTo build and validate an early risk prediction model for gestational diabetes mellitus (GDM) based on first-trimester electronic medical records including maternal demographic and clinical risk factors.MethodsTo develop and validate a GDM prediction model, two datasets were used in this retrospective study. One included data of 14,015 pregnant women from Máxima Medical Center (MMC) in the Netherlands. The other was from an open-source database nuMoM2b including data of 10,038 nulliparous pregnant women, collected in the USA. Widely used maternal demographic and clinical risk factors were considered for modeling. A GDM prediction model based on elastic net logistic regression was trained from a subset of the MMC data. Internal validation was performed on the remaining MMC data to evaluate the model performance. For external validation, the prediction model was tested on an external test set from the nuMoM2b dataset.ResultsAn area under the receiver-operating-characteristic curve (AUC) of 0.81 was achieved for early prediction of GDM on the MMC test data, comparable to the performance reported in previous studies. While the performance markedly decreased to an AUC of 0.69 when testing the MMC-based model on the external nuMoM2b test data, close to the performance trained and tested on the nuMoM2b dataset only (AUC = 0.70).

Prognostic predictive value of urothelial carcinoma of the bladder after TURBT based on multiphase CT radiomics.

To investigate multiphase computed tomography (CT) radiomics-based combined with clinical factors to predict overall survival (OS) in patients with bladder urothelial carcinoma (BLCA) who underwent transurethral resection of bladder tumor (TURBT). Data were retrospectively collected from 114 patients with primary BLCA from February 2016 to February 2018. The regions of interest (ROIs) of the plain, arterial, and venous phase images were manually segmented. The Cox regression algorithm was used to establish 3 basic models for the plain phase (PP), arterial phase (AP), and venous phase (VP) and 2 combination models (AP + VP and PP + AP + VP). The highest-performing radiomics model was selected to calculate the radiomics score (Rad-score), and independent risk factors affecting patients' OS were analyzed using Cox regression. The Rad-score and clinical risk factors were combined to construct a joint model and draw a visualized nomogram. The combined model of PP + AP + VP showed the best performance with the Akaike Information Criterion (AIC) and Consistency Index (C-index) in the test group of 130.48 and 0.779, respectively. A combined model constructed with two independent risk factors (age and Ki-67 expression status) in combination with the Rad-score outperformed the radiomics model alone; AIC and C-index in the test group were 115.74 and 0.840, respectively. The calibration curves showed good agreement between the predicted probabilities of the joint model and the actual (p < 0.05). The decision curve showed that the joint model had good clinical application value within a large range of threshold probabilities. This new model can be used to predict the OS of patients with BLCA who underwent TURBT.

A Second Trimester Prediction Algorithm for Early-Onset Hypertensive Disorders of Pregnancy Occurrence and Severity Based on Soluble fms-like Tyrosine Kinase 1 (sFlt-1)/Placental Growth Factor (PlGF) Ratio and Uterine Doppler Ultrasound in Women at Risk.

Hypertensive disorders of pregnancy (HDPs) represent a significant source of severe maternal and fetal morbidity. Screening strategies relying on traditional medical history and clinical risk factors have traditionally shown relatively modest performance, mainly in the prediction of preeclampsia, displaying a sensitivity of 37% for the early-onset form and 29% for the late-onset form. The development of more accurate predictive and diagnostic models of preeclampsia in the early stages of pregnancy represents a matter of high priority. The aim of the present paper is to create an effective second trimester prediction algorithm of early-onset HDP occurrence and severity, by combining the following two biochemical markers: a soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio and uterine artery Doppler ultrasound parameters, namely the pulsatility index (PI) and the resistivity index (RI), in a population of high-risk pregnant women, initially assessed through traditional risk factors. A prospective single-center observational longitudinal study was conducted, in which 100 women with singleton pregnancy and traditional clinical and medical history risk factors for preeclampsia were enrolled at 24 weeks of gestation. Shortly after study enrollment, all women had their sFlt-1 and PlGF levels and mean uterine artery PI and RI determined. All pregnancies were followed up until delivery. Receiver operating characteristic (ROC) analysis established algorithms based on cutoffs for the prediction of the later development of preeclampsia: PI 1.25 (96.15% sensitivity, 86.49% specificity), RI 0.62 (84.6% sensitivity, 89.2% specificity) and sFlt-1/PlGF ratio 59.55 (100% sensitivity, 89.2% specificity). The sFlt-1/PlGF ratio was the best predictor for preeclampsia, as it displayed the highest area under the curve (AUC) of 0.973. The prediction algorithm for the severe form of preeclampsia, complicated by fetal growth restriction leading to preterm birth, antepartum fetal demise or acute fetal distress with a cerebro-placental ratio of <one consisted of the following cutoffs: PI 1.44 (93.75% sensitivity, 95.24% specificity), RI 0.69 (87.5% sensitivity, 100% specificity) and sFlt-1/PlGF ratio 102.74 (93.75% sensitivity, 95.2% specificity). These algorithms may significantly enhance the prediction accuracy of preeclampsia compared to traditional risk factors. The combination of the sFlt-1/PlGF ratio with mean uterine PI and RI in particular displayed an improved performance in the prediction of severe preeclampsia with the above-mentioned complications, compared to the biochemical markers or uterine Doppler parameters used alone. Therefore, HDP screening strategies should increasingly focus on implementing such algorithms for women who are initially regarded as high risk based on traditional risk factors, in order to properly diagnose HDP and properly limit or manage the later maternal and fetal complications.