Score Index Research Articles

Diagnostic performance of new BAST score versus FIB-4 index in predicating of the liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease

Background and aimMetabolic dysfunction-associated steatotic liver disease (MASLD) formerly known as non-alcoholic fatty liver disease (NAFLD) is the most common liver condition globally. The FIB-4 test is used to detect fibrosis in fatty liver disease but has limited accuracy in predicting liver stiffness, resulting in high rates of false positives and negatives. The new BAST scoring system, incorporating waist circumference, AST, and BMI, has been developed to assess the presence of fibrosis in NAFLD patients. This study compares the effectiveness of BAST and FIB-4 in predicting liver fibrosis in MASLD patients.Patients and methodsThe study included 140 non-diabetic MASLD patients who underwent transient elastography measurement. BAST score and FIB-4 were calculated for each patient. Patients were grouped based on fibrosis severity; F1, F2, and F3–F4. The sensitivity and specificity of the BAST score and FIB-4 were assessed using receiver operating characteristic curves.ResultsThe BAST score increased significantly with fibrosis progression from F1 to F3–F4. In differentiating advanced fibrosis (F2–F3) from mild/moderate fibrosis (F1–F2), the BAST score at cutoff ≤ − 0.451 showed better diagnostic performance with 90.70% sensitivity, 74.07% specificity, 84.8% PPV and 83.3% NPV compared to FIB-4 that had 60.47% sensitivity, 50.0% specificity, 65.8% PPV and 44.3% NPV. Similarly, for differentiating between F1 and F2 fibrosis, the BAST score at cutoff ≤ − 1.11 outperformed FIB-4, with 80.23% sensitivity, 79.49% specificity, 89.6% PPV and 64.6% NPV, while FIB-4 had 59.30% sensitivity, 51.28% specificity, 72.9% PPV and 36% NPV.ConclusionsThe BAST score is a better predictor of liver fibrosis in MASLD compared to FIB-4, especially in cases of advanced fibrosis or cirrhosis.

Intestinal fatty acid binding protein is associated with infarct size and cardiac function in acute heart failure following myocardial infarction

BackgroundIn acute heart failure (HF), reduced cardiac output, vasoconstriction and congestion may damage the intestinal mucosa and disrupt its barrier function. This could facilitate the leakage of bacterial products into...

Clinical study of Wnt inhibitory factor-1 expression and its association with disease severity in non-segmental vitiligo

BackgroundVitiligo is classified as an acquired chronic depigmentation disorder that includes the destruction of epidermal melanocytes. It affects 0.5–1% of the population all over the world. Wnt signaling pathway is vital in melanocytes differentiation and development. WIF-1 is an antagonist of the Wnt signaling pathway; it hinders Wnt from binding its receptors. The present study aims to detect WIF-1 expression in vitiligo skin and if it relates to the disease's severity.ResultsThis case–control study included 70 subjects: 35 vitiligo patients and 35 healthy controls. Skin WIF-1 expression was estimated using quantitative real-time PCR. Assessment of the vitiligo disease activity score and vitiligo area severity index score was determined. WIF-1 expression showed significant elevation in the skin of vitiligo patients compared to the healthy control group.ConclusionOverexpression of WIF-1 may participate in the pathogenesis of vitiligo; hence, it should be a future therapeutic target.

EASIX (endothelial activation and stress index) predicts mortality in patients with coronary artery disease.

Coronary interventions reduce morbidity and mortality in patients with acute coronary syndrome. However, the risk of mortality for patients with coronary artery disease (CAD) additionally depends on their systemic endothelial health status. The 'Endothelial Activation and Stress Index' (EASIX) predicts endothelial complications and survival in diverse clinical settings. We hypothesized that EASIX may predict mortality in patients with CAD. In 1283 patients undergoing coronary catheterization (CC) and having a diagnosis of CAD, EASIX was measured within 52days (range -1year to -14days) before CC and correlated with overall survival. In an independent validation cohort of 1934 patients, EASIXval was measured within 174days (+ 28days to + 11years) after CC. EASIX predicted the risk of mortality after CC (per log2: hazard ratio (HR) 1.29, 95% confidence interval: [1.18-1.41], p < 0.001) in multivariable Cox regression analyses adjusting for age, sex, a high-grade coronary stenosis ≥ 90%, left ventricular ejection fraction, arterial hypertension and diabetes. In the independent cohort, EASIX correlated with EASIXval with rho = 0.7. The long-term predictive value of EASIXval was confirmed (per log2: HR 1.53, [1.42-1.64], p < 0.001) and could be validated by integrated Brier score and concordance index. Pre-established cut-offs (0.88-2.32) associated with increased mortality (cut-off 0.88: HR training: 1.63; HR validation: 1.67, p < 0.0001 and cut-off 2.32: HR training: 3.57; HR validation: 4.65, p < 0.0001). We validated EASIX as a potential biomarker to predict death of CAD patients, irrespective of the timing eitherbefore or after catheterization.

Functional outcome after bicompartmental knee replacement for medial and patellofemoral osteoarthritis.

Total knee arthroplasty (TKA) is used for tricompartmental knee osteoarthritis, while unicompartmental knee arthroplasty (UKA) is preferred for unicompartmental knee osteoarthritis. Bicompartmental knee arthroplasty (BKA) aims to address 2 knee compartments by combining 2 UKA's or 1 UKA with a patellofemoral replacement. This study examines the clinical outcomes of BKA, focusing on pain alleviation and knee function. The aim of this study is to report the functional outcome of BKA and see if this aligns with BKA outcomes from literature in terms of patient reported outcome measurements (PROMs) and range of motion (ROM) after a 2-year follow-up. Additionally, radiographic alignment, implant survivorship, adverse events and length of stay are secondary outcomes. This is a cohort study of 21 patients who underwent BKA for medial and patellofemoral osteoarthritis. The patients had follow-up for at least 2 years postoperatively. PROMs were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), Oxford Knee Score, Western Ontario and McMaster University Osteoarthritis index (WOMAC) and the Visual Analogue Scale (VAS). ROM was measured using a goniometer. Pre- and postoperative radiographic coronal alignment was measured using standard full leg radiographs. Patient demographics, implant survivorship, length of stay and adverse events were recorded. Twenty-one patients (23 knees) were included, with a mean follow-up of 41 months (standard deviation [SD] 12 months; range 24-59 months). Patient-reported outcome measures (PROMs) demonstrated significant improvements, with 80% achieving good to excellent OKS and KSS scores. KOOS scores were similar to scores found in literature. The WOMAC score was higher in our results compared to other authors. Which indicates worse outcome. The mean preoperative hip-knee-ankle angle (HKAA) was 2.4 degrees varus (SD 1.9 degrees; range 1.2 degrees valgus - 6.1 degrees varus), while the mean postoperative HKAA was 0.3 degrees valgus (SD 2.8 degrees; range 4.6 degrees valgus - 5.6 degrees varus) (p < 0.001). Postoperative range of motion averaged 117 degrees (SD 10 degrees; range 98-132). BKA shows promise in alleviating pain and improving knee function in patients with medial and patellofemoral osteoarthritis. Challenges include the risk of revision and technical difficulties during surgery. Comparative studies suggest similar outcomes between BKA and TKA, with potential advantages for younger, more active patients. Further research, particularly randomized trials with larger cohorts, is necessary to elucidate the long-term benefits and drawbacks of BKA compared to other knee arthroplasty options.

Clinical Outcomes and Left Ventricular Functional Remodeling after Extracorporeal Membrane Oxygenation Assisted Percutaneous Coronary Intervention in Patients with Ischemic Cardiomyopathy: A Single-Center Retrospective Observational Study of 76 Cases.

Ischemic cardiomyopathy (ICM) is a common condition that leads to left ventricular (LV) functional remodeling and poor prognosis. Extracorporeal membrane oxygenation (ECMO) can provide temporary circulatory support and facilitate percutaneous coronary intervention (PCI) in patients with ICM and hemodynamic instability. However, the impact of ECMO-assisted PCI on LV functional remodeling and clinical outcomes in ICM patients is unclear. We retrospectively analyzed 76 patients with ICM who underwent ECMO-assisted PCI at our institution between January 2013 and December 2022. We assessed the changes in LV functional remodeling using echocardiography at baseline and 12 months after the procedure. We also evaluated the incidence of major adverse cardiac and cerebrovascular events (MACCEs) and ECMO-related complications during hospitalization and at one-year follow-up. The mean baseline left ventricular ejection fraction (LVEF) was 29.98 ± 2.65%. The rate of complete revascularization was 58%. The median duration of ECMO support was 38.99 hours. The most common ECMO-related complications were bleeding (8%) and lower extremity ischemia (5%). The one-year mortality rate was 30%. The overall freedom from MACCEs at 12 months was 59% (95% confidence interval (CI): 49-71%). LVEF increased significantly after the procedure from baseline to 6 months, yet decreased slightly at 12 months, although it was still higher than the baseline value. Wall motion score index (WMSI), end-diastolic volume index (EDVI), and end-systolic volume index (ESVI) decreased significantly from baseline to 12 months, indicating an improvement in LV function and a reduction in LV size. In a high-volume tertiary center with extensive experience in advanced heart failure therapies and a dedicated ECMO team, ECMO-assisted PCI demonstrated feasibility and safety in patients with ischemic cardiomyopathy. However, the rate of complete revascularization was modest at 58%. Despite the high-risk profile of the patients, ECMO-assisted PCI was associated with a significant improvement in LV functional remodeling and a favorable 12-month survival rate. Further prospective studies are needed to confirm these findings and to identify the optimal patient and device selection criteria for ECMO-assisted PCI.

Phenotypic diversity of key adaptive traits in advanced Nordic and Baltic spring wheat (Triticum aestivum L.) breeding material

Wheat (Triticum aestivum L.) has become the most widely grown cereal crop in the Nordic-Baltic region, but due to climate change, its yields are under increasing risk. Here we present results of an international effort to use available wheat germplasm from the region to identify tools and genotypes for breeding wheat varieties with improved stability. We formed a panel of 300 spring wheat genotypes from the Nordic-Baltic region and studied their phenotypic diversity across environments to identify genotypes with high potential for adaptation to a changing climate. Field experiments were carried out in 2021 and 2022 in Estonia, Latvia, Lithuania and Norway. The performance and stability of yield (GY), protein content (PC), thousand kernel weight (TKW), test weight (TW), length of growing period (GP), and nine other traits were studied. Drought and excessive rainfall occurred in the Baltic countries in 2021–2022, whereas the weather in Norway was more stable. High variability for most traits, and significant GxE effects for all studied traits, were identified. We identified stable genotypes combining yield and quality using the AMMI model-based Weighted Average of Absolute Scores index (WAASB). Finally, we selected nineteen superior genotypes that combined high yield with high values of important quality traits. Thus, combining broad Nordic-Baltic wheat germplasm with extensive field phenotyping, we identified promising breeding material to develop climate-ready spring wheat varieties for the region.

Are trauma centers penalized for improved prehospital resuscitation?: The effect of prehospital transfusion on arrival vitals and predicted mortality.

Prediction models for survival in trauma rely on arrival vital signs to generate survival probabilities. Hospitals are benchmarked on expected and observed outcomes. Prehospital blood (PB) transfusion has been shown to improve mortality, which may affect survival prediction modeling. We hypothesize that the use of PB increases the predicted survival derived from probability models compared with non-blood-based resuscitation. All adult trauma patients presenting to a level 1 trauma center requiring emergency release blood transfusion from January 2017 to December 2021 were reviewed. Patients were grouped into those receiving PB or those who did not (no PB). Prehospital Trauma and Injury Severity Score (TRISS) and shock index were compared with those at presentation to hospital. Univariate and multivariate regressions were performed to identify factors associated with changes in survival probability at presentation. In total, 2117 patients were reviewed (PB, 1,011; no PB, 1,106). Patients receiving PB were younger (35 vs. 40 years, p < 0.001), more likely to have blunt mechanism (71% vs. 65%, p = 0.002), and more severely injured (Injury Severity Score, 27 vs. 25; p < 0.001) and had higher rates of prehospital hypotension (44% vs. 19%, p < 0.001) and shock index (1.10 vs. 0.87, p < 0.001). Upon arrival, PB patients had lower rates of ED hypotension (34% vs. 39%, p = 0.01), and significant improvements in arrival TRISS scores (+0.09 vs. -0.02, p < 0.001) and shock index (+0.10 vs. -0.07, p < 0.001) compared with prehospital. On multivariate analysis, PB was associated with a threefold increase in unexpected survivors (odds ratio, 3.28; 95% confidence interval, 2.23-4.60). The use of PB was associated with improved probability of survival and an increase in unexpected survivors. Applying TRISS and shock index at hospital arrival does not account for en route hemostatic resuscitation, causing patients to arrive with improved vitals despite severity of injury. Caution should be used when implementing survival probability calculations using arrival vitals in centers with prehospital transfusion capability. Retrospective Comparative Study Without Negative Criteria; Level III.

Picky eating in adults: Investigating its relationship with MEDFICTS diet assessment questionnaire score and visceral adiposity index

BACKGROUND: Picky eating is defined as “consuming a limited variety of foods, being strict about the preparation and presentation of preferred foods, and being reluctant to try new foods”. OBJECTIVE: The aim of this study was to investigate the relationship between the picky eating behaviours of adults and the “MEDFICTS (Meats, Eggs, Dairy, Frying, Fats in Bakery Products, Prepared Foods, Fats Added at the Table, Snacks) Dietary Assessment Questionnaire” score and “Visceral Adiposity Index (VAI)”. METHODS: In this cross sectional study, data of 580 adults aged between 19–64 years were evaluated. Descriptive Information Form, “Adult Picky Eating Questionnaire (APEQ)”, “MEDFICTS Diet Assessment Questionnaire”, “International Physical Activity Questionnaire - Short Form (IPAQ-SF)” were used to collect data. The VAI score was calculated with the formula using the “Body Mass Index (BMI)”, “Waist Circumference (WC)”, “High Density Lipoprotein (HDL)” and “Triglyceride (TG)” levels. RESULTS: There is a negative relationship between APEQ total score (β:–0.228, p &lt; 0.05), APEQ “Food Presentation” (β:–0.172, p &lt; 0.05) and “Taste Avoidance” (β:–0.117, p &lt; 0.05) subscales and MEDFICTS score. There is a negative relationship between APEQ total score (β:–0.089, p &lt; 0.05), APEQ “Food Presentation” (β:–0.112, p &lt; 0.05) subscales and VAI. CONCLUSIONS: In adults, picky eating behavior is associated with decreased MEDFICTS Diet Assessment Questionnaire score and reductions in VAI.

The invisible connection of mothers' BMI, emotional appetite, and food choices with childhood obesity.

This study examined the effects of mothers' body mass index (BMI), emotional appetite, and food choices on children's growth curves and adiposity. Data was collected from 492 mothers. The demographic characteristics and anthropometric measurements were obtained using a questionnaire. The mothers' food choices and emotional appetites were assessed using scales. BMI for age Z score and tripoderal index (TMI) were used in the evaluation of children's anthropometric measurements and adiposity. The mean age of mothers' was 39.10 ± 0.26 and BMI was 25.08 ± 0.21. Among the mothers, 54.5% were classified as normal, 28.4% as pre-obese, and 14.7% as obese. Among the children, 31.5% were overweight or obese. There was a strong positive correlation between the mean BMI of the mothers and the mean TMI and BMI of the children (p < 0.001). The "convenience" food choice factor of mothers had negative correlation with childiren's BMI for age (p < 0.005). This study emphasizes the invisible connection between mothers' emotional appetite and food choices and children's BMI and TMI and highlights the importance of paying attention to mothers' eating habits for children's health outcomes. These findings will be informative in the formulation of future health policies. This research revealed the relationship between mothers' food choices and emotional appetites, and their children's growth curves and adiposity. The study proposes the Triponderal Index as an alternative approach to evaluating growth, introducing a novel perspective in growth monitoring. By highlighting the impact of mothers' emotional appetites and food choices on children's dietary habits and weight status, the research emphasizes the significance of family eating habits. The findings support the promotion of healthy dietary practices within families as a crucial measure in preventing and managing childhood obesity, conveying a significant message to parents and healthcare professionals for a healthier future.

Effects of anti-osteoporosis treatment in elderly patients with osteoporosis and lumbar discectomy and fusion.

The effect of anti-osteoporosis treatment in elderly patients with osteoporosis and lumbar discectomy and fusion (LIF) for lumbar degenerative diseases is not well known. This study aimed to evaluate the effect of perioperative anti-osteoporosis treatment in the patients with osteoporosis and LIF. From January to December 2022, patients were divided into three groups according to the inclusive criteria: the normal group (Group A), the osteopenia group (Group B) and the osteoporosis group (Group C). Quantitative computed tomography (QCT), height of the intervertebral space (HIS), segmental sagittal angle (SSA), visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were compared between the groups at the follow-up time. The serum Ca2 + , osteocalcin (OC), propeptide of type I procollagen (PINP) C-terminal cross-linking telopeptide of type I collagen (β-CTX) and 25-OH vitamin D (25-OH VD) levels were compared between the groups at the time of follow-up. Interbody fusion was graded on the X-ray and CT images at the follow-up time. There were 165 patients in this study. There were significant differences in the mean age, mean score, HIS and SSA between the groups at the different follow-up times. There were significant differences in the concentrations of serum Ca2 + , OC, β-CTX, 25-OH VD and PINP at the sixth month after surgery between the groups. There were significant differences in the concentrations of serum Ca2 + , β-CTX and 25-OH VD between the pre-surgery and at six months after surgery in Group B and β-CTX and 25-OH VD in Group C. There was a significant difference in the degree of fusion between Group B and C (χ2= 5.6243, P< 0.05). In elderly patients with LIF and osteoporosis, anti-osteoporosis therapy could reduce bone resorption and thus facilitate fusion. Anti-osteoporosis medication tends to enhance radiological, functional, and fusion short-term outcomes.

Factors affecting the survival of prediabetic patients: comparison of Cox proportional hazards model and random survival forest method

BackgroundThe worldwide prevalence of type 2 diabetes mellitus in adults is experiencing a rapid increase. This study aimed to identify the factors affecting the survival of prediabetic patients using a comparison of the Cox proportional hazards model (CPH) and the Random survival forest (RSF).MethodThis prospective cohort study was performed on 746 prediabetics in southwest Iran. The demographic, lifestyle, and clinical data of the participants were recorded. The CPH and RSF models were used to determine the patients’ survival. Furthermore, the concordance index (C-index) and time-dependent receiver operating characteristic (ROC) curve were employed to compare the performance of the Cox proportional hazards (CPH) model and the random survival forest (RSF) model.ResultsThe 5-year cumulative T2DM incidence was 12.73%. Based on the results of the CPH model, NAFLD (HR = 1.74, 95% CI: 1.06, 2.85), FBS (HR = 1.008, 95% CI: 1.005, 1.012) and increased abdominal fat (HR = 1.02, 95% CI: 1.01, 1.04) were directly associated with diabetes occurrence in prediabetic patients. The RSF model suggests that factors including FBS, waist circumference, depression, NAFLD, afternoon sleep, and female gender are the most important variables that predict diabetes. The C-index indicated that the RSF model has a higher percentage of agreement than the CPH model, and in the weighted Brier Score index, the RSF model had less error than the Kaplan-Meier and CPH model.ConclusionOur findings show that the incidence of diabetes was alarmingly high in Iran. The results suggested that several demographic and clinical factors are associated with diabetes occurrence in prediabetic patients. The high-risk population needs special measures for screening and care programs.

External validation and comparative analysis of the HOSPITAL score and LACE index for predicting readmissions among patients hospitalised with community-acquired pneumonia in Australia.

ObjectiveCommunity-acquired pneumonia (CAP) is a leading cause of emergency hospitalisations globally and is associated with high readmission rates. Specific score systems developed for all medical conditions such as the HOSPITAL score and the LACE index can also usefully predict CAP readmissions. However, there is limited evidence regarding their performance in the Australian healthcare settings.MethodsThis multicentre retrospective study analysed adult CAP discharges from two metropolitan hospitals in South Australia between 1 January 2018 and 31 December 2023. Data for determining the HOSPITAL score and the LACE index were derived from electronic medical records. Demographic characteristics of patients readmitted within 30 days were compared with those who were not readmitted. The scores were evaluated for overall performance, discriminatory power and calibration, with discriminatory power assessed using the concordance statistic (C-statistic).ResultsOver 6years, 7245 CAP discharges were recorded, with 1329 (18.3%) readmissions within 30days. The mean (s.d.) age of the cohort was 74.4 (17.8) years. Readmitted patients were more likely to have multiple morbidities and frailty than those not readmitted (P<0.05). They also had a higher mean number of emergency department presentations and hospital admissions in the previous year and a longer initial hospital stay (P<0.05). Overall, the mean (s.d.) HOSPITAL score and LACE index were 3.4 (2.1) and 9.3 (3.6), respectively. Among readmissions, 28.4% occurred in patients with a HOSPITAL score >4 (intermediate and high-risk group), while 25.8% occurred in patients in the high-risk LACE category (LACE index>10). The C-statistic for the HOSPITAL score and LACE index was 0.62 (95% CI 0.61-0.64) and 0.63 (95% CI 0.61-0.65), respectively, with no significant difference in the area under the receiver operating characteristic curves (P>0.05).ConclusionsThe predictive abilities of the HOSPITAL score and the LACE index for CAP readmissions are modest and comparable in an Australian setting.

Comparative Prognostic Value of Coronary Calcium Score and Perivascular Fat Attenuation Index in Coronary Artery Disease.

Coronary artery disease (CAD) is the leading global cause of mortality, accounting for approximately 30% of all deaths. It is primarily characterized by the accumulation of atherosclerotic plaques within the coronary arteries, leading to reduced blood flow to the heart muscle. Early detection of atherosclerotic plaques is crucial to prevent major adverse cardiac events. Notably, recent studies have shown that 15% of myocardial infarctions occur in patients with non-obstructive CAD, underscoring the importance of comprehensive plaque assessment beyond merely identifying obstructive lesions. Cardiac Computed Tomography Angiography (CCTA) has emerged as a cost-effective and efficient technique for excluding obstructive CAD, particularly in patients with a low-to-intermediate clinical likelihood of the disease. Recent advancements in CCTA technology, such as improved resolution and reduced scan times, have mitigated many technical challenges, allowing for precise quantification and characterization of both calcified and non-calcified atherosclerotic plaques. This review focuses on two critical physiological aspects of atherosclerotic plaques: the burden of calcifications, assessed via the coronary artery calcium score (CACs), and perivascular fat attenuation index (pFAI), an emerging marker of vascular inflammation. The CACs, obtained through non-contrast CT scans, quantifies calcified plaque burden and is widely used to stratify cardiovascular risk, particularly in asymptomatic patients. Despite its prognostic value, the CACs does not provide information on non-calcified plaques or inflammatory status. In contrast, the pFAI, derived from CCTA, serves as an indirect marker of coronary inflammation and has shown potential in predicting adverse cardiac events. Combining both CACs and pFAI assessment could offer a comprehensive risk stratification approach, integrating the established calcification burden with novel inflammatory markers to enhance CAD prevention and management strategies.

Evaluation of correlation between compliance of a patient towards orthodontic treatment and plaque accumulation in lower anterior region with fixed orthodontic appliances. A cross-sectional study

BACKGROUND &amp;OBJECTIVE: Using orthodontic appliances can offer new spots for the oral microbiota and dental plaque to attach. Poor oral hygiene can lead to gingivitis and tooth decay resulting in the removal of braces to repair damage and delay treatment. Orthodontic patients who are mindful of their oral health often show greater compliance with their treatment. They tend to miss fewer appointments and avoid losing brackets, demonstrating a strong commitment to their orthodontic care. This study aims to find a correlation between plaque accumulation and patients’ compliance with their orthodontic treatment. METHODOLOGY:50 orthodontic patients (20 males and 30 females, aged 11 to 25 years) were assessed at their 3rd, 4th, or 5th appointments. The plaque index for each patient was calculated on these appointments. Patient compliance like appointment follow-ups and bracket failures was recorded. A correlation was found between the plaque index and compliance of the patient. RESULTS: A statistical analysis revealed a significant, strong negative correlation between the rate of following appointment follow-ups and the plaque scoring index (r = -0.832, P value &lt; 0.001), and a significant, strongly positive correlation between bracket failure rate and plaque scoring index (r = 0.795, P &lt; 0.001). Patients who had good attendance at follow-up appointments and low bracket failure had lower mean plaque score indices. CONCLUSION: Patients with good compliance in terms of low bracket failure rate and attending follow-up appointments regularly tend to have lower plaque scores.

Monitoring the psychopathological profile of inflammatory bowel disease patients treated with biological agents: a pilot study.

Biological agents were found to alter the psychopathological profile of a small subgroup of patients treated for a variety of conditions, including inflammatory bowel disease (IBD) and psychiatric disorders. The association between the administration of biological agents and psychopathology needs to be further investigated. In this naturalistic prospective cohort study, patients with IBD were assigned to two treatment groups, i.e., a biological agent (which also included tofacitinib) or conventional therapy. Clinician-administered scales were used to assess psychosomatic symptoms (Hamilton Depression Rating Scale [Ham-D], Hamilton Anxiety Rating Scale [Ham-A], Young Mania Rating Scale [YMRS], and Brief Psychiatric Rating Scale [BPRS]) and disease activity (Mayo Score and Harvey-Bradshaw Index [HBI]) at baseline, after one, three, and six months of treatment. Each group was assessed for the course of their scores during the observation period at each assessment point. Patients on biological drugs who completed three months of treatment (N.=32) and six months of treatment (N.=20) scored significantly lower on the Mayo compared to baseline. Patients on conventional treatment obtained significant drops from baseline on the HBI after one and three months of treatment (N.=30) and also at the six-month endpoint (N.=11). Both groups showed no improvement or worsening on the psychiatric rating scales. In this study, we found no evidence of psychiatric symptom worsening, as some literature would suggest. Our data suggest that the use of biological agents in IBD is safe.

Efficacy of acupuncture on drinkers with chronic prostatitis / chronic pelvic pain syndrome: secondary analysis of a randomized clinical trial.

To evaluate the efficacy of acupuncture in drinkers with chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS). We conducted a secondary analysis of a randomized controlled trial across multiple centers, involving 224 drinkers. Patients received either acupuncture or sham acupuncture treatment. The primary outcome was the proportion of responders, defined as participants who had a reduction of 6 points or more from baseline in the National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) total score at weeks 8 and 32. Secondary outcomes measures included the Global Response Assessment (GRA), International Prostate Symptom Score (IPSS) and International Index of Erectile Function 5 (IIEF-5). One hundred and twelve drinkers were included in each group (n = 224 in total). The proportion of responders in terms of NIH-CPSI was 58.9% versus 40.3% in the acupuncture group (AG) and sham acupuncture group (SAG), respectively, with a statistically significant difference of 18.6% (p = 0.002) at week 8. Higher proportions of responders with respect to NIH-CPSI (p < 0.001 at week 32) and GRA (p < 0.001 at week 8 and p = 0.01 at week 32) were observed in the AG compared with the SAG. No between-group differences were found in the changes in IPSS at any assessment time point. Changes in IIEF-5 score were significantly higher in the AG than in the SAG at weeks 20 and 32, while the difference was not statistically significant at week 8. Acupuncture appeared to alleviate the symptoms of pain among drinkers with CP/CPPS and improve their quality of life, but had no demonstrable effect on urinary tract symptoms or erectile function among these patients. NCT03213938 (ClinicalTrials.gov).

Comparison of Pediatric Risk of Mortality (PRISM III) score with Pediatric Index of Mortality (PIM III) score in Pediatric Intensive Care Unit: A Single center, prospective observational study from South India

Abstract Background: Pediatric risk of mortality (PRISM III) score and pediatric index of mortality (PIM III) scores are most recent versions of PRISM and PIM score used for mortality prediction in the Pediatric intensive care units (PICUs). This study aims to compare the performance of these two scores in children admitted to a tertiary PICU of South India. Subjects and Methods: This single-center, prospective observational study was conducted in PICU at a Tertiary Care Hospital in South India over a period of 20 months. A total of 214 cases admitted between the age groups of 1 month and 18 years were included in this study. PIM III and PRISM III scores were calculated. Quantitative correlation between the results of the score was analyzed by spearman test. Discrimination was assessed using the area under receiver operating characteristics curve and calibration using Hosmer–Lemeshow goodness-of-fit test. Results: Out of 214 children, observed mortality was 11 (5.1%). Estimated mortality using PRISM III and PIM III was 4 (1.86%) and 2 (0.93%), respectively. Although both scoring systems had good discrimination performance, PIM III score (0.934 [confidence interval (CI) 95%, 0.886–0.982]) had higher discrimination than PRISM III score(0.888 [CI 95%, 0.797–0.980]). PRISM III score (χ 2 = 4.469 and P = 0.484) had better calibration as compared to PIM III score (χ 2 = 16.093 and P = 0.041). Conclusions: Both PRISM III and PIM III score showed good discriminatory performance, however PRISM III had better calibration than PIM III score.

Comparison of Modified ROX Index Score and ROX Index Score for Early Prediction of High Flow Nasal Oxygen Therapy Outcome in Patients with Acute Respiratory Failure: A Prospective Observational Cohort Study.

We compared the modified ROX index and ROX index scores in earlier predictions of high-flow nasal oxygen (HFNO) therapy outcomes in patients with acute respiratory failure. We conducted a prospective observational study on 151 acute respiratory failure patients initiated on HFNO therapy. The primary objective of this research was to compare the modified ROX index and ROX index to investigate which score predicted HFNO treatment outcome earlier. The modified ROX index score had better predictive power than the ROX score at different time points, especially one hour following the start of HFNO therapy (AUC 0.790; 95% CI: 0.717-0.863; p < 0.001). For the ROX Index at 1 hour, the ideal cut-off value for HFNO outcome was 4.36 (sensitivity: 72.6%, specificity: 53.9%), and for the modified ROX index at 1 hour, it was 4.63 (sensitivity: 74.2%, specificity: 69.7%). The presence of various comorbidities didn't show any change in ROX-HR cut-off values. The modified ROX index is a better predictor of the success of HFNO therapy than the ROX index. Furthermore, the presence of any comorbidities did not affect modified ROX index cut-off values or the outcome of HFNO therapy. Sarkar AG, Sharma A, Kothari N, Goyal S, Meshram T, Kumari K, et al. Comparison of Modified ROX Index Score and ROX Index Score for Early Prediction of High Flow Nasal Oxygen Therapy Outcome in Patients with Acute Respiratory Failure: A Prospective Observational Cohort Study. Indian J Crit Care Med 2024;28(9):842-846.

Study on the clinical effect of initiating continuous blood purification at different times for severe acute pancreatitis

To observe the clinical effect of initiating continuous blood purification (CBP) treatment at different times for patients with severe acute pancreatitis (SAP), and to explore the optimal timing for starting CBP treatment for SAP, so as to provide evidence for clinicians to start CBP treatment. A retrospective cohort study was used to select patients with SAP who received CBP treatment in People's Hospital of Hunan Province from January 2020 to December 2023. According to the timing of CBP initiation, the patients were divided into early initiation group (diagnosis of SAP to the first CBP treatment time < 24 hours) and late initiation group (diagnosis of SAP to the first CBP treatment time of 24-48 hours). The general data, acute physiology and chronic health evaluation II (APACHE II), bedside index for severity in acute pancreatitis (BISAP) score and laboratory indicators, local complications and systemic complications, intensive care unit (ICU) treatment time, hospital stay, treatment cost, and clinical outcome of the two groups were collected and compared. A total of 130 patients with SAP who received CBP treatment were enrolled, including 90 patients in the early initiation group and 40 patients in the late initiation group. Before treatment, there were no significant differences in gender, age, APACHE II score, BISAP score, etiology and laboratory examination indexes between the early initiation group and late initiation group. At 48, 72, 96 hours after treatment, the blood calcium level of the two groups was significantly higher than that before treatment, and the levels of white blood cell count (WBC), C-reactive protein (CRP), lactic acid, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), APACHE II score and BISAP score were significantly lower than those before treatment. The WBC level, APACHE II score and BISAP score of the late initiation group were significantly lower than those of the early initiation group at 72 hours and 96 hours after treatment [WBC (×109/L): 10.96 (8.68, 13.04) vs. 12.45 (8.93, 16.30) at 72 hours after treatment, and 10.18 (8.68, 12.42) vs. 11.96 (8.81, 16.87) at 96 hours after treatment; APACHE II score: 9.50 (5.75, 12.00) vs. 11.00 (6.25, 14.00) at 72 hours after treatment, and 10.00 (4.00, 12.00) vs. 12.00 (7.00, 14.75) at 96 hours after treatment; BISAP score: 2.35±1.03 vs. 2.76±1.10 at 72 hours after treatment, and 2.08±1.21 vs. 2.70±1.11 at 96 hours after treatment], the differences were statistically significant (all P < 0.05). In terms of complications, the incidence of pancreatic abscess in the late initiation group was significantly lower than that in the early initiation group [5.00% (2/40) vs. 20.00% (18/90)], but the incidence of abdominal compartment syndrome was significantly higher than that in the early initiation group [42.50% (17/40) vs. 13.33% (12/90)], the differences were statistically significant (all P < 0.05). In addition, the ICU treatment time in the early initiation group was significantly shorter than that in the late initiation group [days: 11.00 (6.00, 20.00) vs. 15.00 (9.75, 25.00), P < 0.05], and there were no statistically significant differences in hospitalization costs, length of stay and mortality between the two groups. CBP can effectively increase the level of blood calcium and decrease the level of lactic acid and inflammatory factors. Starting CBP within 24-48 hours after diagnosis of SAP can reduce WBC level and disease severity score faster, and reduce the occurrence of pancreatic abscess. Initiation of CBP within 24 hours after diagnosis of SAP can reduce the incidence of abdominal compartment syndrome and shorten the duration of ICU treatment.