Moderate Cases Research Articles

Transient anti-interferon autoantibodies in the airways are associated with recovery from COVID-19

Preexisting anti–interferon-α (anti–IFN-α) autoantibodies in blood are associated with susceptibility to life-threatening COVID-19. However, it is unclear whether anti–IFN-α autoantibodies in the airways, the initial site of infection, can also determine disease outcomes. In this study, we developed a multiparameter technology, FlowBEAT, to quantify and profile the isotypes of anti–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and anti–IFN-α antibodies in longitudinal samples collected over 20 months from the airways and blood of 129 donors spanning mild to severe COVID-19. We found that nasal IgA1 anti–IFN-α autoantibodies were induced after infection onset in more than 70% of mild and moderate COVID-19 cases and were associated with robust anti–SARS-CoV-2 immunity, fewer symptoms, and efficient recovery. Nasal anti–IFN-α autoantibodies followed the peak of host IFN-α production and waned with disease recovery, revealing a regulated balance between IFN-α and anti–IFN-α response. In contrast, systemic IgG1 anti–IFN-α autoantibodies appeared later and were detected only in a subset of patients with elevated systemic inflammation and worsening symptoms. These data reveal a protective role for nasal anti–IFN-α in the immunopathology of COVID-19 and suggest that anti–IFN-α autoantibodies may serve a homeostatic function to regulate host IFN-α after viral infection in the respiratory mucosa.

Accuracy of One-Piece vs. Segmented Three-Dimensional Printed Transfer Trays for Indirect Bracket Placement

Objective: To assess the accuracy of three-dimensional (3D) printed one-piece vs. multiple segmented transfer trays for indirect bonding techniques in moderate and severe crowding cases. Methods: Eighty digital maxillary dental models were produced by an extraoral scanner. 3D-printed one-piece and segmented trays were virtually designed utilizing Maestro 3D Ortho Studio® v4 and printed using a NextDent printer. The sample was classified into two groups: Group 1 (moderate crowding) included 40 digital models with a space deficiency of 6–7 mm, and Group 2 (severe crowding) included 40 digital models with a space deficiency of 10 mm. Ortho classic brackets were then placed into the 3D printed models with the aid of the transfer trays, and the models with the final bracket positioning were scanned using iTero scanner. Four measurements were selected on each tooth to perform the analysis. Mann–Whitney and Kruskal–Wallis tests were used for comparisons. A p-value of ≤ 0.05 was considered statistically significant. Results: In the moderate crowding group, statistically significant differences were detected between the one-piece, segmented, and control groups for three measurements (p < 0.001), while the rest of the measurements showed no significant differences (p > 0.05). In the severe crowding group, no significant differences were detected for any of the measurements. Conclusions: One-piece and segmented 3D-printed transfer trays are considered accurate tools for indirect bonding in moderate and severe malocclusion cases. The severity of crowding did not affect the accuracy of bracket transfer in indirect bonding.

Update on Fatty Liver in Dairy Cattle with Major Emphasis on Epidemiological Patterns, Pathophysiology in Relationship to Abdominal Adiposity, and Early Diagnosis

Fatty liver is a more common than expected metabolic disease affecting dairy cattle around parturition, which generates high economic losses for the dairy industry. The disease has evolved from a low incidence of moderate cases to a greater increase of severe cases in recent years. This evolution could be explained by the higher rate of genetic selection that has been carried out for milk production, which concomitantly brings pleiotropic genes that determine greater abdominal adiposity, ketosis, and other diseases. Abdominal fat is much more reactive, pro-inflammatory, saturated, and low in adiponectin than subcutaneous fat. In this review, we will mainly address the epidemiological aspects, the pathophysiology concerning the different types of fat depots (subcutaneous and abdominal), and the early diagnosis of the disease to carry out efficient control and preventive strategies.

Разработка и валидация ПИТС-индекса для оценки тяжести синдрома последствий интенсивной терапии: описательное проспективное несравнительное когортное исследование

INTRODUCTION: The post intensive care syndrome (PICS) is a clinical manifestation of “learned non-use” phenomena, resulting from the application of metabolic rest strategies such as bed rest, sedation, and ventilation. This leads to prolonged, multifocal dysfunction in vital functions. The lack of standardized diagnostic methods for this syndrome limits its study. For the diagnosis of PICS, we combined 15 signs of vital function disturbances that have the greatest impact on quality of life, with a scoring value of 0.5–1. The sum of these symptoms has been designated as the PICS-index. OBJECTIVE: To develop a scale for calculating the PICS-index with stratification of its values into three ranges of severity: mild, moderate and severe. MATERIALS AND METHODS: A descriptive, prospective, and unmatched cohort study was conducted on 169 patients who had a high dependency on medical care and were admitted to a rehabilitation center between 2022 and 2023. RESULTS: Using the PICS-index, showed that 100 % of patients who spent more than 72 hours in the ICU during the early recovery period (up to 6 months) developed PICS, with a predominance of moderate cases (35–52 %). The proportion of severe PICS forms reached its maximum (37 %) between 3 and 6 months. In the late recovery phase (more than 6 months), mild PICS forms were predominant (45 %). The severity of PICS was influenced by the duration of ICU stay and the timing of mechanical ventilation, but not the age of patients. CONCLUSIONS: The PICS-index is a clinically effective tool for the multidisciplinary diagnosis and assessment of the severity and progression of PICS. Using the PICS-index, we have devised a method for evaluating the predominance of specific signs. The most common signs are disturbance of the gravitational gradient, polyneuromyopathy, dysphagia. This confirms the essence of PICS as a clinical manifestation of the "learned non-use" phenomenon.

In situ pinning or modified Dunn procedure? Which one is superior in slipped capital femoral epiphysis surgery? A case–control study including only stable/moderate cases

Purpose: The study aimed to compare the clinical and radiologic results of in situ pinning and modified Dunn procedure methods in stable–moderate slipped capital femoral epiphyses surgery. Methods: Slipped capital femoral epiphyses cases between January 2000 and December 2022 were retrospectively analyzed. Stable and moderate cases treated with in situ pinning or modified Dunn procedure and those with a follow-up period longer than 1 year were included. Two groups were formed: the in situ pinning group and the modified Dunn procedure group. Radiologically, postoperative alpha angle, Southwick angle, avascular necrosis, and osteoarthritis rates were compared. Clinically, Harris Hip Score and Merle d’Aubigné score were compared. Total complications were evaluated. Results: The in situ pinning group consisted of 28 patients and the modified Dunn procedure group consisted of 17 patients. The groups were similar in terms of age, gender, affected side, body mass index, Fahey/O’Brien Classification, preoperative slip angles, and follow-up time. Operation time was shorter in the in situ pinning group ( p < 0.001). Postoperative Southwick and alpha angle were lower in the modified Dunn procedure group ( p < 0.001). In clinical outcomes, Merle d’Aubigné and Harris Hip Score were higher in the in situ pinning group ( p = 0.013, p = 0.005, respectively). The rate of avascular necrosis was higher in the modified Dunn procedure group ( p = 0.048). There was no difference between the groups in terms of total complications and osteoarthritis. Conclusions: In situ pinning has an advantage over the modified Dunn procedure in the treatment of stable-moderate slipped capital femoral epiphyses due to shorter operative time, better clinical outcomes, and fewer avascular necrosis rates. Although Southwick and alpha angle measurements were found to be higher after in situ pinning compared to the modified Dunn procedure, this does not constitute a significant disadvantage in terms of osteoarthritis development in the mid-term. Level of Evidence: Level III, case–control study.

Approaches to Managing Herniated Disc Surgical vs. Conservative Treatment

Introduction Disc herniation is a displacement of an intervertebral disc, most often caused by degeneration of its outer layer, the annulus fibrosus. This condition can cause various symptoms such as numbness, pain, muscle weakness or lose of sensation. While many patients can be successfully treated with non-surgical methods, some of them some require surgical intervention. Aim of study The objective of this study is to evaluate both surgical and non-surgical treatment methods for herniated disc and seeks to introduce doctors and patients to the advantages and disadvantages associated with them. State of Knowledge Disk herniation occurs when disk material prolapses beyond intervertebral disk’s space. The symptoms may arise when displaced material start to compress major structures located nearby, such as spinal nerves. The most common causes include age-related degeneration, repetitive movements, obesity, trauma or genetic predisposition. Summary (Conclusion) Disk herniation can be managed with various non-surgical and surgical methods. Conservative treatment should be considered as first line treatment showing high success rate for mild to moderate cases in long term relief and preventing recurrence of symptoms. Surgical options offer better short-term relief for sever and more advanced cases but carry greater risks of side effects and involve longer recovery time. Best approach should be carefully selected based on the severity of symptoms and patient needs.

The Management of Periodontally Diseased Individuals-A Registry-Based Study on a Swedish Population.

This registry-based study aimed to describe cross-sectional dental and demographic data with focus on diagnosis and treatment of periodontal disease. A second aim was to analyse the extent and content of performed periodontal treatment in patients with varying degrees of periodontitis and if treatment was provided on equal terms. An additional aim was to identify if possible differences in treatments were related to type of dental insurance system. A study population, 225,913 individuals ≥ 20 years living in the Region of Västra Götaland, was identified by the Swedish Quality Registry for Caries and Periodontal Diseases (SKaPa). Registry data were retrieved for the period 2010-2012. Logistic regression models were used to predict the probability of receiving periodontal interventions and access to fixed annual fees. Among the study population, 17% had periodontal disease (≥ 4 teeth with periodontal pockets ≥ 4 mm) and constituted the final study sample. The probability of periodontal intervention increased with severity of periodontitis, in moderate (OR = 2.3) and severe cases (OR = 5.2) compared to the group with minor disease (p < 0.001). Severe periodontitis was associated with male gender, increasing age and smoking. About 30% of the individuals remained untreated over the 3-year period. Individuals with fee-for-service were more likely to receive periodontal intervention than individuals with fixed annual fees (OR = 1.7; p < 0.001). Severe periodontitis and being in the fee-for-service system were associated with more periodontal interventions. However, one-third of the study subjects remained untreated. These findings indicate the need for improved care on equal terms for patients with periodontal disease.

Outcomes of COVID-19 in Pregnant Women: A Retrospective Analysis of 300 Cases in Jordan

Background: The impact of COVID-19 on pregnancy remains a critical area of research, with growing evidence suggesting that maternal infection, particularly in the third trimester, may lead to significant complications Aims: The primary aim was to investigate the maternal and neonatal outcome of pregnant Jordanian women with COVID-19. The secondary aim included exploring demographics, obstetrics characteristics, and comorbidities among these women. Methods: A retrospective comprehensive review of the records of 300 cases of pregnant women with COVID-19, who were treated between November 2020 and April 2021 at Queen Alia Military Hospital (a main referral center for patients with COVID-19) in Jordan. All cases were confirmed by the rapid antigen test (RAT) + long polymerase chain reaction (PCR) test used to detect SARS-CoV-2 by amplifying viral RNA from patient samples. Women infected with COVID-19 were categorized into four groups according to the RCOG guidelines for COVID-19 infection in pregnancy: asymptomatic, mild, moderate, and severe cases. All cases were managed following the Royal College of Obstetricians and Gynecologists protocol for COVID-19 in pregnancy. Data extracted from patient’s records included demographic information, COVID-19 clinical manifestations, obstetric history, diagnostic findings, treatment plans, comorbidities, gestational age at diagnosis, treatment protocols, and maternal and neonatal outcomes. Results: The mean age was 29.7 years; 98.3% were nonsmokers; 8% had previous miscarriages, and 67.3% had the infection in the third trimester. Iron deficiency anemia affected 30.3%, while 18.3% had comorbidities, mainly hypothyroidism. Most women were asymptomatic 61.7%, but 33% had respiratory symptoms, 4.7% needed intensive care unit (ICU) admission, and 2.7% resulted in maternal deaths. First-trimester and second-trimester miscarriages were recorded in 2.67% and 3.67% of cases, respectively, while preterm labor occurred in 3.0% of pregnancies. Additionally, age and hospitalization duration had a positive correlation with the neonatal outcomes (r = 0.349, p &lt; 0.01), (r = 0.376, p &lt; 0.01), respectively. Furthermore, COVID-19 presentation and treatment options demonstrated a strong positive correlation (p-value &lt;0.01). On the other hand, maternal death had a strong negative correlation with poor neonatal outcomes (r = −0.776, p &lt; 0.01). Conclusion: The study showed that COVID-19 in pregnant women, particularly in the third trimester, is associated with significant neonatal complications, with age, hospitalization duration, and COVID-19 severity strongly impacting outcomes.

Antibodies as Promising Molecules to Block Spike Glycoprotein from SARS-CoV2

Abstract: COVID-19 is caused by a new SARS-CoV-2 virus from the Coronaviridae family, responsible for developing severe acute respiratory syndrome (SARS-CoV). Its emergence in 2019 presented several challenges to global health. The virus can infect host cells using the ACE2 receptor, and after infection, several clinical manifestations appear, ranging from mild symptoms to death. One approach that has shown promising results is convalescent plasma since convalescent plasma (CP) consists of a concentrate of immunoglobulins in the blood of patients recently infected with the coronavirus for those currently infected. Therefore, this therapy uses antibodies in the plasma to neutralize the virus. This literature review aims to evaluate the efficacy of CP therapy in symptomatic COVID-19 patients by analyzing clinical trials and studies published between 2020 and 2023. Therefore, the search identified studies in which the majority reported the efficacy of using convalescent plasma to treat and alleviate the clinical condition of patients diagnosed with COVID-19. Important factors influence the efficacy of CP therapy, such as the timing of administration and the severity of the disease. Early administration in mild and moderate cases has shown promise. Furthermore, molecular docking analysis suggests that antibodies can cause conformational changes in the SARS-CoV-2 spike protein, raising the hypothesis that using CP may interfere with viral entry into host cells.

Potential protective association of the AA genotype and a allele of CXCR4 rs2228014 polymorphism with COVID-19 severity in adult egyptians

BackgroundBy the end of December 2019, a new coronavirus, termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged, and the cause of the disease was named coronavirus disease 2019 (COVID-19). Several genetic factors have been implicated in diverse responses to SARS-CoV-2 infection, such as the C-X-C chemokine receptor 4 (CXCR4) rs2228014 polymorphism, which has been previously studied in various diseases but has not been explored in the context of COVID-19 severity. The current study aimed to assess the association between the rs2228014 polymorphism in the CXCR4 gene and the severity of COVID-19, which has not been previously reported.MethodThis cross-sectional study analyzed 300 adult Egyptian COVID-19 patients (156 with mild or moderate and 144 with severe or critical symptoms) admitted to Assiut University Quarantine Hospital from June to September 2022 during the omicron variant. The rs2228014 polymorphism in the CXCR4 gene was detected using real-time PCR with a TaqMan assay probe. Receiver operating characteristic (ROC) curve analysis was used to determine the best cutoff values for C-reactive protein (CRP) that can be used to estimate the severity of COVID-19. P values less than 0.05 were considered to indicate statistical significance.ResultsNo significant differences in the allelic or genotypic frequencies of CXCR4 rs2228014 were detected between the severity groups. However, the exclusive presence of the AA genotype in mild or moderate cases suggests its potential protective role. Additionally, significant differences in myalgia presentation, leukocyte counts and antibiotic use, were observed among different genotypes. Statistical data showed that the severity of COVID-19 could be predicted at a cutoff value of CRP > 30 mg/L, with a sensitivity of 74.3% and a specificity of 42.9%.ConclusionThe present findings suggest a potential protective role of the AA genotype and A allele of CXCR4 rs2228014 against severe COVID-19. Additionally, factors such as lack of vaccination and comorbidities such as hypertension, renal disease, and diabetes mellitus were associated with increased disease severity.

CRP, PCT, and D-dimer as Biomarkers for Disease Severity in COVID-19 Patients: A Retrospective Study in Kinshasa, Democratic Republic of Congo

Introduction: The COVID-19 pandemic has had a significant impact on global health, resulting in more than 6 million reported deaths worldwide as of April 2023. This study aimed to investigate the potential of C-reactive protein (CRP), procalcitonin (PCT), and D-dimer as biomarkers for assessing disease severity in COVID-19 patients in Kinshasa, Democratic Republic of Congo Methods:A retrospective examination was conducted involving 339 COVID-19 patients admitted to Kinshasa hospitals between January 2021 and March 2022. CRP, PCT, and D-dimer levels were measured in all patients and compared between those with severe and non-severe illnesses. Results: Our findings revealed significantly higher CRP, PCT, and D-dimer levels in severe cases compared to non-severe cases. Specifically, the median CRP level was 120.6 mg/L in severe cases, 47.3 mg/L in mild cases, and 13.5 mg/L in moderate cases. The median PCT levels were 0.26 ng/mL in severe cases, 0.08 ng/ mL in mild cases, and 0.07 ng/L in moderate cases. Additionally, the median D-dimer level was 1836.9 µg/L in severe cases and 597.6 µg/L in mild cases, with a value of 481.1 µg/L in moderate cases. System learning techniques were also employed to predict disease severity based on these biomarkers, achieving high accuracy. Conclusion: Our findings suggest that CRP, PCT, and D-dimer serve as valuable biomarkers for identifying severe COVID-19 cases in Kinshasa. Furthermore, the application of machine learning methods can yield accurate predictions of disease severity based on these biomarkers. These biomarkers hold the potential to assist clinicians in informed decision-making regarding patient management and contribute to improved clinical outcomes for COVID-19 patients.

Determinants of Prevalence and Factors Associated with Anemia among Pregnant Women in Gambia: A Multivariate Analysis using DHS Data

Background Anemia is a prevalent public health concern in The Gambia and other developing nations. While previous studies relied on binary logistic regression, the Multinomial Survey Logistic Regression Model was developed to address complexities in survey design, including sampling weights, stratification, and clustering. Multiple Imputation with Chained Equations (MICE) was employed to address missing data in variables such as anemia level, contraceptive use, and malaria drug intake during pregnancy. Aim/Objective This study aims to determine the prevalence and factors of anemia among pregnant women across eight local government areas in The Gambia. The research focuses on Kanifing, Kuntaur, Mansakonko, Kerewan, Janjanbureh, Basse, Brikama, and Banjul. Given the limited research on anemia among pregnant women in The Gambia, there is a need for further investigation into this topic. Methods MICE were utilized to address missing data due to their validity in handling uncertainty. This method generates multiple reasonable datasets for imputation and analyzes them accurately. A survey logistic regression model was employed to assess data fitness, considering the complex sample design. Anemia levels were measured among 11,865 pregnant women aged 15 to 49 using a systematic questionnaire. The multinomial survey logistic regression model was utilized to account for sampling weights, stratification, and clustering, relaxing the premise of observation independence violated by conventional logistic regression. Results The study involved 11,865 expectant mothers, revealing mild, moderate, and severe cases of anemia with a prevalence of 44.6%. Factors associated with anemia included place of residence, local government area, contraceptive use, age, literacy level, and current pregnancy status. Conclusion Socio-economic, demographic, and environmental factors significantly impact anemia levels among reproductive women in The Gambia. Addressing factors such as place of residence, local government areas, contraceptive use, literacy level, and current pregnancy status is crucial in mitigating anemia risk. Government initiatives, such as improving access to sanitation facilities and offering free check-ups, could effectively address this public health concern.

Ring only repair of bileaflet mitral valve prolapse with mitral regurgitation: Insights from computational modeling

This study evaluates the efficacy of annuloplasty repair as a standalone procedure for treating bileaflet mitral valve prolapse with mitral regurgitation (MR). Various flexible ring bands for MR of different severities were compared to assess their biomechanical impact and treatment outcomes. Computational beating heart models, based on the Living Heart Human Model, were utilized to simulate annuloplasty repairs. Repairs using bands of varying lengths were modeled on moderate and severe MR cases, considering bileaflet mitral valve prolapse. Key parameters, including regurgitant orifice area (ROA), prolapse severity, coaptation length, leaflet position, and deformation, were computed to compare conditions before and after implantation. Annuloplasty repairs effectively reduced the ROA in both moderate and severe MR cases, achieving complete sealing in selective instances. Additionally, annuloplasty repair corrected bileaflet prolapse, with prolapse severity decreasing as the annular size increased. Successful coaptation was indicated by the expansion of each leaflet’s contact area distribution and percentage in contact with the opposing leaflet. The risk of systolic anterior motion, that may obstruct the left ventricular outflow tract, was minimized, as the anterior leaflet was directed towards the posterior position. In conclusion, annuloplasty repair alone can effectively treat MR when an appropriate band length is selected. It facilitates a significant reduction in ROA, correction of bileaflet prolapse, and improvement in leaflet coaptation. These findings have important clinical implications, potentially offering a less complex surgical treatment avenue and reducing complications in the management of MR.

Composite endpoints in COVID-19 randomized controlled trials: a systematic review.

This study aimed to determine the prevalence of ordinal, binary, and numerical composite endpoints among coronavirus disease 2019 trials and the potential bias attributable to their use. We systematically reviewed the Cochrane COVID-19 Study Register to assess the prevalence, characteristics, and bias associated with using composite endpoints in coronavirus disease 2019 randomized clinical trials. We compared the effect measure (relative risk) of composite outcomes and that of its most critical component (i.e. death) by estimating the Bias Attributable to Composite Outcomes index [ln(relative risk for the composite outcome)/ln(relative risk for death)]. Composite endpoints accounted for 152 out of 417 primary endpoints in coronavirus disease 2019 randomized trials, being more frequent among studies published in high-impact journals. Ordinal endpoints were the most common (54% of all composites), followed by binary or time-to-event (34%), numerical (11%), and hierarchical (1%). Composites predominated among trials enrolling patients with severe disease when compared to trials with a mild or moderate case mix (odds ratio = 1.72). Adaptations of the seven-point World Health Organization scale occurred in 40% of the ordinal primary endpoints, which frequently underwent dichotomization for the statistical analyses. Mortality accounted for a median of 24% (interquartile range: 6%-48%) of all events when included in the composite. The median point estimate of the Bias Attributable to Composite Outcomes index was 0.3 (interquartile range: -0.1 to 0.7), being significantly lower than 1 in 5 of 24 comparisons. Composite endpoints were used in a significant proportion of coronavirus disease 2019 trials, especially those involving severely ill patients. This is likely due to the higher anticipated rates of competing events, such as death, in such studies. Ordinal composites were common but often not fully appreciated, reducing the potential gains in information and statistical efficiency. For studies with binary composites, death was the most frequent component, and, unexpectedly, composite outcome estimates were often closer to the null when compared to those for mortality death. Numerical composites were less common, and only two trials used hierarchical endpoints. These newer approaches may offer advantages over traditional binary and ordinal composites; however, their potential benefits warrant further scrutiny. Composite endpoints accounted for more than a third of coronavirus disease 2019 trials' primary endpoints; their use was more common among studies that included patients with severe disease and their point effect estimates tended to underestimate those for mortality.

Prevalence and Correlation between HbA1c Control and Duration of Diabetes with Blindness in the Eastern Part of Libya: Double Centers Study

A prospective cross-sectional study of diabetic patients registered at the Eye department of Tobruk Medical Center in Tobruk-Libya between (01.06.2023 to 29.02.2024). At the same time data was collected in the eye department in Alwahda Derna Teaching Hospital, Data was collected using the same administered questionnaire. Grading of DR was done by slit-lamp examination and Fundoscopy by an ophthalmologist. Descriptive analysis included percentage mean, median, and p - value by using SPSS 25. There were 185 diabetic patients, ages ranging between 30 and 90 years, with a mean of 58, the majority (97.6%) were of Libyan nationality. There were 86 males and 99 females. Patients with a duration of diabetes ranging between 11 and 15 years were at almost a five-fold risk of developing DR compared to those with a duration of &lt; 10 years. Most of advanced complicated diabetic retinopathy cases had diabetes for more than fifteen years, and no advanced disease in the cases with a duration of less than 10 years. The patients with poor controlled blood sugar and HbA1c &gt; 9 throughout the disease were at almost five-folded risk of developing DR compared to those with moderate controlled diabetes cases were HbA1c between (7.5 - 9), patients with poor control of diabetes HbA1c&gt; 9 was 25-folded risk of developing PRP than cases with good control HbA1c &lt; 7.5. The majority of advanced diabetic retinopathy cases were correlated with non-controlled diabetes mellitus HbA1c &gt; 9, where no advanced complication was recorded in well-controlled cases.

Approach to Newborns with Elevated TSH: A Different Perspective from the International Guidelines for Iodine-Deficient Countries.

Lowering of thyroid-stimulating hormone (TSH) cutoffs in newborn screening programs has created a management dilemma by leading to more frequent detection of neonates with elevated TSH concentrations due to false-positive results, transient neonatal hyperthyrotropinemia (NHT), and milder forms of congenital hypothyroidism. Current consensus guidelines recommend starting treatment if the venous TSH level is >20 mU/l in the face of a normal free thyroxin (FT4) level, which is an arbitrary threshold for treatment decisions. In countries such as Türkiye, where transient NHT may be more common due to iodine deficiency and/or overload, putting this recommendation into daily practice may lead to unnecessary and over treatments, long-term follow-ups, and increased workload and costs. In this review, we addressed alternative approaches for infants with elevated TSH concentrations detected at newborn screening. Our management approach can be summarized as follows: Infants with mild NHT (TSH<20 mU/l) should be followed without treatment. In moderate NHT (TSH 20-30 mU/l), treatment or monitoring decisions can be made according to age, TSH trend and absolute FT4 level. Moderate cases of NHT should be treated if age at confirmatory testing is >21 days or if there is no downward trend in TSH and FT4 level is in the lower half of age-specific reference range in the first 21 days. In in-between cases of moderate NHT, thyroid ultrasound can guide treatment decision by determining mild cases of thyroid dysgenesis that require life-long treatment. Otherwise, monitoring is a reasonable option. Infants with compensated hypothyroidism (TSH>30 mU/l) and persistent hyperthyrotropinemia (>6-10 mU/l after neonatal period) should receive L-thyroxine treatment. But all treated cases of isolated TSH elevation should be closely monitored to avoid overtreatment, and re-evaluated by a trial off therapy. This alternative approach will largely eliminate unnecessary treatment of infants with transient NHT, mostly caused by iodine deficiency or excess, and will reduce workload and costs by preventing unwarranted investigation and long-term follow-up.

Correlation of Biochemical Markers with Chest CT Severity Index and Oxygen Saturation in Moderate to Severe COVID-19 Patients: A cross-sectional study

Introduction: COVID-19, a global pandemic, has been linked to biochemical parameters such as Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), Total Leucocyte Count (TLC), Neutrophil/Lymphocyte Ratio (NLR), Lactate Dehydrogenase (LDH), and liver function tests, which correlate with disease severity. Prothrombotic markers like D-Dimer and Fibrinogen levels, along with the CT Severity Index (CTSI) indicating lung involvement, are associated with clinical worsening. This study aims to observe biochemical and chest radiological profiles in moderate to severe COVID-19 patients and explore any correlations between them. Methodology: A hospital-based cross-sectional observational study was conducted at a Medical College and Hospital in Kolkata, involving 80 symptomatic COVID-19 patients with SpO₂ ≤94%. Patients with liver, kidney, chronic inflammatory diseases, COPD, malignancy, or asthma were excluded. Results: Out of 80 patients, 29 had moderate and 51 had severe illness. Statistically significant differences were observed in TLC, ESR, CRP, AST, ALT, A:G ratio, LDH, Fibrinogen, and D-Dimer between moderate and severe cases. The CTSI correlated significantly with TLC, NLR, CRP, AST, ALT, A:G ratio, LDH, Fibrinogen, and D-Dimer. CTSI values also differed significantly between moderate and severe COVID-19 cases. Conclusion: Biochemical markers such as ESR, TLC, CRP, liver enzymes, LDH, D-Dimer, and Fibrinogen can help predict disease severity. These markers also correlate with radiological severity in COVID-19.

Role of interleukin 6 polymorphism and inflammatory markers in outcome of pediatric Covid- 19 patients

BackgroundIL-6 polymorphisms were associated to viral infection outcomes through affection of IL-6 production and it is an early indicator of tissue injury and systemic inflammatory response. The study aimed to determine whether genetic IL-6 polymorphisms, serum interleukin-6 level and inflammatory markers (Presepsin, CXCL-10, C3, and C4) are associated with the prediction of disease severity in pediatric COVID-19 patients and its possible use as a prognostic tool in pediatric patients admitted to hospital.MethodsThis prospective cohort study was conducted on 150 children with COVID-19. Patients were divided according to the severity of infection into four groups: group I (mild) 67 cases; group II (moderate) 53 cases, group III (severe) 17 cases and group IV (critical) 14 cases. Serum Interleukin 6, CXCL-10, Presepsin, renal and liver functions, electrolytes, C3, C4, ferritin, and D dimer serum levels were assessed in all patients. The Kruskal Wallis test used to compare parametric quantitative data between studied groups and Mann Whitney test for each pair of groups. Non-parametric quantitative data was compared between studied groups using a one-way ANOVA test and post-hoc Bonferroni analysis for each pair of groups.ResultsGroup I: 35 males and 32 females with a median age of 16 months. Group II: 17 males and 35 females with a median age of 13 months. Group III: 6 males and 11 females with a median age of 12 months and group IV: 3 males and 11 females with a median age of 12 months. There was no statistical difference between the studied groups regarding gender and age. Serum levels of IL- 6, serum ferritin; D-dimer, Presepsin and CXCL 10 were significantly higher in both severe and critical groups than the other 2 groups (mild and moderate). ROC curve analysis showed that interleukin-6 and Presepsin were good markers for prediction of severity of COVID-19 among the diseased children. For severe cases, the sensitivity of interleukin-6 was 76.47% and specificity was 92.31%. For critical cases, the sensitivity of interleukin-6 was 71.43% and specificity was 82.35%. The sensitivity of Presepsin was 76.47% and specificity was 88.46% in severe cases. For critical cases, the sensitivity of Presepsin was 78.57% and specificity of 91.2%. There was significant difference in IL-6 572 allelic among moderate cases with the most frequent 42.3% for genotype (GC) and allelic among severe cases with the most frequent 47.1% for genotype (GC). Significant difference in IL-6 174 allelic among critical cases with the most frequent 78.6% for genotype (CC).ConclusionsChildren whom expressed GC genotypes of IL6 (-572G > C) polymorphism are at a considerably higher risk of developing a severe disease. This risk is significantly larger in the severe group of children than in children in critical condition who have GC genotypes of IL6 (-174 G > C) polymorphism. While IL6 (-597G > A) polymorphism has no role in COVID 19 severity in children.

Increased Insulin Requirements in Severe Cases of Covid-19 are Higher Than in Moderate Cases

Increased Insulin Requirements in Severe Cases of Covid-19 are Higher Than in Moderate Cases

Association Between Serum Zinc Concentration Levels And Severity Of Coronavirus Disease 2019 (Covid-19) In Japanese Inpatients.

It has been reported that zinc deficiency is related to severe inflammatory conditions especially those of respiratory diseases. However, studies that have examined the association between the serum zinc concentration and the severity of coronavirus disease 2019 (COVID-19) are still limited. The aim of this study was to assess that association in Japanese inpatients with COVID-19. This cross-sectional study, conducted from April 2020 to August 2021, included 467 eligible adult inpatients with COVID-19 whose serum zinc concentration was measured. Serum zinc concentration categories were defined as deficiency (< 60μg/dL), marginal deficiency (≥ 60 to < 80μg/dL), and normal (≥ 80μg/dL). Multivariate logistic regression was used to assess the association between serum zinc deficiency and severe COVID-19. Serum zinc concentration levels were compared between mild and other severities of COVID-19 by Dunnett's method. The P for trend was estimated using the Jonckheere-Terpstra test. The proportions of subjects with serum zinc deficiency (< 60μg/dL) and marginal zinc deficiency (≥ 60 to < 80μg/dL) were 39.5% and 54.3% in women, and 36.4% and 57.0% in men, respectively. Serum zinc deficiency was significantly associated with severe COVID-19 compared to marginal deficiency and normal (odds ratio = 3.60, 95% confidence interval = 1.60-8.13, P < 0.01) after adjusting for confounders. An increase in severity of COVID-19 was inversely related to increases in serum zinc concentration levels (P < 0.01 for trend). Each serum zinc concentration of moderate and severe cases was also significantly lower compared with mild cases (P < 0.01). The severity of COVID-19 was significantly related to serum zinc concentration levels. These results suggest the importance of considering the serum zinc concentration when treating patients with COVID-19.