Disease Severity Research Articles

Current Knowledge on Nail Involvement in Autoimmune Bullous Disorders

<b><i>Background:</i></b> There are few studies, mainly case reports, on the involvement of the nail unit in autoimmune bullous disorders. <b><i>Summary:</i></b> Nail involvement in autoimmune bullous disorders is a significant clinical phenomenon, marked by a range of manifestations, most often not presenting with blisters like on the skin but rather with alterations of the nail unit such as paronychia, onychomadesis, or onycholysis. This involvement is particularly notable due to the unique immunological features of the nail unit, including the expression of various antigens and the presence of Langerhans cells. Conditions like pemphigus vulgaris, bullous pemphigoid, epidermolysis bullosa acquisita, linear IgA disease, and bullous systemic lupus erythematosus can lead to nail abnormalities. The prevalence of nail manifestations varies according to the disorder, and diagnosis often relies on histopathological and immunofluorescence testing. Nail involvement correlates with disease severity and duration, sometimes serving as a herald sign. Further research is needed to guide therapeutic approaches for nail involvement in autoimmune bullous diseases. <b><i>Key Messages:</i></b> Nail involvement in autoimmune bullous nail disorders may be confusing as there are almost never bullae. One should keep the diagnosis in mind when facing an atypical paronychia.

The lung ultrasound in children with SARS-COV-2 infection: a national multicenter prospective study.

Coronavirus disease-19 (COVID-19) caused hospitalizations, severe disease, and deaths in any age, including in the youngest children. The aim of this multicenter national study is to characterize the clinical and the prognostic role of lung ultrasound (LU) in children with COVID-19.We enrolled children between 1 month and 18 years of age with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection who underwent a LU within 6h from the first medical evaluation.A total of 213 children were enrolled, 51.6% were male, median age was 2 years and 5 months (interquartile range (IQR) 4months-11 years and 4 months). One hundred and forty-eight (69.4%) children were admitted in hospital, 9 (6.1%) in pediatric intensive care unit. We found an inverse correlation between the lung ultrasound score (LUS) and the oxygen saturation at the first clinical evaluation (r = -0.16; p = 0.019). Moreover, LUS was significantly higher in patients requiring oxygen supplementation (8 (IQR 3-19) vs 2 (IQR 0-4); p = 0.001).Among LU pathological findings, irregular pleural lines, subpleural consolidations, and pleural effusions were significantly more frequent in patients needing oxygen supplementation (p = 0.007,p = 0.006, and p = 0.001, respectively). Conclusion: This multicenter study showed that LU in children with COVID-19 can highlight pleural line irregularities, vertical artifacts, and subpleural consolidation. Notably, children with higher LUS have a higher risk of hospitalization and need for oxygen supplementation, supporting LU as a valid and safe point-of-care first level tool for the clinical evaluation of children with COVID-19. What is Known: • Few children infected with SARS-CoV-2 develop a severe disease and need oxygen therapy. • Lung ultrasound can easily detect low respiratory tract infection during SARS-CoV-2. What is New: • Children with higher lung ultrasound score have a higher risk of need for oxygen supplementation. • Irregular pleural line, sub-pleural consolidations and pleural effusions were significantly more frequent in patients needing oxygen supplementation.

Adenotonsillectomy Versus Watchful Waiting for Children with Obstructive Sleep Apnea Syndrome: A Systematic Review with Meta-Analysis

AbstractThe treatment of children with Obstructive Sleep Apnea Syndrome (OSAS) remains a point of debate among otorhinolaryngologists worldwide. This study aims to comparatively assess the clinical outcomes of adenotonsillectomy (ATE) and watchful waiting in children with OSAS. We searched the databases of PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), until the 1st of October 2023. Comparative trials assessing the efficacy of adenotonsillectomy and watchful waiting in children with OSAS were considered. The primary outcome measure was the apnea-hypopnea index (AHI), and secondary outcomes included quality of life as measured by OSA-18 score, and mean SpO2 levels. A subgroup analysis evaluating the changes in AHI depending on the severity of the initial disease was also executed. We conducted a random-effects pairwise meta-analysis of change scores to include randomized and non-randomized controlled trials. The quality assessment was carried out by using the Cochrane risk of bias tool for randomized and the ROBINS-I tool for non-randomized trials, respectively. Two randomized and five non-randomized trials were included. There was a statistically significant difference regarding AHI in favor of the ATE group compared to the watchful waiting group (Standardized mean difference [SMD] was − 0.60, 95%CI −0.79 to −0.41, p < 0.001). Likewise, a statistically significant decrease in change scores for OSA-18 between ATE and watchful waiting was noted (SMD was − 0.79, 95%CI −0.97 to −0.61, p < 0.001). On the other hand, there was no significant difference when ATE and watchful waiting groups were compared for SpO2 levels between each other (SMD was 0.52, 95%CI −1.53 to 2.56, p < 0.62). In the subgroup analysis assessing mild OSAS, there was a significant difference in favor of ATE compared to watchful waiting (SMD was −0.91, 95%CI −1.35 to −0.47, p < 0.0001). For mild to moderate OSAS, similar results were noted favoring ATE as well (SMD was − 0.53, 95%CI −0.87 to −0.19, p < 0.003). This study provides evidence of moderate strength supporting the superiority of ATE over the watchful waiting approach in terms of AHI and OSA-18. This also appears to be the case for AHI in children with mild and mild to moderate OSAS.

Unprecedented Guidewire Entrapment Salvaged by Combined Rotational Atherectomy and ‘Twist-wire’ Technique: a case report

Abstract Background Coronary guidewire entrapment is not an uncommon complication of percutaneous coronary intervention, especially in the setting of complex coronary anatomy. Core wire fracture with uncoiling of spring wire represents a catastrophic complication, posing great technical difficulty in percutaneous retrieval. Case summary The patient was a 50-year-old Asian male with ischaemic cardiomyopathy and severe left ventricular impairment. Coronary angiography showed severe left main and triple vessel disease. Coronary artery bypass graft was declined due to high surgical risk. Percutaneous coronary intervention was performed under mechanical circulatory support. However, it was complicated with guidewire entrapment and unravelling with deformity of the newly implanted stent in the left anterior descending artery. The complication was successfully bailed out by rotational atherectomy and the novel intravascular ultrasound (IVUS) and enhanced stent visualization (ESV) system guided ‘Twist-wire’ technique. Complete wire fragments retrieval was achieved with excellent final angiographic and IVUS results immediately after procedure and at 4-month follow-up angiography. Discussion This case represents a rare phenomenon of branch point protrusion (BPP) of stent causing guidewire-stent edge entanglement. A novel ‘Twist-wire’ technique with IVUS and ESV guidance was highlighted to allow successful retrieval of fluoroscopically invisible uncoiled wire filaments.

Air pollution, life’s essential 8, and risk of severe non-alcoholic fatty liver disease among individuals with type 2 diabetes

BackgroundThe impacts of long-term exposure to air pollution on the risk of subsequent non-alcoholic fatty liver disease (NAFLD) among participants with type 2 diabetes (T2D) is ambiguous. The modifying role of Life’s Essential 8 (LE8) remains unknown.MethodsThis study included 23,129 participants with T2D at baseline from the UK Biobank. Annual means of nitrogen dioxide (NO2), nitrogen oxides (NOX), and particulate matter (PM2.5, PM2.5–10, PM10) were estimated using the land-use regression model for each participant. The associations between exposure to air pollution and the risk of severe NAFLD were evaluated using Cox proportional hazard models. The effect modification of LE8 was assessed through stratified analyses.ResultsDuring a median 13.6 years of follow-up, a total of 1,123 severe NAFLD cases occurred. After fully adjusting for potential covariates, higher levels of PM2.5 (hazard ratio [HR] = 1.12, 95%CI:1.02, 1.23 per interquartile range [IQR] increment), NO2 (HR = 1.15, 95%CI:1.04, 1.27), and NOX (HR = 1.08, 95%CI:1.01, 1.17) were associated with an elevated risk of severe NAFLD. In addition, LE8 score was negatively associated with the risk of NAFLD (HR = 0.97, 95% CI: 0.97, 0.98 per point increment). Compared with those who had low air pollution and high LE8, participants with a high air pollution exposure and low LE8 had a significantly higher risk of severe NAFLD.ConclusionsOur findings suggest that long-term exposure to air pollution was associated with an elevated risk of severe NAFLD among participants with T2D. A lower LE8 may increase the adverse impacts of air pollution on NAFLD.

Treatment of mucocutaneous leishmaniasis - A systematic review.

Mucocutaneous leishmaniasis is a severe infectious disease, predominantly endemic in Central and South America and is characterized by granulomatous, destructive mucosal lesions in the oral, nasal, and pharyngeal cavities. It is caused by protozoa of the genus Leishmania spp. transmitted to humans by sandflies. Mucocutaneous leishmaniasis occurs after untreated or inadequately treated cutaneous leishmaniasis and is more common in immunocompromised patients. The aim of this systematic review is to summarize all reported treatment options for mucocutaneous leishmaniasis. This review is based on all English, German, French, Spanish and Portuguese articles published in the databases "PubMed" and "Lilacs" from 1995 to 2020. Most of the medical literature is limited to case reports, small case series, retrospective studies, and a few randomized controlled trials. Various treatment options include pentavalent antimonates such as meglumine antimonate or sodium stibogluconate, amphotericin B (liposomal, deoxycholate, lipid complex, colloidal dispersion), miltefosine, and pentamidine. Other therapeutic options include itraconazole, fluconazole, ketoconazole, aminosidine sulfate, and azithromycin. The choice of drug depends primarily on its availability in the endemic area and the patient's comorbidities.

An interpretable machine learning model for predicting 28-day mortality in patients with sepsis-associated liver injury.

Sepsis-Associated Liver Injury (SALI) is an independent risk factor for death from sepsis. The aim of this study was to develop an interpretable machine learning model for early prediction of 28-day mortality in patients with SALI. Data from the Medical Information Mart for Intensive Care (MIMIC-IV, v2.2, MIMIC-III, v1.4) were used in this study. The study cohort from MIMIC-IV was randomized to the training set (0.7) and the internal validation set (0.3), with MIMIC-III (2001 to 2008) as external validation. The features with more than 20% missing values were deleted and the remaining features were multiple interpolated. Lasso-CV that lasso linear model with iterative fitting along a regularization path in which the best model is selected by cross-validation was used to select important features for model development. Eight machine learning models including Random Forest (RF), Logistic Regression, Decision Tree, Extreme Gradient Boost (XGBoost), K Nearest Neighbor, Support Vector Machine, Generalized Linear Models in which the best model is selected by cross-validation (CV_glmnet), and Linear Discriminant Analysis (LDA) were developed. Shapley additive interpretation (SHAP) was used to improve the interpretability of the optimal model. At last, a total of 1043 patients were included, of whom 710 were from MIMIC-IV and 333 from MIMIC-III. Twenty-four clinically relevant parameters were selected for model construction. For the prediction of 28-day mortality of SALI in the internal validation set, the area under the curve (AUC (95% CI)) of RF was 0.79 (95% CI: 0.73-0.86), and which performed the best. Compared with the traditional disease severity scores including Oxford Acute Severity of Illness Score (OASIS), Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score II (SAPS II), Logistic Organ Dysfunction Score (LODS), Systemic Inflammatory Response Syndrome (SIRS), and Acute Physiology Score III (APS III), RF also had the best performance. SHAP analysis found that Urine output, Charlson Comorbidity Index (CCI), minimal Glasgow Coma Scale (GCS_min), blood urea nitrogen (BUN) and admission_age were the five most important features affecting RF model. Therefore, RF has good predictive ability for 28-day mortality prediction in SALI. Urine output, CCI, GCS_min, BUN and age at admission(admission_age) within 24 h after intensive care unit(ICU) admission contribute significantly to model prediction.

Genetic determinants of renal scarring in children with febrile UTI.

Febrile urinary tract infections (UTIs) are among the most severe bacterial infections in infants, in which a subset of patients develops complications. Identifying infants at risk of recurrent infections or kidney damage based on clinical signs is challenging. Previous observations suggest that genetic factors influence UTI outcomes and could serve as predictors of disease severity. In this study, we conducted a nationwide survey of infant genotypes to develop a strategy for infection management based on individual genetic risk. Our aims were to identify genetic susceptibility variants for renal scarring(RS) and genetic host factors predisposing to dilating vesicoureteral reflux (VUR) and recurrent UTIs. To assess genetic susceptibility, we collected and analyzed DNA from blood using exome genotyping. Disease-associated genetic variants were identified through bioinformatics analysis, including allelic frequency tests and odds ratio calculations. Kidney involvement was defined using dimercaptosuccinic acid (DMSA) scintigraphy. In this investigation, a cohort comprising 1087 infants presenting with their first episode of febrile UTI was included. Among this cohort, a subset of 137 infants who underwent DMSA scanning was subjected to gene association analysis. Remarkable genetic distinctions were observed between patients with RS and those exhibiting resolved kidney involvement. Notably, the genetic signature indicative of renal scarring prominently featured mitochondrial genes. In this nationwide study of genetic susceptibility to RS after febrile UTIs in infancy, we identified a profile dominated by mitochondrial polymorphisms. This profile can serve as a predictor of future complications, including RS and recurrent UTIs.

A Deep Learning-Based Crop Disease Diagnosis Method Using Multimodal Mixup Augmentation

With the widespread adoption of smart farms and continuous advancements in IoT (Internet of Things) technology, acquiring diverse additional data has become increasingly convenient. Consequently, studies relevant to deep learning models that leverage multimodal data for crop disease diagnosis and associated data augmentation methods are significantly growing. We propose a comprehensive deep learning model that predicts crop type, detects disease presence, and assesses disease severity at the same time. We utilize multimodal data comprising crop images and environmental variables such as temperature, humidity, and dew points. We confirmed that the results of diagnosing crop diseases using multimodal data improved 2.58%p performance compared to using crop images only. We also propose a multimodal-based mixup augmentation method capable of utilizing both image and environmental data. In this study, multimodal data refer to data from multiple sources, and multimodal mixup is a data augmentation technique that combines multimodal data for training. This expands the conventional mixup technique that was originally applied solely to image data. Our multimodal mixup augmentation method showcases a performance improvement of 1.33%p compared to the original mixup method.

Hematophagocytic Syndrome in a Patient Co-Infected With HIV: A Case Report

Introduction: Hemophagocytic syndrome is a severe disease characterized by a state of systemic hyperinflammation with overproduction of cytokines. It can respond to genetic causes (primary) or be triggered by infections, drugs, neoplasms or autoimmune diseases. With increased mortality. We present the case of a patient with HIV who developed hemophagocytic syndrome during hospitalization. Case presentation: We present the case of a male patient with human immunodeficiency virus who developed hemophagocytic syndrome with lymphadenopathies and biopsy report concluding the syndromic suspicion. Conclusions: Our case report reflects the clinical and biochemical approach to hemophagocytic syndrome, in which the realization of a histopathological diagnosis was determinant to reflect the cause of the disease in question, we denote the importance of clinical suspicion in infrequent situations related to the patient with immunodeficiency.

Airway pressure release ventilation (APRV) versus pressure support ventilation (PSV)-A prospective intervention trial comparing haemodynamic parameters in intensive care patients.

Assisted mechanical ventilation may alter the pressure profile in the thorax compared to normal breathing, which can affect the blood flow to and from the heart. Studies suggest that in patients with severe lung disease, airway pressure release ventilation (APRV) may be haemodynamically beneficial compared to other ventilator settings. The primary aim of this study was to investigate if APRV affects cardiac index in intubated intensive care patients without severe lung disease when compared to pressure support ventilation (PSV). The secondary aim comprised potential changes in other haemodynamic and ventilatory parameters. Twenty patients were enrolled in the intensive care unit (ICU) at Sahlgrenska University Hospital. Eligible patients met the inclusion criteria; 18 years of age or above, intubated and mechanically ventilated, triggering and stable on PSV mode, with indwelling haemodynamic monitoring via a pulse-induced continuous cardiac output (PiCCO) catheter. The study protocol started with a 30-min interval on PSV mode, followed by a 30-min interval on APRV mode, and finally a 30-min interval back on PSV mode. At the end of each interval, PiCCO outputs, ventilator outputs, arterial and venous blood gas analyses, heart rate and central venous pressure were recorded and compared between modes. There was no significant difference in cardiac index (3.42 vs. 3.39 L/min/m2) between PSV and APRV, but a significant increase in central venous pressure (+1.0 mmHg, p = .027). Furthermore, we found a significant reduction in peak airway pressure (-3.16 cmH2O, p < .01) and an increase in mean airway pressure (+2.1 cmH2O, p < .01). No statistically significant change was found in oxygenation index (partial pressure of O2 [pO2]/fraction of inspired oxygen) nor in other secondary outcomes when comparing PSV and APRV. There was no significant association between global end-diastolic volume index and cardiac index (R2 = 0.0089) or central venous pressure (R2 = 0.278). All parameters returned to baseline after switching the ventilator mode back to PSV. We could not detect any changes in cardiac index in ICU patients without severe lung disease during APRV compared to PSV mode, despite lower peak airwaypressure and increasedmean airway pressure.

First Report of Phytopythium litorale Causing Root Rot on Kousa Dogwood in Tennessee and the United States.

Kousa dogwood (Cornus kousa) is an economically important woody ornamental crop that exhibits creamy, white, pointed bracts in late spring, and reddish to pink drupe fruits in late summer and fall. It bears shiny dark green leaves that become reddish-purple to scarlet in the fall. In August of 2023, 3-year-old container grown C. kousa var. chinensis plants in a commercial nursery in Warren Co., Tennessee, exhibited severe yellowing, dieback and root rot symptoms (Fig. 1a and 1b). Dark brown to black lesions were observed in the root and crown region of the plants. Disease severity was 40% to 60% of root area affected, and disease incidence was approximately 40% of 1,000 plants. Surface-sterilized (10% NaOCl: 1 min) symptomatic root tissues were plated on V8-PARPH and incubated at 25°C. Sparse aerial mycelium, showing a distinct rosette or faint radiate to chrysanthemum colony pattern, was observed within four days of incubation (Fig. 2). All isolates produced ovoid or subglose, papillate, and proliferating sporangia in grass blade water cultures (Derviş et al. 2020). Sporangia measured as 19.18 to 24.80 µm X 18.08 to 22.16 µm (n = 50) with a length/width ratio of 1.06 to 1.11. Zoospores observed were between 7.07 to 9.98 µm in diameter (n = 50). Oogonia and oospores were not produced. The ribosomal internal transcribed spacer (ITS) and large subunit (LSU), as well as mitochondrial cytochrome oxidase subunit II (COX-II) genetic markers were amplified and sequenced using primer pairs ITS1/ITS4 (White et al. 1990), NL1/NL4 (Baten et al. 2014), and cox2-F/cox2-RC4 (Choi et al. 2015), respectively. The ITS, LSU, and COX-II sequences of isolates FBG6343, FBG6344 (ITS: PP458373 and PP461387; LSU: PP461390 and PP461391; COXII: PP477112 and PP477113) were 100% identical to those of MN306118, HQ643386, and MN206732, respectively. Based on the morphology (Nechwatal and Mendgen 2006) and sequence data, the isolates were identified as Phytopythium litorale (Nechw.) Abad, De Cock, Bala, Robideau, Lodhi & Lévesque. The pathogenicity test was performed on 3-year-old C. kousa var. chinensis plants grown in a 3-gal container to fulfill Koch's postulates. Kousa dogwood plants were drench inoculated (800 ml/plant) with a pathogen slurry (two plates of 7-day-old culture/liter) of isolates FBG6343 and FBG6364 (five plants per isolate). Control plants were drenched with agar slurry without the pathogen. The study was conducted in a greenhouse maintained at 21 to 23°C and 70% relative humidity with a 16-h photoperiod and irrigated twice a day for 2 min using an overhead irrigation system. Forty-five days after inoculation, plants showed dieback symptoms, and dark brown lesions developed in the roots of all inoculated plants. Isolates with morphology and sequences identical to those of FBG6343 and FBG6364 were recovered from root tissues of all inoculated plants. All control plants remained symptom-free, and P. litorale was not isolated from the root tissue. Previously, P. litorale was reported to cause disease on apple, kiwi, planatus, and rhododendron (Derviş et al. 2020; Li et al. 2021; Mert et al. 2020; Polat et al. 2023). To our knowledge, this is the first report of P. litorale causing root rot of kousa dogwood in Tennessee and the United States. Identification of this pathogen as the causal agent is crucial to developing timely management practices.

First report of Colletotrichum scovillei causing anthracnose fruit rot of pepper in Ohio.

In August 2019, the Ohio State University Vegetable Pathology laboratory received multiple bell and banana pepper fruits (Capsicum annuum, cvs. unknown) from Columbiana County, Ohio. The grower reported a disease incidence of 100% and severity of 70% in fruits across their pepper fields. Fruit lesions were brown, sunken, and covered with orange-colored sporulation. On banana peppers, the lesions mainly affected the blossom end of the fruits, while the lesions were distributed randomly on bell pepper fruits. Pieces of diseased tissue were cut from the fruit and surface sterilized in 0.5-0.6 % sodium hypochlorite, rinsed in sterile water, blotted dry, and placed on potato dextrose agar. All of the fungal cultures recovered were cottony, pale gray-green with shades of orange on the underside of the mycelial mat. Two representative isolates, SM209-19 (bell pepper) and SM210-19 (banana pepper), were grown on oatmeal agar to induce sporulation. Pink-orange concentric rings containing acervuli and conidia were present on the oatmeal agar plates after one week of growth at 22◦C (12-h dark/light). Conidia (n=29) were hyaline, aseptate, cylindrical in shape, and had an average length of 10.5 µm (std. dev. = 1.3 µm) and width of 4.1 µm (std. dev. = 0.6 µm) (Fig.1). DNA was extracted from both isolates using a DNeasy Plant Kit (Qiagen Inc, Germantown, MD), and partial sequences of the internal transcribed spacer (ITS) region, -tubulin 2 gene (TUB2), and glyceraldehyde-3-phosphate dehydrogenase gene (GDPH) were amplified by PCR with the following primers: ITS4/ITS5 (White et al. 1990), Bt1a/Bt1b (Glass et al. 1995), and GDF1/GDR1 (Guerber et al. 2003), and squenced. The ITS region of both isolates SM209-19 and SM210-19 (PP280815 and PP280816, respectively) showed 100% identity with C. scovillei (Cs) isolate LJTJ35 (KP748226). The partial sequences of GDPH, (PP320348, PP320349, respectively) showed 99% sequence identity with the Cs CBS 126528 (JQ948597) and 100% identity with Cs HP1 (MT826948) The partial sequences of TUB2 (PP472464 and PP472465, respectively) had 100% sequence similarity with the Cs HP1 and Cs CBS 126528 (MT826951, JQ949918 respectively). Pathogenicity was tested in a greenhouse experiment on blossoming bell pepper plants (cv. Carmen) by spraying 10 ml of 1 X 105 conidia/ml suspension onto flower blooms (nine plants per isolate). Control pepper plants were mock inoculated by spraying 10 mL of sterile deionized water. The plants were re-inoculated one week later. Brown, sunken lesions with orange sporulation developed on the fruits of inoculated plants 21 days after the initial inoculation (Fig. 2), while the mock-inoculated plants did not produce any symptoms. Culturing from symptomatic fruits on PDA, following the same method described above, produced fungal colonies with the same morphological traits previously described. C. scovillei causing anthracnose on pepper has been described in the US (Toporek et al. 2021), Brazil (Caires et al. 2014), China (Zhao et al. 2016), and different South Asia Countries (Khalimi et al. 2019). Open-field peppers are produced in Ohio on more than 5,400 acres, with a value of more than $53 million, with anthracnose being one of the most severe fungal diseases reducing yield. This newly reported Colletotichum species could represent a further threat for this crop. Further studies evaluating fungicide sensitivity and efficacy against this pathogen will be of crucial importance for disease management.

Impact of kidney disease on perioperative outcomes of endoscopic BPH surgery: a propensity score matched analysis from the NSQIP database.

To assess the impact of kidney function in patients with BPH undergoing surgery prior to Transurethral resection of prostate (TURP), Laser enucleation of the prostate (LEP), and Laser Vaporization of the prostate (LVP) on operative and post-operative outcomes using the ACS-NSQIP database. The ACS-NSQIP database was reviewed for patients that underwent TURP, LEP and LVP for treatment of patients with BPH between the years of 2008 and 2021. Demographics, comorbidities, bleeding disorders, operative time, and surgical procedure performed were collected for comparison between Kidney function groups: G1, normal/high function; G2-G3, mild/moderate kidney disease; and G4-G5, severe kidney disease. The 30-day peri-operative complications were measured and a multivariate logistic regression analysis was performed while adjusting for all confounding variables. Propensity score matching was performed between the G1 and G4-G5 cohorts. A total of 83,020 patients were included. On multivariable regression, in the G2-G3 cohort, patients were at significantly increased risk for renal complications with OR = 2.43[1.56-3.79]. After propensity score matching, the G4-G5 cohort showed increased odds of pneumonia OR = 4.02[1.343-12.056], renal complications with OR = 7.62[2.283-25.411], cardiac complications OR = 4.53[1.531-13.411], and sepsis/septic shock OR = 1.76[1.091-2.834]. They also had a higher need for blood transfusion OR = 3.58[2.242-5.714], and prolonged hospital stay with OR = 1.49[1.296-1.723]. Pre-operative kidney disease may pose an increased risk of complications for patients undergoing endoscopic BPH surgery. The literature lacks information on the effect of pre-operative kidney disease on endoscopic BPH surgeries. Further studies are required to compare post-operative outcomes of LEP and LVP as compared to TURP across kidney function status.

Impacts of pathogen strain and barley cultivar on Fusarium head blight in barley and during malting

AbstractFusarium head blight (FHB) is a devastating disease in barley, causing significant losses for the malting and brewing industries. We hypothesized that the variation observed in Fusarium‐related issues during malting may be partially attributable to differences among Fusarium graminearum strains. Field trials in 2019–2021 used barley cultivars with different FHB resistance: Newdale (intermediate) and AAC Goldman (moderately resistant). Barley plants were grown under disease‐conducive conditions, and plots were inoculated with conidial suspensions of each of seven different F. graminearum monoclonal isolates plus a noninoculated control. Disease severity (as a percentage of symptomatic spikelets) significantly differed among years (2020 &gt; 2019 &gt; 2021). F. graminearum density in barley varied significantly across years (2019 &gt; 2021 &gt; 2020). Pathogen strain identity and cultivar (Newdale &gt; AAC Goldman) had significant effects on F. graminearum density in barley grain. The harvested barley was micromalted. The deoxynivalenol (DON) content in barley and malt significantly differed among years and cultivars, with the highest levels in 2019 and in Newdale. Pathogen strain identity significantly influenced DON content in barley and malt. F. graminearum density in malt showed significant variation among years (2021 &gt; 2019 &gt; 2020) and was influenced by the pathogen strain identity, while cultivar did not significantly affect F. graminearum density in malt. Gushing varied significantly across years but was not affected by cultivar or pathogen strain identity and was independent of F. graminearum density. Our finding that F. graminearum strain identity altered impact in barley grain and malt may explain the variability of FHB impacts.

A Method Based on Artificial Intelligence That Predicts Arabica Coffee Yield by Analyzing Abiotic Factors and the Prevalence of Coffee Leaf Rust

Coffee is a perennial crop that harbors infections throughout the plant, which may worsen illness under favorable circumstances. Coffee leaf rust, a widespread coffee disease and Arabica is susceptible to leaf rust. Disease incidence and severity depend on abiotic variables. Cloudy and constant South-West monsoon weather (June–September) promotes coffee leaf rust growth. In this five-model study, an Extra Tree and Gradient Boosting regression model predicted coffee crop output in Chikamagaluru, Karnataka, with the least error utilizing biotic and abiotic factors. We investigated additional tree, gradient boosting, RF, Decision Tree, and KNN models using biotic and abiotic predictors. Used the independent testing dataset's MSE, MAE, RMSE Root mean square errors, and R-squared errors to compare model performance. The extra tree (R²=0.98 kg/ha ˉ¹ and RMSE = 7.96 kg/ha ˉ¹) and gradient boosting (R²=0.96 kg/ha ˉ¹ and RMSE = 10.96 kg/ha ˉ¹) regression models used Group 1 and 2 characteristics as predictor variables and different parameter fine tuning functions to estimate coffee yield most accurately. Compared to the less precise probabilistic models utilized in this work, such as Random Forest, decision tree, and KNN models, shown in the results section. The optimum weather parameter for coffee production forecasts and biotic-CLR incidence data outperformed random forest, decision tree, and K-Nearest Neighbor models.

Impact of nutritional risk factors on the development of multiple sclerosis

The literature review considers the data on the assessment of the influence of alimentary factors on the development of a severe neurological disease - multiple sclerosis (MS). MS is a polyetiologic disease, the risk of development of which is influenced by both infectious (Epstein-Barr virus, herpes simplex virus, influenza virus, etc.) and noninfectious factors (genetic predisposition, smoking, geographic region of residence, etc.). MS is a progressive demyelinating disease of the central nervous system (CNS), which leads to neurodegeneration accompanied by a variety of clinical manifestations. The pathogenesis of MS is characterized by immune-mediated damage to the myelin sheaths of nerve fibers, which is manifested by inflammation, neurosynaptic damage, and destruction of white matter, axons, and blood vessels. Rapid non-evolutionary dietary and lifestyle changes, which are driven by urbanization, industrialization and globalization of the food market, are leading to an increase in most chronic non-communicable diseases, including MS. The effects induced by alimentary factors are due to changes in the microbial composition of the gastrointestinal tract (GIT), immune cell function, enzyme systems functioning, etc. The aim of the work is to study the influence of micro/macronutrients, as well as the nature of the diet on the risk of MS development, to assess the role of nutrition in the primary prevention of MS. It has been shown that a diet characterized by a high content of animal fats and trans-isomers of fatty acids (TFA), increased consumption of meat products, but low content of vegetables, fruits and whole-grain products is associated with a higher risk of MS development. Regular inclusion in the diet of sources of polyunsaturated fatty acids (PUFAs) (vegetable oils, seeds, nuts, marine fish) and vitamin D (fatty fish, caviar, butter, egg yolk) leads to lower relapse rates and less new brain lesions among MS patients. The literature review was conducted using open sources posted in electronic databases: PubMed, Medline, Scopus, Google Scholar, World Bank publications, WHO, eLibrary, Cyberleninka, Web of Science.

Generation of induced pluripotent stem cells from an individual with early onset and severe hypertrophic cardiomyopathy linked to MYBPC3: c.772G > A mutation.

Hypertrophic cardiomyopathy (HCM) is frequently caused by mutations in the MYPBC3 gene, which encodes the cardiac myosin-binding protein C (cMyBP-C). Most pathogenic variants in MYPBC3 are either nonsense mutations or result in frameshifts, suggesting that the primary disease mechanism involves reduced functional cMyBP-C protein levels within sarcomeres. However, a subset of MYPBC3 variants are missense mutations, and the molecular mechanisms underlying their pathogenicity remain elusive. Upon in vitro differentiation into cardiomyocytes, induced pluripotent stem cells (iPSCs) derived from HCM patients represent a valuable resource for disease modeling. In this study, we generated twoiPSC lines from peripheral blood mononuclear cells (PBMCs) of a female with early onset and severe HCM linked to the MYBPC3: c.772G > A variant. Although this variant was initially classified as a missense mutation, recent studies indicate that it interferes with splicing and results in a frameshift. The generated iPSC lines exhibit a normal karyotype and display hallmark characteristics of pluripotency, including the ability to undergo trilineage differentiation. These novel iPSCs expand the existing repertoire of MYPBC3-mutated cell lines, broadening the spectrum of resources for exploring how diverse mutations induce HCM. They additionally offer a platform to study potential secondary genetic elements contributing to the pronounced disease severity observed in this individual.

P36 Environmental triggers of psoriasis and relationship to disease severity: insights from the mySkin study

Abstract Introduction and aims Psoriasis is a common debilitating inflammatory skin condition with an established genetic basis. Despite a wealth of genetic research on psoriasis susceptibility, epidemiological studies characterizing environmental triggers of disease onset are limited. Our aim is to identify self-reported triggers of psoriasis onset, and investigate the relationship between triggers and subsequent disease severity. Methods Self-reported data from people with a clinician-confirmed diagnosis of psoriasis were collected through the online mySkin survey. mySkin was launched UK-wide in June 2023 and all surveys completed by 6 December 2023 were analysed. Measures of disease severity at the time of survey completion included Patient Global Assessment and Dermatology Life Quality Index. The association between triggers of psoriasis onset and disease severity was analysed using one-way Anova tests. Results Of 529 participants, 93.4% were of White ethnicity, 64.8% were female and their average age was 51.1 years. Overall, 49.9% reported a family history of psoriasis and 55% (n = 289) of participants reported at least 1 trigger of psoriasis onset. Of those who reported a trigger, the most commonly reported trigger was stress (n = 167, 57.8%), followed by infection (n = 85, 29.4%) and low mood (n = 23, 7.9%). For participants who selected multiple triggers, there was considerable coselection of stress, low mood, climate (pollution, weather) and lifestyle (weight gain, alcohol, smoking) factors. A greater proportion of participants with a family history of psoriasis reported climate and hormonal (pregnancy, childbirth, menopause) triggers of psoriasis onset, compared with those without a family history (73% vs. 26% and 69% vs. 31%, respectively). There was no significant association between triggers of psoriasis onset and disease severity (P = 0.76). Conclusions These self-reported data highlight the importance of stress in psoriasis onset. The co-occurrence of different triggers, including in those with vs. without a family history of psoriasis, underscores the complex aetiology of psoriasis. Further characterization of gene–environment interactions is warranted.

Clinical Characterization of Veterans With Alzheimer Disease by Disease Severity in the United States.

We aimed to examine the clinical characteristics of US veterans who underwent neurocognitive test score-based assessments of Alzheimer disease (AD) stage in the Veterans Affairs Healthcare System (VAHS). Test dates for specific stages of AD were referenced as index dates to study behavioral and psychological symptoms of dementia (BPSD) and other patient characteristics related to utilization/work-up and time to death. We identified veterans with AD and neurocognitive evaluations using the VAHS Electronic Health Record (EHR). Anxiety and sleep disorders/disturbances were the most documented BPSDs across all AD severity stages. Magnetic resonance imaging, neurology and psychiatry consultations, and neuropsychiatric evaluations were slightly higher in veterans with mild AD than in those at later stages. The overall average time to death from the first AD severity record was 5 years for mild and 4 years for moderate/severe AD. We found differences in clinical symptoms, healthcare utilization, and survival among the mild, moderate, and severe stages of AD. These differences are limited by the low documentation of BPSDs among veterans with test score-based AD stages. These data support the hypothesis that our cohorts represent coherent subgroups of patients with AD based on disease severity.