Higher Severity Index Research Articles

P49 Effectiveness of tildrakizumab for the treatment of plaque psoriasis in Austria with regard to itching

Abstract Plaque psoriasis, an autoimmune disease predominantly affecting the skin, is accompanied by itching in 60–90% of the patients, which may seriously affect health-related quality of life (HRQoL). Female gender and high psoriasis area and severity index (PASI) scores are associated with more severe itch. Reduction of itch is one of the most desired treatment outcomes for patients. Tildrakizumab is an interleukin-23p19 inhibitor indicated for the treatment of moderate-to-severe plaque psoriasis with demonstrated long-term efficacy and safety.1 The primary objective of this study is to assess the improvement of itching in patients with plaque psoriasis under tildrakizumab therapy in routine care. The study is a monocentric, national, open, prospective, non-interventional, uncontrolled, single group, post-authorization, observational study carried out at a single study site in Austria for 28 weeks. Itch was assessed by the Numeric Rating Scale (NRS) 0–10 at each visit. Patients with medium-to-severe pruritus were eligible for inclusion in the study. The HRQoL instrument was Dermatology Life Quality Index-Relevant (DLQI-R). Effectiveness was assessed by PASI score. A total of 24 patients were included (58.0% male, mean age of 48 years, 42.0% current smokers). Seven patients had a family history of psoriasis and nine patients reported one or more comorbidities like obesity, dyslipidaemia, hypertension, and diabetes mellitus. The mean itch NRS score decreased from 7.3 at baseline to 2.7 at Week 4 and to 0.4 at Week 28. At baseline, 23 of 24 patients reported an itch NRS ≥4. In only 4 weeks, two-thirds of the patients (66.7%) reached the minimal clinically important difference reduction of ≥4 points, 18 of 23 at Week 16 and all of them at Week 28. At Week 4, after only one injection of tildrakizumab, 30.4% reported an itch NRS 0/1, and at Week 28 all but two patients reported no or minimal itch. The mean DLQI-R score decreased from 12.6 at baseline to 3.2 at Week 28. Mean PASI decreased from 13.2 at baseline to 0.6 at Week 28 which resulted in 91.3% of patients achieving PASI ≤1 at the end of the study. No patients discontinued due to adverse events. In a real-world setting, tildrakizumab quickly and effectively improved itch in psoriasis patients as well as skin symptoms and HRQoL, without safety concerns, and this improvement was maintained through Week 28.

YOUNGER HYPERTENSIVE PATIENTS HAVE LOWER HEALTH-RELATED QUALITY OF LIFE AND DIFFERENT HYPERTENSION CORRELATES. EVIDENCE FROM BULGARIA

The purpose of this study was to determine hypertension correlates among the patients' survey characteristics after splitting the sample into two groups based on their age and perform this assessment separately for each of the groups. Materials and methods. A cross-sectional retrospective study among 647 patients was conducted using self-administered EQ-5D 3L, as well as demographic, economic and health questions. Results. The overall self-reported arterial hypertension (AH) prevalence was 36.9%. The sample was split into two groups: 18-54 and 55+ years, with AH prevalence of 23.5% and 51%, respectively. The differences between AH and non-AH patients in each age group were explored. Younger AH patients significantly more often reported fatigue, headache, chest pain and having at least 1 acute condition for the last year than non-hypertensive ones at the same age. Diabetes, asthma/chronic bronchitis and joint pain/arthritis were also more common among younger AH patients. The overall HRQol and self-perceived health were significantly lower among young hypertensive patients, and their median severity index was higher compared to non-hypertensive adults of the same age. They more often experienced moderate pain/discomfort and moderate anxiety/depression. Despite of this, older AH patients reported similar HRQoL compared to non-AH patients. Conclusions. Different comorbidities were found amongst younger and older hypertensive patients. Most of the already known AH correlates were confirmed only among younger adults (18-54 years old). Arterial hypertension leads to significantly lower health-related quality of life, self-perceived health and higher severity index only among the younger group, mainly due to the depression and pain they experience.

Multifocal candidiasis can be considered a form of invasive candidiasis in critically non-neutropenic patients

Candida infections can be serious in intensive care unit (ICU) patients, as Candida is an organism that specially colonizes the digestive system. In immunocompromised patients, treatment is protocolized, but in non-neutropenic patients, it is not well established. On the other hand, the treatment of this type of infection is not absent of adverse effects. The prevalence of fungal infections, especially candidiasis, and its mortality in the ICU is high, mainly due to the lack of diagnosis and absence of treatment criteria, because they are often detected in the disseminated candidiasis phase, such as candidemia. One of the indicators of the progression of the disease is the presence of Candida in more than two different foci, named Candida multifocality, within the concept of invasive candidiasis. In fact, the invasive fungal diseases in adult patients i intensive care unit (FUNDICU) project was created to optimize the management of candidiasis. The management of candidiasis in ICU patients first requires the identification of patients at high risk of candidiasis, which must be performed based on the evidence of immune dysregulation, higher severity index (acute physiologic assessment and chronic health evaluation and multiple organ dysfunction syndrome), long ICU stays or other factors such as mechanical ventilation or us of broad-spectrum antibiotics. To increase detection and dispense the appropriate antifungal at an early stage, it is necessary to include the concept of multifocality in invasive candidiasis with screening of different foci. Antifungal treatment reduces mortality both overall and attributable to Candida. Detecting a high invasive candidiasis risk is a patient safety concept and should be treated as such. Identifying patients (critically non-neutropenic adult patients with severe multiple organ dysfunction syndrome and the first isolation of Candida spp. in a study sample of possible secondary infection) and demonstrating invasive candidiasis (multifocal or disseminated) require urgent initiation of antifungal treatment to minimize mortality attributable to invasive candidiasis in the ICU and eliminate mortality rates above 50%.

Expanded clinical phenotype spectrum correlates with variant function in SCN2A-related disorders.

SCN2A-related disorders secondary to altered function in the voltage-gated sodium channel Nav1.2 are rare, with clinically heterogeneous expressions that include epilepsy, autism and multiple severe to profound impairments and other conditions. To advance understanding of the clinical phenotypes and their relationship to channel function, 81 patients (36 female, 44%, median age 5.4 years) with 69 unique SCN2A variants were systematically phenotyped and their Nav1.2 channel function systematically assessed. Participants were recruited through the FamileSCN2A Foundation. Primary phenotype (epilepsy of neonatal onset, n = 27; infant onset, n = 18; and later onset n = 24; and autism without seizures, n = 12) was strongly correlated with a non-seizure severity index (P = 0.002), which was based on presence of severe impairments in gross motor, fine motor, communication abilities, gastrostomy tube dependence and diagnosis of cortical visual impairment and scoliosis. Non-seizure severity was greatest in the neonatal-onset group and least in the autism group (P = 0.002). Children with the lowest severity indices were still severely impaired, as reflected by an average Vineland Adaptive Behavior composite score of 49.5 (>3 standard deviations below the norm-referenced mean of the test). Epileptic spasms were significantly more common in infant-onset (67%) than in neonatal (22%) or later-onset (29%) epilepsy (P = 0.007). Primary phenotype was also strongly correlated with variant function (P < 0.0001); gain-of-function and mixed function variants predominated in neonatal-onset epilepsy, shifting to moderate loss of function in infant-onset epilepsy and to severe and complete loss of function in later-onset epilepsy and autism groups. Exploratory cluster analysis identified five groups, representing: (i) primarily later-onset epilepsy with moderate loss-of-function variants and low severity indices; (ii) mostly infant-onset epilepsy with moderate loss-of-function variants but higher severity indices; and (iii) late-onset and autism only, with the lowest severity indices (mostly zero) and severe/complete loss-of-function variants. Two exclusively neonatal clusters were distinguished from each other largely on non-seizure severity scores and secondarily on variant function. The relationship between primary phenotype and variant function emphasizes the role of developmental factors in the differential clinical expression of SCN2A variants based on their effects on Nav1.2 channel function. The non-seizure severity of SCN2A disorders depends on a combination of the age at seizure onset (primary phenotype) and variant function. As precision therapies for SCN2A-related disorders advance towards clinical trials, knowledge of the relationship between variant function and clinical disease expression will be valuable for identifying appropriate patients for these trials and in selecting efficient clinical outcomes.

Additional Value From Free-Text Diagnoses in Electronic Health Records: Hybrid Dictionary and Machine Learning Classification Study.

Physicians are hesitant to forgo the opportunity of entering unstructured clinical notes for structured data entry in electronic health records. Does free text increase informational value in comparison with structured data? This study aims to compare information from unstructured text-based chief complaints harvested and processed by a natural language processing (NLP) algorithm with clinician-entered structured diagnoses in terms of their potential utility for automated improvement of patient workflows. Electronic health records of 293,298 patient visits at the emergency department of a Swiss university hospital from January 2014 to October 2021 were analyzed. Using emergency department overcrowding as a case in point, we compared supervised NLP-based keyword dictionaries of symptom clusters from unstructured clinical notes and clinician-entered chief complaints from a structured drop-down menu with the following 2 outcomes: hospitalization and high Emergency Severity Index (ESI) score. Of 12 symptom clusters, the NLP cluster was substantial in predicting hospitalization in 11 (92%) clusters; 8 (67%) clusters remained significant even after controlling for the cluster of clinician-determined chief complaints in the model. All 12 NLP symptom clusters were significant in predicting a low ESI score, of which 9 (75%) remained significant when controlling for clinician-determined chief complaints. The correlation between NLP clusters and chief complaints was low (r=-0.04 to 0.6), indicating complementarity of information. The NLP-derived features and clinicians' knowledge were complementary in explaining patient outcome heterogeneity. They can provide an efficient approach to patient flow management, for example, in an emergency medicine setting. We further demonstrated the feasibility of creating extensive and precise keyword dictionaries with NLP by medical experts without requiring programming knowledge. Using the dictionary, we could classify short and unstructured clinical texts into diagnostic categories defined by the clinician.

Levels of Angiotensin and Kinin Metabolite Peptides Related to COVID-19 Severity.

In addition to crucial roles in normal human biology, peptide metabolites of the renin-angiotensin (RAS) and kallikrein-kinin systems (KKS) have been reported to be altered in COVID-19 patients. Here, we evaluate new data on RAS and KKS peptides in COVID-19 patient serum obtained from a recently developed, fully validated, and optimized stable isotope labeling LC-MS peptide assay. We found that the RAS peptides angiotensin (ANG) 1, 2, 1-5, and 1-7 were downregulated compared to COVID-free surrogate controls, while the KKS peptides Brad, Brad 1-8, and Brad 1-7 were upregulated. This paper focuses on uncovering the possible diagnostic value of these peptides using receiver operating characteristic (ROC) analyses of these data. ROC plots confirmed that all of the analyte peptides in 80 serum samples from COVID-19 patients were significantly altered from "normal" values of the control samples. The best diagnostic sensitivities and selectivities for COVID vs no COVID were found in ROC plots for Brad and Brad 1-7 (both 99% sensitivity, 100% selectivity). We then analyzed levels of all the peptides grouped according to preassigned values of the World Health Organization (WHO) COVID-19 Severity Index. ROC plots differentiated patients with a high WHO severity index from those with a low WHO severity index with moderate success, with BRAD (73% sensitivity, 79% selectivity) and Ang 1-7 (75% sensitivity, 65% selectivity) giving the best diagnostic performance. Results suggest the possible diagnostic value of these peptides as biomarkers to help identify moderate and serious COVID-19 cases at relatively early stages.

Secondary metabolite induced tolerance to Fusarium oxysporum f.sp. cubense TR4 in banana cv. Grand Naine through in vitro bio-immunization: a prospective research translation from induction to field tolerance

An innovative tissue culture mediated incorporation of metabolite-based biomolecule (Bio-immune) at in vitro stage itself in banana cv. Grand Naine was developed and validated for the production of Fusarium oxysporum f.sp. cubense TR4 tolerant plantlets. The novel bio-immune formulation developed by us, exhibited a significant antifungal potency against Foc TR4 with a high percent inhibition (100%) at a 2.5% concentration of bio-immune on the 5th, 7th, and 9th DAI. Bio-immune integrated during in vitro shoot proliferation stage in banana cv. Grand Naine recorded significant enhancement in the growth of roots and shoots. Bio-immune (0.5%) fortified media produced 12.67 shoots per clump whereas control registered only 9.67 shoots per clump. Similarly, maximum root numbers (7.67) were observed in bio-immune plants which were significantly higher over control (5.0). The bio-immunized banana transplants recorded a higher survival rate (97.57%) during acclimatization as compared to the control (94.53%). Furthermore, evaluation of the bio-immunized plants in pot experiments revealed that unimmunized plants treated with FocTR4 (TF) exhibited mortality between 60 and 90 days. On the 90th day after planting, a high mean disease severity index (DSI) of 3.45 was observed with unimmunized plantlets while the bio-immunized plants (TFBI) and ICAR-FUSICONT treated plants (TFTR) showed substantially reduced DSI (0.20 and 1.00) compared to FocTR4 treated control (TF). Significant increases in polyphenol oxidase (PPO), peroxidase (POD), β-1,3-glucanase, phenylalanine ammonia-lyase (PAL), chitinase activities, and enhanced phenol contents were recorded in bio-immunized plants compared to unimmunized plants. Field experiments at two different locations in Bihar, India revealed that bunch weight, no. of hands/bunch, and no. of fingers/hand of bio-immune treated plants were significantly higher compared to the control.

Predictors of Mortality in Pulmonary Embolism: A Real-Life Study

Objective: The primary aim of this study was to investigate the mortality and associated factors in patients with pulmonary embolism. Methods: A retrospective analysis was performed on adult patients with pulmonary embolism who applied to X University Hospital between January 1, 2017, and January 1, 2023. All-cause mortality and related factors in pulmonary embolism patients were determined. Results: This study included 152 patients with a median age of 59 years and 81 (53.3%) women. The all-cause mortality rate was 25.7%, and pulmonary embolism-related deaths were 1.3%. Age (p&lt;0.001), chronic obstructive pulmonary disease (COPD) (p=0.013), heart failure (p=0.018), atrial fibrillation (p=0.015), massive pulmonary embolism (p=0.029), hemoglobin level (p&lt;0.001) and NT-Pro BNP level (p&lt;0.001) were significantly associated with increased all-cause mortality. In binary logistic regression analysis, for each unit of increasing pulmonary embolism severity index (PESI) score, mortality increased 2.2-fold (95% CI:1.03-5.09), massive PTE 1.6-fold (95% CI:0.14-17.86), anticoagulant duration (daily) 0.98-fold (95% CI:0.98-0.99) and Hb level (per unit Hb reduction) 0.67-fold (95% CI:0.45-1.02) mortality was increasing. There was no statistical difference between the number of hospitalization days for patients with low and high PESI and simplified PE severity index (sPESI) scores. Conclusions: All-cause mortality in patients with pulmonary embolism increased with age, cardiac diseases, and COPD comorbidities. The PESI and sPESI scores used in the acute phase of PTE were found to be highly reliable in predicting all-cause mortality in PE patients. The diagnosis of massive PE and elevated NT-proBNP levels, a marker of right ventricular dysfunction, were factors that increased mortality.

Farmer knowledge, management practices and occurrence of tomato root knot nematodes in Kenya

Root-knot nematodes (RKNs) (Meloidogyne spp.) is a major constraint to tomato (Solanum lycopersicum L.) production in sub-Saharan Africa; yet there is low adoption of recommended nematode control measures in regions like east Africa due to inadequate farmer knowledge about the pest and associated diseases. The objective of this study was to assess farmers’ knowledge status, and intensity of damage of root-knot nematodes and their management practices in Kenya. A survey was conducted in Kenya, during February to August 2021; using a semi-structured questionnaire administered to 282 randomly selected household heads of actively growing tomato farmers, at two elevations in three counties. Most farmers (98.9%) could not identify the disease precisely. They mostly attributed its symptoms to moisture stress and nutrient deûciencies. Most farmers (63%) practiced mono-cropping; while only 4.3% of farmers amended soils with manure. Respondents preferred growing RKN susceptible tomato varieties, mainly Rio-Grande, Cal J, Onyx and Kilele FI. A total of 92% expressed willingness to shift to RKNs resistant varieties, if recommended varieties match their desirable characteristics. Majority of the respondents lacked knowledge on nematode characteristics and its associated disease control. A total of 37.9% of the respondents did not use control measures against the RKNs. There was high disease incidence, severity and galling index in the surveyed areas.

Does percutaneous cholecystostomy affect prognosis of patients with acute cholecystitis that are unresponsive to conservative treatment?

Percutaneous cholecystostomy (PC) can be used as bridging or definitive therapy in some cases of acute cholecystitis. We aimed to compare hospital stay and survival of patients that underwent PC insertion because of acute calculus cholecystitis (ACC) compared to those who did not. This is a retrospective study in which patients with gangrenous cholecystitis and perforation were excluded. Regression models were used to evaluate the influence of PC on mortality and hospital stay. Six hundred and eighty-three patients were admitted because of ACC, and 50 patients were referred to PC. Indication for PC insertion were high disease severity index (DSI, 8 pts) and failure of conservative treatment with total disease duration >7 days (42 pts). Those who underwent PC were older (76.0 ± 12.4 vs. 60.8 ± 19.2, P < 0.001); PC was associated with longer hospital stay (12.8 vs. 6.5 days) and higher one-year mortality (20% vs. 4.9%, P < 0.001). Among patients with non-severe disease severity index (DSI), PC was associated with longer length of hospital stay and higher one-year mortality compared to patients treated conservatively (9.9 ± 0.6 vs. 6.0 ± 0.2 days, and 16.7% vs. 4.0%, respectively, P < 0.001 for both). For patients with severe DSI, PC was associated with similar length of hospital stay and one-year mortality compared to similar patients treated conservatively (16.1 ± 8.1 vs. 18.4 ± 4.0 days, and 37.5% vs. 22.6%, respectively, P = 0.802 and P = 0.389, respectively). In patients with mild-moderate DSI unresponsive to conservative treatment, PC may be associated with deteriorated prognosis compared to conservative treatment. The decision to insert PC in patients unresponsive to conservative therapy even with disease duration >7 days must be re-evaluated.

Review of the reasons for and effectiveness of switching biologics for psoriasis treatment in Korea.

Background Switching of biologics in patients has become common in clinical practice. Objectives This study investigated the reasons for and effectiveness of switching biologic agents during the treatment of psoriasis. Methods We retrospectively reviewed patients with psoriasis who were treated with biologics at Pusan National University Hospital and Chosun University Hospital from March 2012 to June 2020. We assessed their demographics and treatment characteristics (reasons for switching biologics and efficacy of the first- and second biologic agents). Results Of the 162 psoriatic patients treated with biologic agents for more than 52 weeks, 35 required a switch to another biologic agent. The reasons for switching biologic agents were inefficacy (n = 30), adverse events (n = 2) and others (n = 3). The mean psoriasis area and severity index (PASI) score was 12.1 at the start of the second biologic and 3.4 at 14-16 weeks later. Patients were more likely to switch to another biologic agent when they exhibited a high initial psoriasis area and severity index score and concomitant psoriatic arthritis. Limitations As a retrospective study, there were some limitations such as lack of a placebo control group and the time point of 14-16 weeks being somewhat early to judge the effect of the biologics. Conclusions The most common reason for switching biologic agents in Korea was treatment inefficacy, especially secondary failure. Despite the inefficacy of previous biologic agents, switching to a different agent may be an efficacious approach.

Settlement Analysis in Potentially Liquifiable Soil at Kretek 2 Bridge Area

The Kretek 2 Bridge is one of the important infrastructures built on the southern coast road of Java. Referring to the Map of Indonesia Liquefaction Vulnerability Zone in 2019, Kretek 2 Bridge was identified as a high liquefaction susceptibility zone. The result of liquefaction potential analysis on the slab-on-pile section indicates that the soil layer has potential to liquefy if an earthquake occurs. Based on the Liquefaction Severity Index, the slab-on-pile section of the Kretek 2 Bridge has a high severity index at BH-10, moderate severity index at BH-11, and low severity index at BH-01 and BH-12. One of liquefaction effects is a ground settlement. Settlement due to liquefaction is a vertical soil deformation in the soil layer caused by compaction due to the earthquake. This study was conducted by calculating the settlement of sand deposits in slab-on-pile section using an equation proposed by Zhang et al. in 2002 and Yoshimine in 2006. The results of settlement analysis using Zhang’s method to predict settlement in the study area, BH-10 having the most significant settlement at 29.803 cm. Using the settlement analysis method by Yoshimine, the highest settlement found in BH-10, which is 30.401 cm.

Spécies Diversity and Physiological Characterization of Fusarium spp. Isolates Causing Potato (Solanum tuberosum L.) Fusariosis (Far-North, Cameroon)

Introduction: Potato production in the Far North Region, Cameroon is hampered by a wide range of fungi of the genus Fusarium.&#x0D; Aims: The aim of this work was to isolate and conduct physiological characterization of Fusarium spp. isolates responsible for potato Fusarium disease in the Far North Region, Cameroon.&#x0D; Methodology: Isolates were obtained from diseased organs (leaves) from fifteen villages in the district of Mogodé, Mokolo and Koza, Far North Cameroon. The species responsible for fusariosis were identified using several identification Keys on a base of symptoms and morphological spores characteristics (macroconidia, microconidia and chlamydospores). Fusarium incidence and rainfall were assessed. Radial growth, sporulation and pathogenicity of the isolates were use to evaluated the parameters of physiological characterization.&#x0D; Results: The overall average incidence of Fusarium head blight in the Far North Region, Cameroon is 29.36%. Furthermore, out of the 20 isolates obtained, six Fusarium species (Fusarium oxysporium, F. solani, F. equiseti, F. avenacearum, F. colmorum and F. sambicum) were identified. The highest growth rate (8.1 cm), the highest spore production (8 × 105) and the highest severity index (3%) were respectively obtained with the isolates FUROM 2 and FUTEK 3, FUMOG 1, FUMOG 2, FUROM 1 and FURAF from Mogodé District on PCA medium.&#x0D; Conclusion: Potato production in the Far North Region, Cameroon is confronted by various Fusarium species which have physiological characteristics that vary according to the area of origin of the isolates and the growing media.

Smallholder coffee-based farmers’ perception and their adaptation strategies of climate change and variability in South-Eastern Ethiopia

ABSTRACT Recent studies suggest that smallholder farmers’ perceptions rather than exact meteorological data strongly influence how they adapt to the changing climate. Therefore, we explored the climate change (CC) perceptions and adaptation strategies of coffee farmers in dependence on the meteorological data (1983–2020) along an elevation gradient (1,600–2,000 masl) in the Sidama region, Ethiopia. In total, 351 coffee farmers were randomly selected for household interviews, complemented with key informants (KIs), focus group discussions (FGDs), and field observations. Severity Index (SI) was computed to measure farmers’ perception of CC, followed by a Mann–Kendall test to ascertain climate trends. Weighted Average Index (WAI) was also used to rank adaptation strategies. We detected an increasing temperature and annual rainfall trend. Nevertheless, while farmers agreed on rising temperatures, they perceived rainfall reduction, contradicting the meteorological data. The highest SI was recorded for the rising temperature, followed by the uncertainty of rainfall distribution, increasing number of hot days, late-onset, and reduced amount of rainfall. The SI results with KIs and FGDs confirmed that weather events seemed more variable than in the past two to three decades and affected coffee production. As the most important CC adaptation strategies, the respondents practise agroforestry, application of compost, terrace construction, modification of farming calendar, and crop diversification. Our results also revealed that gender, education, farming experience, family size, access to agricultural and farmer-to-farmer extensions, and credit services affected adopting adaptation strategies. This study confirms that farmers’ perception is more important in shaping the applied adaptation strategies.

Association of delirium with increased short-term mortality among older emergency department patients: A cohort study

Study objectiveTo evaluate the association between delirium and subsequent short-term mortality in geriatric patients presenting to the emergency department (ED). MethodsThis was an observational cohort study of adults age ≥75 years who presented to an academic ED and were screened for delirium during their ED visit. The Delirium Triage Screen followed by the Brief Confusion Assessment Method were used to ascertain the presence of delirium. In-hospital, 7-day, and 30-day mortality were compared between patients with and without ED delirium. Odds ratios with 95% confidence intervals (CIs) were calculated through logistic regression after adjusting for confounders including age, sex, history of dementia, ED disposition, and acuity. ResultsA total of 967 ED visits were included for analysis among which delirium was detected in 107 (11.1%). The median age of the cohort was 83 years (IQR 79, 88), 526 (54.4%) were female, 285 (29.5%) had documented dementia, and 171 (17.7%) had a high acuity Emergency Severity Index triage level 1 or 2. During the hospitalization, 5/107 (4.7%) of those with delirium and 4/860 (0.5%) of those without delirium died. Within 7 days of ED departure, 6/107 (5.6%) of those with delirium and 6/860 (0.7%) of those without delirium died (unadjusted OR 8.46, 95% CI 2.68–26.71). Within 30 days, 18/107 (16.8%) of those with delirium and 37/860 (4.3%) of those without delirium died (unadjusted OR 4.50, 95% CI 2.46–8.23). ED delirium remained associated with higher 7-day (adjusted OR 5.23, 95% CI 1.44–19.05, p = 0.008) and 30-day mortality (adjusted OR 2.82, 95% CI 1.45–5.46, p = 0.002). ConclusionDelirium is an important prognostic factor that ED clinicians and nurses must be aware of to optimize delirium prevention, management, disposition, and communication with patients and families.

Failure mode effects and criticality analysis (FMECA) using fuzzy logic for ship dynamic positioning (DP) systems

Predicting the failure modes effect and criticality analysis (FMECA) of a dynamic positioning (DP) system using fuzzy logic is the aim of this research. The identification of DP systems and subsystems, the classification of failure modes into critical and less-critical levels based on the Risk Priority Number (RPN) to depict the main root causes of failure in the DP system are some critical objectives in support of this goal. The analysis offers details on a number of issues, including the causes of failure modes and their effects on the functionality and dependability of equipment. Based on the information provided, it was determined that a number of failure modes produced identical RPN values, and that the ranking scale was erroneous. A new method was tested but could not really prioritize the failure modes with same RPN because of the few choices in the severity, occurrence and detection template. To compensate for this, excel ranking function was employed putting severity, occurrence and detection as key criteria for ranking. Due to the high severity and occurrence index, the RPN ranking results show that the faulty DP system component identified for the scenario SSTs (F1) is categorized as very critical. SSCs (F12), SSPr (F7), SSTs(F2), and SSPs(F15) are additional critical failures. In the study, data analysis and validation were done using a fuzzy rule system based on MATLAB. From the findings, it can be inferred that the failure modes F1, F2, F5, F6, F7, F8, F10, F11, and F15 have values of a similar type of RPN. According to the initial RPN risk level results; there are 19 failure modes in the medium risk level, 2 in the low risk level and 1 in the high risk level. In the final RPN-based risk level results, there are 18 failure scenarios in the low risk level and 4 in the medium risk level. In contrast, there are 5 failure modes in the fuzzy RPN low risk level and 17 failure scenarios in the medium risk level. Without fuzzy logic, the justification score on traditional FMECA can be given directly. This makes traditional FMECA ABS show greater risk than fuzzy FMECA. The failure modes with the highest RPN values were treated as critical parts, so it was recommended that the highest value of RPN be given special attention by making the necessary repairs or replacements in order to lengthen the equipment's lifespan.

Follow-Up of a Cohort of Patients with Post-Acute COVID-19 Syndrome in a Belgian Family Practice

Fifty-five patients who suffered from COVID-19, who were still very ill after several months, with extreme fatigue, effort exhaustion, brain fog, anomia, memory disorder, anosmia, dysgeusia, and other multi-systemic health problems have been followed in a family practice setting between May 2021 and July 2022. Data extracted from the medical records of the 55 patients (40 women), mean age 42.4 (12 to 79 years), and a qualitative study of 6 of them using a semi-open-ended questionnaire allowed to highlight the clinical picture described by WHO as post-acute COVID-19 syndrome (PACS) also known as long COVID. We used brain single-photon emission computed tomography (SPECT-CT) in thirty-two patients with a high severity index and a highly impaired functional status, demonstrating vascular encephalopathy in twenty nine patients and supporting the hypothesis of a persistent cerebral vascular flow disorder in post COVID-19 condition. The patients will benefit from the consortium COVID Human Genetic Effort (covidhge.com) to explore the genetic and immunological basis of their problem, as 23/55 cases don’t have immunological certainty of a COVID-19 infection. There is no known verified treatment. Analyzing the data from the first 52 patients, three categories of patients emerged over time: 16 patients made a full recovery after 6–8 months, 15 patients were able to return to life and work after 12–18 months with some sequelae, both groups being considered cured. In the third group, 21 patients are still very ill and unable to resume their work and life after 18 months. The biopsychosocial consequences on patients’ lives are severe and family doctors are left out in the cold. It is necessary to test the reproducibility of this description, conducted on a small number of patients. Nevertheless, identifying, monitoring and supporting these patients is a necessity in family medicine.

Correlation between oxygen saturation of patient and severity index of COVID-19 pneumonia on CT.

Objective: To investigate the correlation between capillary blood oxygen saturation and Computerized tomography (CT) severity index in patients with Covid-19 pneumonia. Study Design: Cross Sectional study. Setting: Ibne-sina Hospital Multan Medical &amp; Dental College Multan. Period: 1st June 2020 to 1st June 2021. Material &amp; Methods: A cross-sectional analytical study was conducted at the COVID-19 ward of Ibne-sina hospital Multan Medical &amp; Dental College Multan for 1 year. At the time of admission, all capillary oxygen saturation of all the included patients was measured. Pulmonary CT scans were then performed on these patients and CT severity index was calculated. SPSS was used for data analysis. Results: A total of 170 COVID-19 infected patients were included in the study. At the time of admission, the mean oxygen saturation was found to be 88.9% ± 6.53%. Whereas, the mean severity index was15.01 ± 7.79. 22 patients had hypoxia when presented in hospital and a significantly high iCT severity index was found in these patients (p=0.001). Chronic obstructive pulmonary disease (COPD), hypertension, and diabetes were significantly related to reduced blood oxygen saturation (p&lt;0.05). Whereas, patients with hypertension had significantly raised CT scores. A significant inverse correlation was found between capillary oxygen saturation and CT severity index (r = −0.41, p &lt; 0.01). Conclusions: The study revealed a significant inverse correlation between capillary oxygen saturation and CT severity index. Moreover, it was found that underlying commodities (I.e past medical history) can also affect the CT severity index.

Correlation between Oxygen Saturation of patient and Severity Index of Covid 19 Pneumonia on CT

Aim: To investigate the correlation between capillary blood oxygen saturation and Computerized tomography (CT) severity index in patients with Covid-19 pneumonia. Study design: A cross sectional study design Setting &amp; duration: Ibne-sina hospital Multan Medical &amp; Dental College Multan, from 1st June 2020 to 1st June 2021 Methods: A cross-sectional analytical study was conducted at the COVID-19 ward of Ibne-sina hospital Multan Medical &amp; Dental College Multan for 1 year. At the time of admission, all capillary oxygen saturation of all the included patients was measured. Pulmonary CT scans were then performed on these patients and CT severity index was calculated. SPSS was used for data analysis. Results: A total of 170 Covid-19 infected patients were included in the study. At the time of admission, the mean oxygen saturation was found to be 88.9%±6.53%. Whereas, the mean severity index was15.01±7.79. 22 patients had hypoxia when presented in hospital and a significantly high iCT severity index was found in these patients (p=0.001). Chronic obstructive pulmonary disease (COPD), hypertension, and diabetes were significantly related to reduced blood oxygen saturation (p&lt;0.05). A significant inverse correlation was found between capillary oxygen saturation and CT severity index (r= −0.41, p&lt; 0.01). Conclusions: The study revealed a significant inverse correlation between capillary oxygen saturation and CT severity index. Moreover, it was found that underlying commodities (i.e., past medical history) can also affect the CT severity index. Keywords: Covid-19, hypoxia, capillary oxygen saturation, Chest CT, CT severity index.

Involvement of Road Users from the Productive Age Group in Traffic Crashes in Saudi Arabia: An Investigative Study Using Statistical and Machine Learning Techniques

Road traffic crashes (RTCs) are a major problem for authorities and governments worldwide. They incur losses of property, human lives, and productivity. The involvement of teenage drivers and road users is alarmingly prevalent in RTCs since traffic injuries unduly impact the working-age group (15–44 years). Therefore, research on young people’s engagement in RTCs is vital due to its relevance and widespread frequency. Thus, this study focused on evaluating the factors that influence the frequency and severity of RTCs involving adolescent road users aged 15 to 44 in fatal and significant injury RTCs in Al-Ahsa, Saudi Arabia. In this study, firstly, descriptive analyses were performed to justify the target age group analysis. Then, prediction models employing logistic regression and CART were created to study the RTC characteristics impacting the target age group participation in RTCs. The most commonly observed types of crashes are vehicle collisions, followed by multiple-vehicle and pedestrian crashes. Despite its low frequency, the study area has a high severity index for RTCs, where 73% of severe RTCs include individuals aged 15 to 44. Crash events with a large number of injured victims and fatalities are more likely to involve people in the target age range, according to logistic regression and CART models. The CART model also suggests that vehicle overturn RTCs involving victims in the target age range are more likely to occur as a result of driver distraction, speeding, not giving way, or rapid turning. As compared with the logistic regression model, the CART model was more convenient and accurate for understanding the trends and predicting the involvement probability of the target age group in RTCs; however, this model requires a higher processing time for its development.