Moderate-severe Group Research Articles

Correlation of Biochemical Abnormalities with the Severity of Hospitalized Covid-19 Patients

Background: Coronavirus Disease-19 (COVID-19) has a global impact. The laboratory assessments in Covid-19 illness help in better understanding the disease pathophysiology useful in screening asymptomatic individuals to diagnosis, prognosis and monitoring the affected patients. The aim of the study:To observe the association between biochemical and inflammatory parameters among the hospitalised COVID-19 patients of different clinical severity. Materials and methods: This was a retrospective study carried out with the approval of the Institutional Ethics Committee. The study included patients over 18 years, hospitalised with COVID-19 infection, grouped into three severity groups, admitted to ward, high dependency unit or intensive care unit between May to September 2020. Data collection was carried out by manual perusal of inpatient case sheets, computerised patient data system and transcription database for discharge summaries. The biochemical and inflammatory markers like plasma glucose, renal function tests, serum electrolytes, liver function tests, erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), d-dimer, ferritin, Lactate dehydrogenase (LDH) at the time of admission were collected. Data was expressed as mean and standard deviation or median and range. ANOVA test followed by post hoc (Tukey) test, Pearson correlation and Receiver Operating Characteristics (ROC) Curve analysis were performed. Results: Significant correlations were observed between the mild and moderate-severe illness groups with respect to fasting plasma glucose, blood urea nitrogen, creatinine, direct bilirubin, total protein, albumin, ferritin and LDH. The AUC was the highest for LDH at 0.64 followed by blood urea nitrogen to creatinine ratio at 0.62. Conclusion: High levels of renal function parameters were potential predictors of acute kidney injury among patients with COVID-19. Fasting plasma glucose, serum albumin, LDH, Blood urea nitrogen (BUN) and BUN-creatinine ratio are better indicators of the severity of the disease with multiorgan dysfunction.

Effect of Cerebral Small Vessel Disease Burden on Outcomes in Patients With Acute Ischemic Stroke Receiving Endovascular Treatment.

BackgroundCerebral small vessel disease (SVD) is common in the aging population. The study aimed to evaluate the effect of SVD on functional outcomes in patients with acute ischemic stroke (AIS) receiving endovascular treatment (EVT).MethodsFrom a prospective registry, we selected patients with AIS receiving EVT. SVD features, including white matter hyperintensities (WMH), lacunes and brain atrophy, were assessed on MRI and a validated SVD score was calculated to reflect the total SVD burden.ResultsAmong 137 patients included, 106 had none-mild SVD burden and 31 had moderate-severe SVD burden. The moderate-severe SVD burden group showed a significantly higher modified Rankin Scale score at 90 d (median, 4 versus 1 points, adjusted common odds ratio 0.32 [95% CI, 0.14–0.69], P < 0.01) and a significantly smaller improvement of NIHSS at 24 h (median, –3 versus –3 points, adjusted β coefficient 4.02 [95% CI, 0.57–7.48], P = 0.02) and 7 days (median, –4 versus –6 points, adjusted β coefficient 4.71 [95% CI, 1.06–8.36], P = 0.01) than the none-mild group. There was no significant difference in successful recanalization, death within 90 days, symptomatic intracranial hemorrhage within 24 h between two groups (all P > 0.05). Additionally, for each single SVD feature, brain atrophy and WMH, but not lacunes, were associated with the functional outcome.ConclusionModerate-severe SVD burden was associated with poor early and late functional outcomes in patients with AIS receiving EVT. Our results suggest that SVD score may act as a good predictor of outcomes in these patients.

BENEFICIAL EFFECTS OF WEIGHT LOSS ON CENTRAL PRESSURE, ARTERIAL STIFFNESS AND SYMPATHETIC TONE IN OBESE SUBJECTS WITH OBSTRUCTIVE SLEEP APNEA

Objective: Obstructive sleep apnea (OSA) is known to be an independent cardiovascular risk factor. The presence of OSA and obesity may have synergistic effects on the progression of cardiovascular disease. To evaluate the effect of weight loss on vascular disease in obese patients with different OSA severity levels. Design and method: Individuals of both sexes, age between 40 and 70 years and body mass index (BMI) &gt; = 30 and &lt; 40 kg/m2 were submitted to nutritional intervention for 8 weeks with restriction of 800 kcal/day. Pulse wave velocity (PWV) and central hemodynamic parameters were evaluated by oscillometry (Mobil-O-Graph) and sympathetic tone by heart rate variability (HRV). The sleep study was performed using a portable home device (WatchPAT). Results: Patients (n = 70) were divided into two groups based on the apnea-hypopnea index (AHI): mild-absent (MA) group (AHI&lt; 15 events/h, n = 25) with mean age 50 ± 6 years, BMI = 34.5 ± 2.8 kg/m2 and moderate-severe (MS) group (AHI&gt; = 15 events/h, n = 45) with mean age 54 ± 8 years, BMI = 33.8 ± 2.6 kg/m2. After the intervention, weight loss was similar in both groups (-3.20 vs -3.32 kg). Both groups showed a significant reduction in anthropometric parameters. The MS group showed a significant reduction in peripheral systolic blood pressure (BP) (127 ± 15 vs 122 ± 15 mmHg, p = 0.007) and the MA group demonstrated a significant reduction in diastolic BP (78 ± 6 vs 75 ± 6 mmHg, p = 0.046). Central systolic pressure (116 ± 13 vs 107 ± 11 mmHg, p = 0.007), PWV (6.9 ± 0.6 vs 6.7 ± 0.6 m/s, p = 0.002) and vascular age (48 ± 6 vs 46 ± 6 years, p = 0.020) were significantly reduced only in the MA group. This group also demonstrated a significant increase in the RR interval (838 ± 225 vs 948 ± 130 ms, p = 0.032) with a reduction in heart rate (69 ± 5 vs 64 ± 8 bpm, p = 0.015). Conclusions: A small weight loss in a short period of time was able to promote more beneficial effects in obese individuals with non-severe sleep apnea including favorable outcomes on central hemodynamic parameters, arterial stiffness and autonomic activity.

0732 Sonographic Phenotyping of the Upper Airway in OSA Using Backscattered Imaging Analyzed by Machine-Learning

Abstract Introduction Anatomic characterization of the upper airway remains important in directing and monitoring care of patients with obstructive sleep apnea (OSA). Nasopharyngoscopy is routine in clinical practice, but it is invasive, non-reproducible, and only allows subjective assessment. We used machine-learning enabled ultrasonography to correlate upper airway tissue characteristics with OSA severity. Methods Sixty-three subjects (14 female) with a mean age of 39.4±12.6 years, BMI of 26.4±4.6 kg/m2, and AHI of 19.0±16.1 were consented from Stanford Sleep Surgery (July 2020 to May 2021). Standardized ultrasound protocol was used to image the soft palate, oropharynx, and tongue-base. Via machine learning, an FDA-cleared backscattered ultrasound imaging (BUI) of the upper airway was performed. Combined with B-mode measurements of airway muscular cross-sections, a logistic regression model was built to correlate with OSA severity. Results BUI of subjects with mild OSA was different from moderate-severe (AHI≥15) OSA at the soft palate (p=0.0007). The axial-to-lateral ratio of upper airway length was reduced in the lower soft palate of the moderate-severe group (p =0.0207). The logistic regression model with BUI, axial-to-lateral ratio at the soft palate, and BMI showed an Area Under the Receiver Operating Characteristic (AUROC) curve of 0.84 (95% CI 0.726 to 0.920) in moderate-severe OSA. Conclusion A non-invasive yet replicable technique to visualize and phenotype the upper airway is critical in the management of patients with sleep-disordered breathing. Sonographic BUI combined with B-mode airway measurements analyzed by machine learning show promise in characterizing the upper airway in patients with moderate-severe OSA. Support (If Any)

Clinical Correlation Between Overactive Bladder and Allergy in Children.

Background:The International Children's Continence Society defines overactive bladder (OAB) as a clinical syndrome characterized by urgency of urination usually accompanied by frequent urination and nocturia symptoms. This study aims to explore the correlation between overactive bladder (OAB) and allergy in children.Method:The clinical characteristics of 918 patients diagnosed with OAB from January 2020 to March 2021 were retrospectively analyzed. Risk factors for OAB were analyzed using logistic regression analysis, and the effect of desloratadine in the treatment of OAB was evaluated.Results:The incidence of allergic cough or allergic rhinitis in the mild OAB group was higher than the moderate–severe group. Urodynamics demonstrated that the proportion of patients with a sensitive bladder in the overactive detrusor group was significantly higher than the non-overactive detrusor group. The effective rate of treatment of OAB in patients complicated with allergies and taking desloratadine was 90.14%, which was significantly higher than in patients who were not taking desloratadine, and blood IgE level was a risk factor of ineffective treatment with desloratadine.Conclusion:OAB is correlated with allergies in children, and desloratadine can effectively improve OAB symptoms.

Relationship between total testosterone, sex hormone–binding globulin levels and the severity of non-alcoholic fatty liver disease in males: a meta-analysis

Background:In recent years, many studies have reported the relationship between non-alcoholic fatty liver disease (NAFLD) and sex hormones, especially total testosterone (TT) and sex hormone–binding globulin (SHBG). However, the relationship between sex hormones and the severity of NAFLD is still unclear.Methods:PubMed, Embase, Cochrane Library, Web of Science, WanFang, China National Knowledge Infrastructure and VIP databases were searched for relevant studies from inception to 31 August 2021. Values of weighted mean differences (WMDs) and odds ratios (ORs) with their 95% confidence intervals (CIs) were combined by Stata 12.0 software to evaluate the relationship between TT, SHBG and the severity of NAFLD in males.Results:A total of 2995 patients with NAFLD from 10 published cross-sectional studies were included for further analysis. The meta-analysis indicated that the moderate-severe group had a lower TT than the mild group in males with NAFLD (WMD: −0.35 ng/ml, 95% CI = −0.50 to −0.20). TT and SHBG were important risk factors of moderate-severe NAFLD in males (ORTT = 0.79, 95% CI = 0.73 to 0.86; ORSHBG = 0.22, 95% CI = 0.12 to 0.39; p < 0.001). Moreover, when the analysis was limited to men older than age 50, SHBG levels were lower in those with moderate-severe disease (WMD: −11.32 nmol/l, 95% CI = −14.23 to −8.40); while for men with body mass index (BMI) >27 kg/m2, moderate-severe NAFLD had higher SHBG levels than those with mild disease (WMD: 1.20 nmol/l, 95% CI = −2.01 to 4.42).Conclusion:The present meta-analysis shows that lower TT is associated with the severity of NAFLD in males, while the relationship between SHBG and severity of NAFLD is still to be further verified.

Predictors of Developmental and Respiratory Outcomes Among Preterm Infants With Bronchopulmonary Dysplasia.

Objectives: To examine the importance of perinatal and postnatal environmental factors on developmental and respiratory outcomes among preterm infants with bronchopulmonary dysplasia (BPD).Methods: Preterm infants (<32 weeks of gestation) born at a single tertiary medical center between 2012 and 2015 were included. Development was assessed at 12 months corrected age. Parents retrospectively completed a health and lifestyle questionnaire reviewing their child's health during the first 2 years of life. A linear regression model was applied to assess the effect of various perinatal and postnatal factors on development. A machine-learning algorithm was trained to assess factors affecting inhaler use.Results: Of 398 infants meeting the inclusion criteria, 208 qualified for the study: 152 (73.1%) with no BPD, 40 (19.2%) with mild BPD, and 16 (7.7%) with moderate-severe BPD. Those in the moderate-severe group were more likely to be male, have mothers who were less educated, and require longer ventilation periods and less time to regain birth weight. They were also more likely to have mothers with asthma/allergies and to have a parent who smoked. Those in the moderate-severe BPD group exhibited significantly lower developmental scores (85.2 ± 16.4) than the no-BPD group (99.3 ± 10.9) and the mild BPD group (97.8 ± 11.7, p < 0.008) as well as more frequent inhaler use (p = 0.0014) than those with no or mild BPD. In addition to perinatal factors, exposure to breast milk, income level and daycare attendance positively affected development. Exposure to cigarette smoke, allergies among family members and daycare attendance proved to be important factors in inhaler use frequency.Conclusions: Postnatal environmental factors are important in predicting and modifying early childhood outcomes among preterm infants.

The evaluation of serum brain-derived neurotrophic factor and neurofilament light chain levels in patients with obstructive sleep apnea syndrome.

ObjectivesThis study aimed to compare serum levels of brain‐derived neurotrophic factor (BDNF) and neurofilament light (NfL) chain in normal individuals and patients with mild and moderate‐severe obstructive sleep apnea syndrome (OSAS).MethodsWe enrolled 81 subjects referred to Otorhinolaryngology (Ear‐Nose‐Throat), Gazi University Faculty of Medicine, between 2017 and 2019. Based on the severity of OSAS, patients were divided into three groups: group 1 with mild OSAS (apnea‐hypopnea index [AHI] 5‐15; n = 26), group 2 with moderate‐severe OSAS (AHI > 15; n = 32), and group 3 with normal individuals (AHI scores < 5; n = 23).ResultsSerum NfL and BDNF levels were evaluated together with the clinical data for all subjects. Significant differences were seen in the oxygen desaturation index (ODI), apnea index, hypopnea index, sleep efficiency, and NfL levels (P < .05) between the three groups. In the moderate‐severe group, NfL levels showed a significant positive correlation with apnea index (P < .05, r = .389), hypopnea index (P < .05, r = .455), and ODI (P = .04; r = .362).ConclusionsOur findings clarify the pathophysiology of OSAS in cases of repetitive hypoxia and chronic neuronal damage. Based on our results, we recommend that in addition to BDNF, NfL should also be evaluated in different and larger patient cohorts.

Pregabalin poisoning: Evaluation of dose-toxicity relationship.

ContextPregabalin poisoning is mostly benign, although coma and convulsions occasionally occur.AimTo determine the dose‐toxicity relationship of pregabalin.MethodsDose‐toxicity data of isolated pregabalin poisonings were collected from (1) a prospective study performed by the Dutch Poisons Information Centre (4 April 2014 to 4 October 2016) and from (2) case reports and case series reported in literature. Poisonings were graded using the Poisoning Severity Score (PSS) and the relationship between dose (mg kg−1) and PSS was evaluated.ResultsIn our study (n = 21 patients), the most commonly observed symptoms were drowsiness (62%), confusion (29%) and apathy (24%). PSS was none in three (14%), minor in 15 (71%), and moderate in three patients (14%). Most case series also reported a PSS of none to minor in the majority of poisonings (69‐100%). For 34 individual patients (21 from our study and 13 from literature), detailed data on dose and clinical course were available to examine the dose‐toxicity relationship.The median dose was significantly lower in the PSS none‐minor group (“benign”) (8.6 mg kg−1, interquartile range (IQ25‐75) 5.0‐17.6 mg kg−1) than in the PSS moderate‐severe group (“significant toxicity”) (46.7 mg kg−1, IQ25‐75 21.3‐64.3 mg kg−1); estimate of the median difference = 27.3 mg kg−1 (95% confidence interval (CI): 10‐48.6).ConclusionsIn general, higher pregabalin doses result in more severe poisonings. Below 20 mg kg−1 the majority of patients (83%) only suffer from mild poisoning. However, large interindividual differences exist in pregabalin‐induced toxicity. Therefore, pre‐hospital triage should not only include pregabalin dose, but also underlying illnesses, co‐exposures and reported symptoms.

The rCAST score is useful for estimating the neurological prognosis in pediatric patients with post-cardiac arrest syndrome before ICU admission: External validation study using a nationwide prospective registry

IntroductionThe objective of this cohort study was to investigate whether the revised post-Cardiac Arrest Syndrome for Therapeutic hypothermia score (rCAST), which we previously developed as a prognostic score for adult patients with post-cardiac arrest syndrome (PCAS), is also applicable to pediatric patients. MethodsPediatric PCAS patients were included from an out-of-hospital cardiac arrest (OHCA) registry of the Japanese Association for Acute Medicine (JAAM). We validated the predictive accuracy of the rCAST for the neurological outcomes at 30 and 90 days. We also evaluated the probability of a good neurological outcome in each of the three specified severity categories based on the rCAST (low severity: ≤5.5; moderate severity: 6.0–14.0; high severity: ≥14.5). ResultsAmong the 737 pediatric patients with OHCA, the data of 179 pediatric PCAS patients in whom return of spontaneous circulation was achieved were analyzed. The areas under the curve (AUC) of the rCAST for predicting the neurological outcomes at 30 days and 90 days were 0.95 (95% CI: 0.90–0.99) and 0.96 (0.91–1.00), respectively. The proportions of patients with a good neurological outcome at 30 days were 100% (12/12) in the low severity group, 36.1% (13/36) in the moderate severity group, and 2.3% (3/131) in the high severity group. ConclusionsThe AUC of the rCAST for pediatric PCAS patients was found to be greater than 0.9 in the external validation, which corresponds to excellent predictive accuracy. There was no patient with good neurological outcome among the patients with more than 17.0 points (extremely high severity group).

Evaluation of Hematological Parameters of Children Diagnosed with COVID-19: Single-Center Experience.

Objective:Although many pediatric studies on children infected with coronavirus disease 2019 (COVID-19) have been published, the diagnosis, clinical symptoms, laboratory findings, and treatment of COVID-19 in children are still unclear.Materials and Methods:This study was conducted with an aim to examine the hematological findings of symptomatic pediatric patients diagnosed with COVID-19 in May 2020 at the Pandemic Hospital in Dicle University. Patient records were evaluated retrospectively. This study involved 59 symptomatic pediatric patients with a definite diagnosis of COVID-19 who had positive SARS-CoV-2 RT-PCR test results on nasopharyngeal swab between March 15, 2020 and May 31, 2020. Results:The records of a total of 10 (16.9%) patients under the age of 1; 21 (35.6%) patients aged 1-10 years, and, 28 (47.5%) patients aged 10-18 years, who had been diagnosed with COVID-19 were evaluated. Based on severity, 35 (59.3%) patients were in the mild group (group 1) and 24 (40.7%) patients were in the moderate-severe group (group 2). The blood parameters of WBC, neutrophil, lymphocyte, monocyte, and thrombocyte counts, the hemoglobin (Hgb) level, and NLR, PLR, MPV, fibrinogen, ferritin, and D-dimer levels were compared between groups, the difference was not statistically significant (P > .05). LDH was higher in group 2 (P = .014).Conclusion:Since children infected with COVID-19 show mild clinical symptoms or are asymptomatic, fewer pediatric patients may be detected than adults. Therefore, it should be known that the laboratory findings typical for adults may not accompany the disease in pediatric cases. More studies are needed to determine the most appropriate COVID-19 treatment approach for children, as hospitalization history and testing rates are less reported among children.

Ambient temperature and ambulance car visits in Japan by age category and severity

BACKGROUND AND AIM: Using the Japanese public domain data, we have reported that a severe heat exposure during the power outage on 10th of September due to the typhoon raised the number of ambulance car visits due to heatstroke disproportionately. Here, we investigated which age groups and which severity categories were affected. METHODS: Because the Typhoon Faxai hit Japan in September 2019, we collected the ambulance car visit data for September from 2010 to 2019 from the Fire and Disaster Management Agency, the Ministry of Internal Affairs and Communications. Corresponding weather data were collected from the Japan Meteorological Agency. Both datasets are publicly available from the respective websites. Because the already-categorized data either by age group or by severity level were available, we set the age groups as 0-6, 7-17, 18-64 and 65+, and severity levels as mild, moderate, severe, and deceased. The comparison was on the difference between the September heatstroke risk in 2019 and that in the preceding years. First, we examined Chiba prefecture, in which the power outage was by far extensive. As the control, we also examined the surrounding 6 prefectures, where the power outage was minimal. RESULTS:As for Chiba, age groups 18-64 and 65+ and mild to moderate severity groups showed much higher risk. The control prefectures did not show increased risk. Deceased cases were rare, but two deaths in Chiba and no death in the other prefectures were identified on 10th of September. CONCLUSIONS:The severe heat exposure during the typhoon-related power outage increased the risk of mild and moderate heatstroke among 18 years and older age group. KEYWORDS: Temperature,Heatstroke, Ambulance car visits

Modification and accuracy of the STOP-Bang questionnaire for screening obstructive sleep apnea in adults

Objective:To assess the accuracy of the STOP-Bang questionnaire（SBQ） about screening for obstructive sleep apnea（OSA） in adults, and to establish appropriate cutoffs for body mass index（BMI）, neck circumference（NC）, age, and SBQ score for this population in combination with the body size characteristics of the study subjects, and to evaluate the accuracy of the SBQ for combined screening with waist to height ratio（WHtR）. Methods:The data were collected from October, 2019 to November, 2020 at the Affiliated Hospital of Guizhou Medical University, and 218 patients with suspicious OSA were included in this study, all of them completed the SBQ and underwent overnight PSG. SBQ screening and PSG were tested in a blinded concurrent manner. Using the PSG results as the gold standard, the subjects were divided into a diseased group with moderate to severe OSA and a non-diseased group based on apnea hypopnea index. According to SBQ screening results, the subjects were divided into a positive group with moderate severe OSA and negative group. And calculated in the form of four-fold table, the optimal cutoffs were determined by adjusting age, BMI, NC, and SBQ score cutoffs, and calculating the sensitivity, specificity, positive predictive value（PPV）, negative predictive value（NPV）, Youden index, and area under the receiver operating characteristic curve（ROC）. And the modified version of SBQ was combined with WHtR for joint diagnosis to evaluate the accuracy of combined screening. Results:With all 218 patients completing the experiment, 159（72.94%） patients were in the moderate-severe group. The original SBQ had a sensitivity of 93.71%, specificity of 47.46%, PPV of 82.80%, NPV of 73.70%, Youden index of 0.41, and area under the ROC curve（AUC） of 0.71 for predicting moderate to severe OSA. When adjusting the BMI cutoff to 30 kg/m², NC cutoff to 40 cm, and age cutoff to 50 years, the modified SBQ had a sensitivity of 95.60%, specificity of 47.46%, PPV of 83.10%, NPV of 80.00%, Youden index of 0.43, and AUC of 0.72 for predicting moderate to severe OSA. When the modified SBQ score was 4 or more as the cutoff value, the highest Youden index and AUC were 0.54, 0.77 respectively. When the modified SBQ≥3 points were combined with WHtR>0.55, the highest Youden index and AUC were 0.58, 0.79 respectively. Conclusion:SBQ is effective in screening for moderate to severe OSA and better screening accuracy can be achieved by using a modified version of the SBQ（BMI>30 kg/m², NC>40 cm, age>50 years）. The maximum diagnostic accuracy can be achieved when the modified SBQ total score was 4 or more as the cutoff. Those with the modified SBQ total score=3 and WHtR>0.55 can be classified as high risk for moderate to severe OSA, and the modified version of SBQ can be a screening tool to identify moderate to severe OSA.

The effects of high-sensitivity C-reactive protein on the clinical outcomes in obstructive sleep apnea patients undergoing off-pump coronary artery bypass grafting

PurposeTo investigate the relationship between obstructive sleep apnea (OSA) severity and high-sensitivity C-reactive protein (Hs-CRP), and their respective impact on the clinical outcomes in patients undergoing off-pump cardiac artery bypass grafting (OPCABG).MethodsWe enrolled consecutive eligible patients listed for elective OPCABG who underwent cardiorespiratory polygraphy before surgery between January 2019 and December 2019 in this prospective observational single-center study. Baseline, intraoperative, and postoperative clinical data were compared between absent-mild and moderate-severe OSA groups. Regression analysis investigated the relationship between Hs-CRP level and severity of OSA, and further assessed the factors influencing postoperative atrial fibrillation, duration of hospitalization, and hospital cost.ResultsPatients with moderate-severe OSA accounted for 42.3% (52/123) of the cohort. Partial pressure of carbon dioxide (PCO2), Hs-CRP, apnea hypopnea index (AHI), mean apnea time, maximum apnea time, and oxygen desaturation index ODI ≥ 3% were significantly higher in the moderate-severe OSA group than in the absent-mild OSA group. Left ventricle ejection fraction (LVEF), lowest arterial oxygen saturation (SaO2), and mean SaO2 were significantly lower in the moderate-severe OSA group. Moderate-severe OSA was associated with elevated Hs-CRP level (OR = 2.356, 95% CI 1.101–5.041, P = 0.027). Hs-CRP was an independent risk factor for post-CABG atrial fibrillation (POAF) (OR = 1.212, P = 0.01). Hs-CRP level independently correlated with duration of hospitalization (B = 0.456, P = 0.001) and hospital cost (B = 1.111, P = 0.044).ConclusionHs-CRP level was closely related to OSA severity and have potential utility in predicting POAF, duration of hospitalization, and hospital costs in patients undergoing OPCABG.

Complement levels at admission as a reflection of coronavirus disease 2019 (COVID-19) severity state.

Complement system hyperactivation has been proposed as a potential driver of adverse outcomes in severe acute respiratory syndrome coronavirus 2 infected patients, given prior research of complement deposits found in tissue and blood samples, as well as evidence of clinical improvement with anticomplement therapy. Its role in augmenting thrombotic microangiopathy mediated organ damage has also been implicated in coronavirus disease 2019 (COVID‐19). This study aimed to examine associations between complement parameters and progression to severe COVID‐19 illness, as well as correlations with other systems. Blood samples of COVID‐19 patients presenting to the emergency department (ED) were analyzed for a wide panel of complement and inflammatory biomarkers. The primary outcome was COVID‐19 severity at index ED visit, while the secondary outcome was peak disease severity over the course of illness. Fifty‐two COVID‐19 patients were enrolled. C3a (p = 0.018), C3a/C3 ratio (p = 0.002), and sC5b‐9/C3 ratio (p = 0.021) were significantly elevated in with severe disease at ED presentation. Over the course of illness, C3a (p = 0.028) and C3a/C3 ratio (p = 0.003) were highest in the moderate severity group. In multivariate regression controlled for confounders, complement hyperactivation failed to predict progression to severe disease. C3a, C3a/C3 ratio, and sC5b‐9/C3 ratio were correlated positively with numerous inflammatory biomarkers, fibrinogen, and VWF:Ag, and negatively with plasminogen and ADAMTS13 activity. We found evidence of complement hyperactivation in COVID‐19, associated with hyperinflammation and thrombotic microangiopathy. Complement inhibition should be further investigated for potential benefit in patients displaying a hyperinflammatory and microangiopathic phenotype.

Outcome Related to Level of Targeted Temperature Management in Postcardiac Arrest Syndrome of Low, Moderate, and High Severities: A Nationwide Multicenter Prospective Registry.

The optimal target temperature during targeted temperature management for patients after cardiac arrest remains under debate. The aim of this study was to evaluate the association between targeted temperature management at lower target temperatures and the neurologic outcomes among patients classified by the severity of postcardiac arrest syndrome. A multicenter observational study from the out-of-hospital cardiac arrest registry of the Japanese Association for Acute Medicine, which is a nationwide prospective registry of out-of-hospital cardiac arrest patients. A total of 125 critical care medical centers or hospitals with an emergency care department across Japan. A total of 1,111 out-of-hospital cardiac arrest patients who had received targeted temperature management. We divided all 1,111 postcardiac arrest syndrome patients treated with targeted temperature management into two groups: those who received targeted temperature management at a lower target temperature (33-34°C) and those who received targeted temperature management at a higher target temperature (35-36°C). In regard to classification of the patients, we divided the patients into three categories of severity (low, moderate, and high severities) using the risk classification tool, post-Cardiac Arrest Syndrome for Therapeutic hypothermia, which was previously validated. The primary outcome was the percentage of patients with a good neurologic outcome at 30 days, and the secondary outcome was the survival rate at 30 days. Multivariate analysis showed that targeted temperature management at 33-34°C was significantly associated with a good neurologic outcome and survival at 30 days in the moderate severity (odds ratio, 1.70 [95% CI, 1.03-2.83] and 1.90 [95% CI, 1.15-3.16], respectively), but not in the patients of low or high severity (pinteraction = 0.033). Propensity score analysis also showed that targeted temperature management at 33-34°C was associated with a good neurologic outcome in the moderate-severity group (p = 0.022). Targeted temperature management at 33-34°C was associated with a significantly higher rate of a good neurologic outcome in the moderate-severity postcardiac arrest syndrome group, but not in the low- or high-severity group.

Baseline and follow-up serum ferritin level as a prognostic factor in coronavirus disease 2019-infected patients

Objective In the past few months, WHO declared coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 as a major pandemic, with increasing number of discovered cases and mortalities in all countries. Up till now, there are a lot of controversial data on its pathogenesis, possible complications, prognostic factors, and available preventive and/or therapeutic options. A series of fast growing research studies are being conducted aiming at studying prognostic criteria that may predict the disease severity and possible outcomes and hence plan of management either home or hospital management. Patients and methods Our cohort study included 73 COVID-19-confirmed positive cases by nasopharyngeal swab/reverse transcriptase PCR to evaluate correlation between serum ferritin levels (baseline and follow-up samples at day 7), as well as C-reactive protein levels and severity of clinical presentation of COVID-19-infected patients. Results Our results have demonstrated a statistically significant difference between mild (n=40) and moderate cases (n=33) regarding baseline ferritin level (P=0.00); however; no significant difference was detected among ferritin changes during the course of the disease (P=0.744), and also, no statistically significant difference in ferritin changes was found among mild and moderate severity groups (P=0.942). Finally, the only significant predictors of clinical severity were baseline ferritin and C-reactive protein levels according to multivariate analysis model (P=0.014 and =0.000, respectively). Conclusions The current study added further evidence to suggest baseline serum ferritin as an index of severity in COVID-19 and could have a prognostic effect; however, we cannot rely on follow-up serum ferritin during treatment and the course of the disease to predict outcome of the disease, and it may be misleading.

Thalamocortical Functional Connectivity in Patients With White Matter Hyperintensities.

Background: White matter hyperintensities (WMH)s is a very common neuroradiological manifestation in the elderly and is an increased risk of dementia and cognitive decline. As we all know, the thalamocortical circuit plays an important part in cognition regulation. However, the role of this circuit in WMHs and its related cognitive deficits is still unclear.Method: Eighty WMH patients and 37 healthy controls (HCs) were enrolled in the current study. WMH patients were divided into a mild WMH group (n = 33) and moderate-severe WMH group (n = 47) according to Fazekas scores. Resting-state functional magnetic resonance imaging (rs-fMRI) data of all participants were collected for thalamocortical functional connectivity (FC) analysis. The analysis was performed in two steps. First, the whole cerebral cortex was divided into six regions of interest (ROIs), which were used as seeds to investigate the changes of FC with the thalamus. Then, the subregion of the thalamus generated in the previous step was used as the seed for FC analysis with the whole brain.Results: In the first step of FC analysis, it was found that precentral gyrus (PrCG)-interthalamic adhesion (ITA) FC values in moderate-severe WMH group were higher than those in HC and mild WMH groups. However, when compared with the HC group, the increase of PrCG-ITA FC values in mild WMH group was not statistically significant. In the second step of FC analysis, the ITA was set as the seed, and compared with the HC group, the results showed that the FC values of the ITA-medial frontal gyrus (MFG) in mild group and moderate-severe WMH groups were significantly increased. In addition, the FC values in moderate-severe group were significantly higher than those in mild group. Finally, it was also found that FC values (PrCG-ITA and ITA-MFG) were significantly correlated with neuropsychological test results for multiple cognitive functions such as memory, execution and attention in WMH patients.Conclusion: Abnormal thalamocortical FC was closely related with cognitive impairments in WMH patients.

Evaluating the Impact of Intensive Case Management for Severe Vocational Injuries on Work Incapacity and Costs

Purpose This study investigates the impact of an intensive case management program on sick leave days, permanent work incapacity levels and treatment costs for severe vocational injuries set up by the French National Insurance Fund in five health insurance districts. Methods The method employed relies on a four-step matching procedure combining Coarsened Exact Matching and Propensity Score Matching, based on an original administrative dataset. Average Treatment effects on the Treated were estimated using a parametric model with a large set of covariates. Results After one-year follow-up, workers in the treatment group had higher sickness absence rates, with 22 extra days, and the program led to 2.7 (95% CI 2.3–3.1) times more diagnoses of permanent work incapacity in the treatment group. With an estimated yearly operational cost of 2,722 € per treated worker, the average total extra treatment cost was 4,569 € for treated workers, which corresponds to a cost increase of 29.2% for the insurance fund. Conclusions The higher costs found for the treatment group are mainly due to longer sick leave duration for the moderate severity group, implying higher cash transfers in the form of one-off indemnities. Even though workers in the treated group have more diagnoses of permanent work incapacity, the difference of severity between groups is small. Our results on longer sick leave duration are partly to be explained by interactions between the case managers and the occupational physicians that encouraged patients to stay longer off-work for better recovery, despite the higher costs that this represented for the insurance fund and the well-documented adverse side effects of longer periods off-work.

Primary Immun Deficiency in Patients with Non-Cystic Fibrosis Bronchiectasis and Its Relationship with Clinical Parameters.

Bronchiectasis is characterized by chronic respiratory infection. The role of immunodeficiency in this disease is poorly studied in relation to clinical indices. The primary aim of this study was to determine the frequency of these neglected altered immune status by evaluating immunoglobulins, lymphocyte subsets, complement levels, and neutrophil function, and to assess its relationship with clinical parameters in adult patients with non-cystic fibrosis bronchiectasis (NCFB). A total of 74 (30 men and 44 women with a mean age of 47±17 years) adult patients with stable NCFB were enrolled in this study. The bronchiectasis severity index (BSI) and FACED (F:FEV1, A: Age, C: Chronic colonization, E: Extension, D: Dyspnea) scores were assessed. Peripheral blood samples were collected for the detection of total IgG, IgA, IgM, IgE, and IgG subclasses and C3 and C4 levels. The counts of CD3, CD4, CD8, CD19, CD16/56 expressing peripheral blood lymphocytes and neutrophil oxidative function were evaluated. In the study population, BSI and FACED severity index scores increased with longer duration of the disease (p=0.01 and p=0.040, respectively). Of the 74 patients, 27 (37%) showed humoral aberrations. The number of male patients were higher in this group (p=0.03). High serum total IgE levels were associated with high scores in BSI (moderate-severe group versus mild group, p=0.030). Patients with bronchiectasis demonstrated lower CD3+ T cell count, lower CD4+ T helper cell percentage, and lower CD4+ T cell count (p=0.031, p=0.030, p=0.029, respectively) than healthy subjects. A significant negative correlation was found between the percentage and count of CD16/56+ natural killer (NK) cells and the number of exacerbations within the past year (r=-0.230, p=0.049 and r=-0.264, p=0.023, respectively). Humoral aberrations in adult patients with NCFB were found to be frequent. IgE levels were related to high scores for disease severity indices. Furthermore, patients with low percentage and counts of NK cells had higher rates of exacerbations. These results emphasize the importance of immune function assessment in adult patients with NCFB.