Severe Cases Research Articles

Prevalence and distribution of Plasmodium falciparum multidrug resistant 1 D1246Y allele among children in Ibadan Southwest, Nigeria

The emergence and spread of the Plasmodium falciparum multidrug-resistant 1 (Pfmdr1) allele pose a significant setback to global efforts to control and eradicate malaria infection by diminishing the efficacy of commonly prescribed antimalarial drugs, particularly in Sub-Saharan Africa, where malaria remains endemic. The Pfmdr1 D1246Y mutation is of specific importance due to its potential role in modulating parasite susceptibility to antimalarial medicines and treatment outcomes. This study aimed to determine the presence and prevalence of the wild-type and mutant D1246Y alleles of Pfmdr1 among children in Ibadan, Southwest Nigeria. A total of 133 archived DNA samples collected between March 2016 and June 2021 from children aged 6 to 132 months with varying malaria phenotypes (asymptomatic infection, uncomplicated, and severe malaria) were analyzed. The Pfmdr1 D1246Y allele was amplified via nested PCR, and the mutation was detected using the restriction enzyme EcoRV. The digested nested PCR products were resolved on a 2% agarose gel and visualized under ultraviolet light. All statistical analyses were performed using SPSS version 25, and statistical significance was set at p ≤ 0.05. Among the 133 samples, 97 (72.9%) were successfully genotyped. Of these, 50 (51.55%) carried the wild-type allele, while 47 (48.45%) had the mutant allele. Notably, the Pfmdr1-1246Y mutation was detected in all severe malaria cases (41/41, 100%), whereas its prevalence was significantly lower in asymptomatic (3/36, 8.3%) and uncomplicated malaria cases (3/20, 15%). The difference in mutation prevalence across the malaria phenotypes was statistically significant (p < 0.05). The study provided valuable insight into the coexistence of wild-type and mutant Pfmdr1 D1246Y alleles within the population. It revealed a significantly higher mutation rate in all severe malaria cases, while the wild-type allele remained more prevalent overall. These findings contribute to a deeper understanding of the possible role of the wild-type and mutant D1246Y alleles in the various clinical manifestations of malaria.

First report of Colletotrichum fructicola causing Anthracnose on the leaf of flowering cherry (Prunus serrulata 'Sekiyama') in China.

Flowering cherry (Prunus serrulata) is a notable garden tree that blooms in early spring. In June 2023, an anthracnose disease was identified on 60% of P. serrulata 'Sekiyama' plants in the Fenghuanggou Scenic Area (0.2 ha.) in Nanchang City, Jiangxi Province (28.37° N, 116.01° E). At early disease stages, brown, small spots (0.5 to 1 mm) appeared on the upper surface of leaves. Subsequently, a chlorotic halo developed around each lesion. Then necrotic lesions were enlarged, the leaves were perforated. Ten symptomatic leaves were collected from 5 trees, rinsed under running water for 3 min, sectioned into 5×5 mm pieces, disinfected in 75% ethanol for 30 sec and rinsed three times with sterile water. Tissue pieces were placed on potato dextrose agar (PDA) and incubated at 27 °C for three days. Among the 15 isolates, 5 isolates with similar morphology were obtained from the 10 infected tissue pieces. Colonies were off-white with cotton-like hyphae, with the reverse of the culture became brownish. Conidia were hyaline, smooth-walled, cylindrical, aseptate, and had wide rounded ends and were measured 0.91 to 1.41 μm × 2.11 to 3.18 μm (n=28). To identify these isolates, ITS1/ITS4 (Gardes and Bruns, 1993) primers were first used to amplify the ITS sequence, and it was found that the five isolates had 100% homology to the genus Colletotrichum (Tang et al., 2022). One isolate (ZJ1-1) was selected for subsequent verification, and partial chitin synthase (CHS), calmodulin (CAL) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) genes were amplified with the primers CHS-79F/CHS-345R (Carbone and Kohn, 1999), CL1C/CL2C (Weir et al., 2012) and GDF/GDR (Templeton et al., 1992), respectively. Sequences were deposited in GenBank as accession numbers PP481926 (CHS), PP481927 (CAL), PP481925 (GAPDH), and PP077091 (ITS). Blast analysis demonstrated that the sequences were 99% to 100% identical with those of Colletotrichum fructicola isolate ICMP18646 (JX009874, JX009674, JX010032, JX010173). A phylogenetic tree was produced using CHS-CAL-GAPDH-ITS concatenated sequences in MEGA 11.0 and found that ZJ1-1 was assigned to the C. fructicola clade with 95% bootstrap support. According to its morphological characteristics and molecular biology, the strain was identified as C. fructicola ( Kang et al., 2023). The fungus ZJ1-1 was inoculated onto healthy 3-year-old P. serrulata 'Sekiyama' trees. 3 trees were wounded and inoculated with 10 μL spore suspension (1.0×106 conidia/mL) of ZJ1-1, and other 3 trees were inoculated with sterile ddH2O to act as the control. The inoculated plants were incubated in a greenhouse with 27 ℃ and 95% RH. Each plant was inoculated on three leaves, with three replicates. Symptoms of anthracnose appeared on the third day following inoculation, but no symptoms appeared on the trees maintained as controls. C. fructicola was re-isolated (named 003) from the inoculated leaves and confirmed by the methods described above, whereas no fungus was isolated from the control plants. To our knowledge, C. fructicola caused anthracnose has been reported on Paeonia lactiflora, Prunus avium and Prunus sibirica (Kang et al., 2023; Zhou et al., 2023; Han et al., 2023), but this is the first report of C. fructicola causing leaf spot disease on flowering cherry in China. C. fructicola can induce leaf defoliation of flowering cherry in severe cases, and further investigations are required to ascertain the potential pathogenicity of other Colletotrichum sp.

Short-Term Biologic Therapy for Guttate Psoriasis: Successful Treatment with Bimekizumab and Literature Review.

Guttate psoriasis is a psoriasis subtype often triggered by infections that may progress to chronic plaque psoriasis. While some cases resolve on their own, severe cases can be challenging to manage. Our case, along with recent reports, suggests that interim treatment with biologics such as IL-17 and IL-23 inhibitors may induce long-term remission. Further research is needed to explore the potential role of biologics as a therapeutic option for this condition.

First Report of Leaf Blight on Lithocarpus litseifolius Caused by Diaporthe amygdali in China.

Lithocarpus litseifolius is a third-generation new tea source that integrates "tea, sugar, and medicine" (Wang et al., 2021). In July 2023, a leaf blight on L. litseifolius was observed in the L. litseifolius plantation (0.33 ha) at Mount Dajue, Fuzhou City, Jiangxi Province, China (27.696119°N, 117.172554°E). The disease incidence was estimated to be above 40%. The symptoms on leaves showed brown necrotic lesions at the tips and margin of leaves, and localized areas on leaf blades. As the disease developed, the lesions enlarged and the leaves incurved with time and, in severe cases, the whole leaves became light brown, necrotic, desiccated, papery, dead, and eventually defoliated. We collected 10 leaves from the diseased area for pathogen isolation. The leaf tissue near the lesion was cut into 5 × 5 mm slices, disinfected with 75 % ethanol for 30 s, soaked in 2.5 % sodium hypochlorite solution for 3 min, and washed with sterile distilled water 4 times. The sterilized leaves were placed on potato dextrose agar (PDA) plates and incubated in darkness at 28°C for 3 days to isolate symptom-related pathogens. After 3 days of incubation, hyphal tips from the edge of the growing colony were transferred to fresh PDA plates for further purification. Finally, 10 colonies with similar morphology were isolated from 10 symptomatic tissues. Fungal colonies initially appear white, turning pale gray from the center with dense and felted mycelium with concentric zonation. The alpha conidia were on average 2.56× 5.84 μm ( 2.00 to 3.80 × 3.96 to 7.89 μm) in size and were aseptate, hyaline, smooth, and ellipsoidal (n = 30). Based on these morphological characteristics, the fungi were determined to be Diaporthe species (Gomes et al. 2013). The internal transcribed spacer region (ITS), a partial sequence of β-tubulin gene (Tub2) and translation elongation factor 1-α gene (TEF1) of one representative isolate 2BDJS1 were amplified and sequenced using primers ITS1/ITS4 (White et al., 1990), Bt2a/Bt2b (Glass and Donaldson, 1995), and EF1-728F/EF1-986R (Carbone and Kohn, 1999), respectively. The nucleotide sequences obtained from isolate 2BDJS1 were deposited in GenBank under accession numbers PQ185599 (ITS), PQ358310 (TEF1), and PQ358311 (Tub2). BLASTn analysis revealed that the ITS, TEF1, and Tub2 sequences of isolate 2BDJS1 exhibited 97.98%, 95.16%, and 99.79% similarity, respectively, to those of the D. amygdali isolate DJY-HW-1 (GenBank accession numbers MK511798 for ITS, MK570512 for TEF1, and MK570513 for Tub2). A Maximum-Likelihood (ML) phylogenetic tree was constructed using the concatenated ITS-TEF1-Tub2 multigene sequences in MEGA7. The results indicated that isolate 2BDJS1 clustered independently with two reference strains of D. amygdali, with a bootstrap support value of 99%. Combining these molecular data with morphological characteristics, including colony morphology and alpha conidia morphology, we confidently identified isolate 2BDJS1 as D. amygdali. The pathogenicity test was carried out by inoculating the mycelial disc into the leaves of L. litseifolius by piercing method (Wang et al., 2024). The control was inoculated with sterile PDA plug. Each treatment was repeated 6 times. The inoculated plants and the control plants were placed in a greenhouse at 25°C, relative humidity of 80%, and photoperiod of 12 h. All inoculated leaves exhibited blight symptoms 14 days after inoculation, whereas the control plants remained asymptomatic. Based on morphology and DNA sequence verification, only D. amygdali was re-isolated from symptomatic leaves, which confirmed Koch's hypothesis. Previous studies have shown that D. amygdali can cause canker disease in Juglans regia, Carica papaya and Prunus persica (Meng et al., 2018; Alam et al., 2023; Beluzán et al., 2021). As far as we know, this is the first report of leaf blight disease of L. litseifolius caused by D. amygdali in China. L. litseifolius is an important medicinal and edible tree species, and its planting area is increasing year by year. Therefore, it is essential to further investigate the presence of this pathogen in other planting areas of L. litseifolius within the province, and explore mitigation strategies to reduce losses.

Artificial intelligence for abdominopelvic trauma imaging: trends, gaps, and future directions.

Abdominopelvic trauma is a major cause of morbidity and mortality, typically resulting from high-energy mechanisms such as motor vehicle collisions and penetrating injuries. Admission abdominopelvic trauma CT, performed either selectively or as part of a whole-body CT protocol, has become the workhorse screening and surgical planning modality due to improvements in speed and image quality. Radiography remains an essential element of the secondary trauma survey, and Focused Assessment with Sonography for Trauma (FAST) scanning has added value for quick assessment of non-compressible hemorrhage in hemodynamically unstable patients. Complex and severe polytrauma cases often delay radiology report turnaround times, which can potentially impede urgent clinical decision-making. Artificial intelligence (AI) computer-aided detection and diagnosis (CAD) offers promising solutions for enhanced diagnostic efficiency and accuracy in abdominopelvic trauma imaging. Although commercial AI tools for abdominopelvic trauma are currently available for only a few use cases, the literature reveals robust research and development (R&D) of prototype tools. Multiscale convolutional neural networks (CNNs) and transformer-based models are capable of detecting and quantifying solid organ injuries, fractures, and hemorrhage with a high degree of precision. Further, generalist foundation models such as multimodal vision-language models (VLMs) can be adapted and fine-tuned using imaging, clinical, and text data for a range of tasks, including detection, quantitative visualization, prognostication, and report auto-generation. Despite their promise, for most use cases in abdominopelvic trauma, AI CAD tools remain in the pilot stages of technology readiness, with persistent challenges related to data availability; the need for open-access PACS compatible software pipelines for pre-clinical shadow-testing; lack of well-designed multi-institutional validation studies; and regulatory hurdles. This narrative review provides a snapshot of the current state of AI in abdominopelvic trauma, examining existing commercial tools; research and development throughout the technology readiness pipeline; and future directions in this domain.

Determination of both the expression and serum levels of epidermal growth factor and transforming growth factor β1 genes in COVID-19

We aimed to evaluate the effects of both the expression and serum levels of Epidermal growth factor (EGF) and Transforming growth factor-β1 (TGF-β1) genes in patients with different degrees of cellular damage as mild, moderate, severe, and critical illness that can lead to fibrosis caused by SARS-CoV-2. Totally 45 individuals (male: 21(46.67%); female: 24(53.33%)) with COVID-19 infection were included in this study. Four groups were constituted as mild (n = 16)], moderate (n = 10), severe (n = 10), and critical (n = 9) according to the severity of the disease. Blood samples were drawn from the patients, and all of the hemograms, EGF and TGFβ1 gene expression, and serum levels were evaluated. The mean age of individuals was 57.311 ± 18.383 (min: 28, max: 94). Significant differences were found among the groups for PLT (χ2 = 9.955; p = 0.019), CRP (χ2 = 7.693; p = 0.053), Ferritin (χ2 = 22.196; p < 0.001), D-dimer (χ2 = 21.982; p = 0.000), LDH (χ2 = 21.807; p < 0.001) and all these parameters (exclude PLT in severe groups) was increased depending on the severity of the disease. Additionally, significant differences were detected for EGF (χ2 = 29.528; p < 0.001), TGFB1 (χ2 = 28.981; p < 0.001) expression (that increased depending on the disease severity), and EGF (χ2 = 7.84; p = 0.049), TGFB1 (χ2 = 17.451; p = 0.001) serum concentration levels (that decreased depending on the disease severity). This study found statistically significant differences for both EGF 2−ΔΔCt. TGFβ1 2−ΔΔCt and EGF, TGFβ1 serum concentration values among all patient groups. As disease severity increased, EGF 2−ΔΔCt. TGFβ1 2−ΔΔCt levels increased, while EGF and TGFβ1 serum concentration levels decreased. Perhaps this study will be useful in managing COVID-19 infection severity and pulmonary fibrosis cases secondary to COVID-19.

The relationship between vitamin D levels and erectile dysfunction: A mini-review.

The importance of maintaining adequate levels of vitamin D for optimal male sexual health is highlighted by recent evidence suggesting a link between vitamin D insufficiency and erectile dysfunction (ED). This review examines current research that indicates an association between decreased serum concentrations of 25-hydroxyvitamin D (25(OH)D), specifically levels below 20 ng/mL, and a higher prevalence of ED, including severe cases. Studies have shown a significant correlation between a decrease of 10 ng/mL in 25(OH)D levels and a 12% increase in the prevalence of ED. The active form of vitamin D, calcitriol, facilitates the synthesis of nitric oxide, a potent vasodilator crucial for penile erection. Additionally, vitamin D supplementation has been shown to improve erectile function by enhancing endothelial vasodilation and arterial blood flow. It is essential to maintain serum 25(OH)D levels within the recommended range of 20 to 50 ng/mL, given the connection between vascular disorders and ED. A comprehensive approach, including dietary changes, consistent physical activity, and lifestyle modifications, is necessary to prevent ED. While vitamin D deficiency may contribute to ED, it is crucial to recognize that ED is multifactorial and should be addressed by considering all underlying causes. Individuals consistently experiencing symptoms of ED are advised to consult healthcare professionals for appropriate therapeutic interventions. This review emphasizes the importance of considering serum vitamin D levels when assessing male sexual health and calls for further research to clarify the role of vitamin D in the etiology and treatment of ED.

Computational Analysis of Plasmodium falciparum DNA Damage Inducible Protein 1 (PfDdi1): Insights into Binding of Artemisinin and its Derivatives and Implications for Antimalarial Drug Design.

Human malaria remains a global health challenge, with Plasmodium falciparum responsible for the most severe cases. Despite global efforts, eradicating malaria has proven difficult, mainly because of the rise in drug resistance, particularly against artemisinin and its derivatives. One possible cause of this resistance is the activation of the unfolded protein response (UPR), which helps maintain cellular balance under stress. In P. falciparum, the UPR operates through the ubiquitin-proteasome system (UPS), which involves proteins such as Dsk2, Rad23, and Ddi1. Among these, Plasmodium falciparum DNA-damage-inducible protein 1 (PfDdi1) plays a crucial role in DNA repair and is present throughout the parasite life cycle, making it an attractive drug target. However, there is limited research on PfDdi1 as a therapeutic target. Recent in vitro studies have indicated that artemisinin (ART) and dihydroartemisinin (DHA) inhibit PfDdi1 activity. Building on this, we investigated whether ART and its derivatives could serve as inhibitors of PfDdi1 using computational modeling. Our study included clinically relevant ART derivatives such as artemether (ARM), arteether (AET), artemiside (AMD), and artesunate (ATS). All these compounds showed strong binding to PfDdi1, with free binding energies ranging from -20.75 kcal/mol for AET to -34.24 kcal/mol for ATS. ARM increased PfDdi1's structural rigidity and hydrophobic stability, whereas AMD improved its kinetic stability, resulting in the least residue motion. Unlike AET and AMD, the other ligands destabilize the PfDdi1 structure. Importantly, three key binding regions-Loop 1 (GLN 266 - ILE 269), Loop 2 (ILE 323 - TYR 326), and Loop 3 (ALA 292 - GLY 294)-were identified as potential targets for new antimalarial drugs against PfDdi1. This study highlights the potential of ART derivatives as PfDdi1 inhibitors, paving the way for further experimental validation.

Cytokine immune profiles among COVID 19 patients with different disease severities seeking treatment at Moi teaching and referral hospital, Kenya.

Cytokine immune profiles among COVID 19 patients with different disease severities seeking treatment at Moi teaching and referral hospital, Kenya.

Exosomes in acute pancreatitis: Pathways to cellular death regulation and clinical application potential.

Exosomes in acute pancreatitis: Pathways to cellular death regulation and clinical application potential.

Factors influencing the severity of diabetic foot ulcers: a cross-sectional study

BackgroundDiabetic foot ulcers (DFUs) are prevalent among individuals with poorly controlled diabetes, and severe cases can result in increased morbidity and a poor quality of life. This study aimed to identify the factors that affect the severity of DFUs, offering insights into potential interventions that could enhance patient outcomes.MethodologyA prospective cross-sectional study was conducted from August 2023 to March 2024 at Muhimbili National Hospital in Tanzania, involving 177 consecutively selected patients with DFUs. The primary outcome variable was the severity of DFUs, which was assessed using the Meggitt-Wagner severity score. Both socio-demographic and clinical characteristics were evaluated to determine their association with the outcome variable using multivariate ordinal logistic regression analysis.ResultsThe median age of the study participants was 60 years (IQR = 52–68), with a male-to-female ratio of 2 to 1. Notably, Wagner grades 4 and 5 accounted for 57.6% of the participants. Factors associated with increased severity of DFUs included age over 60 years (aOR = 1.83, 95% CI 1.05–3.23, p = 0.035) and poor adherence to diabetes medications (aOR = 2.62, 95% CI 1.36–5.09, p = 0.004). Conversely, having health insurance coverage was linked to better outcomes (aOR = 0.51, 95% CI 0.27–0.96, p = 0.036).ConclusionThe study highlights factors that can enhance comprehensive care for diabetic patients, especially elderly individuals. Key measures include implementing educational programs to encourage medication adherence, improving healthcare access, particularly for uninsured individuals, promoting insurance coverage, and making diabetes treatments more affordable.

Xylem embolism refilling revealed in stems of a weedy grass

Plant hydraulic dysfunction by embolism formation can impair photosynthesis, growth, and reproduction and, in severe cases, lead to death. Embolism reversal, or "refilling," is a hypothesized adaptive process in which xylem functionality is rapidly and sustainably restored. This study investigated xylem embolism refilling during recovery from severe drought stress using entirely noninvasive measurements of the same plants. These results were considered in relation to functional traits to address long-standing gaps in understanding the consequences of severe drought stress. Leaf and stem xylem embolism as well as transpiration, photosynthesis, and stem water potential were characterized nondestructively on intact barnyard grass plants during an acute drought event. Plants were rewatered and returned to growth conditions for 10 d, during which time recovery of stem xylem embolism and transpiration were monitored. Leaf xylem embolism and declines in leaf gas exchange occurred mostly between -1.0 MPa and -2.0 MPa, whereas stem xylem embolism occurred mostly between -3.0 MPa and -4.0 MPa. In all measured plants, which included embolism levels up to 88%, stem xylem embolism reversed completely within 24 h after rewatering, and this refilling supported recovery of transpiration and growth after plants were returned to growth conditions. This study provides direct evidence of complete and functional stem xylem refilling. These results present a clear need to elucidate underlying mechanisms and the adaptive significance of this phenomenon as well as its prevalence in nature.

Prominent and fast response to eculizumab in myasthenic crisis: the potential as rescue therapy in refractory myasthenia gravis.

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease caused by antibodies against the postsynaptic membrane at the neuromuscular junction, leading to muscle weakness, fatigue, and respiratory failure in severe cases. Myasthenic crisis (MC) is a life-threatening condition which requires hospitalization and treatments with intravenous immunoglobulin, plasma exchange and high dose steroids. We report a case of a patient with refractory MC and anti-AChR antibodies positivity who started Eculizumab as rescue therapy, leading to a complete resolution of the acute neuromuscular condition. A 72-year-old man presented with bilateral ptosis, severe weakness in all limbs, dysphonia, dysphagia and dyspnea. He was diagnosed with MG with anti-AChR positivity and refractory MC. He was unresponsive to classical rescue therapy, so he underwent Eculizumab administration which resulted in a notable improvement in symptoms. Eculizumab, a humanized monoclonal antibody that inhibits complement activation, is now approved as treatment for refractory generalized MG with anti-AChR antibodies. The use of eculizumab in refractory MC is still under investigation; however, this case report suggests that it could be a promising treatment option for patients with severe acute clinical condition.

Early neutrophil responses are potential biomarkers to predict severe COVID-19 in adults.

In the early COVID-19 pandemic, the strain on healthcare facilities highlighted the need for reliable biomarkers to predict progression to severe COVID-19. Neutrophils, the most abundant leukocytes in circulation, are early defenders against pathogens. In a Singaporean adult cohort, early neutrophil mediators were assessed for their suitability as prognostic biomarkers of COVID-19 complications. Plasma levels of myeloperoxidase, elastase, soluble urokinase plasminogen activator receptor (suPAR) and soluble suppressor of tumorigenicity 2 (sST2) in 35 non-severe and 14 severe cases were measured twice, 2-7 days apart after hospitalisation. Nineteen controls were included. The levels of MPO, elastase, suPAR and sST2 were significantly higher in patients with severe COVID-19 compared to those with mild and healthy controls. At baseline sampling, MPO and suPAR predicted severe COVID-19 and had AUROCs of 0.76 and 0.87, respectively. MPO and suPAR at cut-off values of 26.41 ng/ml and 3.19 ng/ml, respectively showed approximately 71% sensitivity and 81 - 84% specificity to differentiate severe COVID-19. In contrast, elastase and neutrophil counts were less predictive of severe disease. In adult COVID-19, MPO and suPAR may be reliable prognostic biomarkers of severe disease during acute COVID-19. Further validation of these markers in a larger cohort and in other infectious diseases is warranted.

Advances in the treatment of atherosclerotic plaque based on nanomaterials.

Atherosclerosis is the leading cause of cardiovascular disease worldwide, posing not only a significant threat to cardiovascular health but also impairing the function of multiple organs, with severe cases potentially being life-threatening. Consequently, the effective treatment of atherosclerosis is of paramount importance in reducing the mortality associated with cardiovascular diseases. With the advancement of nanomedicine and a deeper understanding of the pathological mechanisms underlying atherosclerosis, nanomaterials have emerged as promising platforms for precise diagnosis and targeted therapeutic strategies. These materials offer notable advantages, including targeted drug delivery, enhanced bioavailability, improved drug stability, and controlled release. This review provides an overview of the mechanisms underlying atherosclerotic plaque development and examines nanomaterial-based therapeutic approaches for managing atherosclerotic plaques, including therapies targeting cholesterol metabolism, anti-inflammatory strategies, macrophage clearance, and immunotherapy. Additionally, the paper discusses the current technical challenges associated with the clinical transformation of these therapies. Finally, the potential future integration of nanomaterials, smart nanomaterials, and artificial intelligence in the treatment of atherosclerosis is also explored.

Association of VDR and TMPRSS2 gene polymorphisms with COVID-19 severity: a computational and clinical study.

COVID-19 manifestations range from asymptomatic to severe, and are influenced by host genetic factors. This study examined the association between vitamin D receptor (VDR) polymorphisms (TaqI and FokI) and transmembrane serine protease 2 (TMPRSS2) gene polymorphisms (rs12329760) and COVID-19 severity. 242 COVID-19 patients underwent genotyping using PCR-RFLP. Statistical analysis were conducted using SPSS v.21 and SHesis software, and validated by Sanger sequencing. The association of the VDR TaqI, FokI, and TMPRSS2 rs12329760 polymorphisms with COVID-19 severity was investigated. Computational analysis of TMPRSS2 was used to determine the pathogenicity and structural effects of these SNPs. For VDR TaqI, the 'TC' genotype showed higher prevalence in severe cases (50.5%) compared to mild cases (41.4%); however, no statistically significant association was observed [OR: 1.545 (0.893-2.675), p > 0.05]. Similar patterns were noted for the 'CC' genotype and 'C' allele, without statistical significance. For VDR FokI, the 'Ff' genotype showed higher prevalence in severe cases (25.8%) compared to mild cases (20.0%) [OR: 0.766 (0.199-2.951), p = 0.69], with no significant association. In haplotype analysis, elevated frequencies of 'Tf' and 'ft' haplotypes were observed in severe cases, but without statistical significance. For TMPRSS2 rs12329760, the 'CT' genotype showed a marginally higher prevalence in severe cases (50.5%) than in mild cases (49.7%) [OR: 0.805 (0.276-2.345), p > 0.05], without significant association. Computational analysis indicated that the variant does not demonstrate pathogenic effects but may influence protein stability. This study revealed no statistically significant association between VDR (TaqI and FokI) and TMPRSS2 (rs12329760) polymorphisms and COVID-19 severity. Large-scale investigations and functional analysis are required to delineate the impact of these genetic variations on COVID-19 susceptibility and severity.

First report of Moraxella oculi in Brazil in an infectious bovine keratoconjunctivitis outbreak.

Infectious Bovine Keratoconjunctivitis (IBK) is a widespread ocular disease that affects dairy and beef cattle worldwide, caused by Gram-negative bacteria from the genus Moraxella. It is the most common eye disease in cattle, with symptoms including tearing, ocular pain, corneal opacity, photophobia, ulceration, and, in severe cases, permanent blindness. This study focused on characterizing Moraxella species in a 2022 IBK outbreak in Minas Gerais, Brazil. Ocular swabs from 18 symptomatic Holstein cattle were analyzed through colony isolation, physiological tests, and molecular techniques, including PCR-RFLP and sequencing. Results revealed one isolate of Moraxella bovoculi genotype 1 and five isolates of Moraxella oculi, marking the first report of the latter species in Brazil. This study represents the second report of Moraxella oculi isolation and the first in a country different from the initial report. Notably, Moraxella bovis was not isolated in this outbreak. All isolates exhibited susceptibility to the tested antibiotics. Comparative genomic analysis between the Brazilian Moraxella oculi isolate and the American strain (Tifton 1) revealed 99.5% similarity in the 16-23S rRNA locus and 99.0% average nucleotide identity.

Lupus and IgA nephropathy: coexistence or coincident?

Systemic lupus erythematosus is amultisystem autoimmune disease primarily manifesting as lupus nephritis. While lupus nephritis is the most common renal pathology in lupus, non-lupus nephropathies such as IgA nephropathy occasionally occur. This study aims to evaluate the clinical features and outcomes of lupus patients with IgA nephropathy, comparing them with those of primary IgA nephropathy and lupus nephritis. Acomprehensive literature review was conducted using the PubMed and Google Scholar databases to identify cases of systemic lupus erythematosus with IgA nephropathy reported between 1995 and December 2023. A total of 16 cases were identified and 2 additional cases from our clinic were included. These cases were compared with 47lupus nephritis patients from our clinic and 215 primary IgA nephropathy patients from the literature. Data were collected on demographics, serology, renal biopsy findings, treatment, progression to renal failure and mortality. We identified 18cases of lupus with IgA nephropathy with amedian age of 41.6 years and afemale predominance (72.2%). In comparison to the primary IgA nephropathy cohort, lupus with IgA nephropathy group exhibited alower rate of renal failure (11.1% vs.34%) and mortality (5.6% vs.20%). Additionally, the lupus-IgA nephropathy group showed aslightly lower mortality rate compared to the lupus nephritis cohort (5.6% vs. 10.6%). Lupus with predominantly IgA deposits often follows amore indolent course than primary IgA nephropathy but severe cases with crescentic glomerulonephritis can still progress to renal failure.

The Application Value of Ultrasound in Ovarian Hyperstimulation Syndrome and Literature Review.

Ovarian hyperstimulation syndrome (OHSS) is a common complication of assisted reproductive technology, caused by the excessive response of the ovaries to gonadotropins during the ovulation induction process. The clinical manifestations of OHSS include abdominal distension, abdominal pain, nausea, vomiting, etc In severe cases, it can lead to life-threatening symptoms such as ovarian rupture, ascites, and pleural effusion. Ultrasound examination, as an important auxiliary diagnostic tool, can help doctors monitor the size of the ovaries, the number and morphology of follicles, and predict and diagnose the occurrence of OHSS. In terms of treatment, ultrasound-guided puncture and fluid drainage is an effective method to alleviate the symptoms of OHSS. This article reviews the application of ultrasound technology in the prediction, diagnosis, and treatment of OHSS, aiming to provide a more accurate and effective diagnostic and treatment strategy for clinical practice. Through in-depth research, it will help doctors better understand the pathophysiology of OHSS, formulate personalized treatment plans, improve treatment outcomes, and reduce the pain and economic burden on patients.

Clinical characteristics and associated factors of macrolide-resistant mycoplasma pneumoniae pneumonia in children: a systematic review and meta-analysis.

In recent years, the incidence of macrolide-resistant Mycoplasma pneumoniae (MRMP) pneumonia has markedly increased across East Asia, especially in China, Japan, and South Korea, presenting considerable challenges for clinical management. We systematically reviewed and conducted a meta-analysis on the resistance rate, clinical characteristics, and associated factors of MRMP, thereby establishing a foundation for early clinical identification and optimization of treatment strategies. In accordance with the PRISMA 2020 reporting guidelines, six databases including PubMed, Embase, Web of Science, CNKI, VIP, and Wanfang Data were systematically searched for relevant literature up to October 31, 2024. Studies explicitly reporting the clinical characteristics of both MRMP and macrolide-sensitive Mycoplasma pneumoniae (MSMP) pneumonia patients were included, with the population restricted to children. Pooled odds ratio (OR) and mean difference (MD), along with 95% confidence intervals, were calculated using inverse-variance weighting. A significance threshold was set at p < 0.05, and meta-analysis was performed using software such as RevMan, Stata, and R Studio. A total of 65 studies encompassing 20,141 patients were included in this analysis. The meta-analysis revealed that MRMP showed high resistance in East Asia compared to lower resistance in other regions. The overall resistance rate was 61% (95% CI: 54%, 68%), exhibiting notable regional variation. Elevated resistance rates were noted in East Asian countries, specifically China, Japan, and South Korea, reported at 68% (95% CI: 63%, 73%), 61% (95% CI: 43%, 80%), and 63% (95% CI: 42%, 85%), respectively. MRMP resistance was significantly associated with prolonged fever duration (MD: 1.97, 95% CI: 1.10, 2.84), extended hospitalization (MD: 1.96, 95% CI: 1.39, 2.54), elevated log MP-DNA levels (MD: 2.79, 95% CI: 1.54, 4.04), increased proportions of severe (OR: 2.45, 95% CI: 1.75, 3.44) cases and refractory (OR: 3.25, 95% CI: 1.47, 7.17) cases, and the occurrence of complications, particularly intrapulmonary manifestations including pulmonary consolidations (OR: 1.43, 95% CI: 1.14, 1.78), pleural effusions (OR: 2.11, 95% CI: 1.28, 3.49), lobar lesions (OR: 2.03, 95% CI: 1.03, 4.00), mucus plugs (OR: 4.63, 95% CI: 1.66, 12.94), and necrotizing pneumonia (OR: 2.49, 95% CI: 1.19, 5.24), alongside extrapulmonary involvement (OR: 3.08, 95% CI: 2.49, 3.82). No significant differences were observed in peak body temperature (MD: 0.05, 95% CI: -0.11, 0.20) or inflammatory markers including white blood cell count (WBC, MD: 0.28, 95% CI: -0.38, 0.94), C-reactive protein (CRP, MD: 0.71, 95% CI: -2.16, 3.58), Procalcitonin (PCT, MD: -0.11, 95% CI: -0.27, 0.05) and lactate dehydrogenase (LDH, MD: 3.80, 95% CI: -22.92, 30.52). The high resistance rate may be associated with environmental pressure stemming from the widespread use of macrolide antibiotics and increased genetic mutations due to the extensive spread of MP. The observed increase in severe cases, refractory cases, and complications associated with MRMP may be attributed to prolonged colonization resulting from ineffective anti-Mycoplasma pneumoniae treatment, rather than to enhanced virulence or a more severe cytokine storm. PROSPERO registration number CRD42024550871.