Degree Of Severity Research Articles

The difference in IL-17 level between mild and severe COVID-19 inpatients of H. Adam Malik General Hospital

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a new coronavirus, Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2). Pro-inflammatory cytokines play a central role in many viral respiratory infections by coordinating and activating adaptive immune responses. Higher serum levels of pro-inflammatory cytokines (TNF-α, IL-1β, IL-2, IL-6 and IL-17) and chemokines (IL-8) have been observed in many patients with severe COVID-19 compared with individuals with a mild degree. This research is an observational study with cross sectional data collection method. This study took blood samples from mild and severe COVID-19 patients who were treated at the HAM Hospital as many as 34 patients. Samples were examined only once for IL-17 in mild and severe COVID-19 patients. The research was conducted after obtaining ethical approval and informed consent. This study was followed by 18 female subjects (52.9%). The mean age of the subjects was 47.52 years with the youngest age being 23 years old and the oldest being 81 years old. By using the Mann Whitney test, it showed that there was a significant difference in interleukin 17 levels between Covid-19 patients with severe and mild degrees (p = 0.049). IL-17 examination can be used as an alternative diagnostic marker and assess the severity in COVID 19 patients. Further studies are needed that involve a larger number of subjects, and are associated with other inflammatory markers such as CRP or with coagulation status such as D- dimer.

The choice of method of electroneuromyogaphy in remote consequences of gunshot and mine-blast injuries of limb nerves

Objective. Clarification of the nature of damage and degree of functional disorders in the remote consequences of gunshot and mine-blast injuries of limb nerves using neurophysiological techniques (NP) of functional diagnostics (stimulation and needle electromyography), correlation of these data with the nerve damage characteristics determined during surgical interventions (operative findings). Materials and methods. 480 military personnel and civilians, men aged 18-64 years (average age 33.5 years), with gunshot and mine-blast injuries of limb nerves (LNI) within 1 to 11 months after injury were examined. A total of 1400 EMG studies were conducted. Clinical-neurological methods were used to determine the level, degree, and nature of LNI. Results. Among the examined 480 patients, complete nerve damage was detected in 299, and partial in 181. Causes of nerve damage included: shrapnel, gunshot, mine-blast injuries, nerve rupture due to bone fractures, injuries by sharp objects, iatrogenic damage. In 62.3% of cases of complete LNI surgical interventions were performed using the technique of neurotization using branches of donor nerves. Provided anatomical integrity of nerve structures and presence of conductivity during EMG testing, external or internal neurolysis was performed. Surgical intervention timing: up to 6 months post-injury - 68.1% of cases; up to 3 months - 31.9%. Based on the results of comprehensive clinical-NP research, adapted schemes for assessing NP data corresponding to each pathohistological type of LNI were developed, and NP criteria for classifying consequences of LNI into three degrees of severity of functional deficit - mild, moderate, and severe were proposed. Conclusions. Criteria for choosing the optimal NP diagnostic methodology for the remote consequences of gunshot and mine-blast injuries of limb nerves have been determined. Comprehensive clinical-instrumental diagnostics allows to objectify the level and degree of limb nerve damage, signs of neuromuscular apparatus recovery, provides information for planning of the surgical tactics and subsequent rehabilitation therapy.

Workplace accidents, economic determinants and underreporting: an empirical analysis in Italy

PurposeThis paper proposes an analysis of occupational accidents in Italy at the regional level. For this purpose, our panel is composed of 20 regions over the 2010–2019 time span.Design/methodology/approachWe apply different econometric estimation techniques (pooled OLS model, panel fixed and random effects models and semiparametric fixed model) using INAIL and ISTAT data. Our models investigate workplace accidents at the regional level by accounting for socioeconomic, labour market and productive system variables and controlling for possible underreporting bias.FindingsOverall results reveal the existence of a relevant under-notification phenomenon of accidents at work with respect to moderate accidents, that is higher especially for the southern regions of Italy. However, when considering as outcome variable an alternative set of more severe workplace accidents our model specification remains highly jointly statistically significant. Among our main findings, the analysis shows that worker skills (blue collar) strongly affect the regional pattern of workplace accidents, i.e. an increase of 1% of low paid employees generates about an increase of 1.8 severe workplace accidents per thousand workers. Moreover, we provide evidence that the size of the firm is inversely related to the occupational accident rates. Finally, our results highlight a nonlinear relationship between GDP and occupational accidents for the Italian regional context, confirmed by the high statistical significance of the quadratic term in all the estimated linear models and by the semi-parametric analysis.Originality/valueA first element of originality of our study consists of investigating the macro determinants of occupation accidents at a regional Italian level. Second, the empirical literature (Boone and Van Ours, 2006) highlights the possible bias of underreporting behaviours on nonfatal accidents in contrast to fatal accidents that are always reported. From this perspective, we have identified a few analyses (namely, Boone et al., 2011) considering different accident sets characterised by different severity degrees. Thus, this paper contributes to the literature considering five alternative subsets of accidents stratified by degree of severity (i.e. moderate, severe, moderate plus severe, severe plus fatal and total accident rates) to test for possible underreporting bias affecting our econometric model.

Character and Frequency of the Syntropic Extrahepatic Lesions in Cirrhotic Patients with Hepatopulmonary Syndrome of Various Severity Degree

Introduction. All over the world, and in Ukraine in particular, the incidence of liver diseases is constantly increasing. By practicing the most effective individualized appointment of complex treatment, it should be taken into consideration the involvement of different organ systems to the pathological processes of the cirrhotic patients, which we define as syntropic polymorbid lesions. The aim of the study. To determine the frequency and character of syntropic extrahepatic lesions in cirrhotic patients depending on the hepatopulmonary syndrome severity degree. Materials and methods. In a randomized manner with preliminary stratification by the presence of hepatopulmonary syndrome were studied 93 patients with liver cirrhosis, who underwent the comprehensive clinical-laboratory and instrumental examination. Results. According to the obtained results, most often in patients with liver cirrhosis associated with hepatopulmonary syndrome syntropic extrahepatic lesions affected other organ systems as follows: digestive system - 100.0 % patients under investigation; hematopoietic system - 84.9 %; nervous system - 81.7 %; integumentary system and mucous membranes - 78.5 %; blood circulatory system - 76. 3%;osteoarticular system - 67.7 %; urinary system - 22.6 %. Increased severity of hepatopulmonary syndrome significantly (p < 0.05) correlated with thein creased frequency of lesions. Among syntropic polymorbid lesions of the integumentary system and mucous membranes, 68.8 % patients with hepatopulmonary syndrome had jaundice, 66.7 % - telangiectasia. Among lesions of the osteoarticular system osteopenia was diagnosed in 44.7 % of patients, osteoporosis - in 27.7 %. Among lesions of the circulatory system 52.7% of patients suffered from heart rhythm disorders, 49.5 % - from arterial hypotension, 20.4 % - from cirrhotic cardiomyopathy. Among lesions of the hematopoietic system anemia (76.3 %), coagulopathy (73.1 %) and thrombocytopenia (61.3 %) were diagnosed most often. Digestive system lesionsinclude esophageal veins varicosities (94.6 % of patients), hemorrhoidal veins varicosites (68.8 %), and cirrhotic gastropathy (62.4 %). Among lesions of the urinary systemin 21.5 % of patientswas diagnosed type II hepatorenal syndrome. Among the lesions of central nervous system in 81.7 % of patientswas diagnosed hepatic encephalopathy. The frequency of syndromes and nosological units increased significantly (p < 0.05) with the increase of hepatopulmonary syndrome severity. Conclusions. 100.0 % patients with liver cirrhosis accompanied byhepatopulmonary syndromewere affected by syntropic polymorbid lesionsof the digestive system, 94.6 % of which were represented by esophageal vein varicosites. Out of 84.9 % of patients with hematopoietic lesions anemia was diagnosed in 76.3 %, coagulopathy - in 73.1 % of cases. Of total 81.7 % patients withnervous system injurieshepatic encephalopathy was diagnosed in 81.7 % patients. In 78.5 % cases of damaged skin, its appendages and mucous membranesjaundice covered 68.8 %, and telangiectasia 66.7 % of cases. In 76.3 % of cardiovascular system lesions arrhythmias were diagnosed in 52.7 %.With the increasing severity of hepatopulmonary syndrome, the frequency of the above lesions increased significantly (p < 0.05).

Radiation Research Society Journal-based Historical Review of the Use of Biomarkers for Radiation Dose and Injury Assessment: Acute Health Effects Predictions.

A multiple-parameter based approach using radiation-induced clinical signs and symptoms, hematology changes, cytogenetic chromosomal aberrations, and molecular biomarkers changes after radiation exposure is used for biodosimetry-based dose assessment. In the current article, relevant milestones from Radiation Research are documented that forms the basis of the current consensus approach for diagnostics after radiation exposure. For example, in 1962 the use of cytogenetic chromosomal aberration using the lymphocyte metaphase spread dicentric assay for biodosimetry applications was first published in Radiation Research. This assay is now complimented using other cytogenetic chromosomal aberration assays (i.e., chromosomal translocations, cytokinesis-blocked micronuclei, premature chromosome condensation, γ-H2AX foci, etc.). Changes in blood cell counts represent an early-phase biomarker for radiation exposures. Molecular biomarker changes have evolved to include panels of organ-specific plasma proteomic and blood-based gene expression biomarkers for radiation dose assessment. Maturation of these assays are shown by efforts for automated processing and scoring, development of point-of-care diagnostics devices, service laboratories inter-comparison exercises, and applications for dose and injury assessments in radiation accidents. An alternative and complementary approach has been advocated with the focus to de-emphasize "dose" and instead focus on predicting acute or delayed health effects. The same biomarkers used for dose estimation (e.g., lymphocyte counts) can be used to directly predict the later developing severity degree of acute health effects without performing dose estimation as an additional or intermediate step. This review illustrates contributing steps toward these developments published in Radiation Research.

Rhizoctonia species, anastomosis groups, and pathogenicity isolated from common bean in Lake Van Basin, Turkiye

Common bean (Phaseolus vulgaris L.) is an important vegetable crop grown in Lake Van Basin. Local genotypes are widely grown in the region. Rhizoctonia root rot induced by Rhizoctonia solani Kühn is an important soilborne plant disease that leads to global economic losses as well as in Turkey. The present study was conducted to determine anastomosis groups and pathogenicity of Rhizoctonia spp. obtained from bean plants in Lake Van Basin in 2013 and 2014. A total of 236 Rhizoctonia isolates in 5 anastomosis groups were obtained from bean plant roots. It was observed that AG- 4 (112) was the most isolated group in beans, followed by AG- 2 (41), AG- 3 (28), AG- 5 (33), and binucleate AG- K (22) isolates. Pathogenicity test conducted in thirty isolates in 5 anastomosis groups was analyzed for A64 (Bitlis/ Adilcevaz), TR68557 genotypes, and Gina (cv.) under growth chamber conditions. The study findings demonstrated that all tested isolates could infect the bean plant with different degrees of severity; however, the most virulent group was AG- 4. It was determined that the most virulent isolate was Isolate No. 19 in the A64 genotype, Isolate No. 2 in TR68557, and Isolate No. 18 in Gina cv. in in vivo tests. The identification and pathogenicity determination of Rhizoctonia isolates are the first steps towards an efficient control strategy for bean diseases caused by Rhizoctonia species. In order to obtain quality and productive products in the Van Lake Basin, where intensive bean production is carried out, precautions should be taken by considering the damage caused by Rhizoctonia spp. on plants.

Pathogenetic and clinical-neurological features of post-COVID syndrome

Despite the developed methods of treatment and prevention of COVID-19, new strains of the SARS-CoV-2 virus continue to appear. The development of complications from various organs and systems against the background of the coronavirus infection COVID-19 is noted. In patients with three or more chronic diseases, the infection can occur with varying degrees of severity, often leading to the formation of acute vascular accidents. Such patients have an unfavorable rehabilitation prognosis due to the severe course of the disease. The complex of symptoms manifested by various psycho-emotional and functional disorders after the coronavirus infection is called post-COVID syndrome. This syndrome develops 3–4 months after COVID-19 infection. The scientific community has put forward a number of hypotheses describing the pathogenetic features of the post-COVID syndrome. It has been proven that the development of this syndrome is associated with the main pathogenetic mechanisms and course of COVID-19, specifically, a disorder in the hemostasis system and hyperproduction of inflammatory cytokines with the development of a «cytokine storm». Post-COVID syndrome is characterized by a wide range of symptoms, the manifestation of which does not depend on the severity of previous COVID-19. However, there is a more severe manifestation of the post-COVID syndrome, with the risk of developing acute vascular accidents, in patients with chronic pathology of the cardiovascular system. The article presents an analysis of modern literature data on the clinical and neurological features of the development and course of post-COVID syndrome.

Early and Long-Term Results of Minimally Invasive Mitral Valve Repair in Young and Middle-Aged Patients

The aim. To analyze the early and long-term results of minimally invasive mitral valve repair in young and middle-aged patients and compare the outcomes with mitral valve repairs performed through standard sternotomy. Materials and methods. From 2016 to 2021, 128 patients with mitral insufficiency were operated in the Ukrainian Children’s Cardiac Center. Exclusion criteria included patients under 18 or over 59 years old and patients with concomitant pathology of the aortic valve, aorta, and coronary arteries. Results. In the investigated group, the average duration of cardiopulmonary bypass and aortic cross-clamping time was longer than in the comparative group. However, the average duration of mechanical ventilation, average time in theintensive care unit, and average length of hospitalization were shorter in the investigated group. Patients in the investigated group less frequently required red blood cell transfusion (5.6% vs. 14.6%) and plasma transfusion (9.4% vs. 14.6%). The percentage of postoperative complications was almost half lower in the investigated group (3.6% vs. 6.6%). None of the patients in the investigated group showed a severe degree of mitral insufficiency, while two patients in the comparative group had severe mitral insufficiency. Conclusions. Minimally invasive mitral valve repair is associated with a lower percentage of postoperative complications. Early and long-term observation results indicate the high effectiveness and safety of the minimally invasive method.

Epidemiological Characteristics of Inherited Epidermolysis Bullosa in an Eastern European Population.

Background/Objectives: Epidermolysis bullosa (EB) is a hereditary condition characterized by skin and mucosal fragility, with various degrees of severity. This study's objectives are to obtain updated epidemiological data that will help identify the specific types and subtypes of EB, determine the case distribution in Romania, and establish the incidence and prevalence of the condition. Methods: This population-based observational study included Romanian patients and collected data from 2012 to 2024. The following information was recorded: date of birth, status (deceased or alive), date of death (if applicable/available), sex, county, and city of residence, EB type and subtype if available, diagnosis (clinical and/or immunofluorescence mapping, transmission electron microscopy, genetic molecular analysis), affected genes, inheritance, and affected family members. Results: The study included a total of 152 patients. The point prevalence (the proportion of the population with a condition at a specific point in time) and the incidence of EB in Romania were 6.77 per million population and 24.23 per million live births, respectively. EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB), Kindler EB (KEB), and not otherwise specified EB, as well as EB (NOS), were the main types of the condition identified in 21%, 3%, 63%, 2%, and 11% of the total cases. The point prevalence and incidence for the same time intervals were 1.58 and 5.28 in EBS, 0.10 and 1.76 in JEB, 4.72 and 12.34 in DEB, 0.16 and 0 in KEB, and 0.21 and 4.85 in EB (NOS). Conclusions: The study provides updated epidemiological data for Romania and underlines the necessity for accurate diagnosis, facilitated by access to genetic molecular testing and better reporting systems.

Electric Auditory Brainstem Response Audiometry in Cochlear Implants: New Recording Paradigm.

(1) Background: Cochlear implants (CIs) are widely applied to recover audition for patients with severe degrees of or total hearing loss. Electrical stimulation using the electrically evoked ABR (E-ABR) can be recorded in CI recipients through the device. This work was designed to study E-ABR recorded individually from different channels located at the apical, middle, and basal cochlear regions in comparison to their simultaneous separated or adjacent combined recordings. (2) Methods: This study included 17 children fitted with unilateral cochlear implants. All children were subjected to impedance measurement, electrical compound action potentials (ECAP), and E-ABR recording of three channels located at the apical, middle, and basal cochlear regions. This was followed by simultaneous E-ABR recording of the three "separated" channels in comparison to E-ABR recording from three adjacent channels located at the middle cochlear region. (3) Results: Similar E-ABR latencies and amplitudes were found using either individual or simultaneously separated or adjacent combined recording. However, the mean amplitude measures of E-ABR for combined adjacent channels showed a positive correlation with the applied current level. (4) Conclusions: Combined E-ABR recording from adjacent channels is a faster and more reliable technique that can be used effectively without compromising the results of the recorded E-ABR.

ASSESSMENT OF HEALTH-RELEVANT QUALITY OF LIFE IN THE CONTEXT OF THE MEDICAL AND SOCIAL PROFILE OF WOMEN WITH COMPLICATED PREGNANCIES

In modern Russia, there is a decline in the birth rate, a decline in women's reproductive health, and a high rate of complicated pregnancy and childbirth. The causes of unfavorable course and outcome of pregnancy are multifactorial. The contribution of medical factors to the course of the gestational process and the condition of the newborn is often not determinant in the course and outcome of pregnancy. One of the factors influencing the course of pregnancy is health-relevant quality of life. The aim of the study was to analyze the influence of certain characteristics of the medical and social profile on the health-relevant quality of life of pregnant women with complicated pregnancy. Materials and Methods. 153 pregnant women with complicated pregnancy were included in the study. Cohort one-stage sociological study of quality of life was realized by questionnaire survey method. The study of health-relevant quality of life of pregnant women with complicated pregnancy was conducted using the WHOQOL-100 questionnaire (WHO QOL-100). Results. When assessing the quality of life of pregnant women, there is a decrease in the average values of quality of life indicators in the spheres and subspheres of the questionnaire, determined by the somatic condition of respondents. A statistically significant dependence of the decrease in the mean values of the quality of life indicators of respondents in the age group of 30-39 years compared to respondents aged 20-29 years has been established. The evidence of the influence of the level of education on the quality of life of women with pathologic course of pregnancy is presented. In a comparative analysis of the quality of life of respondents whose professional activity is not associated with physical exertion and respondents who perform physical labor of varying degrees of severity, the greatest decrease in the average quality of life indicators is noted in the group of respondents engaged in heavy physical labor. There are higher quality of life indicators of respondents who are officially married. Conclusions. The conducted study provides evidence of somatic and social determinacy of health-relevant quality of life in pregnant women with complicated pregnancy. The established limitations of the quality of life allow objectifying personalized medical and social assistance to pregnant women, aimed at improving their quality of life and pregnancy outcome.

Exploring the effects of faults on the performance of a biological wastewater treatment process

ABSTRACT To prioritise which faults should be detected in a biological wastewater treatment process, and with what level of urgency, it is necessary to understand the effect that they have on the process. Using the Benchmark Simulation Model No. 1 and 2. (BSM1 and BSM2), several process and sensor faults were considered and their impacts on various cost, quality, and controller performance evaluation metrics analysed. Both the cost of treating the wastewater and the quality of the effluent were impacted in varying degrees of severity by the faults tested. The most influential faults in both models were decreases to autotrophic and heterotrophic growth rates, decreases to the heterotrophic death rate, and the inhabitation fault. It was shown that only larger fault sizes were significant, and the required speed of detection is dependent on the fault profile. Prioritising detection of the most influential faults was shown to have significant effects on monitoring requirements for fault detection and the subsequent complexity required of a fault detection system. A valuable takeaway was the similarity of results from BSM1 and BSM2; the consistency of the influential process faults suggests that systems that can be described by these models are likely affected by the same faults.

Analysis of How Obesity Affects the Severity of Covid-19 Second Wave on Hospitalized Patients at RSUD Dr. Saiful Anwar Malang

Background : Based on WHO data, Covid-19 has officially been declared a pandemic because its spread has reached more than 100 infected countries. Several risk factors can affect the severity of Covid-19 patients, one of which is comorbid obesity. The Covid-19 pandemic occurred when the prevalence of overweight/obesity was increasing in almost every country in the world. Chronic inflammation associated with obesity, impaired immune function, and increased expression of ACE 2 contribute to disease severity and worsen clinical outcomes in obese patients with Covid-19 infection. Aim : This study aims to analyse the effect of obesity on the severity of the second wave of Covid-19 patients who were hospitalized at RSUD dr. Saiful Anwar Malang. Methods : This research is an analytic observational study with cross sectional approach. The sample consisted of 46 Covid-19 patients with obesity who were hospitalized at RSUD dr. Saiful Anwar Malng. The data acquired will be analysed using Mann Whitney non-parametric analysis test. Results : In the obese and non-pbese groups, the p-value was 0,042 and the odds ratio was 1,23. In the distribution of age and sex groups, each group obtained a p-value of 0,363 and 0,592. Conclusion : There is a significant difference in obesity among patients, with a 1,23-fold increased risk of experiencing severity compared to those who are not obese. Meanwhile, for the distribution based on age and sex, there was no significant difference, but it tended to have a more critical degree of severity towards men and older age.

Understanding the Endocrine and Molecular Signaling Cascade Regulation Pathways in Children with Hypospadias

AbstractHypospadias (HS) is a congenital defect that occurs due to defective androgenization. It is characterized by the aberrant location of the urinary meatus on the ventral aspect of the penis with various degrees of severity. The molecular mechanisms and genetic associations underlying the condition remain largely unknown. Existing literature revolves around surgical and medical management of the condition. Human chorionic gonadotropin pretreatment in HS is proposed to decrease the severity of the anomaly and improve the clinical outcome of surgery. The underlying mechanisms that drive these outcomes have not been explored. Few studies have explored the endocrine signaling and pathways which lead to the development of the condition. Hence, a prospective study was conducted to understand the same. Eighteen children with mid or proximal penile HS were included as cases, and nine children undergoing circumcision for phimosis (nonpathological) were included as controls. Serum samples from all these children and preputial skin samples taken during surgery were used in the analysis. The hormonal milieu was normal in all children in our cohort. A comparison of previously reported genes with our cohort sequencing revealed changes in several major pathways involved in cell proliferation and differentiation, cell signaling, angiogenesis, and immune response pathways. Compared with healthy controls, HS subjects had 152 differentially expressed genes. Of these, 93 genes were up-regulated, and 59 genes were found to be significantly down-regulated. The gene expression evaluation also showed changes in expression patterns in inflammatory genes and link RNAs, unlike previously reported genes.

Thrombectomy improves functional independence in severe basilar artery occlusion with favorable collateral circulation.

This study aimed to investigate the effect of collateral circulation on the outcomes of thrombectomy versus medical management alone in basilar artery occlusion (BAO) patients with varying stroke severities. Data from the ATTENTION cohort were used to perform a post-hoc analysis comparing the outcomes of thrombectomy with medical management in BAO patients with varying degrees of collateral circulation and stroke severity. Basilar Artery on Computed Tomography Angiography (BATMAN) scores were used to quantify the collateral circulation, and the effect was estimated through a primary outcome of 90-day functional independence (modified Rankin Scale score, mRS ≤2). Favorable versus unfavorable BATMAN scores were analyzed as both continuous and categorical variables, and an adjusted multivariate regression model was applied. Among 221 BAO patients, thrombectomy significantly improved functional independence compared to medical management in patients with favorable BATMAN scores (aOR 7.75, 95% CI 2.78-26.1), but not in those with unfavorable BATMAN scores (aOR 1.33, 95% CI 0.28-6.92; pinteraction = 0.028). When treated as a continuous variable, increased BATMAN score was found to be associated with a higher likelihood of functional independence in the thrombectomy group (aOR 1.97, 95% CI 1.44-2.81; pinteraction = 0.053). In severe stroke patients with higher BATMAN scores (National Institutes of Health Stroke Scale (NIHSS) ≥21), we identified a significant interaction for treatment effect with thrombectomy compared to medical management (pinteraction = 0.042). An increased BATMAN score was significantly associated with a higher probability of functional independence after thrombectomy than after medical management, particularly in patients with severe BAO.

A complementary Diagnostic Tool for Diabetic Peripheral Neuropathy Through Muscle Ultrasound and Machine Learning Algorithms

Diabetic peripheral neuropathy represents one of the common long-terms complications that effect about fifty percentage?of diabetes patients. The habitual diagnosis tool based on nerve conduction study that examine the nerve damage and classify the patient status into normal and diabetic peripheral neuropathy with degree of severity without considering the effect on skeletal muscle and take on patient data. A complementary diagnostic tool proposed, in this study integrates the patient’s data including body mass index, age and duration of diabetic, average blood glucose levels, nerve conduction study that involves amplitude and latency of peroneal and tibial nerves and muscle ultrasound alongside the machine learning algorithms to facilitate the clinicians for a precise diagnosis. A group of control and diabetic patients utilized to gather the data with calculating the muscle thickness and statistical properties from the gray-level ultrasound images of six skeletal muscles. Support vector machine, naïve bayes, ensemble of bagged tree and artificial neural network supervised machine learning algorithms categorize each class with a high classification accuracy, 98.1% for tibialis anterior with naïve bayes algorithm. The outcomes of this study show a promising complementary diagnostic tool that will help the clinicians to perform an exact diagnosis and disclose the side effect on both nerves and muscles of diabetic patients.

The effect of nitric oxide supplied to the oxygenator of the cardiopulmonary bypass on the functions and morphology of internal organs: experimental animal study

To evaluate the effect of NO added to the oxygenator during CPB on the liver and kidneys in pigs.Methods. The experiment was conducted on 10 pigs undergoing cardiac surgery using cardiopulmonary bypass (CPB). Animals of the experimental group (CPB-NO; n = 5) received NO with the gas mixture supplied to the oxygenator at 100 ppm. Animals of the control group (CPB-control; n = 5) did not receive NO via the oxygenator. The surgery lasted 4 hours and was followed by 12-hour postoperative monitoring. To assess the liver and kidney injury, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, creatinine, neutrophil gelatinase-associated lipocalin (NGAL) were determined at baseline, at weaning from the CPB, 6 and 12 hours after weaning from the CPB. A pathomorphological study of the liver and kidneys was also performed.Results. A long period of CPB deliberately used in our experiment caused liver injury. In the CPB-control group, an increase in the ALT concentration was found: 43 (34; 44) U/l at baseline to 82 (53; 99) U/l 12 hours after CPB, p < 0.05. AST concentration in the CPB-control group increased from 25 (17; 26) U/l at baseline to 269 (164; 376) U/l 12 hours after CPB (p < 0.05). We found no significant increase in ALT and AST concentrations in the CPB-NO group. There were no significant differences in ALT and AST concentrations between CPB-NO and CPB-control groups at all study time points. In the CPB-control group, an increase in the creatinine level was found from 131 (129; 133) μmol/l at baseline to 273 (241; 306) μmol/l 12 hours after CPB (p < 0.05). We found no significant increase in creatinine levels in the CPB-NO group. Creatinine levels in the CPB-NO group were significantly lower than in the CPB-control group 12 h after weaning from CPB: 183 (168; 196) vs 273 (241; 306) μmol/l (p < 0.008). We found no significant differences between the study groups by the NGAL level. Morphology revealed characteristic alterative changes in tissues, circulatory disorders, and inflammatory infiltration of varying degrees of severity, which in combination is a manifestation of the acute damaging effect of CPB. In the CPB-NO group, the severity of pathological changes, measured in points, was lower than in the CPB-control group, but no statistically significant differences were found.Conclusion. NO added to the oxygenator gas mixture reduces liver and kidney injury during prolonged CPB. Further research is required.

Pre-school hearing screening is necessary to detect childhood hearing loss after the newborn period: a study exploring risk factors, additional disabilities, and referral pathways

Objective To explore strategies for detecting childhood hearing loss, aside from newborn hearing screening. Design A retrospective review of medical records on the modes of detection of hearing loss, risk factors for late-onset hearing loss, hearing loss degree, aetiology, additional disabilities, and timelines from referral to intervention. Study sample Children, born 2006 to 2015, enrolled for intervention whose hearing loss was detected up to age 7 years but not from newborn hearing screening (n = 326). Results Universal pre-school hearing screening detected 38% of the cohort at 4–5 years of age. Risk factors for late-onset hearing loss were present in 36% of children, 80% of whom had a reported family history. Sixty-nine percent had mild bilateral or unilateral hearing loss. Children with additional disabilities faced significantly longer delays from referral to intervention. Children self-referred due to parent concern had more severe degree of hearing loss than those referred from screening. Conclusion Most children with hearing loss detected after the newborn period do not have any known risk factors for late-onset hearing loss. Pre-school hearing screening is needed for comprehensive detection of hearing loss in early childhood. More work is needed towards improving timely diagnosis and intervention for children with additional disabilities.

Relationship Between Hemoglobin Levels, Index Severity Score, Leukocytes and Degree of Open Fracture with Surgical Complications (Clavien Dindo Classification) in Long Bone Open Fracture Patients with External Fixation and Internal Fixation at Prof. IGNG Ngoerah Hospital

Introduction: Open bone fractures are an emergency case in the field of orthopedics that must be treated quickly because of its significant morbidity and mortality. Several parameters and classifications are used to assess the impact severity of one open bone fracture. There is no study that has discussed the comparison of each parameter yet. Aims of this study to determine the relationship between hemoglobin levels, injury severity score, leukocytes and the degree of open fracture with the outcome of long bone open fracture patients who are carried out external and internal fixation installation surgery and measured through the degree of Clavien Dindo. Methods: This research was carried out at RSUP Prof I.G.N.G. Ngoerah, Denpasar, Bali with research time from May 2023 to December 2023. Clinical and laboratory data were obtained from secondary data from patient medical records. Data analysis in research uses descriptive analysis and inferential analysis. Results: In this study, a sample of 32 patients was obtained with more males than females with percentages of 65.6% and 34.4%. Based on age, the average is 31 years with the youngest being 16 years and the oldest being 58 years. The Hemoglobin level and leukocyte respectively have an average of 8.51 and 17.7 with score of Gustilo Anderson and ISS 2.73 and 10.06. The results of this study showed a significant relationship (p<0.05) with hemoglobin p = 0.525, leukocytes p = 0.01, gustilo Anderson P = 0.028 and ISS p = 0.022 to the classification of clavein dindo Conclusion: The conclusion of this study is that the Clavien-Dindo has a relationship with several factors such as hemoglobin, leukocyte, ISS and gustilo Anderson which can affect patient condition. Keywords: Open Fracture, Clavien Dindo, Hemoglobin, Leukocyte, Index Severity Score, Gustilo Anderson

Early adolescent perceived friendship quality aids affective and neural responses to social inclusion and exclusion in young adults with and without adverse childhood experiences.

Friendships increase mental wellbeing and resilient functioning in young people with childhood adversity (CA). However, the mechanisms of this relationship are unknown. We examined the relationship between perceived friendship quality at age 14 after the experience of CA and reduced affective and neural responses to social exclusion at age 24. Resilient functioning was quantified as psychosocial functioning relative to the degree of CA severity in 310 participants at age 24. From this cohort, 62 young people with and without CA underwent functional Magnetic Resonance Imaging to assess brain responses to social inclusion and exclusion. We observed that good friendship quality was significantly associated with better resilient functioning. Both friendship quality and resilient functioning were related to increased affective responses to social inclusion. We also found that friendship quality, but not resilient functioning, was associated with increased dorsomedial prefrontal cortex responses to peer exclusion. Our findings suggest that friendship quality in early adolescence may contribute to the evaluation of social inclusion by increasing affective sensitivity to positive social experiences and increased brain activity in regions involved in emotion regulation to negative social experiences. Future research is needed to clarify this relationship with resilient functioning in early adulthood.