Different Stages Of Disease Severity Research Articles

Independent and interactive effects of APOEε4 and β‐amyloid on cortical thickness in Alzheimer’s disease

AbstractBackgroundThe apolipoprotein (APOE) ε4 allele is a major risk factor for Alzheimer’s disease (AD) and potentiates β‐amyloid (Aβ) accumulation. Both APOEε4 and Aβ individually contribute to neurodegeneration in the aging brain. Here, we investigate the independent and interactive effects of APOEε4 and global Aβ load on cortical thickness and disease severity across the AD continuum.MethodWe used FreeSurfer v7.1.1 to derive brain morphometry measures from regions‐of‐interest (ROIs) in 796 subjects (N=475 controls (CN), N=77 participants with mild cognitive impairment (MCI), N=244 with dementia; Table 1) to analyze associations between cortical thickness, APOEε4, and Aβ using available T1‐weighted MRI scans from ADNI phases 2 and 3. Multiple linear regression models were run, covarying for age and sex, to examine the effects of APOEε4 status, global Aβ, and their interaction on morphometric measures from ROIs known to be vulnerable to Aβ deposition in aging and disease (Figure 1‐ adapted from La Joie et al.).ResultIn the MCI and dementia groups, higher global Aβ was associated with lower cortical thickness in middle temporal, fusiform, and parietal regions (p<0.05), but was not associated with cortical thickness in controls. In the dementia group, there was a significant effect of Aβ (p<0.001) and an APOEε4 by Aβ interaction (p=0.01) in the inferior parietal gyrus (Figure 2). The interaction effect requires replication due to the multiple hypothesis testing.ConclusionUnlike in healthy aging, as disease severity increases, the interactive effect of Aβ and APOEε4 status significantly affects cortical thickness in regions associated with Aβ deposition. This suggests that APOEε4 differentially affects cortical thinning during different stages of disease severity.

Involvement of high-mobility group box-1 and Dermoscopy in diagnosis of psoriasis severity.

The diagnosis of psoriasis is usually established on clinical grounds but there is lacking of such diagnostic tools to stratify its severity. Psoriasis is a chronic inflammatory disease of skin, nails, and joints. Dermoscopy represent a novel diagnostic tool to diagnose and assess psoriasis severity. The main purpose of this study is to assess the value of dermoscopy associated with serum level of high-mobility group box-1 level (HMGB-1) in the diagnosis and stratification of psoriasis severity. This study included 60 Egyptians subdivided into two equal groups, psoriatic patients, and controls. All patients were subjected first to dermoscopic examination, and then we evaluated the serum levels of HMGB-1 among all studied groups. The level of HMGB-1 increased in psoriatic patients than controls. There was significant difference between patients and controls in the serum levels of HMGB -1. There were also a positive significant correlation between HMGB-1 and different stages of disease severity. There were also significant correlations between HMGB-1 and specific dermoscopic findings like vascular pattern and vascular number, erythema grades as well as types of scales (Fine, coarse) and (Fine, thick). Dermoscopy and HMGB-1 can be considered as a combined novel diagnostic tool for psoriasis severity.

Value of Triage Treatment Strategies to Distribute Hepatitis C Direct-Acting Antiviral Agents in an Integrated Healthcare System: A Cost-Effectiveness Analysis

ObjectivesThis study aimed to assess the cost-effectiveness of fibrosis-based direct-acting antiviral treatment policies for patients with chronic hepatitis C virus at the Kaiser Permanente Mid-Atlantic States health system. MethodsWe used a Markov model to compare the lifetime costs and effects of treating patients with chronic hepatitis C virus at different stages of disease severity, or all stages simultaneously, based on a fibrosis score from the US healthcare sector perspective and societal perspective. The initial distribution of patients across fibrosis scores, the effectiveness of direct-acting antiviral therapy, and follow-up and monitoring protocols were specific to the Kaiser Permanente Mid-Atlantic States health system. Direct and indirect costs, transition probabilities, and utilities were derived from the literature. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of our results. ResultsThe “Treat All” option was dominant from both the societal and healthcare sector perspectives. The conclusion was robust in deterministic sensitivity analysis. The range of incremental costs between the less restrictive policies was small—the difference between the “Treat F1+” and the “Treat All” option was only $111 per person. Probabilistic sensitivity analyses showed, at both the $100 000/quality-adjusted life-year and $150 000/quality-adjusted life-year thresholds, there was a 70% chance that the “Treat All” option was more cost-effective than the “Treat F1+” option. ConclusionsWe found that expanded treatment access is cost-effective and, in many cases, cost saving. Although our results are primarily applicable to a regional integrated healthcare system, it offers some direction to any healthcare setting faced with resource constraints in the face of highly priced drugs.

Internalized skin bias: validation study to explore the impact of the internalization of social stigma on those with hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic auto-inflammatory disease that is highly associated with adverse psychopathology and impaired body image. Previous studies show that patients with HS are also impacted by social stigma associated with their skin disease. Over time, these experiences can influence the way in which patients feel about themselves, leading to internalized skin bias (ISB). To evaluate the validity and reliability of the Internalized Skin Bias Questionnaire (ISBQ) in an HS population and to determine the association of this instrument with markers of HS severity. A cross-sectional survey with 72-h retest was sent to adult patients with HS from March to November 2021. Reliability for the ISBQ was evaluated using Cronbach's alpha and the Concordance Correlation Coefficient (CCC). Construct validity was evaluated using Pearson Correlation Coefficients with similar measures. Internal consistency for the ISBQ instrument was 0.89 with a CCC of 0.88. The ISBQ had moderate correlation (r = 0.63) with the experienced skin stigma questionnaire as well as the BDI-II (r = 0.66) and the psychosocial subscale of the HiSQOL (r = 0.65). ISBQ scores differed significantly across different stages of disease severity (P = 0.04). There was no significant difference between those with different durations of disease (P = 0.47). This study shows that the ISBQ is a valid and reliable instrument that can be used to assess the psychosocial construct of ISB especially in a population of HS patients. Further, ISB places a prevalent negative impact on the psychopathology of patients with HS.

Narrating the natural history of live infection by SARS CoV-2 VOC in animal models.

The requirement for rapid answers during the COVID-19 pandemic has stress-tested the resources of 21st century immunology, virology and vaccinology research, with life-and-death need for meaningful answers. Unsurprisingly, given the scale and features of the disease, many of the answers have come out of analysing the sadly abundant supply of infected people at different stages of disease severity. Such studies, from vaccine trials to characterisation of neutralising antibody epitopes, have yielded a huge body of knowledge that within less than 2-years has eclipsed the datasets for many or most other infectious diseases.

Effects of Telehomecare Interventions on the Management and Complications of Diabetes Mellitus: Protocol for a Systematic Review and Meta-Analysis

Background: Diabetes is one of the most serious health challenges of the 21st century. The number of adults with diabetes has roughly tripled in the last 20 years. The increased burden of chronic diseases and scarce health resources compel healthcare systems to make modern patients more self-sufficient by requiring them to play a more active part in the treatment and management of their disease. Tele-home-care is a method of distance intervention through the transmission of electronic data for follow-up, education, prevention, clinical decision-making, and treatment modulation that has a high potential for the population with diabetes. Previous studies have not systematically evaluated the effects of different features of long-distance caregiving on diabetes at different stages of disease severity.
 Objectives: The present study describes a protocol for a systematic review and meta-analysis for summarizing the evidence comparing telehomecare interventions on diabetes management and its complications.
 Methods: PubMed, Scopus, ISI Web of Science, Cochrane databases, HTA (Health Technology Assessment), NHS EED (NHS Economic Evaluation Database), DARE (Database of Abstract of Reviews of Effects), Embase, and SID will be searched using medical subject heading (MeSH) keywords. Controlled clinical trials in patients with type 1 diabetes, type 2 diabetes, and gestational diabetes will be selected based on predefined eligibility criteria. The risk of bias in studies will be checked using the JADAD score. The mean difference and its standard deviation will be calculated to be used as effect size. A random-effects meta-analysis was performed to pool the results. Subgroup analysis and meta-regression will be conducted to explore the possible sources of heterogeneity.
 Conclusion: The systematic review and meta-analysis provided by the results of a systematic review can be useful to endocrinologists, physicians, public health policymakers, and the general population.

Demographic, Clinical and Immunogenetic Profiles of a Greek Cohort of COVID-19 Patients.

The present cross-sectional study consists of a comprehensive analysis of epidemiological, laboratory, and clinical characteristics of COVID-19 patients in relation to their immunogenetic profiles. We studied 125 COVID-19 patients comprising different stages of disease severity; non-hospitalized (mild n = 69) and hospitalized (n = 56). Analysis of disease characteristics revealed no major differences between males and females of each group of patients while hospitalized patients were older and presented with comorbidities. A positive allele association was observed for HLA-DRB1*01 in total COVID-19 patients versus healthy controls. Subgrouping of COVID-19 patients in mild and hospitalized further identified a statistically significant increase in HLA-DRB1*01 in mild COVID-19 patients versus controls. The frequency of A*11, A*23, and DRB1*09 alleles was higher, while the frequency of C*12 was lower, in hospitalized patients versus healthy controls albeit with uncorrected statistical significance. The identification of specific allele associations may provide useful future markers for disease susceptibility in order to allow successful clinical management of COVID-19 patients.

Primary Hyperoxaluria Type 1 Disease Manifestations and Healthcare Utilization: A Multi-Country, Online, Chart Review Study.

Background: Primary hyperoxaluria type 1 (PH1) is a rare genetic disease that can result in irreversible damage to the kidneys and, eventually, extrarenal organs. While kidney failure is a known consequence of PH1, few studies to date have characterized clinical consequences of PH1 prior to kidney failure, and data on healthcare resource use outcomes across different stages of disease severity in PH1 are also limited. To help fill this knowledge gap, this study characterized the clinical and healthcare resource use (HRU) burden in patients with PH1 with varying stages of kidney disease.Methods: Nephrologists in the United States, Canada, United Kingdom, France, Germany, and Italy abstracted chart data from patients with PH1 under their care via an online questionnaire. Eligible patients had confirmed PH1 and ≥2 office visits from 2016 to 2019.Results: A total of 120 patients were analyzed (median age at diagnosis, 17.4 years old, median age at index 19.5 years old, median eGFR at index 45 ml/min/1.73 m2; median follow-up 1.7 years). During follow-up, the most common PH1 manifestations were kidney stones and urinary tract infections (UTIs, both 56.8%), and the most common symptoms were fatigue/weakness (71.7%) and pain (64.6%). With regard to HRU during follow-up, 37.4% required lithotripsy, 31.3% required ureteroscopy, and 9.6% required nephrolithotomy. PH1-related hospitalizations and emergency/urgent care visits were noted for 84.0 and 81.6% of patients, respectively.Conclusions: The current study demonstrated that patients with PH1 across various stages of kidney disease exhibited a substantial clinical burden, including kidney stones, UTIs, fatigue/weakness, and pain, and required frequent HRU, including kidney stone procedures, hospitalizations, and emergency visits. These findings highlight the significant morbidity and HRU burden in patients with PH1.

Clinical Factors Associated with COVID-19 Severity in Mexican Patients: Cross-Sectional Analysis from a Multicentric Hospital Study.

(1) Background: Latin America has been harshly hit by SARS-CoV-2, but reporting from this region is still incomplete. This study aimed at identifying and comparing clinical characteristics of patients with COVID-19 at different stages of disease severity. (2) Methods: Cross-sectional multicentric study. Individuals with nasopharyngeal PCR were categorized into four groups: (1) negative, (2) positive, not hospitalized, (3) positive, hospitalized with/without supplementary oxygen, and (4) positive, intubated. Clinical and laboratory data were compared, using group 1 as the reference. Multivariate multinomial logistic regression was used to compare adjusted odds ratios. (3) Results: Nine variables remained in the model, explaining 76% of the variability. Men had increased odds, from 1.90 (95%CI 0.87–4.15) in the comparison of 2 vs. 1, to 3.66 (1.12–11.9) in 4 vs. 1. Diabetes and obesity were strong predictors. For diabetes, the odds for groups 2, 3, and 4 were 1.56 (0.29–8.16), 12.8 (2.50–65.8), and 16.1 (2.87–90.2); for obesity, these were 0.79 (0.31–2.05), 3.38 (1.04–10.9), and 4.10 (1.16–14.4), respectively. Fever, myalgia/arthralgia, cough, dyspnea, and neutrophilia were associated with the more severe COVID-19 group. Anosmia/dysgeusia were more likely to occur in group 2 (25.5; 2.51–259). (4) Conclusion: The results point to relevant differences in clinical and laboratory features of COVID-19 by level of severity that can be used in medical practice.

Extracellular vesicle-mediated endothelial apoptosis and EV-associated proteins correlate with COVID-19 disease severity.

Coronavirus disease‐2019 (COVID‐19), caused by the novel severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2), has lead to a global pandemic with a rising toll in infections and deaths. Better understanding of its pathogenesis will greatly improve the outcomes and treatment of affected patients. Here we compared the inflammatory and cardiovascular disease‐related protein cargo of circulating large and small extracellular vesicles (EVs) from 84 hospitalized patients infected with SARS‐CoV‐2 with different stages of disease severity. Our findings reveal significant enrichment of proinflammatory, procoagulation, immunoregulatory and tissue‐remodelling protein signatures in EVs, which remarkably distinguished symptomatic COVID‐19 patients from uninfected controls with matched comorbidities and delineated those with moderate disease from those who were critically ill. Specifically, EN‐RAGE, followed by TF and IL‐18R1, showed the strongest correlation with disease severity and length of hospitalization. Importantly, EVs from COVID‐19 patients induced apoptosis of pulmonary microvascular endothelial cells in the order of disease severity. In conclusion, our findings support a role for EVs in the pathogenesis of COVID‐19 disease and underpin the development of EV‐based approaches to predicting disease severity, determining need for patient hospitalization and identifying new therapeutic targets.

Hybrid simulation modelling for dementia care services planning

Dementia is an increasing problem in today’s ageing society, and meeting future demand for care is a major concern for policy-makers and planners. This paper presents a novel hybrid simulation model that simultaneously takes population-level and patient-level perspectives to calculate the numbers of patients at different stages of disease severity over time, and their associated care costs. System Dynamics is used at population level to capture ageing, dementia onset, and all-cause mortality, whereas disease progression is modelled at individual patient level using Agent-Based methods. This enables the model to account for variability between patients in the rate of cognitive decline, dementia-related mortality and response to treatment interventions. Using epidemiological data from the medical literature, disease progression is modelled via a longitudinal clustering method to identify progression type, followed by mixed-effects regression to reflect each individual’s rate of cognitive decline. Results are presented for population data from the south of England, and show that the currently available interventions have only modest effects at population level.

Development and Evaluation of a Physiologically Based Pharmacokinetic Drug-Disease Model of Propranolol for Suggesting Model Informed Dosing in Liver Cirrhosis Patients.

AimThe study was aimed to understand the underlying causes for the differences in propranolol pharmacokinetics (PK) between healthy and cirrhosis populations by using a systematic whole-body physiologically based pharmacokinetic (PBPK) model-building approach for suggesting model informed propranolol dosing in liver cirrhosis patients with different stages of disease severity.MethodsA whole-body PBPK model was developed by using population simulator PK-Sim® by using reported physicochemical and clinical data for propranolol in healthy and liver cirrhosis populations. The model evaluation was done by visual verification and comparison of PK parameters using their observed/predicted ratios (Robs/pred).ResultsThe developed model has effectively described the disposition of propranolol after intravenous and oral application in healthy and liver cirrhosis populations. All the model predictions were comparable to the observed clinical data and the Robs/pred for all the PK parameters were within a 2-fold range. A significant increase in plasma concentration of propranolol and decrease in drug clearance was observed in progressive stages of liver cirrhosis. The developed model after evaluation with the reported clinical PK data was used for suggesting model informed propranolol dosing in different stages of liver cirrhosis based on systemic unbound drug concentration.ConclusionThe developed PBPK model has successfully described propranolol PK in healthy and cirrhosis populations after IV and oral administration. The evaluated PBPK propranolol-cirrhosis model can have many implications in predicting propranolol dosing in liver cirrhosis patients with different stages of disease severity.

Learning from pathophysiological aspects of COVID-19 clinical, laboratory, and high-resolution CT features: a retrospective analysis of 128 cases by disease severity.

BackgroundThe classic chest CT imaging features of COVID-19 pneumonia have low specificity due to their similarity with a number of other conditions. So, the goal of the present study is to learn from the pathophysiology of COVID-19 clinical features, laboratory results, and high-resolution CT manifestations in different stages of disease severity to provide significant reference values for diagnosis, prevention, and treatment.MethodsThis was a multicentered study that included 128 patients. Demographic, clinical, and laboratory data, in addition to chest HRCT findings, were evaluated. According to chest HRCT features, radiologic scoring were grade 1 and 2 for mild grades of the disease, 3 and 4 for moderate grades of the disease, and 5 and 6 for severe grades of the disease.ResultsPatient clinical symptoms ranged between fever, dry cough, muscle ache (myalgia)/fatigue, dyspnea, hyposomia, sore throat, and diarrhea. Lymphocytes and WBCs were significantly lower in patients with severe COVID-19. A significant negative correlation was found with WBCs (r = − 0.245, P = 0.005), lymphocytes% (r = − 0.586, P < 0.001), RBCs (r = − 0.2488, P = 0.005), Hb (gm/dl) (r = − 0.342, P < 0.001), and HCT (r = − 0.377, P < 0.001). Transferrin and CRP were significantly higher in moderate and severe COVID-19 than mild degree and showed a significant positive correlation with CT score (r = 0.356, P < 0.001) and (r = 0.429, P < 0.001), respectively. The most common CT features were peripheral pulmonary GGO and air space consolidation.ConclusionClinical features, laboratory assessment, and HRCT imaging had their characteristic signs and performances. Correlating them can make it possible for physicians and radiologists to quickly obtain the final diagnosis and staging of the COVID-19 pneumonia.

Molecular Characterization of Tc964, A Novel Antigenic Protein from Trypanosoma cruzi.

The Tc964 protein was initially identified by its presence in the interactome associated with the LYT1 mRNAs, which code for a virulence factor of Trypanosoma cruzi. Tc964 is annotated in the T. cruzi genome as a hypothetical protein. According to phylogenetic analysis, the protein is conserved in the different genera of the Trypanosomatidae family; however, recognizable orthologues were not identified in other groups of organisms. Therefore, as a first step, an in-depth molecular characterization of the Tc946 protein was carried out. Based on structural predictions and molecular dynamics studies, the Tc964 protein would belong to a particular class of GTPases. Subcellular fractionation analysis indicated that Tc964 is a nucleocytoplasmic protein. Additionally, the protein was expressed as a recombinant protein in order to analyze its antigenicity with sera from Chagas disease (CD) patients. Tc964 was found to be antigenic, and B-cell epitopes were mapped by the use of synthetic peptides. In parallel, the Leishmania major homologue (Lm964) was also expressed as recombinant protein and used for a preliminary evaluation of antigen cross-reactivity in CD patients. Interestingly, Tc964 was recognized by sera from Chronic CD (CCD) patients at different stages of disease severity, but no reactivity against this protein was observed when sera from Colombian patients with cutaneous leishmaniasis were analyzed. Therefore, Tc964 would be adequate for CD diagnosis in areas where both infections (CD and leishmaniasis) coexist, even though additional assays using larger collections of sera are needed in order to confirm its usefulness for differential serodiagnosis.

Evolution of hemodynamic forces in the pulmonary tree with progressively worsening pulmonary arterial hypertension in pediatric patients.

Pulmonary arterial hypertension (PAH) is characterized by pulmonary vascular remodeling resulting in right ventricular (RV) dysfunction and ultimately RV failure. Mechanical stimuli acting on the vessel walls of the full pulmonary tree have not previously been comprehensively characterized. The goal of this study is to characterize wall shear stress (WSS) and strain in pediatric PAH patients at different stages of disease severity using computational patient-specific modeling. Computed tomography, magnetic resonance imaging and right heart catheterization data were collected and assimilated into pulmonary artery (PA) models for patients with and without PAH. Patients were grouped in three disease severity groups (control, moderate and severe) based on clinical evaluations. A finite element solver was employed to quantify hemodynamics and wall strains. To estimate WSS in the distal small PAs with diameters ranging from 50 to 500[Formula: see text], a morphometric tree model was created, with inputs coming from outlets of the 3D model. WSS in the proximal PAs decreased with disease severity (control 20.5 vs. moderate 15.8 vs. severe 6.3[Formula: see text], [Formula: see text]). Oscillatory shear index increased in the main pulmonary artery (MPA) with disease severity (0.13 vs. 0.13 vs. 0.2, [Formula: see text]). Wall strains measured by the first invariant of Green strain tensor decreased with disease severity (0.16 vs. 0.12 vs. 0.11, [Formula: see text]). Mean WSS for the distal PAs between 100 and 500[Formula: see text] significantly increased with disease severity (20 vs. 52 vs. 116 [Formula: see text], [Formula: see text]). In conclusion, 3D flow simulations showed that WSS is significantly decreased in the MPA with disease while the mathematical morphometric model suggested increased WSS in the distal small vessels. Computational models can reveal mechanical stimuli acting on vessel walls that may inform patient risk stratification and flow shear experiments.

Community Services, Progression Rate, and Nursing Home Placement In Persons with Alzheimer’s Disease

There are many factors influencing when a person with Alzheimer’s disease (AD) or another dementia is placed in a nursing home (NHP). The aims of this study were to determine if introducing home and community-based services (HCBS) at different stages of disease severity influenced time to NHP in a sample of persons living with AD (n = 1210); examine if disease pre-progression rate (PPR) influenced time to NHP; and explore the interaction between disease severity at first use of HCBS and PPR on time to NHP. Findings suggested that earlier introduction of HCBS delayed time to NHP in a univariate model (p = 0.03), but not when covariates were adjusted (p = 0.39); faster PPR resulted in earlier NHP in both univariate (p < 0.001) and covariate adjusted models (p < 0.01); and earlier introduction of HCBS delayed time to NHP (even when PPR was taken into consideration). Implications are discussed.

Predict Disease Progression With Reaction Rate Equation Modeling of Multimodal MRI and PET.

Neurodegenerative dementia often has multiple types of underlying pathology, for example, beta-amyloid, misfolded tau, chronic neuroinflammation and neurodegeneration may coexist in Alzheimer’s disease. However, the relationship between them is often unclear, in other words, whether one pathology is upstream or downstream of others can be very difficult to investigate directly. This is partly because the underlying pathology in dementia may precede detectable symptoms by several years if not decades. The time scale associated with disease progression in dementia generally exceeds that in conventional longitudinal imaging studies in humans, so it is difficult to directly observe the temporal ordering of different pathologies. Also, animal studies are not always transferable to patients due to obvious differences between the two systems. To investigate the disease progression and relationships among underlying pathological changes, we propose a novel computational modeling approach for multimodal MRI and PET inspired by reaction rate equation in chemical kinetics. We also discuss the possibility and prerequisites to use cross-sectional data to generate preliminary hypothesis for future longitudinal studies. It has been shown that the rate of change in some biomarkers can be approximated by the average trajectory across patients at different stages of disease severity in cross-sectional studies. The relationship modeled in our approach is akin to that in the control theory, and can be assessed by demonstrating that the presence of one disease related biomarker predicts dynamics in another. We argue that the proposed framework has important implications for trials targeting different pathologies in dementia.

Telehealth for patients with chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis protocol

IntroductionChronic obstructive pulmonary disease (COPD) is a highly prevalent chronic disease characterised by persistent respiratory symptoms. A focus of COPD interventional studies is directed towards prevention of exacerbations leading to...

Annoying symptoms and social support in patients with cancer

AimTo find out how the burden associated with experiencing symptoms affects the degree of social support and the incidence of depression in patients with cancer. DesignCross-sectional study. Methods100 patients (47 women and 53 men) diagnosed with cancer, at different stages of disease severity, were involved in the study.We used the Memorial Symptom Assessment Scale (MSAS) to assess symptom survival. The scale assesses 32 symptoms in three sub-scales (physical, psychological, symptoms, total distress). To assess social assistance we used the SELSA range, containing 20 items, divided into 3 sub-categories – social relationships, family relationships, partnerships. To assess the survival of sadness and more serious symptoms of depression, we used a range of depression – CES-D (Center for Epidemiological Studies – Depression Scale). ResultsThe results show that with a higher incidence of troublesome symptoms patients are more likely to suffer on the one hand from depression and, on the other hand, from lower levels of social support in individual domains. The greatest degree of linear dependence is observed between the occurrence of psychological symptoms and the family domain in the SELSA scale (0.470), the occurrence of psychological symptoms and the overall rate of social support (0.456). ConclusionThe results of the study correspond with the conclusions of several studies showing that the occurrence of symptom-aggravating symptoms of patients with oncological disease significantly affects the degree of social support from individual members of the family. For nurses in clinical practice, the assessment of harrowing symptoms using scales can serve to plan and implement effective interventions to promote the quality of life of patients with oncological and other infectious diseases.

MiRNAs in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis

microRNAs (miRNAs) are deregulated in non-alcoholic fatty liver disease (NAFLD) and have been proposed as useful markers for the diagnosis and stratification of disease severity. We conducted a meta-analysis to identify the potential usefulness of miRNA biomarkers in the diagnosis and stratification of NAFLD severity. After a systematic review, circulating miRNA expression consistency and mean fold-changes were analysed using a vote-counting strategy. The sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio and area under the curve (AUC) for the diagnosis of NAFLD or non-alcoholic steatohepatitis (NASH) were pooled using a bivariate meta-analysis. Deeks' funnel plot was used to assess the publication bias. Thirty-seven studies of miRNA expression profiles and six studies of diagnostic accuracy were ultimately included in the quantitative analysis. miRNA-122 and miRNA-192 showed consistent upregulation. miRNA-122 was upregulated in every scenario used to distinguish NAFLD severity. The miRNA expression correlation between the serum and liver tissue was inconsistent across studies. miRNA-122 distinguished NAFLD from healthy controls with an AUC of 0.82 (95% CI 0.75-0.89), and miRNA-34a distinguished non-alcoholic steatohepatitis (NASH) from non-alcoholic fatty liver (NAFL) with an AUC of 0.78 (95% CI 0.67-0.88). miRNA-34a, miRNA-122 and miRNA-192 were identified as potential diagnostic markers to segregate NAFL from NASH. Both miRNA-122, in distinguishing NAFLD from healthy controls, and miRNA-34a, in distinguishing NASH from NAFL, showed moderate diagnostic accuracy. miRNA-122 was upregulated in every scenario of NAFL, NASH and fibrosis. LAY SUMMARY: microRNAs are deregulated in non-alcoholic fatty liver disease. The microRNAs, miRNA-34a, miRNA-122 and miRNA-192, were identified as potential biomarkers of non-alcoholic fatty liver and non-alcoholic steatohepatitis, at different stages of disease severity. The correlation between miRNA expression in the serum and in liver tissue was inconsistent, or even inverse.