Degree Of Severity Research Articles

Coronavirus risk factor by Sugeno fuzzy logic

<span>World recently faced big challenges with the pandemic of coronavirus disease 2019 (COVID-19). Governments suffer from the problem of appropriately identifying the risk factor of this virus and establishing their safety procedures accordingly. This paper concentrates on designing a coronavirus risk factor (CRF) by the power of Sugeno fuzzy logic (SFL). The main advantage of the CRF is that it can provides a quick and suitable risk evaluation. According to the degree of severity, three essential parameters are considered: number of infected cases, number of people in intensive care units (ICU) and number of deaths. All of these parameters are provided per population. Such interesting and promising outcomes are attained, where the total effect is found equal to 95.3%.</span>

Italian National Registry of Alopecia Areata: an epidemiological study of 699 Italian patients.

Alopecia areata (AA) is an organ-specific autoimmune disease that affects the hair follicles of the scalp and the rest of the body causing hair loss. Due to the unpredictable course of AA and the different degrees of severity of hair loss, only a few well-designed clinical studies with a low number of patients are available. Also, there is no specific cure, but topical and systemic anti-inflammatory and immune system suppressant drugs are used for treatment. The need to create a global registry of AA, comparable and reproducible in all countries, has recently emerged. An Italian multicentric electronic registry is proposed as a model to facilitate and guide the recording of epidemiological and clinical data and to monitor the introduction of new therapies in patients with AA. The aim of this study was to evaluate the epidemiological data of patients with AA by collecting detailed information on the course of the disease, associated diseases, concomitant and previous events, and the clinical response to traditional treatments. Estimate the impact on the quality of life of patients. The creation of the National Register of AA has proven to be a valid tool for recording, with a standardized approach, epidemiological data, the trend of AA, response to therapies and quality of life. AA is confirmed as a difficult hair disease to manage due to its unpredictable course and, in most cases, its chronic-relapsing course, capable of having a significant impact on the quality of life of patients.

EEG findings and clinical severity and quality of life in non-epileptic patients with autism spectrum disorders

ABSTRACT Electroencephalogram (EEG) abnormalities could be seen in up to 60% of non-epileptic children with autism spectrum disorder (ASD). They have been used as biomarkers of ASD severity. The objective of our study is to identify EEG abnormalities in children with different degrees of ASD severity based on the Autism Treatment Evaluation Checklist (ATEC). We also want to assess the quality of life for children with ASD. All of the children underwent at least one hour of sleep-deprived EEG. Forty-five children were enrolled, of whom 42 were male. EEG abnormalities were found in 10 (22.2%) children, predominantly in the bilateral frontal areas. There were no differences in EEG findings among the mild, moderate, and severe ASD groups. The severity of ASD was associated with female sex (p-value = 0.013), ASD with attention deficit hyperactivity disorder (ADHD) (p-value = 0.032), ASD children taking medications (p-value = 0.048), and a lower Pediatric Quality of Life Inventory (PedsQL) (p-value <0.001). Social and emotional domains were the most problematic for health-related quality of life in ASD children, according to parent reports of PedsQL. Further studies with a larger sample size will help to clarify the potential associations between EEG abnormalities and the severity of ASD, as well as the impact on quality of life.

Leisure-Time Physical Activity, Time Spent Sitting and Risk of Non-alcoholic Fatty Liver Disease: A Cross-Sectional Study in Puglia.

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world. The increasingly sedentary lifestyle in recent years may have accelerated the development of NAFLD, independent of the level of physical activity. The purpose of this cross-sectional study was to determine the association between leisure-time physical activity (LTPA) and time spent sitting (TSS) and the likelihood of developing NAFLD in a sample of men and women aged 18-64 years, from southern Italy. The study is based on two cohort studies, a randomized clinical trial and an observational cost-benefit study. A total of 1269 participants (51.5% women) drawn from 3992 eligible subjects were enrolled in this study. Leisure-time physical activity (LTPA) and time spent sitting (TSS) were assessed using the Italian long form of the International Physical Activity Questionnaire (IPAQ-LF), designed for administration to adults aged 18 to 65 years. The association of exposures with the probability of belonging to a certain NAFLD degree of severity. The probability of having mild, moderate, and severe NAFLD tends to decrease with increasing LTPA and decreasing TSS levels. We selected a combination of participants aged 50 years and older stratified by gender. Men had a statistically significant difference in the probability of developing moderate NAFLD if they spent 70 h per week sitting and had low LTPA, while among women there was a statistically significant difference in the probability of developing mild or moderate NAFLD if they had moderate LPTA and spent 35-70 h/week sitting. The study thus showed that the amount of LTPA and the amount of TSS are associated with development and progression of NAFLD, but this relationship is not a linear one-especially in women aged ≥ 50 years old.

COVID Pneumonia Severity Detection of Chest CT-Scan Images based on Robust Semantic Segmentation

Image segmentation has steadily grown especially for clinical usage and disease recognition in radiological research. This procedure, aimed at acquiring quantitative measurements, strives to distinguish regions or objects of interest from adjacent body tissues. To be more specific, it entails measuring the area and volume of segmented structures to extract more refined diagnostic information. The main hurdles encountered by segmentation algorithms originate from challenges like variations in intensity, artifacts, and the close juxtaposition of diverse soft tissues in the grayscale. In this paper, a robust semantic segmentation is proposed to specify the infected regions of lung images and consider the severity degree of the pneumonia caused by COVID-19 disease. The proposed model provides an accurate diagnosis of the chest CT scan image with satisfied performance with 93% accuracy and the second most important metric which is the Jaccard Index with 0.746±0.09 shows higher prediction performance than most existing systems in the literature.

#3106 The prevalence and degree of hyperkalaemia in adult patients with chronic kidney disease, in Durban, South Africa

Abstract Background and Aims Hyperkalaemia is a known risk factor for the development of cardiac rhythm disturbances and sudden cardiac death. The presence of chronic kidney disease (CKD) is also an independent risk factor for cardiovascular complications. The prevalence of hyperkalaemia in patients with CKD has previously varied widely between studies. The prevalence of hyperkalaemia in the patients attending the renal clinic at Inkosi Albert Luthuli Central Hospital (IALCH) has not been previously determined. This study aimed to discover the prevalence of hyperkalaemia in patients attending the renal clinic at IALCH, as well as the degree of severity amongst the patients in whom hyperkalaemia was present. Demographic and other variables were also assessed for an association with hyperkalaemia. Method A retrospective review of outpatients attending the renal clinic at IALCH from 1 October 2016 until 30 September 2017. Demographic and clinical characteristics were retrieved and descriptive statistical methods and logistic regression analysis were performed. Results The study consisted of 200 patients, of whom the majority were female (n=120, 60%). The prevalence of hyperkalaemia amongst these patients was found to be 16%. In those with stage 3 CKD, the prevalence of hyperkalaemia was 7.69%. In those with stage 4 CKD, the prevalence of hyperkalaemia was 20.5% and in those with stage 5 CKD the prevalence was 17.3%. There were no statistically significant associations between hyperkalaemia and demographic variables, nor with dietician intervention. There was a significant association with the use of sodium polystyrene sulfonate. Conclusion CKD is a growing burden in the developing world. With CKD comes metabolic and other derangements, including electrolyte abnormalities as well as increased cardiovascular risk. Hyperkalaemia is associated with worsening CKD. In addition, hyperkalaemia puts patients at risk of cardiac dysrhythmias and sudden cardiac death. Pharmacological measures to manage CVD risk should be weighed up against the risk of hyperkalaemia related complications. Potassium lowering agents should be considered to allow for optimal CVD management in the setting of hyperkalaemia in CKD.

#799 M1-M2 macrophages in postmortem biopsies from patients with acute kidney injury with COVID-19 compared to pulmonary bacterial sepsis

Abstract Background and Aims AKI associated with COVID19 is highly prevalent; there is controversy if it is similar to AKI in sepsis of bacterial origin. Macrophage differentiation M1-M2 is a predictor of outcomes. Macrophage expression in kidney tissue is not known in patients with severe COVID19 compared to sepsis of bacterial origin. We compare the tissue expression of macrophage differentiation markers M1-M2, through the expression of CD163, CD68, INOS in postmortem biopsies from patients with C19-LRA and S-AKI. Method Observational, comparative, analytical study. Results 49 subjects were analyzed, 39(COVID-19) and 10(pulmonary sepsis of bacterial origin). No significant baseline differences. The degree of AKI had no difference between groups, but in COVID-19 there were severe grades 2-3, compared to bacterial sepsis p = 0.89. Histopathologically there were no differences with the degree of LTA and IFTA. NTI was more frequent in bacterial sepsis vs COVID-19 100%/12.8% (p &amp;lt; 0.001). When comparing macrophage expression we found that the expression of M1(INOS) was not different, the expression of M2(CD163) was higher in patients with bacterial Sepsis with 100% corresponding to severe grade vs 28.2% in patients with COVID19 p&amp;gt;0.001. The classification between degrees of AKI were statistically positive for patients with COVID19 and CD163 with r2: 0.26 and CD68 with r2: 0.36 with p 0.01 and 0.02 respectively. The classification with NTI was positive in COVID19 and bacterial sepsis with an r2: 0.34 for CD163, r2: 0.11 for CD68 p &amp;lt; 0.001. Regarding IFTA in COVID-19 and bacterial sepsis, r2: 0.12 for CD163, r2: 0.11 for CD68 (p 0.01 and 0.03 respectively). Steroid use was negatively correlated on the COVID19 with bacterial sobreinfectión + the bacterial sepsis group with the marker CD163 with r2: 0.23 p = 0.005. The association between moderate and severe positivity for CD68+ and NTI had an OR of 15.5 (CI 3.21-64.6) p = 0.001. Conclusion The 2 groups had a similar severity, AKI in COVID19 was more severe compared to bacterial Sepsis, histologically there were no differences in AKI, but there was a marked difference in the presence of NTI, this being more frequent in the bacterial sepsis group. Findings different from those reported in other bibliographies where the degree of acute kidney injury was higher in COVID19. When comparing the dominant macrophage phenotype, iNOS(M1) had no difference between the groups, on the contrary CD163(M2) was different, with severe staining in all cases with bacterial sepsis, similar to what was seen with NTI and lower degrees of clinical severity of LRA. When evaluating the correlations we found a moderate correlation between the presence of NTI and CD163(M2), mild for NTI and CD68(M0). Finding suggestive of the macrophage role especially low M2 in the context of NTI, it is important to note that those with CD163 had lower degrees of acute kidney injury, more reported as KDIGO1, which is reproducible taking into account other studies in which the CD163(M2) was associated with higher degrees of repair, while their depletion was associated with greater severity of kidney injury. With respect to the treatment established, there was a slight correlation between the use of steroids in the population with bacterial superinfection with CD163(M2), in a recent study it was shown that the use of steroids could induce the repopulation of CD163.

#723 The impact of kidney function on arterial stiffness in COVID-19 survivors: an analysis from CARTESIAN Study

Abstract Background and Aims SARS-CoV-2 pandemic has been linked to an increased incidence of cardiovascular events, potentially due to accelerated vascular aging [1]. Conversely, impaired kidney function is known to contribute to the pathogenesis of heightened arterial stiffness, independent of traditional cardiovascular risk factors [2]. This study aimed to assess the impact of COVID-19 on arterial stiffness among a cohort of survivors of the first pandemic wave, with varying degrees of infection severity. The assessment was conducted at 6 ± 3 (T1) and 12 ± 3 months (T2) post-infection, with the population stratified based on kidney function. Method the CARTESIAN study, a large international multicenter cohort study, was designed to assess the long-term effects of COVID-19 on vascular aging. A total of 938 subjects were stratified into three groups based on their estimated glomerular filtration rate (eGFR) percentiles using the CKD-EPI_2021 equation: 1) &amp;gt;75th percentile, 2) 75th-25th percentile, and 3) &amp;lt;25th percentile, respectively. The same population was further categorized based on the severity of COVID-19 into three groups: 1) patients who were not hospitalized (No-Hosp), 2) subjects requiring hospitalization in a medical unit (Hosp), or 3) those in an intensive care unit (ICU). Arterial stiffness was evaluated using carotid-femoral pulse wave velocity (cf-PWV). A hierarchical repeated measures mixed model analysis was conducted to compare cf-PWV across these groups (&amp;gt;75th, 75th-25th, and &amp;lt;25th groups, respectively). Results in the cross-section analysis (T1) &amp;lt;25th group exhibited higher age, increased cardiovascular risk factors, and higher prevalence of severe COVID-19 compared to the &amp;gt;75th group. Using hierarchical linear modeling, the &amp;lt;25th exhibited higher cf-PWV than the &amp;gt;75th group, even after adjusting for both all the random and fixed variables, included the three COVID-19 group (+0.51 m/s, p = 0.013). In longitudinal analysis, globally, no substantial changes were found in the cf-PWV between T1 and T2, remained significantly higher in the &amp;lt;25th group compared to the &amp;gt;75th group (p = 0.003), in a linear mixed model adjusted for all the random and fixed variables. Interestingly, a significant interaction between eGFR groups* COVID-19 groups was found in repeated measures analysis (p = 0.039). In particular, within ICU group, we found a significant increase of cf-PWV between 6- and 12-months in &amp;lt;25th group, from 8.64 [7.59-9.31] to 9.41 [8.89-10.41] m/s, p = 0.021) (Fig. 1). Conclusion the findings suggest that individuals with both lower eGFR and a history of severe COVID-19 may be at a heightened risk of accelerated arterial aging. Understanding these dynamics is crucial for targeted interventions to mitigate long-term cardiovascular consequences in COVID-19 survivors with kidney disease.

Pulmonary MicroRNA expression after heterologous challenge with swine influenza A virus (H1N2) in immunized and non-immunized pigs

MicroRNAs (miRNAs) contribute to post-transcriptional modulation of the host response during influenza A virus (IAV) infection and may be involved in shaping disease severity. Differential disease severity was achieved in two groups of pigs by immunization of one group with a commercial swine IAV vaccine prior to heterologous IAV (H1N2) challenge of both groups. Lung tissue was harvested 1, 3, and 14 days after challenge and miRNA expression was quantified. Gene Ontology term enrichment analysis was employed to examine the functional relevance of genes potentially regulated by differentially expressed miRNAs in pigs with varying degrees of disease severity following IAV infection. Results suggested that the miRNA response associated with less severe disease may modulate host mechanisms essential for viral life cycle, e.g. transcription, translation, and protein trafficking. During more severe disease, miRNA-mediated regulation may focus on dampening virus-specific processes e.g. virion assembly and viral protein processing, and controlling host metabolism.

Cytokine and chemokine profiles in the sera of COVID-19 patients with different stages of severity

IntroductionCOVID-19 is a viral infection that disturbs the host's immune system and causes an overproduction of cytokines leading to a cytokine storm. The present study aimed to evaluate the serum levels of 27 protein biomarkers to determine their association with COVID-19 disease severity. MethodsThe serum levels of 89 patients with different degrees of COVID-19 disease severity [asymptomatic (n = 14), moderate (n = 14), severe (n = 30), and critical (n = 31)] and 14 healthy individuals were tested for a panel of 27 cytokines and chemokines using Luminex assay (27 Bio‑Plex Pro Human Cytokine, Bio-rad™). ResultsIL-12, IL-2 and IL-13, as well as IL-17 and GM-CSF were clearly undetectable in asymptomatic patients. IL-8 levels were higher in asymptomatic compared with other groups. Very high levels of IL-6, IL-10 and the chemokines MIP-1α, MCP-1 and IP10 were associated with disease progression, while IL-4 tends to decrease with disease severity. ConclusionOur study provides more evidence that excessive cytokine synthesis is linked to the disease progression.

A Prospective Study On Internet Addiction In Young Adults

Internet addiction has become an important issue in young population who are at risk of the adverse effects of internet addiction due to their high levels of internet use for social networking, gaming, streaming, and other online activities. Knowing the factors responsible for the development of internet Addiction can be useful for both prevention and treatment as well as targeted intervention for this type of addiction. This study was conducted to determine prevalence of Internet addiction among young population, its associated factors and analysing the possible differences related to gender. This cross-sectional study was conducted on young adults of 18-24 years age studying at Nims,university ,Jaipur, Rajasthan during the months of October and November 2023 . Predefined questionnaire of young etal was used to capture the data pertaining to internet addiction among the study population. A total of 141participants between 18years and 34 years of both genders were selected (247 males and 207 females) for the study. In the present study among the 24 participants, 67% were females and 33% were males. Overall internet addiction including severe and moderate degree was more than 50% which was higher than previous studies. Impact of internet addiction was observed in form of Reduced productivity at work, loss of sleep and depression/mood swings etc

Comparative salivary proteomics analysis of children with and without early childhood caries using the DIA approach: A pilot study.

To screen differentially expressed proteins (DEPs) in the saliva of Early childhood caries (ECC) with different degrees of severity. The proteomic profiles of salivary of children with ECC of varying severity by data independent acquisition data independent acquisition (DIA) technique. A total of 12 preschool children aged 3-5 years were included in this study. In this study, a total of 15,083 peptides and 1944 proteins were quantified; The results of DEPs screening showed that 34 DEPs were identified between the group H and the group LC, including 18 up-regulated proteins and 16 down-regulated proteins; 34 DEPs were screened between the group H and the group HC, including 17 up-regulated proteins and 17 down-regulated proteins; 42 DEPs were screened between the group LC and the group HC, including 18 up-regulated proteins and 24 down-regulated proteins. Among these DEPs, we screened several key proteins that may play a role in ECC, such as MK, histone H4, TGFβ3, ZG16B, MUC20, and SMR-3B. Salivary proteins, as important host factors of caries, are differentially expressed between the saliva of ECC children and healthy children. Specific DEPs are expected to become potential biomarkers for the diagnosis of ECC.

Relationship Between the Gut Microbiota and Neurological Deficits in Patients With Cerebral Ischemic Stroke.

The aim of the paper was to investigate the composition and structure of intestinal flora in patients with cerebral ischemic stroke (CIS), and to investigate the relationship between gut microbiota (GM) and different levels of stroke severity. In this study, 47 CIS patients (16 mild, 21 moderate, and 10 severe) and 15 healthy controls were included. General information, clinical data, and behavioral scores of the enrolled subjects were collected. Deoxyribonucleic acid in fecal intestinal flora was extracted and detected using high-throughput Illumina 16S ribosomal ribonucleic acid sequencing technology. Finally, the correlation between the community composition of intestinal microbiota and National Institutes of Health Stroke Scale (NIHSS) score in CIS patients was analyzed. Compared with healthy controls, there was no statistically significant difference in Alpha diversity among CIS patients, but the principal coordinate analysis showed significant differences in the composition of the GM among stroke patients with different degrees of severity and controls. In CIS patients, Streptococcus was significantly enriched, and Eshibacter-Shigella, Bacteroides, and Agathobacter were significantly down-regulated (P < .05). In addition, the relative abundance of Blautia was negatively correlated with the NIHSS score. Our results show that different degrees of CIS severity exert distinct effects on the intestinal microbiome. This study reveals the intestinal microecological changes after brain injury from the perspective of brain-gut axis. Intestinal microorganisms not only reveal the possible pathological process and indicate the severity of neurologic impairment, but also make targeted therapy possible for CIS patients.

Permissive prejudice in localized authoritarian consolidation: evidence from Turkey's municipalities

ABSTRACT What strategies do competitive authoritarian regimes use to target local-level opposition gains? How and why can these strategies vary subnationally? We analyse how national-level identity politics shapes regimes’ repression calculus at the local level. We suggest permissive prejudice leads regimes to choose harsher strategies in localities governed by stigmatized minority groups than in majority-led localities. To study this phenomenon, we identify three strategies varying in degrees of severity and visibility, and present an original dataset of repressive events in Turkey’s municipalities from 2016–2022. We argue anti-Kurdish prejudice explains the ruling AKP’s use of a harsh strategy of leader replacement in 149 cases of Kurdish-led municipalities yet only one Turkish-led municipality. Supporting our claim, the AKP used behind-the-scenes hamstringing to obstruct opposition mayors in Turkish-led municipalities. Our findings highlight the permissive and restrictive roles that identity politics plays in shaping local-level repression and wider patterns of authoritarian consolidation.

Cognitive dysfunctions in the course of SARS‑CoV‑2 virus infection, including NeuroCOVID, frontal syndrome and cytokine storm (Review).

During the coronavirus disease 2019 (COVID-19) pandemic, cognitive impairment of varying degrees of severity began to be observed in a significant percentage of patients. The present study discussed the impact of immunological processes on structural and functional changes in the central nervous system and the related cognitive disorders. The purpose of the present review was to analyse and discuss available information from the scientific literature considering the possible relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection and cognitive impairment, including NeuroCOVID, frontal syndrome and cytokine storm. A systematic literature review was conducted using: Google Scholar, Elsevier and the PubMed database. When searching for materials, the following keywords were used: 'cognitive dysfunctions', 'SARS-CoV-2', 'COVID-19', 'Neuro-SARS2', 'NeuroCOVID', 'frontal syndrome', 'cytokine storm', 'Long COVID-19'. A total of 96 articles were included in the study. The analysis focused on the characteristics of each study's materials, methods, results and conclusions. SARS-CoV-2 infection may induce or influence existing cognitive disorders of various nature and severity. The influence of immunological factors related to the response against SARS-CoV-2 on the disturbance of cerebral perfusion, the functioning of nerve cells and the neuroprotective effect has been demonstrated. Particular importance is attached to the cytokine storm and the related difference between pro- and anti-inflammatory effects, oxidative stress, disturbances in the regulation of the hypothalamic-pituitary-adrenal axis and the stress response of the body.

RELEVANCE AND PROBLEMS OF DESIGNING POST-OPERATIVE REHABILITATION CENTERS FOR ARMED FIGHTERS

At the time when Ukraine is fighting for its independence, many of its defenders receive injuries of varying degrees of severity during the hostilities. Of course, they are provided with the first qualified and specialized medical care in military hospitals and specialized medical facilities. But the rehabilitation of military personnel is of great importance for the full restoration of their functions and the opportunity to fully work and livе in society. While there are no projects for the complete reconstruction of the destroyed cities of Ukraine, it is necessary to take priority steps aimed at a number of modern problems, among which the design of rehabilitation centers that provide not only physical rehabilitation, but also psychological rehabilitation is important.

MISDIAGNOSED PARTIAL ANOMALOUS PULMONARY VENOUS RETURN AS A CAUSE OF RIGHT VENTRICULAR DILATION IN TRICUSPID VALVE DYSPLASIA

Abstract A 38–year–old woman comes to our attention for regular follow–up of a known tricuspid valve dysplasia, diagnosed since she was 19 years old. The patient has been persistently asymptomatic and hemodynamically compensated. In previous cardiac assessments, there was moderate and stable tricuspid regurgitation (TR) that never reached the diagnostic criteria for Ebstein‘s anomaly (7 mm). The right atrium was dilated, and the right ventricle was at the upper limits of normal dimensions. However, our evaluation revealed a worsening of TR to a severe degree, associated with valvular annulus dilation and severe dilation of the right ventricle, which remained normokinetic, and evident diastolic overload of the interventricular septum. Therefore, a cardiac surgery intervention was indicated to correct the valvulopathy. During hospitalization, a transthoracic echocardiogram was repeated to investigate a possible cause of right ventricular overload, not fully explained by the relatively short duration of severe TR. During the exam, suspecting Partial Anomalous Pulmonary Venous Return (PAPVR) as one of the possible determinants, a vessel compatible with left superior pulmonary venous return was visualized, which converged into the anonymous vein and then into the right superior vena cava. Further diagnostic investigation with magnetic resonance angiography and computed tomography angiography confirmed the severe dilation of the right cardiac chambers and the presence of left upper pulmonary venous return and part of the left lower lobe into the left anonymous vein, with a Qp/Qs of 1.7 in relation to the pre–tricuspidal shunt. Therefore, a cardiac surgery intervention was indicated for PAPVR correction. However, previously unnoticed thrombocytosis was revealed in the hematological exams, leading to the initiation of a pertinent hematological workup and the cardiac surgery intervention was postponed to reduce the risk of perioperative complications. In conclusion, PAPVR is a rare congenital condition that can remain asymptomatic until adulthood due to a chronic adaptation of the right heart to volume overload and should, therefore, be considered in the differential diagnosis of right cardiac chambers dilation, especially when other causes do not justify its pathophysiology.

SEVERE MITRAL INSUFFICIENCY FROM RHEUMATIC DISEASE: A CASE REPORT

Abstract Acute rheumatic fever continues to be a major health problem in many parts of thw world. It’s more common in low–income or developing parts of the world. Antibiotics for bacterial infections may not be available in these areas. In developed countries, cardiac involvement is quite rare. Although traditionally considered to be a disease associated with poverty, rheumatic fever continues to persist even among the middle–class population in developed countries. Children and teenagers with intreated strep infections are the most likely to get rheumatic fever. Signs of heart damage can develop years after the infection. Rheumatic heart disease is the result of valvular damage caused by an abnormal immune response to Streptococcus pyogenes infection. After multiple episodes of rheumatic fever, progressive fibrosis of the heart valves can occur: mitral regurgitation is the most common valvular lesion. We report the case of a 13–year–old, Italian, middle–class girl with rheumatic mitral valve involvement. A 13–years–old comes to the clinic for onset of worsening dyspnea ad easy fatigability. History turns out to be negative for cardiovascular disease and history of recent infections. Echocardiographic examination showed a dilated left ventricle (VTD 148ml, 98 m/mq) with preserved chinese. Severe dilatation of the left atrium with atrio–aortic ratio 2.3 and atrial volume 91 ml/mq. The mitral valve presented a myxomatous, thickened leaflets, predominantly the posterior which appeared retracted and hypomobile with thickening of the subvalvular apparatus with coaptation deficit along the entire coaptation rhyme realizing severe degree insufficiency (CV 7mm, ERO 0.8 cm2, CO 39 l/min). A small cleft at the level of A1, main lesion jet (A1–P3–P2) was also visible. The Echocardiographic appearance suggested outcomes from rheumatic disease so antistreptolysin titer and anti–DNase B antibodies were assayed with high levels found. Penicillin prophylaxis was therefore initiated. For the continuation of the therapeutic course, the case was discussed collegially and a valve replacement rather tan repair was advocated because the valvular and subvalvular apparatus were far too damaged.

The impact of COVID-19 pandemic and psychological resilience among undergraduate medical students

Pandemic always has negative impact on students in higher education. Especially when learning emphasises on hands-on experience. Due to movement The social distancing and online teaching during COVID-19 pandemic had impact on student learning, We aimed to assess the prevalence of anxiety, depression and resilience of medical students to COVID-19 related worries during pandemic.We conducted a cross-sectional study among 1200 undergraduate medical students. The survey questionnaires has six parts; demography information, modified version of COVID-19 related worries, the impact of COVID-19 in teaching and learning, resilience using the Connor-Davidson Resilience Scale, generalized anxiety disorder 7-item (GAD-7) scale &amp; lastly patient health questionnaire-2 (PHQ-2). The Cronbach’s alpha coefficient of GAD-7 was 0.930 and PHQ-2 was 0.811. We used multiple linear regression to determine the association between resilience and anxiety, depression, and COVID-19 related worries. All the statistical tests were two-sided, and the level of significance was set at 0.05. Most of the students showed a moderate amount of COVID-19 related worries about contracting, dying or unintentionally infecting others, having financial burden following pandemic, affecting their study. Around 32.8% of the medical students had minimal anxiety while 35.7% had mild, 14.1% had moderate and 17.4% had severe anxiety disorder. The mean resilience score was 23.1 (SD 7.3). There was statistically significant negative association between resilience and anxiety with regression coefficient of -0.36 (95% confidence interval -0.43 to -0.29), P&amp;#60;0.001. Female students had significantly higher anxiety (regression coefficient 2.03; 95% confidence interval 0.92 to 3.15; P&amp;#60;0.001) and COVID-19 related worries (regression coefficient 2.91; 95% confidence interval 1.48 to 4.35; P&amp;#60;0.001) than male students.A significant proportion of medical students experienced anxiety and depressive symptoms, with varying degrees of severity. We emphasize the need for targeted support and interventions to address anxiety, depression, and promote resilience.

Health-related quality of life in patients with generalized pustular psoriasis – a Swedish register study

Background Real-world data on health-related quality of life (HRQoL) in generalized pustular psoriasis (GPP) are scarce and studies have been restricted in terms of instruments used for assessments. Objective To assess generic and dermatology-specific HRQoL of patients with GPP compared with patients with plaque psoriasis using real-world data from the Swedish National Register for Systemic Treatment of Psoriasis. Methods Cross-sectional data from 2006 to 2021 including 7041 individuals with plaque psoriasis without GPP and 80 patients with GPP, of which 19% also had plaque psoriasis. Total scores for the EuroQol-5 Dimensions (EQ-5D) and Dermatology Life Quality Index (DLQI), as well as degree of severity within the instruments’ dimensions/questions, were compared between patient groups. Results EQ-5D scores were significantly (p < .01) lower (worse) in patients with GPP (mean [standard deviation (SD)] 0.613 [0.346]) vs. patients with plaque psoriasis (mean [SD] 0.715 [0.274]), indicating lower generic HRQoL of patients with GPP. Significantly (p < .01) higher (worse) total DLQI scores were observed for patients with GPP (mean [SD] 10.6 [8.9]) compared with patients with plaque psoriasis (mean [SD] 7.7 [7.1]), with proportionally more patients with GPP having severe (20% vs. 16%) and very severe (17% vs. 8%) problems. The worsened scores for GPP vs. plaque psoriasis were consistent across EQ-5D dimensions and DLQI questions. Conclusions Individuals with GPP have a considerable impairment in both generic and dermatology-specific HRQoL. The HRQoL was significantly worse in individuals with GPP compared to individuals with plaque psoriasis. The significant HRQoL impairment of GPP shows the potential value of better healthcare interventions for this multisystem disease.