Disease Rating Research Articles

Risk assessment and prediction of nosocomial infections based on surveillance data using machine learning methods

BackgroundNosocomial infections with heavy disease burden are becoming a major threat to the health care system around the world. Through long-term, systematic, continuous data collection and analysis, Nosocomial infection surveillance (NIS) systems are constructed in each hospital; while these data are only used as real-time surveillance but fail to realize the prediction and early warning function. Study is to screen effective predictors from the routine NIS data, through integrating the multiple risk factors and Machine learning (ML) methods, and eventually realize the trend prediction and risk threshold of Incidence of Nosocomial infection (INI).MethodsWe selected two representative hospitals in southern and northern China, and collected NIS data from 2014 to 2021. Thirty-nine factors including hospital operation volume, nosocomial infection, antibacterial drug use and outdoor temperature data, etc. Five ML methods were used to fit the INI prediction model respectively, and to evaluate and compare their performance.ResultsCompared with other models, Random Forest showed the best performance (5-fold AUC = 0.983) in both hospitals, followed by Support Vector Machine. Among all the factors, 12 indicators were significantly different between high-risk and low-risk groups for INI (P < 0.05). After screening the effective predictors through importance analysis, prediction model of the time trend was successfully constructed (R2 = 0.473 and 0.780, BIC = -1.537 and -0.731).ConclusionsThe number of surgeries, antibiotics use density, critical disease rate and unreasonable prescription rate and other key indicators could be fitted to be the threshold predictions of INI and quantitative early warning.

P-317 Risk of endometrial polyps and hyperplasia after tamoxifen treatment in women with breast cancer: a population-based study in Taiwan

Abstract Study question This study aimed to examine the association between tamoxifen treatment and incident risks of uterine disease among breast cancer patients in Taiwan. Summary answer We found tamoxifen treatment group may have greater risk of endometrial polyps and hyperplasia than unexposured group after adjusting for age and body mass index. What is known already In the worldwide Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) breast cancer treatment trail reported that the women continue tamoxifen up to 10 years, compared with 5 years may reduce breast cancer recurrence and mortality rate. However, tamoxifen use has been reported to be associated with the cumulative risk of subsequently endometrial cancer during 5–14 years was 3.1%. Specifically, several Western studies have showed that the high incidence of endometrial cancer in breast cancer survivors with tamoxifen treatment. Study design, size, duration We conducted a retrospective cohort study using population-based data from Taiwan Cancer Registry and the National Health Insurance Research Database (NHIRD), and the National Population Registry Data set from 2011 to 2020. Participants/materials, setting, methods A total 138,934 newly diagnosed breast cancer female patients with age greater than 18 years old were included. We further used a 1-to-1 propensity score matching to generate comparable exposure and un-exposure groups. Cox proportional hazard regression models were used to examine the research question. All statistical analysis was performed using SAS version 9.4, and p-values &amp;lt; 0.05 were considered statistically significant Main results and the role of chance Incidence rate ratio (IRR) to compare incidence rate of uterine disease between tamoxifen treatment groups and unexposed group, adjusting for age and BMI. Our results showed that IRR were 1.36, 0.33, 3.73, 0.63, endometrial polyps, endometrial carcinoma, endometrial hyperplasia and uterine carcinosarcoma, respectively. This study found possible correlations between tamoxifen exposure with endometrial polyps and hyperplasia among breast cancer. During the 10-year study period, tamoxifen group did not significantly increase the risk of endometrial cancer in breast cancer survivors at aged 40 and over. Limitations, reasons for caution Our cohort study with 10-year period is its short study period, Tamoxifen group did not significantly increase the risk of endometrial cancer. Wider implications of the findings This cohort study found higher endometrial polyps and hyperplasia incidence rates among women with breast cancer who received tamoxifen women than those not treated with tamoxifen. Results of this study suggest that clinicians should consider the risk of uterine disease among tamoxifen use and counsel patients accordingly. Trial registration number KMUHIRB-G(II)20200217

385 Surgical and Oncological Anal Cancer Outcomes at a Regional Tertiary Centre

Abstract Aim There is little data in the UK about anal cancer outcomes. Our aim was to look at the rates of residual and recurrent disease following surgical or oncological treatment as well as the correspondence with the resection margin. Method A retrospective review of those who were diagnosed with anal cancer between 1/1/2017 and 1/1/2022. We reviewed their grade of cancer, the treatment received, the resection margin following surgery, and their outcomes. Results 95 patients were included. 84 patients received treatment with the aim of cure and 11 patients received palliation from diagnosis. Of those treated with an intent to cure, 61.9% of patients had no residual disease or disease recurrence, 17.9% of patients had residual disease and 20.2% had recurrence (10.7% local; 1.2% regional; 8.3% distant). 29.8% of this patient group have died. 54.1% of those with residual or local recurrence had salvage surgery. 30.8% had a positive margin. 100% of patients with a positive margin at salvage surgery have now died compared to 55.5% of those with a negative margin. 8 patients were treated with local excision for T1 disease. 62.5% had a R1 resection margin. Following further treatment 0% have had disease reoccurrence. Conclusions The survival rate of this group of patients is 62.1%. Despite having a negative resection margin at salvage surgery, long-term survival is poor. Compared with local excision of T1 disease, despite a positive or negative margin, survival is 100% in this group.

Progress in research and development of preventive vaccines for children in China.

The infant and child stage is an important stage for the continuation and development of human society. The initial years of life have a lasting impact on a child's future. Children under the age of 5 have an immature immune system, especially infants and young children under 6 months of age. At this stage, the population has a low immunity to pathogen infections, making them vulnerable to bacteria and viruses. Vaccination can enhance the immunity of infants and children to specific diseases, reduce the transmission rate of infectious diseases, and promote the development of global public health. This article summarizes the current application status of Rotavirus (RV) vaccine, Hand-foot -mouth disease (HFMD) vaccine, and Pneumococcal Conjugate Vaccine (PCV) in China, as well as the research progress of clinical trial vaccine, laying a foundation for subsequent vaccine development.

The global, regional, and national patterns of change in the burden of non-malignant upper gastrointestinal diseases from 1990 to 2019 and the forecast for the next decade.

Non-malignant upper gastrointestinal diseases, including peptic ulcer disease (PUD), gastritis and duodenitis (GD), and gastroesophageal reflux disease (GERD), significantly challenge global healthcare. These conditions not only impact patient health but also highlight socio-economic development issues and healthcare system accessibility and efficiency. Utilizing the Global Burden of Disease (GBD) database, this study aims to assess the global burden of PUD, GD, and GERD comprehensively, examining their association with the sociodemographic index (SDI). Employing data from the GBD 2019 database, this study analyzed the disability-adjusted life years (DALYs) for PUD, GD, and GERD. We integrated the SDI with the inequality slope index and concentration index for an international health inequality analysis, assessing disparities in the burden of these non-malignant upper gastrointestinal diseases. Decomposition analysis was conducted to determine the effects of population growth, aging, and epidemiological shifts on disease burden. Frontier analysis was performed to identify potential improvement areas and disparities among countries by development status. Disease time trends were depicted using a Joinpoint regression model, and the Bayesian age-period-cohort (BAPC) model projected the disease burden up to 2030. Between 1990 and 2019, the age-standardized DALYs rates (ASDR) for non-malignant upper gastrointestinal diseases declined. However, global geographic heterogeneity remained evident, closely linked to the SDI. Notably, low-SDI countries experienced higher disease burdens. Population growth and aging emerged as principal contributors to the increasing disease burden. Despite development levels, many countries have considerable potential for reducing the burden of these diseases. Furthermore, significant variations in the time trends of non-malignant upper gastrointestinal diseases were observed among countries and regions with different SDI levels, a pattern expected to continue through 2030. Non-malignant upper gastrointestinal diseases demonstrate notable heterogeneity across age, gender, and geography, with the disparities most marked in underdeveloped regions or countries. Consequently, it is imperative to focus research on policy development and to enact prevention and treatment strategies tailored to high-risk groups. This targeted approach is essential for mitigating the disease burden effectively.

Efficacy and Safety of Zonisamide as Adjunctive Therapy in Motor Symptoms of Advanced Parkinson's Disease (PD) in Egyptian Population

Abstract Background Management of motor complications -especially wearing off- in advanced PD is very challenging. Zonisamide (ZNS) is an antiepileptic drug that showed beneficial effects in motor symptoms of PD in previous studies. Methods To determine the efficacy and safety of ZNS in motor symptoms of advanced PD, we conducted a one month double blinded randomized placebo-controlled crossover study in Egypt. PD patients with Hoehn &amp;amp; Yahr stage ≥ 2 (onstate) and at least 2 hours off time daily were randomized to one of three groups: ZNS 25mg, ZNS 50 mg and placebo. Primary outcome measure was change in off time based on part IV MDS-UPDRS (Movement disorders society-Unified Parkinson’s disease rating scale). Secondary outcome measures were: change in on time based on part IV MDS- UPDRS, change in total score MDS-UPDRS, score of part III MDS-UPDRS. Results Of 69 patients enrolled in the study and underwent randomization to the 3 groups, 49 patients completed one month follow-up. Only 26 patients underwent crossover and 20 patients completed one month follow-up. So, the total number of patients analyzed at 1 month was: 69 patients (25 patients ZNS 25 mg group, 18 patients ZNS 50 mg group and 26 patients placebo group). Both ZNS 25 and 50 mg groups showed significant improvement of total MDS-UPDRS score, Tremors ON score and part 4. Except for sedation, there was no significant adverse effects in both ZNS 25,50 mg groups as compared to placebo. Conclusion ZNS (25,50 mg) is safe and effective in improving motor symptoms of advanced PD as adjunctive therapy.

Radiomics score derived from T1-w/T2-w ratio image can predict motor symptom progression in Parkinson's disease.

To clarify the association between a radiomics score (Rad-score) derived from T1-weighted signal intensity to T2-weighted signal intensity (T1-w/T2-w) ratio images and the progression of motor symptoms in Parkinson's disease (PD). This retrospective study included patients with PD enrolled in the Parkinson's Progression Markers Initiative. The Movement Disorders Society-Unified Parkinson's Disease Rating Scale Part III score ≥ 33 and/or Hoehn and Yahr stage ≥ 3 indicated motor function decline. The Rad-score was constructed using radiomics features extracted from T1-w/T2-w ratio images. The Kaplan-Meier analysis and Cox regression analyses were used to assess the time differences in motor function decline between the high and low Rad-score groups. A total of 171 patients with PD were divided into training (n = 101, mean age at baseline, 61.6 ± 9.3 years) and testing (n = 70, mean age at baseline, 61.6 ± 10 years). The patients in the high Rad-score group had a shorter time to motor function decline than those in the low Rad-score group in the training dataset (log-rank test, p < 0.001) and testing dataset (log-rank test, p < 0.001). The multivariate Cox regression using the Rad-score and clinical factors revealed a significant association between the Rad-score and motor function decline in the training dataset (HR = 2.368, 95%CI:1.423-3.943, p < 0.001) and testing dataset (HR = 2.931, 95%CI:1.472-5.837, p = 0.002). Rad-scores based on radiomics features derived from T1-w/T2-w ratio images were associated with the progression of motor symptoms in PD. The radiomics score derived from the T1-weighted/T2-weighted ratio images offers a predictive tool for assessing the progression of motor symptom in patients with PD. Radiomics score derived from T1-weighted/T2-weighted ratio images is correlated with the motor symptoms of Parkinson's disease. A high radiomics score correlated with faster motor function decline in patients with Parkinson's disease. The proposed radiomics score offers predictive insight into the progression of motor symptoms of Parkinson's disease.

Dynamic properties in functional connectivity changes and striatal dopamine deficiency in Parkinson's disease.

Recent studies in Parkinson's disease (PD) patients reported disruptions in dynamic functional connectivity (dFC, i.e., a characterization of spontaneous fluctuations in functional connectivity over time). Here, we assessed whether the integrity of striatal dopamine terminals directly modulates dFC metrics in two separate PD cohorts, indexing dopamine-related changes in large-scale brain network dynamics and its implications in clinical features. We pooled data from two disease-control cohorts reflecting early PD. From the Parkinson's Progression Marker Initiative (PPMI) cohort, resting-state functional magnetic resonance imaging (rsfMRI) and dopamine transporter (DaT) single-photon emission computed tomography (SPECT) were available for 63 PD patients and 16 age- and sex-matched healthy controls. From the clinical research group 219 (KFO) cohort, rsfMRI imaging was available for 52 PD patients and 17 age- and sex-matched healthy controls. A subset of 41 PD patients and 13 healthy control subjects additionally underwent 18F-DOPA-positron emission tomography (PET) imaging. The striatal synthesis capacity of 18F-DOPA PET and dopamine terminal quantity of DaT SPECT images were extracted for the putamen and the caudate. After rsfMRI pre-processing, an independent component analysis was performed on both cohorts simultaneously. Based on the derived components, an individual sliding window approach (44 s window) and a subsequent k-means clustering were conducted separately for each cohort to derive dFC states (reemerging intra- and interindividual connectivity patterns). From these states, we derived temporal metrics, such as average dwell time per state, state attendance, and number of transitions and compared them between groups and cohorts. Further, we correlated these with the respective measures for local dopaminergic impairment and clinical severity. The cohorts did not differ regarding age and sex. Between cohorts, PD groups differed regarding disease duration, education, cognitive scores and L-dopa equivalent daily dose. In both cohorts, the dFC analysis resulted in three distinct states, varying in connectivity patterns and strength. In the PPMI cohort, PD patients showed a lower state attendance for the globally integrated (GI) state and a lower number of transitions than controls. Significantly, worse motor scores (Unified Parkinson's Disease Rating Scale Part III) and dopaminergic impairment in the putamen and the caudate were associated with low average dwell time in the GI state and a low total number of transitions. These results were not observed in the KFO cohort: No group differences in dFC measures or associations between dFC variables and dopamine synthesis capacity were observed. Notably, worse motor performance was associated with a low number of bidirectional transitions between the GI and the lesser connected (LC) state across the PD groups of both cohorts. Hence, in early PD, relative preservation of motor performance may be linked to a more dynamic engagement of an interconnected brain state. Specifically, those large-scale network dynamics seem to relate to striatal dopamine availability. Notably, most of these results were obtained only for one cohort, suggesting that dFC is impacted by certain cohort features like educational level, or disease severity. As we could not pinpoint these features with the data at hand, we suspect that other, in our case untracked, demographical features drive connectivity dynamics in PD. PRACTITIONER POINTS: Exploring dopamine's role in brain network dynamics in two Parkinson's disease (PD) cohorts, we unraveled PD-specific changes in dynamic functional connectivity. Results in the Parkinson's Progression Marker Initiative (PPMI) and the KFO cohort suggest motor performance may be linked to a more dynamic engagement and disengagement of an interconnected brain state. Results only in the PPMI cohort suggest striatal dopamine availability influences large-scale network dynamics that are relevant in motor control.

Motor improvement in Parkinson’s disease patients receiving caffeine adjuvants: A double-blind randomized controlled trial in Indonesia

Parkinson's disease (PD) manifests as a movement and brain function disorder characterized by symptoms such as resting tremors, rigidity, bradykinesia, and postural instability, leading to disability among patients. The use of psychostimulants such as caffeine has been associated with the improvement of motor symptoms in PD patients; however, studies regarding the effect of caffeine adjuvant therapy on motor function among PD patients in the Indonesian population are lacking. The aim of this study was to evaluate motor improvement as measured by the change in scores of the Movement Disorder Society - Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III) among PD patients receiving caffeine adjuvant. A double-blind randomized controlled trial (RCT) was conducted among PD patients at Dr. Soetomo General Academic Hospital and Universitas Airlangga Hospital, Surabaya, Indonesia, from April to August 2023. A total of 27 patients were enrolled and randomly assigned to an intervention (receiving caffeine adjuvant, n=15) and control group (receiving placebo, n=12). Motor improvement was measured using the UPDRS III score prior to intervention and three weeks after. The Chi-squared test was used to analyze the difference in UPDRS III scores between the two groups. Motor improvement, as demonstrated by a reduction in the UPDRS III score, was observed in patients receiving caffeine adjuvant compared to those receiving placebo (80.0% vs 16.7%; p=0.004). Regarding the safety profile, only four out of 15 (26.6%) patients treated with caffeine reported minor adverse events. These conditions improved over time during the intervention. None of the 12 patients in the placebo reported adverse events. This study provides valuable insights into the initial dosage of caffeine that improves motor function in PD patients with minimum adverse effects.

Deep Brain Stimulation of the Subthalamic Nucleus vs. Globus Pallidus Internus in the Treatment of Parkinson’s Disease: A Systematic Review

Abstract Background Parkinson’s disease (PD) is a very common debilitating disease especially in the elderly population. Bilateral stimulation of the subthalamic nucleus or the globus pallidus internus provides significant motor benefits for patients with advanced Parkinson’s disease, while reducing dyskinesia and motor fluctuation. High frequency stimulation of the STN and the GPi is relatively safe. The effects are stable even after 1 year of stimulation. Aim of the Work The primary goal of the current review is to compare the efficacy of using the Subthalamic Nucleus (STN) vs. the Globus Pallidus Internus (GPi) as the primary target for Deep Brain Stimulation (DBS) in the treatment of Parkinson disease (PD); in terms of improved motor function measured using the Unified Parkinson's Disease Rating Scale (UPDRS), psychiatric symptoms, rate of reduction of medication, and complications. This will be done through a systematic review of literature addressing this research question. Patients and Methods In this Review, the authors are aiming at the analysis of the collective outcomes from studies comparing bilateral deep brain stimulation of the Subthalamic Nucleus and the Globus Pallidus Internus in the management of idiopathic Parkinson’s disease. The following electronic databases were searched for included articles: PubMed, Google Scholar, EMBASE, Science Direct, Cochrane database of systematic reviews, using the keywords “Parkinson’s disease – treatment – management – deep brain stimulation – subthalamic – globus pallidus internus” in different combinations. Also, manual search were conducted for reference lists of included articles. Limiting the search in English. The information sources previously mentioned were searched from 2000 to 2021. Results A total of 594 patients underwent STN-DBS, with a mean change in total UPDRSIII score of 3.26 on medication and 25.04 off medication. A total of 446 patients underwent GPi-DBS, with a mean change in total UPDRSIII score of 4.75 on medication and 19.31 off medication. There was a higher change for GPi on medication that was statistically significant with a p value (˂0.001), while off medication STN caused a higher change that was also statistically significant with a p value (˂0.001). We observed a statistically significant higher average improvement in ADLs after STN-DBS than GPi, however, non- motor function improvements were greater after GPi DBS than STN DBS. Conclusion Based on our systematic review and other available data in the literature, the STN may be the preferred target for DBS in consideration of motor function improvement, medication reduction, and economic efficiency, although GPI stimulation has some advantages in terms of mood and cognition. Treatment decisions should be individualized and based on patients’ specific symptoms and expectations. Additional well-designed multicenter clinical trials that can minimize bias are needed, especially for evaluation of the long-term outcomes of the two stimulation targets.

Serotype distribution, antibiotic resistance, multilocus sequence typing, and virulence factors of invasive and non-invasive Streptococcus pneumoniae in Northeast China from 2000 to 2021.

Streptococcus pneumoniae infection is a major public health concern with high morbidity and mortality rates. This study aimed to evaluate the serotype distribution, antimicrobial resistance changes, clonal composition, and virulence factors of S. pneumoniae isolates causing pneumococcal disease in northeast China from 2000 to 2021. A total of 1,454 S. pneumoniae isolates were included, with 568 invasive strains and 886 non-invasive strains. The patients from whom the S. pneumoniae were isolated ranged in age from 26 days to 95 years, with those ≤ 5 years old comprising the largest group (67.19%). 19F, 19A, 23F, 14, and 6B were the most common serotypes, of which 19A and 19F were the main serotypes of invasive and non-invasive S. pneumoniae, respectively. CC271 was the most common multilocus sequence type. Serotype 14 had the lowest expression of cbpA, rrgA, and psrP genes, but expression levels of 19A and 19F genes were similar. All isolates were sensitive to ertapenem, moxifloxacin, linezolid, and vancomycin but highly resistant to macrolides, tetracyclines, and cotrimoxazole. Simultaneous resistance to erythromycin, clindamycin, tetracyclines, and trimethoprim/sulfamethoxazole was common pattern among multidrug-resistant isolates. Non-invasive S. pneumoniae had higher resistance to β-lactam antibiotics than invasive strains. 19A and 19F were the main strains of penicillin-resistant S. pneumoniae. The resistance rate of β-lactam antibiotics decreased from 2017 to 2021 compared to previous periods. Including PCV13 in the national immunization program can reduce the morbidity and mortality rates of pneumococcal disease effectively.

Higher Onset of Periprosthetic Joint Infections in Patients With Teeth Compared to Those Without Teeth.

Bacteria can enter the bloodstream through simple actions such as brushing teeth, flossing, and even chewing food, increasing the chance of hematogenous seeding of prosthetic joints. Antibiotics before dental work in patients with orthopedic hardware is a topic of debate because of concerns for antibiotic resistance. Patients with dentures theoretically avoid this risk due to the lack of teeth and their maintenance. Most periprosthetic joint infections (PJIs) that occur in the first six months after surgery are due to wound infection, whereas late PJIs are more commonly caused by hematogenous seeding. Charts from patients who received primary total joint arthroplasty were interrogated for the condition of their teeth at the time of operation. If the patient had a PJI, the time from surgery and the organism responsible were noted. Multivariate linear regressions were performed for statistical analysis to compare rates of dental status, infection, comorbidities, and demographics. From the 1,500 charts reviewed, patients with teeth and edentulous had similar rates of comorbidities. PJI patients had higher rates of chronic kidney disease than patients who did not have the infection. The overall rate of infections in patients with teeth was 2.14%, close to the national average. The rate of infection in patients without teeth was 0.78%. Patients with teeth have a higher rate of infection one month or longer from surgery than edentulous patients. There was an increased infection rate in patients with teeth at six months and greater since the primary total joint arthroplasty. The organisms responsible for many of the PJIs are commonly found in the mouth of humans. Having teeth is a potential risk factor for late PJI.

Differential Responses to Low- and High-Frequency Subthalamic Nucleus Deep Brain Stimulation on Sensor-Measured Components of Bradykinesia in Parkinson's Disease.

The current approach to assessing bradykinesia in Parkinson's Disease relies on the Unified Parkinson's Disease Rating Scale (UPDRS), which is a numeric scale. Inertial sensors offer the ability to probe subcomponents of bradykinesia: motor speed, amplitude, and rhythm. Thus, we sought to investigate the differential effects of high-frequency compared to low-frequency subthalamic nucleus (STN) deep brain stimulation (DBS) on these quantified facets of bradykinesia. We recruited advanced Parkinson's Disease subjects with a chronic bilateral subthalamic nucleus (STN) DBS implantation to a single-blind stimulation trial where each combination of medication state (OFF/ON), electrode contacts, and stimulation frequency (60 Hz/180 Hz) was assessed. The Kinesia One sensor system was used to measure upper limb bradykinesia. For each stimulation trial, subjects performed extremity motor tasks. Sensor data were recorded continuously. We identified STN DBS parameters that were associated with improved upper extremity bradykinesia symptoms using a mixed linear regression model. We recruited 22 subjects (6 females) for this study. The 180 Hz STN DBS (compared to the 60 Hz STN DBS) and dopaminergic medications improved all subcomponents of upper extremity bradykinesia (motor speed, amplitude, and rhythm). For the motor rhythm subcomponent of bradykinesia, ventral contacts yielded improved symptom improvement compared to dorsal contacts. The differential impact of high- and low-frequency STN DBS on the symptoms of bradykinesia may advise programming for these patients but warrants further investigation. Wearable sensors represent a valuable addition to the armamentarium that furthers our ability to conduct objective, quantitative clinical assessments.

Effects of transcranial direct current stimulation along with cognitive training on cognitive functions and activities of daily living in patients with Parkinson's disease: A pilot randomized controlled trial

AbstractBackgroundCognitive impairment is one of the most common symptoms of Parkinson's disease (PD). In recent years, the effect of transcranial direct current stimulation (tDCS) have been investigated on various disabilities related to PD, including sensory and motor deficits and fatigue.AimTo investigate effects of transcranial direct current stimulation (tDCS) along with cognitive training on attention, working memory, reaction time (RTI), response inhibition, and activities of daily living performance.MethodsThis pilot randomized, single‐blinded, and sham‐controlled trial was performed on 32 people with PD who were blocked randomized equally into intervention and control groups. Intervention group received ten 20‐min sessions of tDCS during ten 45‐min sessions of cognitive training, while control group received ten 20‐min sessions of sham‐tDCS during ten 45‐min sessions of cognitive training. Anodal electrode of tDCS (2 mA) was placed over left dorsolateral prefrontal cortex (DLPFC), while cathode was over right supraorbital region. A blinded assessor performed pretest, posttest, and follow‐up assessments using the Unified Parkinson's Disease Rating Scale and four subtests of the CANTAB computer test including Match to Sample Visual Search, spatial span task, stop signal task, and RTI.ResultsThe results showed significant differences within groups over time in the mean scores of attention (F = 24.73, p = 0.00), working memory (F = 19.06, p = 0.000), RTI (F = 8.63, p = 0.005), response inhibition (F = 15.75, p = 0.000), and activity of daily living performance (F = 6.73, p = 0.013).ConclusiontDCS (anodal electrode over the left DLPFC and cathodal electrode over the right supraorbital region) along with cognitive training could facilitate improvement of cognitive functions and activities of daily living performance compared to routine cognitive exercises in people with PD.

Sex- differences in alpha-1 antitrypsin deficiency: Data from the EARCO Registry

Background: Sex and gender influence many aspects of chronic obstructive pulmonary disease (COPD). Limited data are available on this topic in alpha-1 antitrypsin deficiency (AATD). We therfore aimed to investigate sex issues in the EARCO registry, a prospective, international, observational cohort study.Methods: Baseline data from PiZZ individuals, enrolled in the registry with complete data on sex and smoking history were analysed by group comparisons and binary logistic regression analyses.Results: 1283 patients with AATD, 49.3% women were analysed. Females reported less tobacco consumption (16.8±12.2 vs. 19.6±14.5 PY p=0.006), occupational exposures towards gases, dusts or asbestos (p<0.005 each) and consumed less alcohol (5.5±7.6 vs. 8.4±10.3 u/week p<0.001). Females reported COPD (41% vs. 57%; p<0.001) and liver disease (11% vs. 20% p<0.001) less often. However, they had a higher prevalence of bronchiectasis (24% vs. 13% p<0.001). Despite better lung function (FEV1%pred. 73.6±29.9 vs. 62.7±29.5 p<0.001) females reported a similar symptom burden (CAT 13.4±9.5 vs. 12.5±8.9 p=ns) and exacerbation frequency (at least one in the previous year 30% vs. 26% p=ns) compared to males. In multivariate analyses, female sex was an independent risk factor for exacerbations in the previous year OR 1.6 p=0.001 in addition to smoking history, COPD, asthma and bronchiectasis and was also identified as risk factors for symptom burden (CAT≥10) OR 1.4 p=0.014 besides age, BMI, COPD and smoking history.Conclusion: Men had higher rates of COPD and liver disease, women were more likely to have bronchiectasis. Women's higher symptom burden and exacerbation frequency suggest they may need tailored treatment approaches.

Assessment of clinical phenotypic characteristics of patients with angioedema without wheals in a turkish population.

Background: Angioedema (AE) is defined as localized, self-limited swelling of subcutaneous tissues and mucosa. Objective: The aim of this study was to compare the phenotypic characteristics of patients with AE without wheals. Methods: This prospective study included adult patients with recurrent AE without wheals. Demographic and laboratory data of the patients were recorded in the patient file when they presented to the outpatient clinic between August 2018 and August 2020. The patients were contacted by phone to evaluate whether their AE had gone into remission between October 2023 and January 2024. The phenotypic characteristics of AE subtypes were compared. Results: The study included a total of 143 patients. The average age, age of onset of AE, rates of diabetes mellitus, hypertension and coronary artery disease were higher in the patients with angiotensin-converting enzyme inhibitor (ACEI) use related acquired AE (AAE) (AAE-ACEI). The rates of allergic rhinitis, drug allergy, atopy, and aeroallergen sensitivity, and the median total immunoglobulin E level were higher in patients with idiopathic histaminergic AAE (AAE-IH). The rate of face and/or perioral AE attacks was higher in the patients with AAE-ACEI, AAE-IH, and idiopathic non-histaminergic AAE. The rate of AE attacks in limbs, abdominal, genital and other parts of the body was higher in patients with hereditary AE (HAE). The baseline AE activity score was lower in the patients with AAE-IH and higher in the patients with HAE. In long-term follow-up, the remission rate of AE attacks was significant higher in patients with AAE-ACEI and AAE-IH. Conclusion: The phenotypic characteristic features of Turkish patients with AE without wheals may vary, depending on the underlying AE pathogenesis. C1 inhibitor level and function, complement C4 and C1q, and genetic tests contributed to the diagnosis; other laboratory tests did not contribute to the diagnosis.

Longitudinal Cognitive and Motor Delay after Pediatric Heart Transplantation and Associated Survival

We investigated factors associated with the longitudinal presence of neurodevelopmental delays in pediatric heart transplant (HTx) recipients. The United Network for Organ Sharing Registry was queried for patients <18 years who received a first-time isolated HTx between March 2008 and December 2022. Two patient cohorts were developed, those with/without: 1) definitive motor delay (MD) and 2) definitive cognitive delay (CD). A total of 3847(n=3267[no MD], n=580[definitive MD]) and 3446(n=2689[no CD], n=757[definitive CD]) patients were included across MD and CD cohorts, respectively. Cohorts shared 3189 patients. Compared to intracohort non-delayed patients, definitive MD and CD cohorts each independently had higher rates of congenital heart disease, ventilator support at transplant, and stroke prior to discharge (p<0.001 for all). Patients with a definitive delay at follow-up had worse longitudinal survival, with hazard ratios of 2.82(95% CI: 2.32-3.44, p<0.001) and 1.67(95% CI: 1.32-2.05, p<0.001) for MD and CD cohorts, respectively. Both stroke prior to discharge and symptomatic cerebrovascular disease at listing were predictors of CD and MD at follow-up. Definitive MD and CD cohorts each independently had higher rates of stroke prior to discharge (MD cohort, 57/580=9.8% versus 48/3267=1.5%; CD cohort, 53/757=7.0% versus 42/2689=1.6%, p<0.001 for both), and symptomatic cerebrovascular disease at listing was a predictor of CD and MD at follow-up (CD cohort, OR=4.16[95% CI: 2.62-6.58]; MD cohort, OR=3.30[95% CI: 2.06-5.22]. Patients with MD and/or CD following HTx share several characteristics (including increased stroke prior to discharge) and have decreased longitudinal survival compared to their non-delayed counterparts.

Assessment of clinical phenotypic characteristics of patients with angioedema without wheals in a turkish population.

Background: Angioedema (AE) is defined as localized, self-limited swelling of subcutaneous tissues and mucosa. Objective: The aim of this study was to compare the phenotypic characteristics of patients with AE without wheals. Methods: This prospective study included adult patients with recurrent AE without wheals. Demographic and laboratory data of the patients were recorded in the patient file when they presented to the outpatient clinic between August 2018 and August 2020. The patients were contacted by phone to evaluate whether their AE had gone into remission between October 2023 and January 2024. The phenotypic characteristics of AE subtypes were compared. Results: The study included a total of 143 patients. The average age, age of onset of AE, rates of diabetes mellitus, hypertension and coronary artery disease were higher in the patients with angiotensin-converting enzyme inhibitor (ACEI) use related acquired AE (AAE) (AAE-ACEI). The rates of allergic rhinitis, drug allergy, atopy, and aeroallergen sensitivity, and the median total immunoglobulin E level were higher in patients with idiopathic histaminergic AAE (AAE-IH). The rate of face and/or perioral AE attacks was higher in the patients with AAE-ACEI, AAE-IH, and idiopathic non-histaminergic AAE. The rate of AE attacks in limbs, abdominal, genital and other parts of the body was higher in patients with hereditary AE (HAE). The baseline AE activity score was lower in the patients with AAE-IH and higher in the patients with HAE. In long-term follow-up, the remission rate of AE attacks was significant higher in patients with AAE-ACEI and AAE-IH. Conclusion: The phenotypic characteristic features of Turkish patients with AE without wheals may vary, depending on the underlying AE pathogenesis. C1 inhibitor level and function, complement C4 and C1q, and genetic tests contributed to the diagnosis; other laboratory tests did not contribute to the diagnosis.

Sex-Differences in Alpha-1 Antitrypsin Deficiency: Data From the EARCO Registry

BackgroundSex and gender influence many aspects of chronic obstructive pulmonary disease (COPD). Limited data are available on this topic in alpha-1 antitrypsin deficiency (AATD). We therefore aimed to investigate sex issues in the EARCO registry, a prospective, international, observational cohort study. MethodsBaseline data from PiZZ individuals, enrolled in the registry with complete data on sex and smoking history were analysed by group comparisons and binary logistic regression analyses. Results1283 patients with AATD, 49.3% women were analysed. Females reported less tobacco consumption (16.8±12.2 vs. 19.6±14.5 PY, p=0.006), occupational exposures towards gases, dusts or asbestos (p<0.005 each) and consumed less alcohol (5.5±7.6 vs. 8.4±10.3u/week, p<0.001). Females reported COPD (41% vs. 57%, p<0.001) and liver disease (11% vs. 20%, p<0.001) less often. However, they had a higher prevalence of bronchiectasis (24% vs. 13%, p<0.001). Despite better lung function (FEV1%pred. 73.6±29.9 vs. 62.7±29.5, p<0.001) females reported a similar symptom burden (CAT 13.4±9.5 vs. 12.5±8.9, p=ns) and exacerbation frequency (at least one in the previous year 30% vs. 26%, p=ns) compared to males. In multivariate analyses, female sex was an independent risk factor for exacerbations in the previous year OR 1.6 p=0.001 in addition to smoking history, COPD, asthma and bronchiectasis and was also identified as risk factors for symptom burden (CAT≥10) OR 1.4 p=0.014 besides age, BMI, COPD and smoking history. ConclusionMen had higher rates of COPD and liver disease, women were more likely to have bronchiectasis. Women's higher symptom burden and exacerbation frequency suggest they may need tailored treatment approaches.

Global burden of fungal skin diseases: An update from the Global Burden of Diseases Study 2019.

Fungal skin diseases are the most common and widespread fungal infections, exerting a significant impact on patients' socio-psychological health and the quality of life. To assess and compare the global burden of fungal skin diseases in 2019 and over the past 30 years. Data were retrieved from the Global Burden of Disease Study 2019. Incidence and years lived with disability (YLDs) were used to assess the burden of fungal skin diseases. A total of 204 countries and territories were hierarchically organised into 21 regions and seven super-regions. Data were presented as absolute numbers and rates per 100,000 population, stratified by sex, age, year and location. In 2019, the global incidence rate and YLD rate of fungal skin diseases were 21,277 (95% UI 19 298-23,399) and 42 (95% UI 17-88) per 100,000 population, respectively. Sub-Saharan Africa bore the heaviest disease burden, especially children aged 5-9 years had a significantly higher incidence rate, YLD rate and YLDs to incidence ratio compared to other regions. Moreover, more than half of the incident cases among the elderly came from high-income regions and Southeast Asia, East Asia, and Oceania. Over the past 30 years, the number of incident cases and YLDs of fungal skin diseases has been continuously increasing worldwide, but the incidence rates and YLD rates have not shown significant changes. The global burden of fungal skin diseases has been continuously rising. Children in Sub-Saharan Africa are experiencing higher disease incidence and severity compared to other regions.