National Institute Of Health Criteria Research Articles

Impact of neurofibromatosis type 1 on quality of life using the Skindex-29 questionnaire quality of life in NF1.

Neurofibromatosis type 1 (NF1) is one of the most common RASopathies predisposing affected patients to melanic lesions and benign tumors. NF1 is associated with considerable esthetic and functional burden negatively affecting the patient's quality of life (QoL). This study aims to assess the clinical features of NF1 patients and evaluate their impact on QoL. We identified NF1 patients from a public health database of a region in Spain. All patients underwent clinical and ophthalmological evaluation for NF1 features. We measured QoL using the Spanish version of the Skindex-29. Forty patients fulfilled the NF1 National Institute of Health criteria when we recruited patients. The median age was 42.00 years (IQR 26.5 -53.75). The median total Skindex-29 score was 12.3 (IQR 5.9-22.4); (emotion: 15.0, IQR 5.0-37.5; symptoms 8.9, IQR 0.0-17.9 and functioning 8.3; IQR 0.5-18.3). Women and NF1 patients with lower educational levels were associated with poorer QoL scores. We identified itching and sleep troubles to influence NF1 patients' QoL negatively. NF1 considerably influences the psychological well-being of NF1 patients. We observed that female and low-educated patients scored higher on the emotional dimension of the Skindex-29 and could, therefore, be more at risk of depression. We also pointed out some "minor symptoms" that negatively impact NF1 patients' QoL such, as itching and sleep troubles which doctors could treat if sought by doctors.

Evaluation of differences in quality of life in patients with chronic graft-versus-host disease

Objective: To evaluate the status of, differences in, and factors influencing quality of life (QoL) in patients with chronic graft-versus-host disease (GVHD). Methods: From September 2021 to February 2023, a cross-sectional study of 140 patients with chronic GVHD was conducted at our center. Symptom burden was assessed by the Lee Symptomatology Scale (LSS), and QoL was assessed by the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) (version 1) and five-level EuroQoL five-dimensional questionnaire (EQ-5D-5L). Results: Data from 140 respondents, including 32 (22.9%) with mild chronic GVHD, 87 (62.1%) with moderate chronic GVHD, and 21 (15.0%) with severe chronic GVHD, were analyzed. Of the respondents, 61.4% were male, and the median transplantation age was 34 (15-68) years. The primary diagnoses were acute myeloid leukemia (50.0%), acute lymphoblastic leukemia (20.0%), and myelodysplastic syndrome (15.0%). The common chronic GVHD-affected organs included the skin in 74 patients (52.9%), the eyes in 57 patients (40.7%), and the liver in 50 patients (35.7%). Among the whole cohort, the eye (20.48±23.75), psychological (16.13±17.00), and oral (13.66±20.55) scores were highest in the LSS group. The physiological function (36.07±11.13), social function (36.10±10.68), and role-emotional functioning (38.36±11.88) scores were lowest in the SF-36 group. The EQ-5D index was 0.764. The total LSS scores for mild, moderate, and severe chronic GVHD were 6.51±6.15, 10.07±5.61, and 20.90±10.09, respectively. The SF-36 physical component scores (PCSs) were 43.12±6.38, 40.73±7.14, and 36.97±6.97, respectively, and the mental component scores (MCSs) were 43.00±8.47, 38.90±9.52, and 28.96±9.63, respectively. The EQ-5D values were 0.810±0.124, 0.762±0.179, and 0.702±0.198, respectively. The multivariate analysis showed that the overall symptom burden (β=-0.517), oral symptom burden (β=-0.456), National Institute of Health (NIH) criteria for the eyes (β=-0.376), and nutrition-related symptom burden (β=-0.211) were significantly negatively correlated with the PCS. The NIH score (β=-0.260) was negatively correlated with the MCS score. Oral symptom burden (β=-0.400), joint/fascia NIH criteria (β=-0.332), number of involved systems (β=-0.253), overall NIH criteria (β=-0.205), and number of immunosuppressants taken (β=-0.171) were significantly negatively correlated with the EQ-5D score (all P<0.05). Medium to strong correlations were found between the EQ-5D score and the SF-36 score (|r|=0.384-0.571, P<0.001). Conclusions: The QoL of patients with chronic GVHD is impaired, and the more severe the disease, the poorer the QoL. Overall symptom burden, severity of eyes, and oral symptom burden were the most important factors affecting QoL.

Assessment of Takayasu's arteritis activity by ultrasound localization microscopy.

Ultrasound localization microscopy (ULM) based on ultrafast ultrasound imaging of circulating microbubbles (MB) can image microvascular blood flows invivo up to the micron scale. Takayasu arteritis (TA) has an increased vascularisation of the thickened arterial wall when active. We aimed to perform vasa vasorum ULM of the carotid wall and demonstrate that ULM can provide imaging markers to assess the TA activity. Patients with TA were consecutively included with assessment of activity by the National Institute of Health criteria: 5 had active TA (median age 35.8 [24.5-46.0] years) and 11 had quiescent TA (37.2 [31.7-47.3] years). ULM was performed using a 6.4MHz probe and a dedicated imaging sequence (plane waves with 8 angles, frame rate 500Hz), coupled with the intravenous injection of MB. Individual MB were localised at a subwavelength scale then tracked, allowing the reconstruction of the vasa vasorum flow anatomy and velocity. ULM allowed to show microvessels and to measure their flow velocity within the arterial wall. The number of MB detected per second in the wall was 121 [80-146] in active cases vs. 10 [6-15] in quiescent cases (p=0.0005), with a mean velocity of 40.5 [39.0-42.9] mm.s-1 in active cases. ULM allows visualisation of microvessels within the thickened carotid wall in TA, with significantly greater MB density in active cases. ULM provides a precise visualisation invivo of the vasa vasorum and gives access to the arterial wall vascularisation quantification. French Society of Cardiology. ART (Technological Research Accelerator) biomedical ultrasound program of INSERM, France.

Surfing the Waves: Differences in Hospitalised COVID-19 Patients across 4 Variant Waves in a Belgian University Hospital

The unprecedented COVID-19 pandemic took the form of successive variant waves, spreading across the globe. We wanted to investigate any shift in hospitalised patients' profiles throughout the pandemic. For this study, we used a registry that collected data automatically from electronic patient health records. We compared clinical data and severity scores, using the National Institute of Health (NIH) severity scores, from all patients admitted for COVID-19 during four SARS-CoV-2 variant waves. Our study concluded that patients hospitalised for COVID-19 showed very different profiles across the four variant waves in Belgium. Patients were younger during the Alpha and Delta waves and frailer during the Omicron period. 'Critical' patients according to the NIH criteria formed the largest fraction among the Alpha wave patients (47.7%), while 'severe' patients formed the largest fraction among Omicron patients (61.6%). We discussed host factors, vaccination status, and other confounders to put this into perspective. High-quality real-life data remain crucial to inform stakeholders and policymakers that shifts in patients' clinical profiles have an impact on clinical practice.

Blood glucose control with different treatment regimens in type 2 diabetes patients hospitalized with COVID-19 infection: A retrospective study.

Coronavirus disease (COVID-19) is closely associated with hyperglycemia and a worse prognosis in patients with a previous diagnosis of type 2 diabetes mellitus. A few studies investigated the effects of diabetes treatment regimens in these patients during hospitalization. Here, we evaluate the impact of insulin and non-insulin therapy on glucose control in patients with type 2 diabetes admitted with COVID-19. This is a retrospective study including 359 COVID-19 patients with type 2 diabetes. Patients were divided into 2 groups according to diabetes treatment during hospitalization. The first group included patients treated with insulin only, and the second group patients treated with other antidiabetic agents with or without insulin. Average blood glucose was higher in the insulin-only treatment group (201 ± 66 mg/dL vs 180 ± 71 mg/dL, P = .004), even after excluding mechanically ventilated patients (192 ± 69 vs 169 ± 59 mg/dL, P = .003). In patients with moderate severity of COVID-19, average blood glucose was also significantly higher in the insulin-only treated group (197 ± 76 vs 168 ± 51 mg/dL, P = .001). Most patients (80%) in the combination treatment group received metformin. Moderately affected COVID-19 patients with type 2 diabetes could safely be treated with antihyperglycemic medications with or without insulin.

The diagnostic performance of antimullerian hormone for polycystic ovarian syndrome and polycystic ovarian morphology.

The diagnosis of polycystic ovary syndrome (PCOS) remains a challenge to clinicians due to heterogeneous clinical presentation and diagnostic criteria. This study investigated the utilization of Anti-Müllerian hormone (AMH) alone or replacing polycystic ovarian morphology (PCOM) in the PCOS diagnostic criteria. A total of 401 women were categorised as PCOS (n:154), nonPCOS with polycystic ovarian morphology (PCOM) (n:105), and nonPCOS with normal ovarian morphology (NOM) (n:142). First, the diagnostic performance of AMH for PCOS diagnosis in Rotterdam, Androgen Excess Society, and National Institutes of Health (NIH) criteria was analyzed. Second, AMH was used instead of PCOM in Rotterdam criteria and we searched diagnostic performance for PCOS phenotypes. AMH levels were positively correlated with LH, testosterone, hirsutism score, menstrual cycle length, and antral follicle count (p < 0.05). AMH alone had specificity and sensitivity for PCOS diagnosis were 84.9% and 72.4% in Rotterdam (AUC: 0.866); 84.4% and 72% in Androgen Excess Society (AUC: 0.857); 83.3% and 66.4% in National Institute of Health criteria (AUC: 0.825). AMH alone had satisfactory diagnostic potential for phenotype A, but not other phenotypes. The replacement of PCOM with AMH in Rotterdam criteria had a high diagnostic potential for PCOS (AUC: 0.934, sensitivity:97.4%, specificity: 90.67%). Phenotype A and phenotype D were diagnosed with 100% sensitivity and 94.5% specificity. Phenotype C was recognised with 96.15% sensitivity and 94.5% specificity. AMH may be used with high diagnostic accuracy instead of PCOM in the Rotterdam PCOS criteria.

Efficacy of endoscopic ultrasound in the evaluation of small gastrointestinal stromal tumors.

BACKGROUNDGastrointestinal stromal tumors (GISTs) with a diameter of < 2 cm are called small GISTs. Currently, endoscopic ultrasound (EUS) is widely used as a regular follow-up method for GISTs, which can also provide a preliminary basis for judging the malignancy potential of lesions. However, there are no studies on the accuracy of EUS to assess the malignant potential of small GISTs.AIMTo evaluate the efficacy of EUS in the diagnosis and risk assessment of small GISTs.METHODSWe collected data from patients with small GISTs who were admitted to Shengjing Hospital of China Medical University between October 2014 and July 2019. The accurate diagnosis and risk classifications of patients were based on the pathological assessment according to the modified National Institute of Health criteria after endoscopic resection or laparoscopic surgery. Preoperative EUS features (marginal irregularity, cystic changes, homogeneity, ulceration, and strong echogenic foci) were retrospectively analyzed. The assessment results based on EUS features were compared with the pathological features.RESULTSA total of 256 patients (69 men and 187 women) were enrolled. Pathological results included 232, 16, 7, and 1 very low-, low-, intermediate-, and high-risk cases, respectively. The most frequent tumor location was the gastric fundus (78.1%), and mitoses were calculated as > 5/50 high power field in 8 (3.1%) patients. Marginal irregularity, ulceration, strong echo foci, and heterogeneity were detected in 1 (0.4%), 2 (0.8%), 22 (8.6%), and 67 (65.1%) patients, respectively. However, cystic changes were not detected. Tumor size was positively correlated with the mitotic index (P < 0.001). Receiver operating curve analysis identified 1.48 cm as the best cut-off value to predict malignant potential (95% confidence interval: 0.824–0.956). EUS heterogeneity with tumor diameters > 1.48 cm was associated with higher risk classification (P < 0.05).CONCLUSIONSmall GISTs (diameters > 1.48 cm) with positive EUS features should receive intensive surveillance or undergo endoscopic surgery. EUS and dissection are efficient diagnostic and therapeutic approaches for small GISTs.

Ocular Chronic Graft-versus-Host Disease and Its Relation to Other Organ Manifestations and Outcomes after Allogeneic Hematopoietic Cell Transplantation

Ocular chronic graft-versus-host disease (cGVHD) has been shown to significantly reduce quality of life after allogeneic hematopoietic stem cell transplantation (HSCT). To learn more about this bothersome complication, we investigated the relationship between ocular cGVHD and cGVHD in other organs. We also investigated the associations between ocular cGVHD and overall mortality, nonrelapse mortality, and relapse. In this single-center study, we retrospectively included 1221 consecutive adults who underwent allogeneic HSCT. Patients were examined by an ophthalmologist before HSCT and annually for 5 years after HSCT or more frequently if needed. Patients with dry eye disease before HSCT were excluded. The International Chronic Ocular GVHD Consensus Group criteria were used to diagnose ocular cGVHD. Nonocular cGVHD was diagnosed using the National Institute of Health criteria. Out of 601 patients who were diagnosed with systemic cGVHD during follow-up, 279 (46%) developed ocular cGVHD. Ocular cGVHD was more frequent in patients with extensive cGVHD compared to those with limited cGVHD (50% versus 29%; P < .0001) and was associated with cGVHD in skin (P < .0001), oral cavity (P=.0024), genitals (P=.0023), and nails (P=.031). The frequency of ocular cGVHD was higher in patients with skin cGVHD with sclerosis compared to those with skin cGVHD without sclerosis (70% versus 49%; P=.0003). In an adjusted time-dependent Cox model, ocular cGVHD was associated with increased nonrelapse mortality (adjusted hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.17 to 2.21; P=.003), whereas there was no support for an association with relapse (adjusted HR, .85; 95% CI, .53 to 1.36; P=.5). Special attention to eye problems after HSCT should be given to patients with extensive cGVHD and cGVHD in ectodermal-derived organs (skin, mouth, nails, and genitals). Furthermore, ocular cGVHD is a potential risk factor for nonrelapse mortality. © 2022 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

P1342: A SCREENING TOOL TO DETECT CHRONIC OCULAR GRAFT VERSUS HOST DISEASE IN A HEMATOLOGY/ ONCOLOGY OUTPATIENT SETTING

Background: Chronic ocular GvHD (oGvHD) is reported to occur in 30-60% of patients after hematological stem cell transplantation (HSCT). Presently, there is no diagnostic test available nor a single ‘gold standard’ sign or symptom for the disease. Instead the diagnosis is confirmed through criteria set by the National Institute of Health (NIH) and the International Chronic Ocular Graft-vs-Host-Disease Consensus Group (ICCGvHD), which place a heavy reliance on findings found on slit lamp examinations. Furthermore, after HSCT patients can suffer from non-GvHD related complications, such as cataracts, leading to compound presentations. Thus, this need for a specialist examination and confounding presentation means that often patient’s oGvHD may be advanced before the diagnosis is established and subsequent referral to specialist care. Such delays cause unnecessary suffering and, in some cases, permanent damage. Aims: We aimed to develop an effective and efficient screening tool for chronic oGvHD that could be integrated into a Hematology/ Oncology outpatient clinic. Methods: All post-HSCT patients attending the Hematology/ Oncology outpatient department clinic 18 months were invited to partake in the study. In PHASE I the Ocular Surface Disease Index (OSDI) questionnaire was used to screen the participants for chronic oGvHD and a score of >33 was chosen as the threshold. In PHASE II if participants scored >33 in the OSDI they were then asked a further ‘yes/ no’ question relating to daily use of ocular lubricants. If both criteria were fulfilled, chronic oGvHD was considered likely. In case instance, questionnaires were completed before the ophthalmic examination to prevent bias, and examination was performed by a trained ophthalmologist. Participants were considered to have a diagnosis of chronic oGvHD if they fulfilled one or both of the NIH or ICCGvHD criteria. The efficacy of was measured by sensitivity and specificity along with PPV and NPV. LR were used to assess the screening algorithm as it is less likely to change with disease prevalence. Pearson r formulation was used to determine degree of correlation between OSDI scores and disease severity. Results: PHASE I (n=100) resulted in a sensitivity of 100%, specificity of 86.9%, PPV of 0.59, NPV of 1.0 and a LR of 7.3 (p <0.0001). PHASE II (n=68) resulted in 100% sensitivity and specificity with a PPV and NPV of 1.00 (p <0.0001). Disease severity and ocular surface disease strongly correlated (n=65, 0.67, p <0.0001). Summary/Conclusion: We propose that a simple algorithm using the self-assessment OSDI questionnaire and a polar ‘yes/ no’ question relating to ocular lubricant usage that could be widely implemented in hematology/oncology settings to screen for oGvHD with minimal cost and inconvenience. The algorithm also provides an accurate prediction of disease severity, enabling ophthalmology services to triage patients so that timely care is provided to those in greatest need.

Derivation and Validation of a New Disease Activity Assessment Tool With Higher Accuracy for Takayasu Arteritis.

ObjectiveTo develop a new disease activity assessment tool with high accuracy for Takayasu arteritis.MethodsIndividual items from National Institute of Health (NIH) criteria and the Indian Takayasu Clinical Activity Score (ITAS2010) were tested as candidate variables to develop a new disease activity assessment tool in a derivation cohort (N = 100). Physician global assessment on disease activity was used as the gold standard. Multivariable logistic regression models were constructed and the model with the highest accuracy was identified. A formula assessing disease activity was generated using simplified β coefficients (rounded to decimal place). Diagnostic performance was evaluated through estimating the area under the curve (AUC). The new assessment tool was subsequently validated in a validation cohort (N = 46).ResultsThe multivariable model yielding the highest accuracy consisted of a high erythrocyte sedimentation rate (ESR), NIH criteria 1 and 4, and carotidynia. Using simplified β coefficients, the following disease activity assessment tool was developed: high ESR (3 points), NIH criterion 1 (2 points), NIH criterion 4 (4 points), and carotidynia (3 points) (total score ≥5, active; total score <5, inactive). The new disease activity assessment tool had a higher AUC (89.37) for discriminating active and inactive diseases than NIH criteria (AUC 77.96), ITAS2010 (AUC 66.12), ITAS-ESR (AUC 75.58), and ITAS-C-reactive protein (AUC 71.34). The AUC (85.23) of the new assessment tool was similar in the validation cohort.ConclusionA new disease activity assessment tool that consists of high ESR, NIH criteria 1 and 4, and carotidynia had higher accuracy in discriminating active and inactive disease than currently used clinical assessment tools.

Lost microbes of COVID-19: Bifidobacterium, Faecalibacterium depletion and decreased microbiome diversity associated with SARS-CoV-2 infection severity

ObjectiveThe study objective was to compare gut microbiome diversity and composition in SARS-CoV-2 PCR-positive patients whose symptoms ranged from asymptomatic to severe versus PCR-negative exposed controls.DesignUsing a cross-sectional design, we...

Surgical disparities among patients with primary hyperparathyroidism: a national inpatient sample database study

Socioeconomic and racial disparities in access to medical care have been shown to impact the morbidity and mortality of patients with surgically managed conditions. Primary Hyperparathyroidism (PHPT) is cured only by parathyroidectomy. Limited data exists examining the role of racial and socioeconomic disparity on surgical referral. Patients carrying a diagnosis of PHPT between the years of 2000–2017 were identified through the National Inpatient Sample (NIS) database. A Chi Square analysis was used to compare categorical variables and a logistic regression model with odds ratios was used to identify social predictors of surgical management. Only patients with APR-DRG Severity of Illness classifications of mild/moderate were included in the analysis, excluding patients with severe comorbidities precluding surgery. 78,520 patients were included. 75% were female. 14% were Black and 6% were Hispanic. 77% underwent parathyroidectomy. In this analysis, no statistically significant difference in odds of surgery was observed in White vs. Black patients. Hispanic patients were more likely to undergo operation than White patients (OR 1.22 [1.02–1.47] p < 0.05). Income quartile did not affect odds of surgery. Patients with private insurance were significantly more likely to be surgically managed when compared to Medicaid patients (1.40 [1.15–1.72] p < 0.001). A subgroup analysis of patients <50 years old, all of whom met National Institute of Health criteria for parathyroidectomy, was performed. Of these patients, privately insured patients were significantly more likely to undergo surgery than Medicaid patients (1.50 [1.10–2.04] p < 0.05). No statistically significant difference in odds of operation was observed between racial categories in this subgroup analysis. Patients in the highest income quartile had an increased odds of surgery when compared to patients in the lowest income quartile (OR 1.47 [1.10–1.97] p < 0.001). In patients diagnosed with PHPT, being privately insured with income in the highest quartile were factors predictive of undergoing operation for PHPT. Therefore, it is expected that patients who are on Medicaid and in the lowest income quartile would be more likely to develop the morbidities associated with advanced primary hyperparathyroidism.

A151 RISK FACTORS FOR VENOUS THROMBOEMBOLISM AFTER HOSPITAL DISCHARGE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

BackgroundInflammatory bowel disease (IBD) is a chronic inflammatory condition which is independently associated with venous thromboembolism (VTE). Although the absolute risk of VTE is greatest during hospitalization, the risk remains elevated in the early post-discharge period. The risk factors for VTE during this vulnerable period remain unknown.AimsWe performed a systematic review and meta-analysis to determine risk factors for VTE in the post discharge period among adult patients with IBD.MethodsWe performed a systematic search of Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials from inception through April 29, 2021 for publications that reported risk factors for VTE during the post-discharge period among patients with IBD. Study eligibility was assessed independently in duplicate without age or language restriction. We defined the post-discharge period as within 6 months of discharge. Pooled summary estimates of adjusted hazard/odds ratios, when available, were calculated for individual risk factors using random effects model with 95% confidence intervals. The analysis was performed when a minimum of three studies were available for a given risk factor. Heterogeneity was assessed using I2 statistic. Study quality was assessed using an adapted version of the National Institute of Health criteria.ResultsWe identified 10 studies from a total of 4339 abstracts that met our inclusion criteria: 8 population-based studies, 1 multicenter observational study and 1 single center observational study. Risk factors for post-discharge VTE were assessed at 6 weeks in 1 study, 1 month in 5 studies, 3 months in 2 studies, and 6 months in 2 studies. The variables assessed in our meta-analysis are reported in Table 1. Exposure to corticosteroid (odds ratio [OR], 1.77; 95% CI, 1.53–2.06) but not biologics (OR, 1.21; 95% CI 0.80–1.82) was associated with an increased risk of VTE. Furthermore, greater length of stay (OR 1.49; 95% CI, 1.01–2.20), ulcerative colitis (OR 1.41; 95% CI, 1.19–1.66), history of malignancy (OR 1.35; 95% CI, 1.12–1.62), and surgery during admission (OR 1.26; 95% CI, 1.12–1.42) but not female sex (OR 0.98; 95% CI, 0.88–1.10) or surgery type (OR 1.09; 95% CI, 0.75–1.57) were associated with increased risk of VTE after discharge. Overall, the study quality was rated as fair.ConclusionsIn our meta-analysis, which consisted of moderate quality of evidence, we identified multiple risk factors associated with VTE in the post-discharge period. This work will help inform which factors should be considered for developing point of care clinical predictive models to help guide when extended VTE prophylaxis is required. Funding AgenciesNone

Outcome of post-COVID-19 fungal pyelonephritis: A single Indian tertiary center experience.

Introduction:COVID-19 pandemic is associated with secondary opportunistic fungal infections. These have an aggressive course with a high mortality rate. We present our experience of seven cases of post-COVID-19 fungal pyelonephritis.Methods:An observational study over a period of 8 months of May to December 2021 was carried out at our tertiary care hospital, including all patients with features of fungal pyelonephritis in post-COVID-19 setting. The patient demographics, details of previous COVID-19 infection, details of present admission and management were collected. The endpoints were either discharge from the hospital or death.Results:Seven patients were included. Mean age of presentation was 42 years (range: 20–63 years, standard deviation ± 14.2). Male-to-female ratio was 6:1. One patient was diabetic. Two patients were asymptomatic, one had mild infection, and four patients had severe COVID-19 infection as per National Institute of Health criteria. In the present admission, all patients had symptomatic pyelonephritis with laboratory parameters showing elevated D dimer, C reactive protein, and total leukocyte counts. In all seven patients, ultrasound of kidney ureter bladder region showed bulky kidney, color Doppler showed main renal arterial thrombosis in two patients, segmental arterial thrombosis in another patient. Computed tomography scan was suggestive of changes of pyelonephritis in all patients with multiple renal hypodense areas. All patients required nephrectomy with biopsy suggestive of changes of necrotizing fungal inflammation. Three patients expired.Conclusion:Management of post-COVID-19 fungal pyelonephritis should be aggressive and suspicious laboratory and imaging findings should be treated by early nephrectomy.

The Effectiveness and Safety of Hyperbaric Oxygen Therapy in Various Phenotypes of Inflammatory Bowel Disease: Systematic Review With Meta-analysis.

Accumulating evidence suggests that hyperbaric oxygen therapy (HBOT) may be effective for inflammatory bowel disease (IBD). Our systematic review aimed to quantify the effectiveness and safety of HBOT in various IBD phenotypes. We performed a proportional meta-analysis. Multiple databases were systematically searched from inception through November 2020 without language restriction. We included studies that reported effectiveness and/or safety of HBOT in IBD. Weighted summary estimates with 95% confidence intervals (Cis) were calculated for clinical outcomes for each IBD phenotype using random-effects models. Study quality was assessed using the Cochrane evaluation handbook and National Institute of Health criteria. Nineteen studies with 809 patients total were eligible: 3 randomized controlled trials and 16 case series. Rates of clinical remission included 87% (95% CI, 10-100) for ulcerative colitis (n = 42), 88% (95% CI, 46-98) for luminal Crohn's disease (CD, n = 8), 60% (95% CI, 40-76) for perianal CD (n = 102), 31% (95% CI, 16-50) for pouch disorders (n = 60), 92% (95% CI, 38-100) for pyoderma gangrenosum (n = 5), and 65% (95% CI, 10-97) for perianal sinus/metastatic CD (n = 7). Of the 12 studies that reported on safety, 15% of patients (n = 30) had minor adverse events. Study quality was low in the majority of studies due to an absence of comparator arms, inadequate description of concomitant interventions, and/or lack of objective outcomes. Limited high-quality evidence suggests that HBOT is safe and associated with substantial rates of clinical remission for multiple IBD phenotypes. Well-designed randomized controlled trials are warranted to confirm the benefit of HBOT in IBD.

Elevated chemokines concentration is associated with disease activity in Takayasu arteritis

BackgroundChemokines were seldom investigated in Takayasu arteritis (TA) patients. This study aimed to evaluate the plasma levels of chemokines and their association with disease activity, including C-C chemokine ligand (CCL) 2, CCL3, CCL11, CCL20, C-X-C chemokine ligand (CXCL) 8 and CXCL10. MethodsChemokines were measured in 85 TA patients, and 28 age- and gender-matched healthy controls. The disease activity of these TA patients was assessed according to the National Institute of Health (NIH) criteria. The relationship between the plasma levels of chemokines and disease activity was analyzed. ResultsAmong the 85 TA patients, 24 (28.2%) patients had active disease according to the NIH criteria. Significantly increased levels of CCL2, CCL3, CCL20, CXCL8 and CXCL10 were observed in TA patients when compared to healthy controls, while increased levels of CCL2, CCL20, CXCL8 and CXCL10 in TA patients with active disease when compared to those with inactive disease (all p < 0.05). The plasma cut-off values of CCL2, CCL20, CXCL8 and CXCL10 were 309.6 pg/ml, 131.4 pg/ml, 4.7 pg/ml, and 282.1 pg/ml, which maximized the ability of disease activity assessment and had a sensitivity/specificity of 66.7%/67.2%, 54.2%/77.1%,70.8%/72.1%,83.3%/54.1%, respectively (p < 0.05). Among patients with negative erythrocyte sedimentation rate, C-reactive protein or high-sensitivity C-reactive protein, CCL2, CCL20, CXCL8, and CXCL10 still had a high-sensitivity to recognize patients in the active phase. ConclusionsThis study showed that the expression level of CCL2, CCL20, CXCL8 and CXCL10 was elevated in active TA patients, indicating that these chemokines might act as potential biomarkers in evaluating the disease activity.

LAPAROSCOPIC SLEEVE GASTRECTOMY WITH LOOP BIPARTITION MORE PHYSIOLOGICAL TECHNIQUE: ONE YEAR EXPERIENCE

Background: Overweight and obesity were estimated to cause 3.4 million deaths, 3.9% of years of life lost, and 3.8% of disability-adjusted life-years (DALYs) worldwide. Bariatric surgery is the most effective modality for long-term weight loss and for resolving the associated comorbidities. However, controversies exist regarding the ideal weight loss metabolic procedure. This allowed continuous search for new techniques.Aim of the work: to evaluate short-term outcomes and associated complications of laparoscopic sleeve gastrectomy with loop bipartition.Patients and Methods: The present study was conducted on fifteen patients who met the National Institute of Health criteria for bariatric surgery. These patients were enrolled in a prospective study at Ain-Shams University Hospitals from December 2015 to May 2017) and they underwent laparoscopic sleeve gastrectomy with loop bipartition. Preoperative work up included full history, full clinical examination, abdominal ultrasonography, biochemical labs. Procedure was performed by laparoscopic approach.Results: excess weight loss percentage at 6 months, 12 months respectively was 67%, 92%. This results were very comparable to mahdy et al. and santoro et al. Sleeve gastrectomy with loop bipartition comorbidities related outcomes were complete remission of 66% in T2DM, 71% in HTN, 100% others comorbidities and another studies for bipartition reached more than 90% in T2DM, 80% in HTN, 85% others comorbidities. In our study we recorded that Sleeve gastrectomy with loop bipartition has strong impact on resolution of comorbidities in comparison with BPD, DS, RYGB.Conclusion: Sleeve gastrectomy with loop bipartition is a new promising procedure that based on a new paradigm of helping GI facing and adapting to the modern diet without adding new morbidities with precise adsjusting of the neurohormonal aspects. Preliminary results points to potent simple safe procedure in treating obesity and metabolic syndrome.

Clinical Characteristics and Risk Factors for Severe Disease of Coronavirus Disease 2019 in a Low Case Fatality Rate Region in Korea.

BackgroundJeju island had the seventh highest incidence rate of coronavirus disease 2019 (COVID-19) but showed the lowest case fatality rate among 17 provinces of Korea, which may be associated with comorbidities and geographic differences. This study aimed to analyze the epidemiological and clinical characteristics of patients with COVID-19 and evaluate the risk factors for severe COVID-19 in Jeju island, Korea.Materials and MethodsAll patients with COVID-19 admitted between February 20, 2020, and June 19, 2021, at a single center were retrospectively enrolled in this study. The severity of illness was defined using five categories (asymptomatic, mild, moderate, severe, and critical) according to the National Institute of Health criteria. Then, patients with severe and critical illness were grouped into a severe group, whereas patients with asymptomatic, mild, and moderate illness were grouped into a non-severe group. Multivariate logistic regression analysis was performed using risk factors that were found to be significantly associated with the severe group.ResultsThis study included 348 patients with a median age was 57 years, and 37.5% were aged 60 or older. Among them, 43.4% were male and 10.9% were asymptomatic, whereas 41.4%, 33.9%, 12.9%, and 1.1% had mild, moderate, severe, and critical illness. The all-cause mortality of patients with COVID-19 was 0.28% (1/348). Among confirmed patients with COVID-19, exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was mainly within Jeju island (75.9%). The mean body mass index was 24.09 ± 4.04 kg/m2, the median comorbidity index score was low in each group (0 in asymptomatic; 1 in mild; 1 in moderate; 1 in severe; and 2 in critical group, P <0.548). In the multivariable analysis, male sex [odds ratio (OR), 6.37; 95% confidence interval (CI), 2.69 – 15.13; P <0.001], ≥65 years of age (OR, 2.68; 95% CI, 1.18 – 6.10; P <0.019), chronic pulmonary disease (OR, 6.10; 95% CI, 1.40 – 26.61; P = 0.016), and length of fever duration (OR, 1.33; 95% CI, 1.19 – 1.49; P <0.001) were independently associated with severe COVID-19.ConclusionThe most relevant risk factors of COVID-19 severity were male sex, older age, underlying chronic lung diseases, and duration of fever during hospitalization. The risk factors for severe COVID-19 were not significantly different from those reported in other studies. However, a lower proportion of the older population among confirmed SARS-CoV-2 cases might contribute to the lower fatality rate than the national rate.

Updated prevalence, predictors and treatment outcomes for bronchiolitis obliterans syndrome after allogeneic stem cell transplantation

IntroductionBronchiolitis obliterans syndrome (BOS) after allogeneic haemopoietic stem cell transplant (HSCT) is an under-recognised and difficult to treat disease. This occurs in the context of limited clinical research and inconsistent diagnostic criteria. MethodRetrospective data was collected on 275 patients who underwent allogeneic HSCT at an Australian tertiary hospital between 2007 and 2017. The prevalence of BOS, defined by 2014 National Institute of Health criteria, as well as predictors for BOS and mortality were determined. Treatment outcomes, using serial spirometry, were compared between patients who received early versus late immunosuppression for BOS. ResultsThe prevalence of BOS was 9.1%. Myeloablative conditioning (OR: 2.7, 95%CI: 1.13–6.50, p = 0.03) and extra-pulmonary chronic graft-versus-host disease (OR 2.62, 95% CI: 1.04–6.60, p = 0.04) were associated with BOS. There was reduced median survival in the BOS group compared with the non-BOS group, but this was not statistically significant (4.1years (IQR: 2.8, 6.8) versus 4.6years (IQR: 2.4, 7.8), respectively, p = 0.33). The vast majority (87.5%) of BOS patients failed to attain improvement in FEV1 at 12 months, regardless of treatment strategy. Patients who underwent a late immunosuppression strategy had worse mean FEV1 decline compared to those who received early immunosuppression (−36.3% versus −1.6%, respectively, p = 0.03). ConclusionBOS is a common and progressive disease following HSCT and is largely refractory to current treatment strategies. Compared to late immunosuppression, early augmentation of immunosuppression may slow lung function deterioration in the short term. However, further research is urgently needed to identify effective prevention and treatment strategies for BOS.

In utero exposure to maternal stressful life events and risk of polycystic ovary syndrome in the offspring: The Raine Study

BackgroundPCOS is the most common endocrine disorder in reproductive age women. The origins of PCOS are unknown but experimental and limited human evidence suggests that greater prenatal exposure to androgens may predispose to PCOS. Experimental evidence suggests that maternal stressors may affect reproductive function in the offspring via changes in prenatal androgen exposure. In this present study, we aim to investigate whether maternal stressful life events during pregnancy are associated with polycystic ovary morphology (PCOM) or polycystic ovary syndrome (PCOS) in adolescent offspring. MethodIn a large population-based pregnancy cohort study (The Raine Study) continuously followed from prenatal life through to adolescence we examined the association between maternal stressful life events during pregnancy in both early and late gestation, and subsequent circulating concentrations of ovarian and adrenal androgens, PCOM and PCOS in the normal menstrual cycle of offspring age 14–16 years. Maternal stressful life events were prospectively recorded during pregnancy at 18 and 34 weeks using a 10-point questionnaire. Female offspring (n = 223) completed a questionnaire about their menstrual cycles, underwent a clinical examination for hirsutism (Ferriman-Gallwey score) and transabdominal pelvic ultrasound examination to determine ovarian morphology according to standardized criteria for classification of PCOM. Plasma samples were obtained at day 2–6 of the normal menstrual cycle for measurement of androgens. PCOM was defined according to the international consensus definition, 2003 and the evidence-based guideline for the assessment and management of PCOS, 2018. PCOS was diagnosed according to Rotterdam criteria and National Institute of Health (NIH) criteria. Multivariate linear and logistic regression analyses were used to examine the associations between maternal stressful life event exposure and ovarian morphology (PCOM), circulating ovarian and adrenal androgens (clinical and biochemical hyperandrogenism (hirsutism)) and presence of PCOS. ResultsOf 223 recruited adolescent girls, 78 (35.9%) and 68 (31.3%) had PCOM by the 2003 and 2018 criteria respectively, while 66 (29.6%) and 37 (16.6%) had PCOS, using Rotterdam and NIH criteria, respectively. Most girls (141/223, 63.2%) were exposed to at least one stressful life event in early gestation and around half (121/223, 54.3%) were exposed to at least one stressful life event in late gestation. Maternal stressful life events in early gestation were associated with a statistically significant lower prevalence of PCOM when applying the 2003 criteria [adjusted odds ratio [aOR] and 95% confidence intervals (CI): 0.74 (95% CI: 0.55; 0.99)], and a similar association was detected when applying the 2018 PCOM criteria (aOR, 0.69, 95% CI: 0.50; 0.95)]. Maternal stressful life events in early gestation were also associated with lower circulating concentrations of testosterone (β = −0.05, 95% CI: −0.09; −0.004) and androstenedione (β = −0.05, 95% CI: −0.10; −0.002) in the offspring. No similar effects for PCOM or circulating androgens were detected in late gestation. No statistically significant associations between maternal stressful life events in early or late gestation with PCOS (neither Rotterdam nor NIH criteria) in adolescence were detected. The prospective collection of maternal stressful life events during both early and late gestation and direct measurement of PCOM, PCOS and circulating androgens in adolescence and key co-variates implies minimal possibility of recall, information bias and selection bias. ConclusionMaternal exposure to stressful life events in early gestation is associated with significantly reduced circulating ovarian and adrenal androgen concentrations in adolescence (testosterone and androstenedione), and an indication of fewer cases of polycystic ovary morphology (PCOM) defined by the 2003 international consensus definition and by the 2018 international evidence-based guideline, but has no effect on polycystic ovary syndrome (PCOS), diagnosed using either Rotterdam or NIH criteria.